Talk:Alternative medicine (theories)

What this page is

responding to various issues raised in the discussion below

Yes, I'd like to have this page located in the Philosophy workgroup. It will I hope be a 'interdisciplinary' page linking philosophical and cultural-historical ideas with scientific and 'medical' debates. Howard said he'd like this made clear - I hope this now is. I do not wish to decide when it is finished, but I hope to shepherd it along a bit.

As Pierre has explained, this is yet at an early stage. The argument made below that content must be pretty final before it is put on CZ flies, as Pierre I suspect was getting at when he mentioned the constables! against the principles of the whole CZ project. This page - like all pages - is put up NOW for people to develop collaboratively. In two years time it may still be unfinished, Howard and Milton and myself may have 'resigned', or been put in prison! and the page become quite different in focus. But pages need to be allowed to develop. Of course the links are not there, yes, it reads (at the moment) like an essay, no, I am still travelling and have no time or opportunity to work on it. The criticism is early and inappropriate.

Second point, the exisiting complementary and alternative medicine page has been noted and indeed there is overlap - so what is new! Often there will be overlap in subjects. We may need to consider this issue when THAT page has some sort of structure and content worth taking into consideration. At the moment, it is a stub drawing the bulk of its content from 'Homeopathy' (or so it looked liked to me) rather than being a genuine look at its ostensible subject. This page has a different aim and different parameters. I think it will justify its parallel existence - there is surely little to be gained from attempting to stop new pages at early stages of their development.

As Pierre says, give us some time, or better still, make constructive contributions. A lot of time it seems has gone into this talk page, much less into CZ content proper.

Martin Cohen 18:26, 13 December 2008 (UTC)

Puzzled for the need for this page

There exists a page on complementary and alternative medicine, which certainly includes alternative medicine. In many contexts, alternative, but not complementary, medicine is called a "whole system", which must be used to the exclusion of all else, with no opportunities for synergy. Complementary doesn't necessarily mean complementary to mainstream medicine; aromatherapy and massage, for example, seem to work better when used together.

Without a strong argument to the contrary, I urge this be merged into complementary and alternative medicine, which certainly should have a strong related articles section. There's considerable CZ feeling that we are better differentiated with a lesser number of highly linked articles, than a larger number of often orphaned articles. Howard C. Berkowitz 15:29, 4 December 2008 (UTC)

Essay or encyclopedic article?

This article is an opinionated essay, the opinion expressed in it may, or may not, be of interest, but the article does not convey any factual encyclopedic information. --Paul Wormer 08:47, 12 December 2008 (UTC)

Another encyclopedic problem

The article contains ideas that could link to other articles, and perhaps find synergy with other ideas. Instead, however, is isolated. The concepts are neither linked nor sourced.

There ar taxonomies of alternative medicine theories in complementary and alternative medicine and in National Center for Complementary and Alternative Medicine? Are they totally unacceptable to the authors? Actually, I see no structures under which various theories go, and I note the absence of the essentials of some nontraditional theories, be they biofields, mind-body interactions, manipulations, etc. There seem to be some philosophical concepts that raise questions but don't describe anything, which to me is the basic purpose of an encyclopedia. Howard C. Berkowitz 10:18, 12 December 2008 (UTC)

Yes, I must qualify my earlier comment somewhat, there are indeed "encyclopedic facts", as for instance:

the onion was favoured by the Egyptians not only as a food, and used as a medicine, but also respected for reflecting their view of the universe's multi-layered structure."

but such kinds of facts are so much unconnected to the subject of the article and come so much out of the blue that they make the impression of being invented by the author(s). In an article about old Egyptian culture, written by somebody who obviously knew the subject, I would accept such a statement. But in the way it is presented here, such "facts" are very hard to believe in. What multi-layered structure of the universe did the Egyptians imagine? Did they really assume the cosmos looked like an onion? How do we know that? I've read quite a bit about the history of cosmology, but I've never heard this before; a reliable reference is in order.--Paul Wormer 11:04, 12 December 2008 (UTC)

Another collaboration problem

but such kinds of facts are so much unconnected to the subject of the article and come so much out of the blue that they make the impression of being invented by the author(s).

This in neither respectful nor useful. Stick with constructive criticisms such as "a reliable reference is in order".

Professor Wormer, it is interesting to note that you claim "I've read quite a bit about the history of cosmology", but bring nothing to the article. Should I remind you that this encyclopedia is a collaborative project?

Howard, thanks for the input. This article is in its infancy. At the end of the day, the goal is to get approval, and we're all aware of what it means.

--Pierre-Alain Gouanvic 16:48, 12 December 2008 (UTC)

As you say, CZ is a collaborative project. Given that, I can't help wonder why this article suddenly appeared, when there is a clearly relevant article, complementary and alternative medicine (CAM), which indeed needs much work. I plan to be doing substantial editing very soon, as soon as I get an answer back on a collaborative question. Hopefully that will be today, which will include, in part, either adapting or cloning the taxonomy of CAM techniques in National Center for Complementary and Alternative Medicine.

"Alternative" and "complementary" medicine have related but distinct meanings; the titling of the other article CAM was a deliberate change. Is this article really meant to discuss alternative medicine alone, in isolation? If it is, then why is it not linked to that to which it is an alternative?

On the CAM talk page, there is an active discussion of theories, in which there was no question, by the main creator(s) of this article, that there were concerns about theories. The main page of the current article has absolutely no wikilinks to other articles, and indeed doesn't follow CZ formatting or flow conventions. There are many flat assertions that should be sourced, but there are exactly zero citations.

So, what is the problem that this article is trying to solve, which cannot be addressed as an extension and enhancement of existing work? Sorry, but what has happened here so far doesn't feel very collaborative. Howard C. Berkowitz 19:57, 12 December 2008 (UTC)

life and the universe

"Under this paradigm, it is believed (but not provable) that, by reducing life to its most fundamental components, by analyzing all its details, it will be possible to account for the observed universe."

Isn't this mixing up biology and physics? Why life? I would have thought matter would be more appropriate? Chris Day 20:08, 12 December 2008 (UTC)

it depends on the point of view. When the article develops, it will become evident (IMO) that different theories ascribe different relationships between life and matter. Let's keep your point in mind, shall we?

--Pierre-Alain Gouanvic 17:40, 13 December 2008 (UTC)

Sheldrake

"When he published in a book his analyses and hypotheses, the most respected journal, Nature, called his book "a book for burning" through the voice of John Maddox, the editor-in-chief. Rupert Sheldrake had proposed the notion of morphogenetic fields, a notion not unlike Plato's Ideas."

This implies that morphogenetic fields are some how heretical yet they are standard fare in biology, what makes Sheldrake's distinct? Chris Day 20:13, 12 December 2008 (UTC)

OK, I just read some of his stuff, you mean morphic fields and morphic resonance. i don't understand why the self organising principles in biology cannot account for morphic resonance? Chris Day 20:35, 12 December 2008 (UTC)

More and more, I'm getting a sense that this article was created from the perspective that philosophical, social, and other paradigms than a bioscience one should be used for describing at least medicine, and, for that matter, all existence. Fine. If so, say it explicitly, and source it; there's a comment at homeopathy about "we must" consider alternatives.

This article does not seem to be about theories of alternative medicine. It seems to be about an alternate view of biology, and perhaps concepts at the level of cosmology and matter. It's certainly not limited to medicine, as it is now titled.

If a discussion of theories of alternative medicine specifically, accepting at least some bioscience context, is desired, that should be edited into complementary and alternative medicine. If a discussion of alternative health-positive techniques not using a bioscience context is desired, rename this article, because it's otherwise redefining "medicine". If a discussion of all existences, from some paradigm that I don't understand, is desired, the authors thereof should start out with a sufficiently clear title and introduction so that the reader can have some idea what is to be read. I have to agree that right now, this comes across as a rambling essay, completely isolated with no links or sources, but carrying a flavor of rejecting conventional ideas for the sake of rejecting. Perhaps the title should be phrased in philosophical terms, but it just doesn't seem to match the content.Howard C. Berkowitz 21:05, 12 December 2008 (UTC)

I think that we'll address all those things when this page advances. Right now, it's Martin first draft, followed by mine. Thank you for your patience.

--Pierre-Alain Gouanvic 05:23, 13 December 2008 (UTC)

I'm a little confused. Why put this out on a page if you don't want comments? There are times where I will put an article in mainspace that I'd really rather not have changed at first, because I may be testing some links or article merges that only work in mainspace. There are several articles where I'm variously working as a workgroup editor to help improve an article in a specialized area, which isn't going to gather a large audience. In another case, a couple of experienced people are helping a first-time author adjust to CZ conventions, and, while there were concerns at first, it's been highly interactive.

In this case, I'm rather puzzled. When I get comments that my draft is hard to follow, I consider them seriously, and at least respond. Indeed, there was a recent case where just such a situation arose, and, it turned out, part of the problem was assuming that several sections must be wrong because Wikipedia said otherwise -- even though the article cited primary sources. That finally took an editor ruling on fact.

So, I guess, progress away. Do let others know when they may question. Please do not thank me for my patience, as I really am not offering any. Now, I've had cases where someone started bold rewriting of my text as I was still typing it, and that was considered unreasonable by many. Commenting on the talk page, however, is quite within the rules and, I believe, customs of CZ. Howard C. Berkowitz 05:39, 13 December 2008 (UTC)

Time

So okay, you have much time to write on this talk page, to ask many questions, and you expect others to follow your rythm. And you have no patience to offer. I'm calling a constable. --Pierre-Alain Gouanvic 06:54, 13 December 2008 (UTC)

Pierre-Alain, may I offer a suggestion? One way to avoid having people comment on an article in development is to do all of your development in a personal sandbox. I have written a good many articles in CZ and I have first developed all of them in my sandbox before I create a new article. In that way, when you create a new article, it is ready to receive comments on its Talk page since you will have developed it to the limit of your ability. If needed, you can invite others to comment in the Talk page of your sandbox ... again before creating a new article.

If you are unfamiliar with how to create a sandbox, I should be happy to create one for you ... just let me know. -Milton Beychok 07:36, 13 December 2008 (UTC)

Pierre-Alain, I'm not a constable by any means, but I've certainly been around CZ for a lengthy period now and have interacted in various ways with many people in many different articles. It seems to me that you (and perhaps Martin) are very incorrectly attempting to claim ownership of a particular article and doing whatever you can to prevent anyone else from participating or even contributing to it. I recall to you, as I'm sure the constables, or even Larry himself, eventually will: no one owns articles in CZ; EVERYONE is free, even encouraged to edit them at will. Please consider this carefully and then act accordingly. Thank you. Hayford Peirce 16:30, 13 December 2008 (UTC)

Milton's suggestion is a good one. If you don't want others to comment, do the work in a sandbox. It's perfectly fair, and I think that the constables will agree, that the owner of the sandbox can say who, if anyone, can comment on text there. That is not true in mainspace. I have seen things in mainspace where there was an explicit request for only certain people to change sections for a defined period of time, which was agreed-to by constables, editors, or both. Note that I am speaking of changing things, which is more dramatic than asking questions on a talk page. There was no prior warning on the talk page that comments are unwelcome. Howard C. Berkowitz 10:49, 13 December 2008 (UTC)

Constable comment

Gentlemen, I see this article is currenty only under the Healing Arts Workgroup. From what I can tell, that means there are no editors active on this page. Anyone can make comments or changes to pages and talk pages provided they do not violate the CZ:Professionalism conventions. If there is a question of the need for this article, it needs to be answered by the workgroup or barring that, the Editor in Chief. There is nothing that says that anyone need respond to everything written on a talp page, though courtesy might suggest that you do. D. Matt Innis 15:45, 13 December 2008 (UTC)

Though I am a healing arts editor, I will be working this article as a constable. Nothing I say should be construed as an editor's suggestion or ruling. D. Matt Innis 15:48, 13 December 2008 (UTC)

I would like to add, Matt, as while, speaking as an individual, I do not see the need for this article, especially when there are existing related ones, my comment here was to ask for clarification as to the purpose of this article, as opposed to adding material to other articles. There might be perfectly good reasons for the article. There might not be awareness of other related pages. The only way to determine this is to ask questions on the talk page. I agree there is no obligation to answer, although it may be courteous and wise to do so.Howard C. Berkowitz 15:58, 13 December 2008 (UTC)

These are editorial decisions. Be careful not to turn them into professional ones. D. Matt Innis 16:49, 13 December 2008 (UTC)

Attribution

Matt:

Gentlemen, I see this article is currenty only under the Healing Arts Workgroup.

It is appropriate to place it in the philosophy workgroup (Martin Cohen, philosophy editor, created it). It is also appropriate to recognize Martin as an editor for this philosophy page. --Pierre-Alain Gouanvic 17:26, 13 December 2008 (UTC)

Pierre, while Martin, a philosophy editor, created this article, that does not automatically place it in the Philosophy Workgroup. Workgroups can decide where their interests lie. It would have to be an article that has a philosophy element and of interest to philosophers. If there is a dispute there, that is a between workgroups and I would refer them to the Editor in Chief, that would be a content decision that a constable will not dictate. D. Matt Innis 18:06, 13 December 2008 (UTC)

Pierre, while Martin, a philosophy editor, created this article, that does not automatically place it in the Philosophy Workgroup.

It wasn't my intention to suggest that it was automatic. My intention was to suggest that a philosophy editor had had the (good) idea to create a philosophy page about a topic.

Matt, I was quoting you because I wanted to provide context.

Gentlemen, I see this article is currenty only under the Healing Arts Workgroup.

(emphasis mine)

None of the policy implications were intended; actually, the policy debate started with Howard's response.

I will be offline for a (short) while.

--Pierre-Alain Gouanvic 19:26, 13 December 2008 (UTC)

Understood, thanks Pierre. D. Matt Innis 19:45, 13 December 2008 (UTC)

If he contributed substantially to the writing of the article, he is not allowed, under CZ rules, to exercise Editor authority over it. As an example of how this works even in a noncontroversial case, I am an editor in several groups, including Engineering. I was asked to assist in getting an article ready for Approval, and then signing off on the article so that it could be approved.

When I read the page, which dealt with chemical engineering, it seemed to be missing some information on safety and emergency response procedures should the manufacturing plant have an accident and release ammonia into the atmosphere. Had I made the changes myself, I would have lost the ability to approve the article or make rulings on it, without special approval. So, I did some research, put the results on the talk page, and let the author select what he wanted from the citations I provided. He did select and rephrase some of the material, so I was able to approve the article because I was not approving my own work.

There are cases where an editor can be part of the approval of an article on which he has worked, but the basic rule is that two other editors of workgroup(s) having responsibility over the article, have to agree. There can be exceptions, but this would require Editor-in-Chief or Editorial Council approval. Howard C. Berkowitz 17:38, 13 December 2008 (UTC)

If this article were to fall under a workgroup in which an author is an editor, I don't see anything that would prohibit them from choosing to become an editor on the page, though they could choose not to if they don't feel qualified. I also don't see any rules that suggest that an editor cannot write the entire article and not be allowed to exercise editor priveleges. If there are other interpretations, these need to be cleared up on in the Editorial council. D. Matt Innis 18:06, 13 December 2008 (UTC)

For the narrow context of Approval, see http://en.citizendium.org/wiki?title=CZ:Approval_Process&action=edit&section=3. An Editor, therefore, is explicitly forbidden to exercise Approval authority on articles to which they have contributed. You've frequently observed that one cannot be both Constable and Editor on the same article.

I hope it doesn't come to taking this to the Editorial Council, but if an article's primary focus is in a given workgroup "A", but it does have aspects that make multiple workgroups relevant, I hope it's generally accepted that a expert in workgroup "B" can make content rulings on specific points that are discipline "A" areas. For example, I am a Computers and Military and Engineering Editor, and cryptography legitimately relates to all of them. I can legitimately make content rulings on how cryptography is used in computers, the history of miitary intelligence used against encryption, and the design of physical encryption equipment. I am not professionally qualified, however, to rule on the mathematical details of an encryption algorithm; that would be a matter for a Mathematics editor. In this case, professional expertise in philosophy does not make one qualified to make rulings on biology-specific aspects of the article. Howard C. Berkowitz 18:29, 13 December 2008 (UTC)

For the narrow context of Approval, see http://en.citizendium.org/wiki?title=CZ:Approval_Process&action=edit&section=3. Yes, this is for the approval process only, they can still make style and content decisions.

An Editor, therefore, is explicitly forbidden to exercise Approval authority on articles to which they have contributed. I don't see this anywhere. They can still participate in the group editor approval. Maybe we are agreeing here? D. Matt Innis 19:44, 13 December 2008 (UTC)

I agree wholeheartedly with the spirit of your second paragraph, though I don't recall it as written in policy. D. Matt Innis 19:44, 13 December 2008 (UTC)

"Comments not welcome"

Howard has created this impression that comments are not welcome. If you read what I say, you'll see that it is a misrepresentation. Comments are welcome. --Pierre-Alain Gouanvic 17:34, 13 December 2008 (UTC)

Two short responses. More to come.

--Pierre-Alain Gouanvic 18:33, 13 December 2008 (UTC)

Reserve judgement

I am an editor in this work group; at present this article is a very preliminary stub and I think we should just wait awhile and see how it progresses. When it's more mature I'll take a look again. But I suggest we just relax and let's judge this not as it is now but as it becomes.Gareth Leng 18:42, 13 December 2008 (UTC)

Source?

This article copied a fair amount of information from the (commercial) web site of Kathleen Karlsen, MA, who writes about her own source of knowledge:

In addition to my lifelong love of art, I have been a student of metaphysics since about the age of fifteen. I love stories about the extraordinary--people, experiences, miraculous circumstances and amazing events. I also enjoy organizing information to share the things I find with others.

Kathleen Karlsen, MA, does not refer to (as far as I could see) other sources for her wisdom. Do we really want to copy some of the things she found to CZ?

Furthermore, Kathleen Karlsen, MA, writes:

Article Use Policy: All content on this web site is protected by international copyright laws for intellectual property and may not be reproduced, used, stored in a retrieval system or transmitted in any form or by any means without prior permission.

Does CZ have this permission? --Paul Wormer 15:43, 16 December 2008 (UTC)

Paul's concerns need to be followed up on. Martin, try contacting Kathleen and see what she says. Otherwise, it's looking good, particularly the use of prose. If we can get some more eyes on this to fact check and clarify or clean-up, we can approve this one and move on. D. Matt Innis 02:33, 17 December 2008 (UTC)

Plato vs Democritus and atomism

Reference: Democritus – scientific wizard of the 5th century bc ROBERT L. OLDERSHAW

Abstract Roughly 2400 years ago, during an era largely characterized by unscientific thought, a school of natural philosophers led by Democritus of Abdera developed a remarkably accurate understanding of our physical world. How could this small group have discovered so much at a time when technology and mathematics were at such a rudimentary level? What if their methods and ideas had caught on immediately, instead of being virtually ignored for 2000 years?

Looks interesting. quote:

Democritus “had a remarkably modern understanding of concepts like the conservation of mass/energy, the indirect nature of perception, the continual formation of and destruction of physical systems, the reality of empty space, the basic theory of colours and the fundamental principles of causality and determinism.

--Pierre-Alain Gouanvic 07:25, 17 December 2008 (UTC)

Comments

Many things I like about this article, think it's progressing well. A few comments-

• Think its Thomas Kuhn not Samuel; the quote though is unusually obscure for him?

(response by Pierre-Alain to Gareth:) God, I keep inverting these two names! Its Thomas Samuel Kuhn, so, yes Thomas.

--Pierre-Alain Gouanvic 16:02, 17 December 2008 (UTC)

(response by Pierre-Alain to Gareth:) Obscure? I can't tell. We'd have to ask a philosopher. Martin? How does it sound to your trained ears? My understanding is that, as Kuhn complained himself, many people are unaware of how he evolved after his monumental, ultra-quoted, Structure of Scientific Revolutions. This quote comes from "The road since structure". I like the fact that he adresses in a simple, illustrative way, orally, the difficult notion of incommensurability. I thought it flowed well in this article. But I'd like to have Martin's judgment.

--Pierre-Alain Gouanvic 16:22, 17 December 2008 (UTC)

• Conventional emphasis on treatment not prevention? Really think this is not true. Think of the vaccination programmes, the mass screening programmes for early detection of pre-disease states, genetic screening for risk factors, prenatal diagnosis, well person clinics, preventative dentistry, the new generation drugs like statins, public health initiatives like anti smoking campaigns, clean water, food safety regulation, environmental expoxure monitoring, clean air initiatives, sanitation...

(response by Pierre-Alain to Gareth:) I think that this comment illustrates the kind of work we'll have to do soon: we'll have to provide an overview of the variety of CAM practices (versus conventional). One way to specify Martin's words, I believe, is to say: disease-centered, treatment-oriented (conventional) vs salutogenic (health-centered). There are two types of prevention; actually, conventional prevention means early treatment (with the associated risks of side-effects), while in CAM, prevention means health promotion (with side-benefits on a variety of risk factors). To exemplify:

vaccination programmes: vaccination primes the immune system against a single pathogen. It is disease-centered. This specialization of the immune system may have unwanted consequences (PMID: 15914231; just an example). CAMs are intended to make the immune system more competent: it works on the "terrain", it's health-centered (salutogenic). I'm not saying that a disease-centered practice cannot save lives (just to be very clear).

ps: CAMs are complementary to vaccination especially when dealing with the young and the aging, who are immunocompromised. Just a note for our future developments on the relationship of CAM with convmed.

(taking a pause)--Pierre-Alain Gouanvic 17:22, 17 December 2008 (UTC)

(response by Pierre-Alain to Gareth:)

"the mass screening programmes for early detection of pre-disease states, genetic screening for risk factors, prenatal diagnosis"

I have some first hand experience with genetic diseases, as the proud bearer of a lethal inborn error of metabolism (you guessed it, it's recessive -- my wife has the same). Suppose you get a gene-based or marker-based diagnosis for you or your unborn child; the specialist will first say that gene therapy is still, unfortunately, experimental (in most cases). Convmed cannot fix your genes -- yet. Then, surprise, specialists will (often) say that they can "only" practice a form of CAM, vitamin/nutrition therapy, to compensate for the genetic-biochemical defect. Which leads to the surprising result that specialists will use vitamins, minerals, amino acids... orthomolecular medicine, in other words. There is CAM within the highest spheres of convmed. Is Pr Anthony Sebastian a naturopath? Some could get this impression. But no, he's a evolutionary biologist -- but you could find people within convmed who would say that it's CAM. We'll have to deal with the problem of demarcation. When I tell people (pharmacists, doctors) that therapy x using some molecule m is practiced by some specialist clinicians, I often get this strange look and the response: "but you're talking about alternative medicine here, right?". No. I am talking about a scientifically sound treatment that is under-funded and under-represented, because it is not patentable. It's more of a sociopolitical problem. Entering convmed is expensive. Would Pr Sebastian agree with my analysis?

Also see the demarcation section, below.

--Pierre-Alain Gouanvic 19:52, 17 December 2008 (UTC)

Public health initiatives

(response by Pierre-Alain to Gareth:)

"public health initiatives like anti smoking campaigns, clean water, food safety regulation, environmental expoxure monitoring, clean air initiatives, sanitation"

I think that presenting all these things as products of conventional medicine is an instance of (scientific) revisionism (as we say in philosophy of science). All these interventions were promoted by voting citizens and elected officials. We can trace most (all) of these policies -- not medical interventions -- to the modern naturopathic tradition, which was politically expelled from medical organizations in the beginning of the 1900 (Flexner report). We must be thankful to people driven by a sense of what's "natural" for the (re)introduction of all these notions (clean air, food, water) into the mainstream discourse.

--Pierre-Alain Gouanvic 04:05, 18 December 2008 (UTC)

Just not true; the clearest example is smoking - the anti-smoking actions were a very direct response to clinical research, notably associated with Richard Dall in the 1950's, who showed the very strong link between cigarette smoking and lung leading to a campaign led by health professionals (see [cancer.http://www.historyandpolicy.org/papers/policy-paper-59.html]). Before then, smoking was populary regarded as healthy (and marketed as health promoting).Gareth Leng 11:19, 19 December 2008 (UTC)

Dana Ullman explained in his recent book how the American Medical Association promoted smoking and unhealthy food through the JAMA, earned huge revenues from ads for the food and tobacco industries, silenced the naturopaths (treating them as quacks) who were against these un-natural habits.

http://www.alternet.org/healthwellness/81659/:

Today, history is rewritten as the winners claim that their research was necessary to "discover" that the very things they promoted before were unhealthy. So, yes, Richard Doll (not Dall), fought for the recognition of the carcinogenicity of tobacco. The part of the story that's missing from your "just not true" response is that Doll was payed to minimize the environmental roots of cancer (http://www.preventcancer.com/losing/other/doll.htm)...

This "clearest example" is far from clear. It is an example of how science (epidemiology, here) and doctors were in fact manipulated to protect the private industry, it's a success story of corporate influence, more than medical influence! Add to this that the medical institutions actually delayed the realization of what naturopaths had found (at least) decades before. So, okay, it took some medical experts to challenge the assumption, approved and promoted by conventional medicine and its corporate advertising partners, that smoking was no big deal.

The other public health issues were pushed by scientists as well, you're right. But, again, it was against a medical community who showed (and still shows) very little interest for the environmental causes of disease.

Finally, when you say : "the anti-smoking actions were a very direct response to clinical research, notably associated with Richard Dall in the 1950's, who showed the very strong link between cigarette smoking and lung leading to a campaign led by health professionals" I find that it is not so much in agreement with your supporting reference. What you call a very direct response, I call a very delayed, public-driven movement. Quotes:

Today's alliance between doctors and the government to influence individual lifestyles is a relatively recent phenomenon.

The connection between smoking and lung cancer had been elaborated in the 1950s by Richard Doll and Austen Bradford Hill. But they had not pressed their results on policy makers, preferring to keep science and politics separate. .... gastroenterologist from the Central Middlesex hospital, with whom Doll had originally worked, wrote to the President of the College, Lord Brain, urging that the College put out a statement on the effect of smoking on health 'with particular reference to the rising generation'. Brain, a shy reserved man, took a month to reply, only to turn the proposal down. The reasons for his refusal were typical of the time, revealing doctors' dislike of giving advice:

The work of Richard Doll and Bradford Hill has received very wide publicity and must be known, I should imagine, to every doctor in the country, so it is difficult to see that the College could add anything to the knowledge of the existing facts. If we go beyond facts, to the question of the giving of advice to the public as to what action they should take in the light of the facts, I doubt very much whether that should be a function of the College.

--Pierre-Alain Gouanvic 05:11, 20 December 2008 (UTC)

It's very true that until recently medicine tended to keep clear of policy. And when that changed they were very influential. As far as environmental causes of disease - this as I know very well, has been the subject of massive research. Doll was partly funded through industry, but his colleagues have objected to any idea that this had any influence on him - of course now there are much clearer rules on conflict of interest than then. It's a tricky question - many pro-homeopathy studies are funded by Boiron, are they automatically suspect? Maybe. Whatever, I am sure that it was the establishment of a clear link between smoking and lung cancer that led to the change in public attitudes and policy.

Public campaigns have indeed influenced policy occasionally - as with DDT - in that case, according to the World Health Organisation and others, at the cost of a massive death toll for babies in Africa; the WHO is now campaigning to reverse the ban on DDT (see[1]). I don't know the truth there, all I do know is to doubt anything that anyone says without seeing the evidence. As far as I'm concerned naturopathy is a massive fraud, because they can sell their products with claims that require no evidence whatsoever - and that's just not good for anyone. Gareth Leng 18:25, 20 December 2008 (UTC)

Of course it depends on where these costs are attributed to - but they are very significant.

• Some aspects are addressed in a way that is clearly "partial" For example "the 30 years from 1967 to 1998, just under 6000 ‘adverse events’ world-wide can be traced back to the prescription of herbal and other alternative medicines, this figure can only be contrasted with those from a University of Toronto study in 1998 which found that there were at least 106 000 fatalities each year, in the US alone, from side-effects of officially sanctioned and proved drugs [9]." I think it's probably true to say that in the last four thousand years no adverse events can be definitively attributed to prayer, while many miracles have been attributed to prayer by the Roman Catholic Church. True, but really the nonsense should be obvious. Yes there is a very large toll from conventional drugs - but this needs to be looked at in the context of the dramatic falls in death rates from a very wide range of specific diseases that can now be treated effectively - including many cancers, heart conditions. Declaring the one side without the other is just wrong, and it would be irresponsible I think to project an unbalanced negative message about modern drugs.

Tamoxifen and breast cancer mortality

Take just one particular example. In 1992, tamoxifen was introduced as a treatment for breast cancer. Since then, in Europe, mortality rates from breast cancer in women have fallen from 40/100,000 per year in 1991 to under 30/100,000 per year by 2006 [2]. This means that, in Europe alone, every year there are 20,000 fewer deaths from breast cancer mainly attributable to just this single drug.

I don't know where you got this in your reference. The graph of mortality rates indicates a plateau effect from 1985 to 1989, followed by a decline. All this happened before tamoxifen.

Figure 2.2 - from 1991 onwards there's a continuous fall. Did it start before? Dubious from the graph. Tamoxifen was in general use after 1992, but of course had been in large clinical trials for some years before, and of course it was these trial results that brought it into general use - I guess its possible that trial results started the fall. As you say, rightly, it's never possible to draw a firm conclusion from an association - there are always other confounding variables. Which is why conventional medicine generally expects a scientific basis for new treatments - validation of mechanism of action in controlled laboratory tests. Tamoxifen didn't come out of nowhere - it came from the laboratory from basic medical research that depended on (i) sequencing the human oestrogen receptor and (ii) developing techniques for mapping their expression in tissue and (iii)developing techniques for culturing cancer cells in vitro ; followed by showing a) the presence of oestrogen receptors in human breast cancer cells and b) the key role of oestrogen in cell proliferation in these cells followed by c) a drug discovery programme to identify ligands for the oestrogen receptor and d) a chemistry programme to modify those ligands to produce one which would act as an antagonist and then....a lot more to develop bioavailabily, test specificity and proof of principle in animal studies, test safety in animal studies and only then test first safety then efficacy in humans. It's a long path with a lot of very hard science there.Gareth Leng 18:53, 20 December 2008 (UTC)

Your enthusiasm for tamoxifen, which is still certainly justified to some extent, goes slightly beyond what your reference concludes:

"The reduction in breast cancer mortality rates is likely to have several different causes including screening, increasing specialisation of care and the widespread adoption of tamoxifen treatment since 1992."

It seems to me that this tendency to overestimate the role of tamoxifen parallels a general tendency to overestimate the role of medicine. I translated (to French) "State of the Evidence 2008, The Connection between breast cancer and the environment" Edited by Janet Gray, Ph.D. (http://www.breastcancerfund.org/site/pp.asp?c=kwKXLdPaE&b=3266489). ::A couple of things I could say, which will resonate with what I answered to you above (public health):

Trends that we see in the population, especially with an hormone-sensitive cancer, often reflect changes in the environment that occured decades before. The intrauterine and peripubertal programming of breast cancer was modified decades ago by several environmental, often endocrine-disruptors related changes: the ban of DDT, the decline in diethylstilbestrol use, (nb: perhaps the ban of nuclear trials (thanks Linus)) and similar changes that occured after the free-for-all boom of the pharmaceutical-chemical conglomerates.

Again, the scientific institutions, claiming to be neutral, have been less than willing to take their responsibilities (see the story of Doll, above). And they still are: consider the absence of those considerations from the speculations of the Cancer Research UK report that you provide (see quote "The reduction in breast cancer mortality rates is likely to have several different causes including ..."). Prevention and the awareness of what's natural, environmentally responsible remain, even after years of research on xenoestrogens and on the early-life determinants of breast cancer incidence and mortality, incompatible with a treatment/disease-centered paradigm. This is a clear case where grassroot organizations, citizens and legislators have to join forces with the minority of (credentialed) scientists who have a preven(ta)tive, "health and nature" mindset.

--Pierre-Alain Gouanvic 08:37, 20 December 2008 (UTC)

The evidence, when you do gather it, is often not as you might expect. In the case of environmental radioactive exposure, we may have got it quite wrong - the evidence from Chernobyl is on balance, surprisingly, that low levels of radiation might be beneficial, not harmful. Cancer Research UK is a very large independent charity, wholly funded by public subscriptions. It takes no money from industry or government. There has been a lot of money spent on xenoestrogen research, it's been very much a mainstream conventional science effort - but sadly it looks as though its turning out to be a false lead. Lots of our leads are like that. For breast cancer there is hope for even more progress, because unlike many diseases which are "environmentally driven" (which does not imply that they are linked to modern or unnatural things, only that they are linked to things other than our genes, including things like sunlight), it has a very strong genetic component - so there will be more potential drug targets.Gareth Leng 18:53, 20 December 2008 (UTC)

However, the mortality figures are also misstated; in the USA there were just 10,000 deaths attributed to prescription errors in 1998 [3] - and of course these mainly arise because a drug is not prescribed that could have been effective. The number 100,000 is deaths from all medically associated interventions - and includes deaths during surgery and following post surgical complications, deaths from hospital-acquired infections, and deaths that were avoidable but because the condition was misdiagnosed, effective treatment was not given.

• Generally, perhaps there's a bit of a lack of clarity about what conventional medicine is exactly. Personally, I go with Tom Meade's statement that the history of conventional medicine until the mid 20th century was mainly the history of the placebo effect. The first real conventional drug, aspirin, only came along at the start of the 20th century; vaccination had begun earlier but it only really took off in the 20th century, antibiotics came in the middle of the century - and almost all modern drugs since then. Almost every properly controlled clinical trial has been since the middle of the 20th century. So the earlier history of conventional medicine is really a history of organisational structures and a philosophical focus on approaching disease through scientific understanding of the causes of disease - an approach that only lately has borne fruit.

Sheldrake and his critics

• Please avoid words like "respected" - they invite the question "respected by whom?" and vacillate between argument by authority and an invitation to derision. Rupert Sheldrake's scientific arguments are, as far as I am aware, not given any serious consideration in academic biology.

(response)

I will try to avoid this phrasing.

Sheldrake's scientific arguments have been disputed by: John Maddox, Michael Shermer, Lewis Wolpert, Richard Wiseman, David Marks, Richard Dawkins and of course the non-scientist James Randi. If you want to talk about academic biology specifically, it shouldn't come as a surprise that Sheldrake is a persona non grata, after reading this impressive (non-inclusive) list of respected/esteemed/? scientists.

I suggest you read some of these scientific debates. Just go on Sheldrake's website. Here's the direct link: http://www.sheldrake.org/D&C/controversies/

--Pierre-Alain Gouanvic 09:16, 20 December 2008 (UTC)

• Some bits I didn't recognise as being really true. "Conventional medicine, of course, is concerned with shapes, as exemplified by our modern icons : the double helix (DNA), the key-lock model of chemical messenger-receptor action, and the more elaborate 3D protein simulations that fascinate most of us. However, although molecular biochemistry is entirely based on the shape of proteins, molecules and electron clouds around nuclei"

Well,if I was to think of what conventional medicine is concerned with, shapes would come verylow on the list. The double helix is an icon of molecular biology because it elegantly displays a mechanism for protein replication. However molecular biology is about structure not shapes, and the structure includes sequence as well as conformation, and attributes particular functional significance to sequence - the ligand-receptor lock is primarily a molecular interaction not a topological interaction - the conformation is important to bring molecules together but it's how particular molecules are brought together and then interact that is important. But even then this is only a part of contemporary molecular biology, and frankly a part that we can't properly address yet because studying the structure of large proteins and how they fold and interact is very computationally demanding.

(response by Pierre-Alain to Gareth:) concerning "Well,if I was to think of what conventional medicine is concerned with, shapes would come verylow on the list"

Most of the money that is spent on medical R&D goes to identify the shapes or structures, at the molecular scale, that new drugs (new shapes) will interact with.

Simply not true on several levels -where on earth does this idea come from? First not remotely true about the money, on any interpretation, only a relatively tiny part is spent in this way, (even if you include commercial pharmaceutical R&D). Second, there is a misunderstanding here - molecular interactions arise from chemical properties, not shapes - the shapes are relevant only because when very large, complex molecules interact physically, their shapes constrain which particular chemical interactions are possible. To rationally design a drug to fit a receptor, you might model the receptor and then seek to design a drug with the right shape to fit, but you also have to design it with the right chemical elements to interact. This approach to drug design is relatively rare though, most approaches work from the chemical sequence alone, at least initially.Gareth Leng 11:29, 19 December 2008 (UTC)

I understand what you're saying, and I don't see exactly where your detailed illustration contradicts the point that is made, that is summarised as follows: "molecular biochemistry is entirely based on the shape of proteins, molecules and electron clouds around nuclei". I suggest that you wait until I compare how, in a holist paradigm, one thinks about shapes/structures. It will "resonate" with our onion business.

--Pierre-Alain Gouanvic 02:10, 18 December 2008 (UTC)

• "Under this paradigm, it is believed (but not provable) that, "

Please think about this phrasing. Yes of course it is true. But are you always going to qualify statements with "(but not provable)" when that is true? Are you happy to add this to the opening main text sentence: "The underlying (but not provable) assumptions of alternative medicine...." Please be careful about the tone introduced by phrasing that expresses a truth, but also displays an editorial bias.Gareth Leng 11:55, 17 December 2008 (UTC)

(response by Pierre-Alain to Gareth:) As I was writing that, I was wondering "what's this neutral, more technical, term I have on the tip of the tongue?" Being unable to remember with certainty, I left this as is until I remember. Axiom is the term I had in mind. But the more common "postulate" might be better.

--Pierre-Alain Gouanvic 02:33, 18 December 2008 (UTC)

I'll respond in the body of your message. Thanks Gareth.

--Pierre-Alain Gouanvic 16:02, 17 December 2008 (UTC)

Scientific content

I agree with Matt that the prose is of this article is fluent and better than the average CZ prose (especially mine). However, I'm worried about the scientific value of its content. To me quite a few of its statements have the smell of urban legend, comparable to the story about the 60 different words for snow of the Inuit, see here.

Take for instance the following quotation:

For example, according to Kathleen Karlsen, MA , an advocate of herbal medicine, a 60,000 year old burial site excavated in Iraq included eight different medicinal plants.

We have to trust a fairly arbitrary web site telling us that archeologists excavated a 60,000 year old burial site. This is extremely old, the Babylonian and Assyrian civilizations don't go further back than 4000 to 5000 years. Further we are asked to believe that identifiable remainders of plants were found and, moreover, that that they were medicinal.

• Insertion. PS: I googled some, and of course our big neighbor had the answer, see here:

In excavations in Shanidar Cave (Northern Iraq) a few 60,000 year old Neanderthal skeletons were found. Clumps of pollen were discovered which suggested that entire flowering plants had entered the grave deposit. A study of the particular flower types suggested that the flowers may have been chosen for their specific medicinal properties. This led to the idea that the man could possibly have had shamanic powers, perhaps acting as medicine man to the Shanidar Neandertals. However, recent work into the flower burial has suggested that perhaps the pollen was introduced to the burial by animal action as several burrows of a gerbil-like rodent known as a Persian jird were found nearby. The jird is known to store large numbers of seeds and flowers at certain points in their burrows and this argument was used in conjunction with the lack of ritual treatment of the rest of the skeletons in the cave to suggest that the burial had natural, not cultural origins.

Now, in my view—which I hold strongly—the person responsible for entering a fact should do his/her homework and make the fact at least plausible by some credible reference (which Kathleen Karlsen's site is not). If the person hates doing homework, she/he can omit the fact, one doesn't have to go back to the Neanderthal era to write about alternative medicine. (I also googled the onion model of the Egyptian cosmos, but no luck there.)

• End insertion. --Paul Wormer 12:48, 18 December 2008 (UTC)

Another example is the ancient-Egyptian's view of the cosmos, which we must accept (without proof) to have been onion-like. I have here The Copernican Revolution by Thomas S. Kuhn, PhD, formerly professor at the prestigious Universities of California (Berkeley), Princeton and MIT. (Maybe Thomas Kuhn is related to Samuel Kuhn?). TSK writes on p. 5 that the Egyptian cosmology pictures the earth as an elongated platter. The platter's long dimension paralleled the Nile. Above the platter earth was air, itself a god, supporting an inverted-platter dome, the skies. The terrestrial platter floats on water. Do we recognize an onion in this description? I don't see that.

I could continue giving examples, but my opinion about the way in which this article is developing must be clear now. Of course, I know of the ridiculous [citation needed] template of Wikipedia (I have seen it attached to the statement that 16 ounce make a pound) and I'm definitely not in favor of such a thing, but IMHO this article goes too far into the other direction: towards unproven folklore and urban legend.--Paul Wormer 14:24, 17 December 2008 (UTC)

Demarcation

Some comments by Gareth led me to realize that the demarcation between CAM and convmed should be viewed from a sociopolitical perspective as well:

Ethical problems arising in evidence based complementary and alternative medicine, J Med Ethics. 2004 April; 30(2): 156–159. [4]

RESEARCH FUNDS ARE SCARCE

Funds are scarce for CAM research compared with most areas of medical research.21 Governments and other funding bodies usually allocate health resources on the basis of existing evidence.22 Because the evidence for CAM is fragmentary and evolving, research applications in CAM—other than to government agencies specifically created to fund CAM research, such as the (rather unique) National Center for Complementary and Alternative Medicine (NCCAM) at the NIH in the US—have a lower chance of receiving funding than those in conventional medicine.

This situation creates a systemic bias, which results in allocation of resources to those areas of (conventional) medicine for which reasonably good evidence already exists. The resulting funding stream is at the expense of areas in which no or less evidence currently exists—for example, CAM.23 This impinges on the ethical principle of justice. In principle, it also perpetuates the under researched status of CAM.

Underresearched=alternative, very often: Some critics of CAM have said that there is no CAM, there's only medicine that work and medicine that doesn't work (Marcia Angell, former NEJM editor, right?). This is naive : who pays to enquire about that?

--Pierre-Alain Gouanvic 19:26, 17 December 2008 (UTC)

Modus operandi

As I stated on the homeopathy talk page, it is better for me, and probably for most of us, to put more in related articles and less on talk pages; many profound disagrements are more likely to resolve if Citizens put their argumentative points in an encyclopedic form, to which they can link to in their discussion.

For instance, drug discovery, history of medicine (AMA subsection), Flexner report, gestalt (epistemology), breast cancer, endocrine disruptor, logical reductionism and eliminativism.

As I wrote on the CZ page Core controversial articles (http://en.citizendium.org/wiki/CZ:Core_controversial_articles):

This page is intended to provide links to existing and not yet created articles that are likely to raise passions, attract contributors, encourage the creation of numerous ancillary articles, and provide Citizendium opportunities to show to the world how important and inevitable it is.

... and I should add, improve the quality of existing articles. --Pierre-Alain Gouanvic 19:35, 20 December 2008 (UTC)

Principally a copyedit; perhaps some information on formatting conventions.

I've gone through the article and put a number of things into CZ formatting conventions. At the beginning, I have put the introduction into the CZ convention, which calls for no subject line, and the title of the article bolded in the first sentence.

Inline citations are preferred; the means I used to do additional citations to the same work greatly reduces the size of the references section and is easier to read. An inline citation, certainly giving title and author, is much preferred to an external link (i.e., URL).

Generally, it is best not to put potentially controversial text into a footnote. If it is an arguable point, it should be easily readable in the context where it is raised.

Also, I have deleted several subjective adjectives to people. "Respected" and the like really need to be cited, or not used. Do consider that a signed article subpage may be appropriate for some of the more essay-like comments.

When a reasonably available source, such as the New England Journal of Medicine, is cited by a secondary source, try to give enough bibliographic information so the reader has a chance to find the primary source.

Do consider consequences of extensive use of text boxes, especially with relatively dark colored backgrounds. White or very light gray backgrounds greatly increase accessibility. Just as one piece of guidance, there is a good deal of information available from implementation guidelines for Section 508 of the U.S Rehabilitation Act, which tries to minimize barriers to accessibility for users with physical disabilities. [5]; I will be working on a more extensive article on accessibility and usability. Incidentally, the preceding link is an appropriate use for a hard-coded external link, because the expectation is that the external source needs to be read.

1. If one tries to print the document, for later perusal, on a monochrome printer, the box will come out as a black mass if the printer does not use grayscale. Even with grayscale, colors this dark will tend to make a printed copy unreadable.
2. Not all users have perfect color vision. They may have the same sort of problems as a monochrome printer; they literally may not be able to read the text against the background.
3. For users that have very limited or no vision, and use a text-to-speech problem, even multicolumn text can be a problem; I am considering, much as I prefer two-column lengthy bibliographies, going back to a one-column format. A text-to-speech converter usually has to be programmed to deal with tables or columns, as the default mode is scanning horizontally across the screen. The devices can usually recognize true graphics and skip over them, but this sort of text box will typically be unusable.

Howard C. Berkowitz 16:15, 22 December 2008 (UTC)