Talk:Alternative medicine/Archive 19

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Need for new section on evidence basis

We currently have some good content regarding the evidence basis for alternative medicine, but it's spread over several sections. These have been touched on in the edits of the last few days. We should start a new section and collect it in one place. In some cases this would mean copying it (rather than removing it) from its current location, since it is an integral part of the whole fabric of an existing section, but in some cases a rewording of sections would allow us to use content in the new section. The new section should document the diverse and conflicting POV over whether and to what degree there is a good evidence basis for alternative medicine in general and with specific techniques, although we shouldn't get too detailed about individual techniques, but refer to their articles.

I suggest that the safest and least disruptive approach would be to copy the relevant material into a list here (the order is unimportant at first), then combine it using good prose into a trial version here where we can work on it. When we have a consensus version, it can be included. Once that is done, we can work on getting rid of unnecessary duplication in other sections.

This is important because this is one of the biggest points of contention between the mainstream medical community and believers in alternative medicine. The claims made are directly contradictory to each other creating much confusion in the minds of the public, even if there is much less contention over the matter within the scientific community. These facts can be made clear by using references to scientific research, to notable opinions, and to news coverage of the issue. We already have enough in the article, but we could add even more, since the sources do exist. The section should make it clear what the differing sides think about the matter and should use attribution properly.

What think ye? -- Brangifer (talk) 15:18, 1 January 2010 (UTC)

Seems like a very good idea to me. Gandydancer (talk) 03:42, 2 January 2010 (UTC)

revising lead paragraph

I do not feel that it is correct to open the article with a statement by a person who, as far as I can tell, is not qualified to make a judgment on CAM. If someone has more information on Dr. Davis, I'd like to see it, since when I google him I come up with next to nothing. On the other hand, the well known Cochran group says something quite different to define CAM:

What are considered complementary or alternative practices in one country may be considered conventional medical practices in another. Therefore, our definition is broad and general: complementary medicine includes all such practices and ideas which are outside the domain of conventional medicine in several countries and defined by its users as preventing or treating illness, or promoting health and well-being. These practices complement mainstream medicine by 1) contributing to a common whole, 2) satisfying a demand not met by conventional practices, and 3) diversifying the conceptual framework of medicine."[17]

Furthermore, if one were to use the statement, "that which has not been shown consistently to be effective" one would need to include some mainstream drugs, antidepressants, for just one example. Thoughts? Gandydancer (talk) 15:36, 24 January 2010 (UTC)

I also have a problem with this in the opening section:

Because alternative techniques tend to lack evidence, some have advocated defining it as non-evidence based medicine, or not medicine at all. Some researchers state that the evidence-based approach to defining CAM is problematic because some CAM is tested, and research suggests that many mainstream medical techniques lack solid evidence.[11]

For one thing, it uses the word "some" twice. The reference is several pages from a book that is not noteworty written by an author who is not either. Plus, I really can't figure out what this editor was trying to say. Can you? Thoughts? Gandydancer (talk) 22:36, 24 January 2010 (UTC)

wow, it's been a while since I read the intro all the way through. that second paragraph is awfully POV-pushy. I'll revise. you can feel free to recise it as well, you know. be bold when you see problems. --Ludwigs2 00:23, 25 January 2010 (UTC)

Gandydancer, you're throwing our "not noteworthy" quite a bit. By whose definition? Are you engaged in whitewashing by removing critical POV? If they're sourced properly, then your personal opinion needs to be weighed against the opinions of lots of other editors before you start deleting sourced material. That's normally considered vandalism. You have been bold and removed material. That it was sourced is problematic, so you shouldn't have done it. But since you were reverted (twice!) and stil persisted, that's a violation of the WP:BRD cycle. It only has one cycle. You should have immediately, right after the first restoration, started this discussion. It's good you're doing it now and we might we get somewhere with this.

Ludwigs, I reverted one of your deletions as we don't delete POV here, especially when properly sourced. If the wording could be made better, as well it might, then let's discuss it here first.

As you know, this article has been a war zone many times and we need to avoid returning to those days. It can certainly be improved, so suggestions are always welcome. I'm not saying that your objections might not have legitimacy. I'm just saying that we should discuss it first. -- Brangifer (talk) 05:15, 25 January 2010 (UTC)

It is important to note that you're editing the lead, which is based on content in the body of the article. The body should be altered before making changes to the lead. Some of the aspects you're dealing with are a reflection of content here: Alternative_Medicine#Relation_to_evidence-based_medicine. Note that there isn't total agreement on definitions, which is why there is internally inconsistent and conflicting content, which is a good thing....the article reflects the real world. Things are evolving and the article will reflect it. -- Brangifer (talk) 05:27, 25 January 2010 (UTC)

I know about evidence-based research - it is a minority position (fairly small minority, at that) that was invented as a semi-skeptical attempt to redefine CAM and alternative medicine. It is not fully developed, and not generally accepted, and Its presence in the article is well out of proportion to its acceptance by the scholarly/medical world. It may grow over time, but that is irrelevant per WP:SPECULATION. further, my revisions eliminated some obvious misstatements - for instance, this phrase - "The claims made by alternative medicine practitioners are generally not accepted by the medical community because evidence-based assessment of safety and efficacy..." is entirely incorrect, for the following reasons:

alternative medicine practitioners do not make claims, they have practices
many classically defined Alt med practices are accepted by the medical community (it's only under EB assumptions that that becomes tautologically impossible)
'evidence-based' assessments are not standard scientific language, and many conventional medicines would fail by those standards anyway, so that phrase is almost entirely misleading

I hadn't really wanted to get into major edits right now (because I have other things to do) but if you insist I can go and edit that section with an eye to wP:undue to justify attempts to balance the lead. right now, though, I'm just going to reinstate the changes that I made - please read them this time before you revert, because it really is an improvement to the article. --Ludwigs2 05:56, 25 January 2010 (UTC)

You're not listening. We need to avoid edit warring here again. Discuss such changes first. I'm reverting and will take this further if necessary. Discussion is the way to do this. Some of your statements are flat out contradicted by the sources being quoted. You're removing sourced information. Just because you don't agree is no reason to remove it. -- Brangifer (talk) 06:56, 25 January 2010 (UTC)

I'm always amazed when people say 'don't edit war' right before they begin edit warring on their own. look, I have discussed the edit I made, just above - you've reverted (twice now) without addressing my edits in any meaningful way, or even (I suspect) reading what I wrote. what's up with that? I'll AGF this and give you a chance to explain why you're so upset about relatively minor changes, and why you think my explanations above don't work, but if you don't engage in proper discussion I will have no choice but to revert it again. ok? so, ball's in your court - explain what's wrong with the edits I made. --Ludwigs2 07:22, 25 January 2010 (UTC)

I'll add that in your haste to revert my changes you also removed some changes I made to templates at other places in the body. I will consider it a sign of good faith if you go back and restore the non-intro changes that I made to the article. --Ludwigs2 07:33, 25 January 2010 (UTC)

I have reinstated your tag. Better to tag and discuss, rather than make non-consensus changes. That's my concern. The changes that initiated this section and the following changes weren't consensus changes and should be discussed first. That's why I reverted back to the "status quo". Not that status quo is always good, it just needs to be discussed. I had read your arguments above and found them to be plainly false or misleading opinions that didn't justify making changes to sourced material. Alternative medicine practitioners and advocates DO make claims, often radical lies, in order to promote their businesses and ideas. Those claims are often very dangerous. Some, not "many" classically defined Alt med practices, are accepted by a few in the medical community, even though they still lack convincing evidence. OTOH, if you're referring to some method that has long-since proven itself beyond doubt with good research, then of course it's accepted and should no longer be termed "alternative". It has made the transition. That used to happen more often, less so now, and even less so in the future. Currently very few of the methods that are classified as alternative have a chance of ever becoming proven, as they have been investigated and found wanting. That's why the skeptical definition applies even more so now than before: "unproven and disproven". Many have been disproven. The question of whether conventional medicines would fail testing is always relevant, and that's what the process of EBM does, it weeds out the wheat from the chaff. Such methods are then discarded, sometimes grudgingly, but it happens. They then often are continued by quack MDs who also promote alternative medicine. Chelation therapy for non-indicated and off-label uses are an example.

Note that some of your rewordings changed the meaning and left out wordings that were sourced to very notable individuals. That's why you need to copy the original wording (before this mess) with the references to this talk page and let's work on them here. You're smart and you may well have a better way of wording this stuff. I'm very willing to work with you in this process, but do it here, not in the article. It needs to remain stable. -- Brangifer (talk) 15:17, 25 January 2010 (UTC)

(outdent)

Let me address your points in order, because they really have no basis in fact:

'Consensus' and 'status quo' are not synonymous. Consensus is an agreement that content actually reflects the real world, which we clearly do not have.
"Alternative medicine practitioners and advocates DO make claims, often radical lies, in order to promote their businesses and ideas." Some AM practitioners do this. So do some mainstream medical (MM) practitioners. There are charlatans on both sides of the fence here. Most AM and MM people, however, don't make overt claims, they simply do what they believe is best for your health. When an acupuncturist tells you that he wants to needle a particular meridian he is not 'lying' to you (e.g. telling you something he believes is false, and he is not making a 'claim'; he's simply following a practice. You personally may not think that practice has merits (that's fine), but that is a different matter.
Your next three statements come straight out of the Evidence-Based medicine POV - while showing a certain amount of common sense, they are not the current common understanding on AM in the medical world, and shouldn't be presented as such. I can't be clearer about this - you cannot write the article from the perspective of a minor skeptical theory within conventional medicine. .

Believe me, I understand where you're coming from politically, but this is wikipedia, not politics. You can't allow your personal beliefs to influence your editing of the page. --Ludwigs2 17:05, 25 January 2010 (UTC)

I took the liberty of punctuating and capitalizing the right spots in your message so I could understand it better. The meaning isn't affected at all. I'll reply by the numbers:

Of course they're not synonymous. My point is that controversial changes should be discussed first. That's all.
I'm not implying that all make claims or that they're lying. Some make claims. Some lie. Most believe in what they're doing, so even if their statements aren't true, they're not lying. It's all a matter of motives. No disagreement there. My beliefs about their practices isn't the point here. It's neither here nor there. I was just responding to your statement above: "alternative medicine practitioners do not make claims, they have practices." I don't claim that all of them make loud claims, but the very fact that they are practicing involves them making claims to their patients and customers. Other practitioners and advocates are very vocal in their advertising. Gary Null, Tim Bolen, Andrew Weil and Joseph Mercola are some examples. Note that I'm not opposing the inclusion of opinions they hold when properly sourced. You seem to be denying that the opinions of those who hold the opposite POV should be suppressed or denigrated in this article. That's a violation of FRINGE, WEIGHT, and NPOV. The mainstream POV gets the most weight, and skeptics are the ones who support that POV. It seems to me that you're pulling in the opposite direction and trying to diminish such content here.
I'm not saying the article should be written from the POV of skeptics, but it should include the POV of skeptics, and you seem to be trying to diminish that content. The article shouldn't be written from the POV of believers in alternative medicine either, but it should definitely include it.

No, unlike you, I'm not trying to diminish that POV at all. You accuse me of allowing my POV to influence my editing. If that's true, then we're certainly even, but it's not that simple. We each have our own POV, POV that exist in the real world, and that's perfectly fine. We just need to make sure that each other's POV is represented using good sources. Both should be in the article. I'm not denying you that right. Why are you denying me that right, as required by NPOV? -- Brangifer (talk) 02:18, 26 January 2010 (UTC)

ok, one good cheap POV shot deserves another, so lets let that slide and drop it, because we both no its not particularly true. back to points.

good enough - however, I don't really see anything controversial in these changes, and I'm not sure why you're objecting
the current line in the article implies 'very clearly that all alt med practitioners are making claims when in fact you just said that they don't all do that. so why did you revert my edit that changed that line? to your other points:
- "the very fact that they are practicing involves them making claims to their patients and customers" - this is true of all medical practitioners, Alt or Mainstream. if you go into your doctors office, he will make claims about the various treatments that you might get.
- "You seem to be denying that the opinions of those who hold the opposite POV should be suppressed or denigrated in this article." - that's an idiotic statement. I did not remove any of any skeptic talk, I just balanced it. Evidence-based medicine is still a relatively small and minor POV, and does not reflect the opinions of Alt med practitioneres or mainstream medicine
again, same point - I didn't remove anything from the lead - did you even read what I wrote

Stop arguing without information - READ the changes I made and tell me how any of what you're complaining about above applies to what I did. --Ludwigs2 02:34, 26 January 2010 (UTC)

QUOTE FROM BRANGIFER:

Gandydancer, you're throwing our "not noteworthy" quite a bit. By whose definition? Are you engaged in whitewashing by removing critical POV? If they're sourced properly, then your personal opinion needs to be weighed against the opinions of lots of other editors before you start deleting sourced material. That's normally considered vandalism. You have been bold and removed material. That it was sourced is problematic, so you shouldn't have done it. But since you were reverted (twice!) and stil persisted, that's a violation of the WP:BRD cycle. It only has one cycle. You should have immediately, right after the first restoration, started this discussion. It's good you're doing it now and we might we get somewhere with this.[END QUOTE]

Here is what I removed: ...or "that which has not been shown consistently to be effective."[2], and it is from the opening sentence of the article, and it is a quote of an MD that nobody's ever heard of from a book that nobody's ever heard of either. When I said he is not noteworthy, I am NOT using my own definition, I am using the Wikipedia definition. Compare that statement to the balanced Cochrane definition. Are we, in the opening sentence of this article, going to use the statement of an unheard of person/book or a Cochrane review? If Brangifer can find a guideline that suggests this, I'd like to see it. Not that you'd need to check the guidelines as it's only common sense. Furthermore, as I said, to suggest that the definition "everything that has not been shown to be consistently effective" would have to include medications used in mainstream medicine as well. For instance recent studies have shown that antidepressants are effective for severe depression but not effective for mild depression--interestingly, it has been found that St. John's wort HAS been found to be effective for mild depression, but not severe depression. I am tempted to get into a discussion about accusations of vandalism and the suggestion made so frequently that editors to this article are creating editing wars, but I will not further stir the pot for now. Gandydancer (talk) 12:09, 26 January 2010 (UTC)

Gandydancer, notability is not a requirement for inclusion of references, only for the creation of articles. The subject of an article must be notable, but the content can be from V & RS, including unnotable ones. There are numerous definitions of alternative medicine, some of them conflicting, and we are including some of them from various sides of the debate. That's what NPOV requires. If this article were to make it seem like there are clearcut definitions and that there are only two sides to the debate, it would be misleading, because that's not the way it really is in the real world. -- Brangifer (talk) 14:53, 26 January 2010 (UTC)

As I look at the recent (and deep) edit history, and this particular section of the discussion, it seems to me that the problem has mainly to do with failing to recognize that the term is a matter of dispute: whether it designates something that can be defined (except by lists and by exclusion from institutionally sanctioned practices), and then only secondarily whether anything coherent can be said about the things it gets attached to. It seems to me that the article needs to talk about medical practice, science, and what counts as either of those things, but it can’t go there without acknowledging that this term is an operator in a semantic contest. I have redrafted the intro to recognize the opposed points of view, to include recognition that there are perspectives on the term from the medical establishment, from those who identify as part of a CAM movement or community, from those who work with language, folklore, the sociology and history of ideas. DavidOaks (talk) 15:43, 26 January 2010 (UTC)

David, I hate to say it, but your rewrite messed up some extremely sensitive wordings. The history of this article has been characterized by some long and fierce edit wars, with ArbCom cases, blocks and bans, ArbCom sanctions, lockdown protections of the article, and numerous editors on various sides of the debates finally arriving at a finely balanced consensus lead. That has now been seriously disturbed, violating the rules for how a lead must be written, and also messing up the reason for certain redirects. Note that this article is the result of merges of several former articles (Complementary and alternative medicine, and Complementary medicine). The conditions for merging those articles here are violated by removing the content that came from them and which was in the lead. That's a contractual violation of agreements made at the time, and that must be fixed. If you'll go back, you'll see that the lead had those article titles in bold. That is only allowed because of the redirects from those former articles. That content must be restored to the lead.

Only someone who has lived through all these elements of the article's history would know these things and why the lead shouldn't have been disturbed without very careful discussions and consensus of each word and phrase first. You are excused because you didn't know all of this, so please don't take offense because I'm reverting it all back to its original state. That's the only way to get back to the condition that existed as a result of all those complicated events and agreements.

A peeve is also that our MoS isn't followed in the formatting around the refs. The spacings are all screwed up now. Basically it should be restored to its previous state and only consensus edits should be made to it. This edit warring is what I've tried to warn about, but unsuccessfully. Some have insisted on editing the article while discussions were ongoing. That's totally wrong. Never make an edit that you know might be contested while discussions are still ongoing. Only revert back to the previous stable version. Then, only after consensus is very clear, should it be altered in any manner. Edit wars suck! -- Brangifer (talk) 07:02, 28 January 2010 (UTC)

OK, one approach would be to revert to what it was immediately before my change, and imbed a hidden comment warning future editors of the situation -- that the lead was highly contentious, is fine-tuned, and should not be altered without consensus. DavidOaks (talk) 12:33, 28 January 2010 (UTC)

Thanks, and I feel you have made a very good start. I do have a problem with this statement: "...the practices so designated have little in common except their lack of conventional scientific basis." Just to take one example of many: green tea. See this page please: http://www.sciencedaily.com/search/?type=news&keyword=green+tea&section=health&filename=&period=1825&sort=relevance I could give many other examples.Gandydancer (talk) 16:07, 26 January 2010 (UTC)

If "having a problem with it" means "people will disagree," I think that's what we've got to include. It's a fairly harsh statement rhetorically, but the writer's a professor of biostatistics, the book's a recent offering from one of the most prestigious university presses -- it represents a significant opinion. DavidOaks (talk)

David - not bad (a few redundancies I'll remove in a bit), but you missed the main point of contention, which is the myopic focus in 'evidence-based medicine' in the second paragraph. I have no problem with EBM (well, except that it is thin and has some obvious flaws of logic) but it is not the proper lens through which to view Alt Med because it is not the conventional view either in medical science or alternative medicine. If you want to address that, I'd apprciate it. --Ludwigs2 16:13, 26 January 2010 (UTC)

Well, I don't share the conviction, put forward here in a number of forms, that "evidence based medicine" is a minority view. I freely admit I haven't done any systematic study, but I spend an awful lot of time with medical educators, and I get the strong impression that it's among the dominant curricular paradigms. I think at the very least we need to get a handle on its status before we make rhetorical decisions based on its being a minority view. It could well be that EBM is another term that has a different meaning for you than for me (I gather it is simply normative scientific rigor, but specifically applied to the administrative healthcare environment we currently have)DavidOaks (talk) 16:31, 26 January 2010 (UTC)

Brangifer, however you are opening the article using an unknown person/book. You are using that reference to override the Cochrane review:

"What are considered complementary or alternative practices in one country may be considered conventional medical practices in another. Therefore, our definition is broad and general: complementary medicine includes all such practices and ideas which are outside the domain of conventional medicine in several countries and defined by its users as preventing or treating illness, or promoting health and well-being. These practices complement mainstream medicine by 1) contributing to a common whole, 2) satisfying a demand not met by conventional practices, and 3) diversifying the conceptual framework of medicine."[17]

If I were to go to a wikipedia article and add a statement to refute a Cochrane review with some opinion by some MD that nobody had ever heard of, how long do you think my edit would last? Obviously, not very long. Why would you think it would be different with this article? You seem to forget again and again that your POV about CAM is not shared by thousands of others. Not mine, my well-educated friends, and not thousands of people including health care professionals in the US and elsewhere.Gandydancer (talk) 16:32, 26 January 2010 (UTC)

Gandy, that reference never "overrode" or "refuted" Cochrane. It was just one of varous conflicting definitions we included to show that there isn't unity on the subject. Cochrane isn't the only or final word. The disunity of definitions must be preserved. That's the way it is in the real world. -- Brangifer (talk) 07:02, 28 January 2010 (UTC)

Sorry, I missed that... Who said that EBM is a minority view?Gandydancer (talk) 16:39, 26 January 2010 (UTC)

My earlier link does not seem to work. Try this as an example of one of the many "scientific" studies that have been done: http://www.sciencedaily.com/releases/2008/07/080702080624.htm Gandydancer (talk) 16:53, 26 January 2010 (UTC)

wow - can we keep the indents sane, please?

I said EBM was a minority view. I recognize that the idea that medicine should be based on scientific evidence is both widespread and mainstream - I have no problem with that. but the actual, explicit tenets of the thing called Evidence-Based Medicine (as proposed by people like the Cochran Collaboration) are not widely accepted, and suffer from some inherent flaws. You'll notice that all I did in my previous revisions was separate scientific medicine (which is widely accepted) from evidence-based medicine (which is one minor viewpoint about scientific medicine). I don't have a problem with giving scientific medicine it's due - I do have a problem with editors who seems to want to advance the Cochrane group to a much higher level of prominence than they actually occupy. can you all see that distinction? --Ludwigs2 16:57, 26 January 2010 (UTC)

That's a pretty radical view I've never heard before. Unless I'm totally misunderstanding you, it reeks of ignorance of mainstream medicine. It sounds like your own opinion which isn't echoed anywhere in the medical or scientific establishment. EBM is the prevailing paradigm. That doesn't mean it's finished being applied to every method in use in mainstream medicine, or that it's all taken effect yet, which might be what you're referring to. If so, no denial there. It's a movement and way of thought, a method for using the scientific method to sift the chaff from the wheat. It has nothing to do with skeptics and certainly wasn't invented by quackbusters. Keep in mind that the scientific method is the basic application of skeptical principles to how one approaches claims. In that sense there is a total alignment with skeptical thinking. Skeptical thinking in medical matters is aligned with mainstream scientific principles, and is even echoed in Wikipedia's polices of V & RS. A Wikipedia editor says "show me the proof/references", and a skeptic says "show me the evidence".

EBM is mainstream thought. It is used by ordinary scientists in their efforts to determine what really works among the methods that are already incorporated and being used. They can thus eliminate methods that have been favorites, but which actually don't work as thought. Skeptics also use the concept in their attempts to prevent unproven alternative methods from being blindly accepted by scientists who don't know what they're really dealing with. They can easily be fooled by first appearances. They want alternative methods to be subjected to the same types of rigorous research demanded of other methods before being accepted. No, EBM is mainstream, skeptics are also mainstream, and the EBM paradigm works fine within the laboratory and out on the frontlines of quackbusting. -- Brangifer (talk) 21:02, 26 January 2010 (UTC)

first point: let me be clear - I don't generally use the word sceptic as an epithet (as you seem to be implying here). I lean that way sometimes, but only when I see someone abusing proper skepticism in order to advance a belief.

Second, as far as I can tell you are failing to distinguish between the normal scientific reliance on evidence of certain types, and the philosophical position named 'evidence-based medicine'. I have no qualms with the first, but the second (currently) is a philosophically underdeveloped minority position with pretensions of universality (as all good philosophical positions must have). If you want to talk about the kind of scientific evidence that medicine relies on, you will find no objection from me. if you want to talk about 'evidence-based medicine' then you'll need to frame it appropriately as a philosophical perspective. if you want to continue to confuse the two then we have a problem, because I can only see that as (a) an odd misuse of language or (b) an effort to advance a position beyond its prominence. --Ludwigs2 21:21, 26 January 2010 (UTC)

Sorry about the indent - someone else posted while I was working on my post. Ludwigs, while I do agree with you, I do not believe that here and now is the place/time for you to push that point of view. I have even looked at the Cochrane page and thought of adding criticisms, but I am not really qualified to do that. I have a friend who teaches stats and she is critical of that type of review and feels that evidense based studies should have their place as well. She was referring to mainstream meds not alt. med., but it is even more true with alt. med. I feel it would be great if you would write a paragraph in the article if you can find references, however I strongly feel that we must accept that rightly or wrongly, we need to accept that it is the Golden Rule at wikipedia. At least, that has been my experience when trying to edit. BTW, where are you getting your information when saying that Cochrane type reviews, etc., are not widely accepted? I thought it was just me... Gandydancer (talk) 17:25, 26 January 2010 (UTC)

it's a lack of evidence, really: Cochrane is not cited outside of skeptical journals, and I've never seen EBM mentioned in a mainstream medical journal (not that I read all that many of them). it may be that the EBM label will become the norm in a decade or so. but if it does, it will be in a different substantive form than it's in now - the current version, as has been noted, doesn't effectively distinguish between accepted and unaccepted forms of medicine. For the moment (as far as I can tell) it's just a neologism that was invented by concerned skeptics as a way of forestalling what they saw as a dangerous trend in the populace towards non-mainstream medical perspectives.

Again a very radical and seemingly ignorant view. Cochrane is used by scientists in their literature searching work and EBM comes from and is discussed in mainstream journals all the time. Very strange views I've never heard before. Pure OR. -- Brangifer (talk) 21:09, 26 January 2010 (UTC)

this would be the time for you to (a) stop insulting me, and (b) start producing some evidence that demonstrates that what you say is true. insults are unproductive, and if you continue I'll ask an administrator to intervene. do we understand each other? --Ludwigs2 21:26, 26 January 2010 (UTC)

I'm not pushing a point of view - one can't push NPOV. read this diff which branfiger is so up in arms about and tell me what it is he actually is up in arms about. it seems like a wholly innocuous improvement to me. --Ludwigs2 17:42, 26 January 2010 (UTC)

OK, back to work... This sentence: The category is difficult to define, in part because of the wide spectrum of beliefs and practices which may be so designated, [2], the lack of agreement as to what constitutes a “successful treatment outcome”[3] as well as the fact that the practices so designated have little in common except their lack of conventional scientific basis [4].

I would like to change it to read like this: The category is difficult to define, in part because of the wide spectrum of beliefs and practices which may be so designated, [2], the lack of agreement as to what constitutes a “successful treatment outcome”[3] as well as the fact that critics argue that the practices so designated have little in common except their lack of conventional scientific basis [4].

I would like this change because, as I have said, many CAM treatments have been "scientifically" studied. Here, for example, is a PubMed zink study: http://www.ncbi.nlm.nih.gov/pubmed/18045283?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=14 And here is what the Mayo Clinic has to say about CAM - surely you'd think that if they claim that studies have been done, one could trust that they are correct: http://www.mayoclinic.com/health/alternative-medicine/PN00001 Also note on p.2 they explain why so few CAM studies have been done. I really do just find it amazing that anything to do with CAM in wikipedia seems to cause all hell to break loose. It is being taught to nursing students, med students, and used to compliment mainline medical care extensivly. Gandydancer (talk) 19:26, 26 January 2010 (UTC)

Identifying the perspective in note 4 as coming from a critic seems quite reasonable and improves neutrality. Now, entirely separate question: treatments that have had extensive scietific testing and are taught in mainstream medical institutions -- how are they then CAM? This is the definitional problem that -- as it seems to me -- we keep barking our shins on. DavidOaks (talk) 20:07, 26 January 2010 (UTC)

(e/c) wow - took me a while to find the change there.

I see what you're getting at, but I think adding that one word is problematic, since it open the question of what a 'critic' is). really more of a bandaid than a cure. I think it would be better if we went withe a broader rewrite like so:

The category is difficult to define: it is a 'catch-all' label for a wide spectrum of beliefs and practices which have little in common except that they are not derived from the methodology of conventional scientific medicine. They may differ in their assumptions from conventional medicine and from each other, and may even have significant differences in what they consider valid evidence or successful treatment outcomes.

what do you think? --Ludwigs2 20:13, 26 January 2010 (UTC)

@ David - you're speaking from the perspective of EBM. in colleges that teach such things (to my knowledge), courses are usually offered explicitly under the CAM or AltMed label: they are neither treated as mainstream medicine nor reviled as unworkable - it's a purely pragmatic approach to the topic. --Ludwigs2 20:18, 26 January 2010 (UTC)

I think part of the problem is the equivacation of mainstream with "scientifically proven" medicine. A lot of mainstream medicine is not based on scientifically proven medicine - take off-label use of drugs. This is legal, and an accepted part of "mainstream' medicine, up to the discretion of the physician. To restate what is on Wikipedia on Off-label use

Up to one-fifth of all drugs are prescribed off label and amongst psychiatric drugs, off-label use rises to 31% (Radley, et al. 2006).^[1] New drugs are often not tested for safety and efficacy specifically in children. Therefore, it is believed that 50-75% of all medications prescribed by pediatricians in the U.S. are for off-label indications.^[2]Some drugs are used more frequently off label than for their original, FDA-approved indications. A 1991 study by the U.S. General Accounting Office found that one-third of all drug administrations to cancer patients were off label, and more than half of cancer patients received at least one drug for an off-label indication. A 1997 survey of 200 cancer doctors by the American Enterprise Institute and the American Cancer Society found that 60% of them prescribed drugs off label.^[3]. Frequently, the standard of care for a particular type or stage of cancer involves the off-label use of one or more drugs. An example is the use of tricyclic antidepressants to treat neuropathic pain. This old class of antidepressants is now rarely used for clinical depression due to side effects, but the tricyclics are often effective for treating pain.

. And, even for those "proven" medicines, clinical trials can prove that something works X% of the time - that can be anywhere from close to 100% (NNT=1) to 1% (NNT>99), which means that some mainstream medicine is administered, even when it is known that it won't work for a good percentage of the people that it is prescribed to, in hopes that it will help a few. The reason might be that there is not anything else, or that the doctor might feel that this patient might be a good candidate for this based on the physician's personal experience with using that drug. Scientifically proven methods/medicine is only a part of Mainstream medicine, not the whole. stmrlbs|talk 05:01, 27 January 2010 (UTC)

This is what I was trying to capture in the derived from language, above. off-label drug use has not been tested for efficacy, but the drugs have been developed under a western-scientific testing paradigm, so there is at least the marginal assumption that they've been tested for safety in that model. So, there is no more evidence that the off-label use of a drug works than there is that a traditional herbal medication works; it's just that the traditional herbal medicine hasn't been derived from the same model. --Ludwigs2 06:09, 27 January 2010 (UTC)

People have no idea how poorly some of the drugs on the market have been tested and how little they are aware of the results. See this report on a sleep med for instance:

Rozerem (ramelteon), for example, was approved in 2005 for chronic insomnia and was aggressively promoted to consumers. No efficacy data were provided in the label.4 The phase 3 sleep-laboratory studies that were included in the FDA’s medical review show that Rozerem reduced the time required for patients to fall asleep (as measured by polysomnography) by 14 minutes among younger adults and by 7 minutes among older adults (see box on Rozerem data). However, there were no subjective improvements in total sleep time, sleep quality, or the time it took to fall asleep. Two phase 3 outpatient trials confirmed that people didn’t notice much benefit from Rozerem. In a trial involving younger adults, Rozerem had no effect on any subjective sleep outcome; in one involving older adults, the drug reduced reported time to fall asleep by 7 minutes but did not reduce the proportion of cases meeting the definition of insomnia (taking more than 30 minutes to fall asleep). Nor did it improve any of the secondary outcomes: falling back asleep, number of awakenings, total sleep time, or sleep quality.

http://healthcarereform.nejm.org/?p=2126&query=home Gandydancer (talk) 14:53, 27 January 2010 (UTC)

Again, back to the wording about the "fact" that CAMs have not been scientifically tested, see this Cochrane review of St. John's wort: http://www.cochrane.org/reviews/en/ab000448.html

Is there an agreement that I may change the wording as I suggested above? Gandydancer (talk) 15:15, 27 January 2010 (UTC)

sorry, this thread has gotten awfully sidetracked. can you create a new 'proposed revisions' section and restate the change you want to make? I've lost it in the mess above. --Ludwigs2 16:16, 27 January 2010 (UTC)

I agree we need a new start, however for now I will just paste it here:

This sentence: The category is difficult to define, in part because of the wide spectrum of beliefs and practices which may be so designated, [2], the lack of agreement as to what constitutes a “successful treatment outcome”[3] as well as the fact that the practices so designated have little in common except their lack of conventional scientific basis [4].

I would like to change it to read like this: The category is difficult to define, in part because of the wide spectrum of beliefs and practices which may be so designated, [2], the lack of agreement as to what constitutes a “successful treatment outcome”[3] as well as the fact that critics argue that the practices so designated have little in common except their lack of conventional scientific basis [4].

This should be a good way to keep NPOV because the Snake Oil book, while I do not agree with it, is extremely against all CAM and has been widely read and is familiar to most people (unlike the Davis book that I have argued against). Gandydancer (talk) 16:43, 27 January 2010 (UTC)

I don't have any objection to the addition of the word 'critic', but I don't think the revision really gets at the issue. as I said, I think we need a more extensive revision. it's a start, though. --Ludwigs2 19:04, 27 January 2010 (UTC)

revising lead paragraph, cont'd

(If only because we NEED a new section). Now, while observing WP:AGF, I have to say that I see some partisanship here (no one needs to read the page to know that; simply noting the number of archived discussions is sufficient). I also see a certain pattern of repeated claims and positionings that need to be addressed.

First, the treatment of resistance to CAM as coming from EBM, which in turn is treated as a minority position (therefore easily ignored) but also equated with institutional and conventional medicine (so that being able to ignore EBM defuses virtually any critique of CAM). Sources must be brought forward identifying EBM as identical with institutional medcine, and/or a minority opinion in medical education (it kind of has to be one or the other, and my distrust is awakened by the way it seems to keep switching), or these positions must be abandoned. I have not yet gone source-hunting myself, but some informal offline polling tells me that EBM is taken as a current buzzword for the fairly recent implementation of scientific principles to the actual delivery of healthcare and healthcare decision making as well as has long been the case with questions of individual therapeutic benefit, and it is regarded as entirely mainstream. When CAM is criticized for failure to meet standards of saftey and effectiveness, it is not under attack by philosophical EBM.

Second, the claims about sources being notable or "heard-of" by "everybody" or the reverse. I'm not sure how one sustains a claim that nobody had ever heard of a given thing. See WP:Google for the essential wrongheadedness of the approach. Notability is not a requirement for WP:RS; pertinence is. When the topic embraces folk medicine, a folklorist who has written about the differences between folk medicine and other practices is pertinent. When the topic is language, a comedian who focuses on the use of language in the subject of alternative medicine is pertinent.

Third: definitions (this is the big one)

CAM seems not to be definable except in "practical" terms (which seems to mean a list whose logic no one can explain, and whose contents none can characterize)

Institutional medicine seems not to be definable, since there are claims that some of its science has contained error, its permissive attitude towards off-label use of approved drugs counts as CAM (?), and some CAM procedures get rigorous scientific testing (and yet remain CAM?).

The first thing has to do with the nature of the subject. The next two seem to me claims that must be made explicit and then supported with WP:RS, or must be abandoned. This blurring of lines has the effect of undermining the authority of scientific, institutional medicine while simultaneously raising the dignity of CAM. If that's the case, the necessary and inevitable conclusion is that the entire matter is political, ideological and linguistic, without scientific content of any kind: there is no meaningful distinction between CAM and any other medical theory or practice. Again, that being decided, the article needs a complete reboot, and really has to be exclusively about language. DavidOaks (talk) 19:50, 27 January 2010 (UTC)

I honestly think that there's a lot of 'mountains from molehills' reasoning going on here. the way I see it:

Alt Med/Cam are not difficult to define: they are medical practices that are not derived from conventional (western/scientific) medical science. If you want to be really specific, AltMed/Cam is any healing practice that is not explicitly recognized by medical associations such as the AMA.
- the definition has nothing to do with efficacy or safety, though there are any number of editors who want to make that association. The best one can say is that CAM practices are not tested for efficacy and safety under the same paradigms as institution-approved practices.
no one is arguing that conventional medicine is not based on scientific evidence. all I am arguing is that the particular label 'Evidence-based medicine' refers to a particular philosophical attempt to re-conceptualize the difference between 'mainstream' and 'alternative' medicine. In practice, this is probably an approximation of what most doctors/researchers do - they evaluate treatments based on evidence of efficacy and safety. I think you're right about it being a buzzword - most doctors/researchers do not think of it in terms of EBM, they think of it in terms of normal scientific practice. we cannot elevate the philosophical perspective to undue prominence by insisting on using the term any more than we can deny to prominence of normal scientific practice.
- remember, EBM was created as a response to altmed/CAM, not the other way around.
I don't particularly want to 'raise the dignity of CAM' (whatever you meant by that phrase); nor do I want to disparage CAM as something less-than. Wikipedia is not the place to argue whether CAM does or doesn't work.

I personally think that everyone should get away from (a) any tendency they feel to push one or another side of this debate, and (b) any tendency they feel to accuse others of doing that. We're ot going to get an NPOV article any other way than that. --Ludwigs2 20:29, 27 January 2010 (UTC)

[QUOTE]Second, the claims about sources being notable or "heard-of" by "everybody" or the reverse. I'm not sure how one sustains a claim that nobody had ever heard of a given thing. See WP:Google for the essential wrongheadedness of the approach. Notability is not a requirement for WP:RS; pertinence is. When the topic embraces folk medicine, a folklorist who has written about the differences between folk medicine and other practices is pertinent. When the topic is language, a comedian who focuses on the use of language in the subject of alternative medicine is pertinent.[/QUOTE]

So you are telling me that I am not correct and that I do not understand wikipedia quidelines, when I suggest that a well-recognized auther/book that discusses all aspects of CAM is better than an unknown author/book that discusses one aspect of CAM, folk medicine? You actually feel that they are on equal footing for the opening sentences of this article?? If this discussion is going to move away from an honest effort to come up with wording that is satisfactory to all, I shall lose interest in a hurry. Gandydancer (talk) 02:40, 28 January 2010 (UTC)

Gandy, as a newbie here, I'll excuse you. The more one learns about NPOV, the more one realizes that an NPOV article contains content that will grate on the sensitivities of pretty much everyone on either side of the debates. That is a requirement -- that we include content that reflects the debates and disunity of the subject. It's not our business to pick and choose one statement or quote we feel summarizes the subject. That can't be done satisfactorily to everyone. We must pick several of the best/worst and strongest examples of each POV, IOW what is "best" for one side will be considered "worst" by the other, and that content must coexist within the same article and in the lead. Deletionism of opposing POV is a serious violation of NPOV. -- Brangifer (talk) 07:20, 28 January 2010 (UTC)

I'm telling you that your insistence on comparing them is inappropriate. They speak to entirely different aspects of the issue. Beyond the act of comparing them, in terms of your method of comparing them, yes, it's outside of wikiguidelines. Still trying to work out the methodology behind these repeated determinations -- "unknown" "nobody ever heard of." Whether a thing is familiar to a given editor is not a useful standard. See WP:Notability DavidOaks (talk) 04:03, 28 January 2010 (UTC)

BUllRangifer, Please read my posts before you are ready to be so kind as to excuse me for my lack of experience which has led to a serious violation of NPOV. If you had read my posts you would know that I DID want to site the most notable "authority" who has come out against CAM rather than some obscure MD writing about folk medicine. Gandydancer (talk) 10:19, 28 January 2010 (UTC)

DavidOaks, It is beyond me why you continue to insist that it would be as appropriate to open the article with a quote from an unknown MD writing for a state's folklore site (or whatever it was...) as compared to a well-known book, the Snake Oil book. Though frankly, I question your judgement anyway, since you are the person that reverted Vsmith's delete of the inclusion of a comedian's take on CAM in this article, as though a medical article is appropriate for that! Gandydancer (talk) 11:37, 28 January 2010 (UTC)

Please note -- the source to which you refer hasn't been part of the article for quite some time. In fact, I was the one who removed it. The conversation here is about wikiprinciples, not the particular source. I am correcting your tendency to make wide-ranging judments about what is obscure, what is relevant, without explaining your means for arriving at those judgments, without securing consensus. This is bad practice, and it's consistent. DavidOaks (talk) 12:14, 28 January 2010 (UTC)

I know you removed it. In fact, you are the person that added the Snake Oil ref, which I feel is excellent. And, as for the Davis ref not being here for quite some time, it is the fact that I removed it on the 24th with the statement "Dr. Davis is not noteworthy or qualified to make this statement" and I further stated that it was not appropriate to open the article with a statement made by an unknown ("expert"), that has started this controversy in the first place. Why you would suggest that I need to be corrected because this constitutes "your tendency to make wide-ranging judments about what is obscure, what is relevant, without explaining your means for arriving at those judgments, without securing consensus. This is bad practice and its consistent". Yes, I have consistently said that. I have not wavered. I have NOT said that there is no place in the article for Dr. Davis. If folk med is discussed later in the article, he may work in just fine. Or if this article was titled "Folk Medicine", it may work very well in the lead paragraph. But you DO NOT open this article, the first line in fact, with an unknown MD who wrote about folk medicine for a state's folklore page. And why I need to defend this over and over is beyond me. Gandydancer (talk) 14:21, 28 January 2010 (UTC)

(outdent) You need to defend it because you haven't. You have finally gotten around to stating that you think the reference is not relevant -- that's good. You have not explained WHY you think that the views of a folklorist, writing on folk medicine, are irrelevant to a topic closely related to folk medicine, and that would be your next step. You also repeatedly make determinations of prominence without accounting for how you arrived at them. If there's a wikipolicy for nobody-ever-heard-of-ness, let's have it. Otherwise, try this example: I personally think that health care reform has nothing to do with political philosophies; I think that's a smokescreen to conceal another set of motivations. Health care reform should be about medicine. Moreover, I have never heard of Alan Reynolds. He should not be in the lead of an article on health care reform. He certainly does not belong in the same prominence with writers appearing in medical journals, espcially those whom everybody has heard of: Gerard F. Anderson, Uwe E. Reinhardt, Peter S. Hussey and Varduhi Petrosyan. So because I have determined that Reynolds is obscure, irrelevant, he has to go. Now, should I just delete him? Do you think I'm going to get consensus over there? Or will I find myself reverting, being reverted, and saying "why I have to defend this is beyond me!" (of course I will do nothing so WP:Pointy.) Now, my own view is that the lead should give a sense of the things that are generally meant by CAM, but should be very clear by the end of that first paragraph that it's open to debate whether the term really has a clear meaning, or is primarily a cluster of connotations. I submit that proposal for consensus, which is what you should have done. More: I think that the views of a folklorist, writing on the relation of folk medicine to institutional medicine, are relevant to an article on the relation of CAM (which partially subsumes folk medicine) to instituional medicine. I am explaining what I propose and how I reasoned my way there. This is what you need to do, as a matter of habit. WP:Be Bold is a policy, but the situation here calls for it to be tempered by WP:Consensus, and that's what we're trying to do. If you wish to argue that Minchin's linguistic insights are irrelevant, you must say so, and see whether there's substantial agreement. If you think that nobody's ever heard of him or he's obscure, then you need to help us understand how that determination is made. Does it just mean that you've never heard of him? See, I had never heard of him before joining this discussion. But I think he has framed something significant, done so in memorable form, and as a public thinker about language, has the authority to do so. If you disagree, say why. If you simply feel that he has no standing to make comments on semantics, either because he specifically suffers from some defect, or because comedians in general are barred from relevance, generally or only on this subject, then you must say so. This article is highly contested ground, so there's more than the usual requirement to explain oneself. Myself, I think Minchin's formulation of the linguistic problem is more elegant and apt, and I think a comedian has some standing as a social critic, and I think that social criticism is properly part of the lead for this concept. Those too are things we can and should get consensus on. DavidOaks (talk) 15:16, 28 January 2010 (UTC)

[QUOTE]You need to defend it because you haven't[QUOTE] What??? It was the very first thing I did. I said: "I do not feel that it is correct to open the article with a statement by a person who, as far as I can tell, is not qualified to make a judgment on CAM. If someone has more information on Dr. Davis, I'd like to see it, since when I google him I come up with next to nothing." I clearly say here he is not qualified as far as I can tell (he wrote an article about folk medicine) and he is not notable. Gandydancer (talk) 15:59, 28 January 2010 (UTC)

Hmm, maybe we have different ideas of what "defend" means. For me, it has to do with explaining reasons, rather than asserting views. Your errors are several. You first fail to show why notability is relevant. There is no wikipolicy that requires notability as part of the WP:RS. Then your "proof" of non-notability depends on googling. You were directed to look at WP:Google in order to discover the inappropriateness of that approach. You were invited multiple times to clarify your position on the relevance of a folklorist's view on the distinction between scientific and CAM based on that writer's distinction between scietific and folk medicine, with an explicit link between folk medicine and CAM. As far as I can see, you haven't done it. And you needn't bother, because it's really beside the point, as the discussion has moved beyond that particular question. But I am willing to take this time with you, because you seem eager to contribute, but also need to come a little further in understanding how consensus works. I myself now think the lead will be strengthened by sticking to the medical sources Bullrangifer lists, not because defining CAM is out of the range of someone who has written about folk medicine, not because only medical people should be allowed to speak about the meaning of the term (I actually think a linguist or a philosopher of science is the most well-suited professionally) but for the more purely rhetorical reason that figuring out that relevance is really hard for some people, or at least it sets up a speedbump and just generally invites nonproductive arguments. Now, go down to that section and respond to the merits of those proposals. DavidOaks (talk) 17:40, 28 January 2010 (UTC)

reversions and consensus

we are in the middle of discussing productive changes to the page. reversions are counter-productive. please use this space to explain why these changes ou keep reverting cannot be made. --Ludwigs2 07:34, 28 January 2010 (UTC)

The key word is "discussing". Discussion is good, but making changes without consensus is counterproductive. Be patient. Making changes to the lead is always a sensitive issue because changes there are supposed to reflect changes to the actual content of the article. Yes, wordings in the lead can be written awkwardly or poorly and can be improved, but substantive changes need a very solid consensus based on changes in the body of the article.

Have you noticed the references section at the bottom of this talk page? It's there for a reason. It's there so that editors can copy (NOT edit) questioned content from the article and together with editors who hold opposing POV work on revising it here. Only after there is a consensus does the new version get used to replace the old version. That's what's known as collaborative editing. It takes a lot of good faith and the ability to write for the opponent. While that may grate on one's nerves, at least enable it.

My major objection to this latest debacle has been regarding process rather than content. When consensus gets violated, all hell breaks loose. We need to avoid edit wars. This article has been quite stable for some time until a newbie came along and boldly removed content they didn't like. It was restored and they did it again. That started an edit war and I rebooted the situation so we can start collaborative editing. I'm perfectly willing to discuss changes, but do it here, not by making controversial edits. -- Brangifer (talk) 15:15, 28 January 2010 (UTC)

Oh, cut it out. When I made my edit and it was reversed with the comment "where have you discussed this on the talk page", I immediately started a talk page discussion. I did not revert the edit, and in fact have not made a single edit since that time. Gandydancer (talk) 17:01, 28 January 2010 (UTC)

You're painting a one-sided picture of what happened. Before that you had made your first undiscussed deletion that started this edit war. The content was restored (your undiscussed deletion really constituted vandalism) and you redeleted it exactly 21 minutes later, still without discussion, thereby violating the WP:BRD cycle. Then what you mentioned happened. Three hours after your first deletion, you started a discussion.

What you are mentioning happened 1 1/2 hours before you started the discussion. After all that, it's true you didn't revert, but that's not what I was referring to. I was referring to the events as described above.

I will commend you for then doing the right thing. You stopped editing and have stuck to discussing. That's the right thing to do, in contrast to Ludwigs2 and Stmrlb. They have continued to edit war, instead of to exclusively discuss. That's very unwikipedian and a blockable offense. Ludwigs2 knows this, as their long block log can attest.

The existence of a discussion doesn't give a right to make an edit or press forward with a deletion. That violates the BRD cycle. The discussion should proceed until a consensus has been reached before making more edits. This whole thing has been characterized by the idea (applied by Ludwigs2) that making controversial changes is okay as long as a discussion is in process. That's not collaborative editing. That's edit warring. It is only the successful resolution of the discussion, resulting in an agreement, that allows editing to begin again.

That's why I rebooted back to the pre edit war status and encouraged a discussion on each point of discussion, even providing subsections for doing so. As each point is discussed and a consensus emerges, we can make ONE edit that we can all agree upon and defend and mark that section as "resolved", then move on to the next section. I am very disappointed to see that Ludwigs2 has reverted back to the tactics that led to their numerous blocks for edit warring, and I fear that will have to happen again. I have repeatedly asked for the edit warring to stop and to stick to only discussing things. Only after a consensus emerges should edits be made.

Rather than arguing about content right now, I want to get a statement from Ludwigs2 as to whether the process I describe is a reasonable one or not. I want a promise from Ludwigs2 that they will stick to discussion and not wage a war on two fronts, one on this talk page and one simultaneously on the article. -- Brangifer (talk) 07:39, 29 January 2010 (UTC)

Brangifer: I'm sorry that you object to the process we've been using, but I don't honestly care. I suggest that you stop reverting, stop explaining why we can't make changes to the page, and start discussing the changes we are trying to make. the first two are non-productive; the second might get us somewhere. I've made multiple comments on this talk page that you have not yet addressed; do you want to start with those? --Ludwigs2 18:15, 28 January 2010 (UTC)

You should care. You aren't the only editor here, and you don't own this article. If you're not willing to care, then stop edit warring, leave the editing table, and find something else to do. I have a real life and it's impossible to fight an edit war on two fronts. You're demanding discussion of controversial edits that should not have been made at all. It's impossible to keep up with such a situation, which necessitates reversion of multiple edits. Since those edits shouldn't have been made, it's proper to do that. Above I'm proposing an alternative to edit warring and I hope you will promise to accept it. It's nothing other than standard practice required by our policies. I'm asking you to abide by them, and I want promises from you. -- Brangifer (talk) 07:39, 29 January 2010 (UTC)

arbcom

I've been forced to open up an arbcom enforcement request against Verbal, because of his editing practices on this page. you can read or comment at Wikipedia:Arbitration/Requests/Enforcement#Verbal. --Ludwigs2 22:36, 29 January 2010 (UTC)

POV Intro tag

Can this tag please be justified, concisely, with specific points? Otherwise it will likely be removed. Thanks, Verbal chat

thanks, yes. I placed it there because there is an broad failure of discussion on the following two points I have raised above:

there is an excess emphasis on the the philosophical position of 'Evidence-Based medicine', as opposed to a more neutral reference to scientific medical practices. Wikipedia is not the correct venue to campaign for a particular philosophical viewpoint. I think EBM is prominent enough to get mention in the lead, but I don't think the medical position in its entirety should be cast as being derived from EBM (particularly since EBM was specifically invented as a means to redefine medical perspectives towards AltMed).
The intro leads with critical commentary. It should lead with a neutral description of the topic - i.e., one that does not attempt to call into question the safety or efficacy of AltMed in bulk or as a matter of definition. critical perspectives should be added later in the intro to balance out any perception that AltMed has broad medical acceptance, but this is an article about Alt Med, not against alt med, and shouldn't give the appearance of being the latter.

--Ludwigs2 19:23, 28 January 2010 (UTC)

OK, weighing in: I don't think EBM needs explicit mention in the lead. Now, are you saying that invoking a standard of empirical testing is invoking EBM? Forgive if I've misunderstood. I wouldn't agree with that. I think submission to empirical testing is essential to the definition of the contrasting category, scientific med. Similarly, the lead should not say that altmed is of questionable safety and effectiveness. It should say that it has not been systematically evaluated for safety and effectiveness. Otherwsie it would be medicine. (gee, Tim Minchin said it so much better). DavidOaks (talk) 19:18, 29 January 2010 (UTC)

I don't feel the first point is correct, and the second one isn't a problem per David. Verbal chat 19:28, 29 January 2010 (UTC)

(e/c) If you want to remove EBM from the lead entirely, I'd be ok with that - my main point was that it was over-represented. we can discuss that in more detail as needed. I wasn't saying that 'invoking a standard of empirical testing is invoking EBM', but I get the sense that a couple of editors here are making that association, which strikes me (and you, apparently) as incorrect.

I think we need something a little more nuanced than has not been systematically evaluated for safety and effectiveness, since the extent to which practices have been tested for either varies significantly across practices. Acupuncture and chiropractic have undergone certain kinds of testing, traditional chinese medicine less so (though it has a tremendously long history of non-scientific testing), Reiki is neither tested nor testable... however, my real point (again) is not an objection to the qualification, but an objection to the fact that the qualification leads the article. the fact that it has not been systematically evaluated according to the principles of scientific medicine is not a defining characteristic of AM, except to the extent that (as I said above) AM is not derived from the conventional assumptions of western scientific medicine.

@ verbal: feelings are not valid arguments on wikipedia, generally speaking. do you have something more substantive? --Ludwigs2 19:40, 29 January 2010 (UTC)

When you've backed up any of your points with respectable references, then I will spend more time evaluating them. For now, I see nothing substantive - just your decidedly fringe opinion that you "feel" this page is POV. Verbal chat 21:53, 29 January 2010 (UTC)

that's too bad. I'm entitled to add a dispute tag, and you're obliged to discuss it meaningfully before removing it, even if you think it's crap. --Ludwigs2 22:44, 29 January 2010 (UTC)

Most of the trouble with having complementary therapies tested and having studies done is that for any academic or physician to actually begin testing any CAM, they would be committing career suicide or at least be seen as a kook. However, most complementary therapists don't have the academic background to design and set up a proper study. Then there is the funding problem. Designing and carrying out a decent study is fairly expensive. It would have to be funded by a large enough, wealthy enough organization. There aren't too many of these organizations around in the complementary therapies community. The American Chiropractic Association is likely the only one to do this easily, but personally I have not been impressed by the studies I have seen commissioned by the ACA. Look at the poorly designed (probably rigged) study on chiropractic vs. the McKenzie Technique. The McKenzie Technique by the way, is a physiotherapy technique for lumbar disk damage. The study is readily online and found with google. We have to ensure that whoever funds the studies is if not unbiased, then of integrity.

It is likely that if different complementary therapies were tested in an unbiased way some would fail, but others would show demonstrable benefits for the public. I can't speak for everyone in the complementary therapy community, but I would welcome the opportunity to have these things put to the test and have the chips fall where they may as long as the studies are fairly and properly set up. Likely some prefer that their livelihood not be put under a microscope, but many of us have confidence in our particular therapies--otherwise we wouldn't have gotten into the business.

I've looked into a number of complementary therapies and have found that they are a mixed bag. Some I believe are not effective, while others are preferable to what might be suggested by mainstream medicine. And still others do have some benefits, but the benefits are hyped and exaggerated by their supporters. However, separating the wheat from the chaff would be a positive contribution for the public.

Incidentally, it seem likely that a study of reiki could be done in a scientific way. I can't see how they couldn't test the rate of healing on --say--burns or wounds of a measurable size. It could easily be done on animals for instance. Then we could create lesions of uniform size and depth, then divide it up into test group, control group, and a group of test animals which might have a pseudo-reiki treatment to take into consideration any other factors. I doubt that rabbits experience a placebo effect, but reiki treatments and being handled by people may have some effects due to reduction of stress or relaxation. So saying that these things are untestable seems unlikely —Preceding unsigned comment added by Nacken (talk • contribs) 05:53, 2 February 2010 (UTC)

~~Nacken~~ —Preceding unsigned comment added by Nacken (talk • contribs) 05:42, 2 February 2010 (UTC)

I agree with your sentiments in many ways. Not all alternative therapists are quacks, and the honest therapists would welcome good research on their methods. Everyone would benefit if the "truth" could be ascertained.

There are (at least) two factors influencing research: (1) the commercial interests of pharmaceutial companies and (2) the desire of proponenets for scientific legitimization. There are far more factors, but those two factors are already quite visible.

Pharmaceutical companies aren't blind or ignorant regarding alternative methods. They employ people who do nothing but search for substances and methods that might be turned into a profitable new drug or method. If there is a claim for anything, even in the remotest jungle region, and of course every claim on the internet, they HAVE already checked it out if there is the remotest chance of it really working. Don't underestimate their ability to turn literally anything into a patentable product.
The other factor is the NCCAM. They are a pro-alternative organisation with alternative therapists serving on the guiding committees. They have a huge interest in researching all kinds of known alternative methods, including spiritual ones, and they have the money to do it. They have actually been doing that for a long time now, and the results have been published. The results have been dismally disappointing to them as advocates, and of course to therapists. The article describes those results at the end of this section.

So what can honest therapists do who find their methods have actually been disproven? They can either find something else to do, or modify their method of working and the claims they make. -- Brangifer (talk) 06:21, 2 February 2010 (UTC)

Protected

I have currently protected the article, no doubt at the wrong version. As you all most likely know, this is an article under arbcom probation and the standard expected of editors here do not include multiple editors doing very few article edits but reverting each other for nearly a week. As soon as it was clear that there was opposition to a content change, editing should stop (no-one has edited the article in the last hours, but I felt it best to formally freeze it). In a relatively delicate article such as this, excessively reverting or not working towards achieving consensus is grounds of sanctions and/or editing restrictions.

I would welcome more comments at the above arbitration enforcement request Wikipedia:Arbitration/Requests/Enforcement#Verbal regarding the conduct of the parties involved. henrik•talk 23:19, 30 January 2010 (UTC)

the terms Alternative Medicine vs. Complementary Medicine

Having worked in the field for about 20 years, what I've noticed is that we talk about complementary medicine rather than alternative medicine. The term alternative medicine is used by people who are unfriendly to these forms of therapy. It is a pejorative term. We normally don't think of these therapies as an either/or proposition. We think of what we do as being supplemental or complementary to what mainstream medicine does. Certainly we are not going to tell you to ignore your doctor.

~~Nacken~~ —Preceding unsigned comment added by Nacken (talk • contribs) 05:06, 2 February 2010 (UTC)

This is especially true in England, where it is customary to use the terms complementary and CAM, unlike in the USA. Alternative medicine is the oldest term, while CAM is a newer marketing terminology designed to make alternative methods sound more useful and more, well, "complementary" to mainstream medicine than they necessarily are. It's true that some are, but some that are called CAM are still just as ludicrous as before they were called CAM. They are just using the marketing terminology. It's not a black and white issue and there's lots of history behind this. Keep in mind that more money is paid out for alternative medicine than for mainstream medicine. It's a huge industry with very large profits because manufacturers of alternative products and supplements do very little, if any, research. The biggest money is of course in the homeopathic industry, where bottled water is sold for a fortune. The 20 million dollar duck is a good example. It's described here:

Oscillococcinum, a 200C product "for the relief of colds and flu-like symptoms," involves "dilutions" that are even more far-fetched. Its "active ingredient" is prepared by incubating small amounts of a freshly killed duck's liver and heart for 40 days. The resultant solution is then filtered, freeze-dried, rehydrated, repeatedly diluted, and impregnated into sugar granules. If a single molecule of the duck's heart or liver were to survive the dilution, its concentration would be 1 in 100200. This huge number, which has 400 zeroes, is vastly greater than the estimated number of molecules in the universe (about one googol, which is a 1 followed by 100 zeroes). In its February 17, 1997, issue, U.S. News & World Report noted that only one duck per year is needed to manufacture the product, which had total sales of $20 million in 1996. The magazine dubbed that unlucky bird "the $20-million duck."

That's where the really big money is. There is probably no other product with such a huge profit margin when one looks at profit in relation to investment in research. -- Brangifer (talk) 06:33, 2 February 2010 (UTC)

small potatoes. Try looking at the orphan drug Glivec - almost 4 billion in sales [1], and that is with India giving Novartis a hard time. Diovan isn't doing badly either: a little over 6 billion. stmrlbs|talk 02:40, 3 February 2010 (UTC)

Not only was that in 1996, but I'm referring to profit in relation to investment in research. With homeopathy, there's basically no research performed by producers, just profit. How much does one duck cost in relation to the total sales? Not a bad deal! Water is cheap. -- Brangifer (talk) 07:37, 3 February 2010 (UTC)

Unfortunately, that's a specious argument. General practitioners don't do any research either (not to mention your garden variety cosmetic surgeon) and they make way more than your average alternative medicine provider. --Ludwigs2 08:03, 3 February 2010 (UTC)

Don't change the subject. Nobody was talking about them. -- Brangifer (talk) 15:35, 3 February 2010 (UTC)

you talk about how alt med people make higher profit margins than drug companies, when in fact alt med people should not be compared to drug companied, but rather to GPs. that's what the vast majority of altmed people do - they apply medical techniques they learned somewhere ostensibly to help people get better, just like GPs. what issue do you have with that? --Ludwigs2 18:42, February 3, 2010 (UTC)

I have no problem with that, it just wasn't what I was talking about. I wasn't talking about "alt med people". I was talking about the manufacturers of homeopathic remedies. I have also tweaked something I wrote to make it clear that I'm not talking about total profits, but about the ratio of profits to investment in research. There is no comparison between manufacturers of homeopathic agents and regular pharmaceuticals. There is no doubt that many pharmaceuticals bring in more money, but homeopathic production is done in the absence of any meaningful research investment, only lots of marketing investment. -- Brangifer (talk) 06:41, 4 February 2010 (UTC)

ah, ok, I misread. my apologies, and I'll retract the comment. --Ludwigs2 02:47, 5 February 2010 (UTC)

Apology accepted. An understandable mistake. Welcome to the club of imperfect human beings. I'm a charter member ;-) -- Brangifer (talk) 03:13, 5 February 2010 (UTC)

BullRangifer, we are talking about billions for ONE company for ONE product. And Novartis has several products in the billions in sales. As far as research, the public sector was very much involved in the development of Glivec along with Novartis [2] Marcia Angell - who you quoted previously in talking about a definition of alternative medicine - wrote about the development of Glivec and other drugs here [3](do a find on Novartis). It costs around $3000 per month [4] . There is a reason that Novartis invested heavily in fighting India to get their patent extended. There are billions involved. You need to look at both sides of the fence when you talk about who makes the highest profits. stmrlbs|talk 03:40, 4 February 2010 (UTC)

Note my comment above. ~~BTW, your long harangues against mainstream medicine and pharmaceuticals are rather off topic here. There are articles here where they would fit in better.~~ -- Brangifer (talk) 06:41, 4 February 2010 (UTC)

which comment are you talking about? the long harangue about 20 million dollar duck (with a full paragraph quote from quackwatch) that had nothing to do with the difference between CAM and Alternative medicine?. BullRangifer, if you choose to state opinions like "That's where the really big money is. There is probably no other product with such a huge profit margin" (your original statement), don't act offended when someone counters with information that disagrees with your opinion. stmrlbs|talk 01:55, 5 February 2010 (UTC)

Stmrlbs, I owe you a BIG apology! I just went back over this page and discovered that your comments were actually related to the discussion about off-label use, and that they were thus on-topic. I'm very sorry and will strike my comment. BTW, what you wrote doesn't disagree with my opinion since I agree that there's lots of money made by pharmaceutical manufacturers and that they charge too much whenever they are allowed to do so. My point was that they have to reinvest lots of their profits in research. -- Brangifer (talk) 02:27, 5 February 2010 (UTC)

Name change to Complementary and Alternative Medicine

The most obvious reason: Read the references - they are for the most part not related to alternative med, but to the more recent term CAM. That is what this article is about, both approaches, and the title of the article needs to reflect and address that. As Vitaminman has documented, CAM has become more mainstream - not alternative med, but both A and C med. If someone has a good argument for not changing the article, please post it here. If not, I suggest we change the name to reflect a more recent viewpoint of altmed. Gandydancer (talk) 03:51, 3 February 2010 (UTC)

Been there, done that. It's a done deal and we're not going back over that nightmare again unless you can present more compelliing arguments than were used before, and you're not even close to getting there. You will have to study the archives very thoroughly and come back with something new. That will take many days. Until then, no go. -- Brangifer (talk) 07:40, 3 February 2010 (UTC)

geez, do you ever assume good faith?

--Ludwigs2 08:03, 3 February 2010 (UTC)

This has nothing to do with good faith. This has to do with requesting better arguments than recycled ones we've heard before. Gandydancer is a newbie who needs to know that we've been there before. They need to do more research. That's all. You are the one exercising bad faith. Your combative attitude reveals that you need to be topic banned from these topics. -- Brangifer (talk) 15:39, 3 February 2010 (UTC)

BTW, I still haven't gotten any promise from you that you won't repeat your violations of BRD. I want an assurance from you that you realize that it's wrong to discuss and repeatedly edit in a controversial manner at the same time. The BRD cycle doesn't have a repeat button at the end. Discuss means ONLY discuss, not edit at the same time. Will you promise not to do that again? Have you understood? -- Brangifer (talk) 15:44, 3 February 2010 (UTC)

see that's what I mean: if you actually assumed good faith, you wouldn't need any promises of that nature.

with respect to the other point... the fact that you believe an argument is an old recycled one doesn't mean (1) that it actually is (memory is tricky), and (2) doesn't mean that you get to claim some high ground. if you think that the argument was made before, go and find it and represent it - it's not our responsibility to do your work for you. I personally don't care what arguments were made before - if they are good they can get made again, if they are bad they are best forgotten. Gandydancer does not need to go find the point that refutes his argument - you need to do that, and if you're not willing to, then you don't have a leg to stand on in the discussion. If there's something that gets asked frequently enough that this is a bother for you, that something ought to be in the FAQ for your convenience, but you have no one to blame except yourself if it isn't. --Ludwigs2 18:37, 3 February 2010 (UTC)

I'm asking you, as a gesture of good faith on your part, to show some evidence in words that you have understood what went wrong in that edit war. I haven't seen any evidence anywhere that you realize what you did wrong. You even demanded on my talk page that I follow BRD, and yet you weren't doing it yourself. Do you see the problem? I would like to regain my faith in you, but I need you to give me a reason why I should do so. That would really help. -- Brangifer (talk) 06:46, 4 February 2010 (UTC)

(outdent) The FAQ idea is a good one, for avoiding continual re-hashings of long-talked-over points. There's an example at the top of the talkpage for homeopathy that should adapt pretty neatly to this one. DavidOaks (talk) 19:43, 3 February 2010 (UTC)

Setting aside the issue of Brangifer's lack of good faith, I agree with him that we've been there and done that. In the absence of some new and compelling arguments in support of the name change, the existing name should stay. Vitaminman (talk) 06:59, 4 February 2010 (UTC)

Look, I'm not in favor of the change myself, but frankly I think it's officious and supercilious to tell someone that you've discussed the issue before and aren't interested in further discussion. that 'this has already been decided' thing absolutely reeks of page ownership. Now I doubt that's your intent, but that is the way it comes off. If someone raises an idea, and you are opposed to it, it is your responsibility to present the arguments again, on the off chance that the consensus might change. that's the way it works, sorry. --Ludwigs2 08:51, 4 February 2010 (UTC)

It is also a fail WP:CCC. - "Consensus is not immutable. Past decisions are open to challenge and are not binding, and one must realize that such changes are often reasonable." Just because it has been decided previously NOT to change the name of the article, that doesn't mean that that decision cannot be challenged. With different editors, a different consensus may emerge. DigitalC (talk) 04:25, 9 February 2010 (UTC)

That's very true, but we both know that it will be the same editors, more or less, who will meet up. It will just end up in another long battle. Things have been quiet and we've been able to concentrate on more constructive things. I just haven't heard anything that even comes close to a good reason to change. Changing, just because change isn't forbidden, isn't very compelling. The content would essentially be the same. If there are aspects that are missing or need changing, then why not concentrate on doing that? We'd need some concrete proposals, but change for the sake of improvement is definitely welcome. "Improvement cannot occur without change, but there can be a lot of change without improvement." -- Brangifer (talk) 05:40, 9 February 2010 (UTC)

Continued from above...

I don't see why we have to rewrite the book - we have several good definitions already. This one for example:

"Complementary and Alternative Medicine (CAM) is a broad domain of resources that encompasses health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period. CAM includes such resources perceived by their users as associated with positive health outcomes. Boundaries within CAM and between the CAM domain and the domain of the dominant system are not always sharp or fixed."[16]

Also, I feel we need to change the name of the article to Complementary and Alternative Medicine.Gandydancer (talk) 03:37, 31 January 2010 (UTC)

that definition (while hellishly wordy) does work for me. with respect to renaming the article CAM, well... I was the one who merged the article into its (more or less) current incarnation, a couple of years ago. There was a big debate over whether it should be called CAM or Alternative Medicine, and we decided to stick with Alt Med because we felt that CAM was still kind of an underused neologism. I still think Alt Med is more recognizable to people, though we could reopen the discussion and see if sources have changed their views on it. --Ludwigs2 04:54, 31 January 2010 (UTC)

As long as we continue to define CAM in the lead, as we currently do, there is no need to rename the article. -- Brangifer (talk) 06:41, 31 January 2010 (UTC)

Sure, this latest proposed definition works as the proponent's, which is essential, and while it's verbose, it covers that part of the territory. It does include acknowledgement of the squishiness of the term, but it does not include recognition of the controversiality of CAM. That has to be in the first paragraph, like "mythical" "reputed" "supposed" "speculated" and "debated" have to be in the first paragraph of Loch Ness Monster (actually, not all of them; I'm gonna rewrite that puppy). DavidOaks (talk) 15:45, 31 January 2010 (UTC)

Actually, that's not true; this is a perfectly valid, neutral description. David, you seem to believe that any description of alt med that doesn't include disparagement is a form of advocacy, which is pure unadulterated bias. Obviously we need to include you POV (because it's a noteworthy POV), but it cannot dominate the article. I will point you to Wikipedia:Fringe_theories#Evaluating_claims, particularly this line: "This is particularly true within articles dedicated specifically to fringe ideas: Such articles should first describe the idea clearly and objectively, then refer the reader to more accepted ideas, and avoid excessive use of point-counterpoint style refutations." This is what I'm aiming for. no idea is ever defined in terms of its failings. --Ludwigs2 16:36, 31 January 2010 (UTC)

You say "not true;" you might more accurately phrase it "I disagree." I see it as valid, yes, but not neutral and not complete. You are correct, any def of altmed that does not note why it's alt rather than med is incomplete with bias against revealing why it is not universally admired. That POV cannot dominate the article -- never said it should. But it has to be core to the def. You nd I have made outselves clear; let's let the consensus process go forward now. BTW -- are you affirming altmed as WP:fringe? DavidOaks (talk) 16:40, 31 January 2010 (UTC)

A statement which defines alt med as different than conventional medicine is neutral; a statement that implies it's less than conventional medicine is biased. the second is not allowable. can you preovide a statement you like that does the first? If not, then we'll have to go Gandy's, as the most neutral statement available. --Ludwigs2 18:09, 31 January 2010 (UTC)

(outdent) Disagree. A statement that defines altmed as different from med is accurate but incomplete. It needs to be paired with a statement that explains in what way it differs. We absolutely need more than one statement, more than one quote, because there is more than one aspect to be accounted for, and the definition itself is a field of semantic contention. We are now disagreed on what constitutes neutral def and what constitutes bias. I would say leaving out any mention of controversy on a subject which is not definable outside of controversy is biased in favor of proponents. Imagine trying to define tea bagger protests while working under a rule that you're not allowed to say they disagree with anything, or anybody disagrees with them. Let there be two WP:RS quotes in the 1st par.DavidOaks (talk) 18:31, 31 January 2010 (UTC)

I understand Ludwigs2's concern, but also agree with David that some mention needs to occur in the first paragraph. I'm glad to see that discussion is moving forward.

To move forward, I suggest that actual proposals be presented here, discussed, and then tweaked into an acceptable format. Please don't try for major changes across multiple paragraphs. Small changes may be enough. -- Brangifer (talk) 19:53, 31 January 2010 (UTC)

To me i dont see anything wrong with the introduction how it stands except the statement "it is often opposed to evidence based medicine and encompasses therapies with a historical or cultural, rather than a scientific, basis." The statement "Evidence based Medicine" could be changed to Standard Medicine,Conventional Medicine or something better anyone can think of along these lines but not Traditional Medicine as it then might bring confusion with the field of Traditional Chinese medicine. The reason why i feel this wording change is necessary is because sometimes Conventional Medicine is also not Evidence based and also some things that fall under the "umbrella" of Alternative Medicine can sometimes be evidence based eg:some herbal medicine and some TCM herbal medicines. Also it is not always the case that the modalities go off a historical or cultural rather than a scientific basis. I find none of the proposed quotes above satisfactory,eg:Angell,Carroll,Happle,Novella as all of their statements would then render this article not NPOV but i do find the quote by Davis satisfactory and NPOV as it simply objectively states a fact ""that which has not been shown consistently to be effective" and doesnt have bias,POV or opinion. I suggest to leave the Davis quote in or if people have issue with it being from a folklorist then to find the similar statement but from someone in medicine. Also, if people want the mention of the criticism of Alternative Medicine added in the introduction then perhaps this below passage could be edited out and placed in the below main body section "It is frequently grouped with complementary medicine, which generally refers to the same interventions when used in conjunction with mainstream techniques,[4][5][6] under the umbrella term complementary and alternative medicine, or CAM. Some significant researchers in alternative medicine oppose this grouping, preferring to emphasize differences of approach, but nevertheless use the term CAM, which has become standard.[7][8]"

and in its place put something along the lines of "There is scepticism or non acceptance of Alternative Medicines from some practitioners or organisations in Conventional Medicine due to the belief that sometimes "The claims that CAM treatment providers make about their benefits can sound promising. However, researchers do not know how safe many CAM treatments are or how well they work. Studies are underway to determine the safety and usefulness of many CAM practices."

(quote from Meddlineplus) http://www.nlm.nih.gov/medlineplus/complementaryandalternativemedicine.html

Links to support my suggested changes

Some Non evidence based in Conventional Medicine

http://pediatrics.aappublications.org/cgi/content/full/121/5/1070-a

http://content.nejm.org/cgi/content/abstract/358/3/252

http://ebmh.bmj.com/content/12/3/65.full

Some Evidence Based in Alternative Medicine

http://www.cochrane.org/reviews/en/ab000145.html

http://www.cochrane.org/reviews/en/ab006206.html

http://www.cochrane.org/reviews/en/ab003230.html

Some scientific basis and not cultural or historical in Alternative Medicine

http://www.phytomedicinejournal.com/search/quick?restrictName.phymed=phymed&search_area=journal&search_text1=Bronchitis

http://www.mskcc.org/mskcc/html/58481.cfm#C

http://www.cmjournal.org/

http://rmit.com.au/browse;ID=fp46zcaom6cb Severina123 (talk) 16:02, 19 February 2010 (UTC)

Can we edit and organise this article

Can we edit and condense this nauseating long article? I propose that we put this phrase below into the Definitions and catagories section and keep the section purely for discussion of that.

"It is frequently grouped with complementary medicine, which generally refers to the same interventions when used in conjunction with mainstream techniques,[4][5][6] under the umbrella term complementary and alternative medicine, or CAM. Some significant researchers in alternative medicine oppose this grouping, preferring to emphasize differences of approach, but nevertheless use the term CAM, which has become standard.[7][8]"

Can we give rid of the comedian and possibly add the below phrase in another section?

"The Washington Post reports that a growing number of traditionally trained physicians practice integrative medicine, which it defines as "conventional medical care that incorporates strategies such as acupuncture, reiki and herbal remedies"

It not easy with this article because really,it seems to me that all the branches of treatments under the umbrella of Alternative medicine should have individual wikipedia pages and perhaps the Alternative Medicine Wikipedia page should just give a brief outline because not all the information is going to be relevant to each modality and each modality should be dealt with on an individual basis. nevertheless,the article is here,so i propose could we get rid of the "Relation to evidence-based medicine" title and change then to two titles along the lines of "arguments and proponents for alternative medicine" and "arguments and proponents against alternative medicine" and condense this but have it cover all the information eg:who says why alternative medicines should be used and why,who is skeptical regarding it and why etc. The whole "Relation to evidence-based medicine" section is a bit longwinded. Its also not an easy read due to being unorganised.

Can we remove the "NCCAM classifications" section?Is it really necesssary as it just makes a too long article even longer.Could the classifications eg:chiro,osteo,biofield,ayurveda and so on be somehow added at the introductory part of the article and have it so if a person clicks over it they can be brought to the Wikipedia article on that subject. Alternatively could "naturopathy, chiropractic, herbalism" and so on be edited out of the introductory and it all be put in "NCCAM classifications" section but with just the title words and not things like "Whole medical systems cut across more...." etc-it just makes the article too longwinded.

The section "Contemporary use of alternative medicine" is also too unorganised and overwhelming. Perhaps that section could be changed to something along the lines of Use among medical practitioners and uses across different countries,plus statistics?

The section "Public use in the US" could be turned into a whole another Wikipedia article perhaps about the statistical analysis of Alternative Medicine use in USA.

This statement would better fit in the Arguments and Proponents against Alternative Medicine "Some skeptics of alternative practices say that a person may attribute symptomatic relief to an otherwise ineffective therapy due to the placebo effect, the natural recovery from or the cyclical nature of an illness (the regression fallacy), or the possibility that the person never originally had a true illness.[99]"

Same for this To ABC Online, MacLennan also gives another possible mechanism: "And lastly there's the cynicism and disappointment and depression that some patients get from going on from one alternative medicine to the next, and they find after three months the placebo effect wears off, and they're disappointed and they move on to the next one, and they're disappointed and disillusioned, and that can create depression and make the eventual treatment of the patient with anything effective difficult, because you may not get compliance, because they've seen the failure so often in the past".[103]

I propose removing this below phrase as it isnt factual."whereas alternative treatments generally are not subjected to such testing at all"

Many Herbal medicine which is under the umbrella of Alternative Medicine is tested and studied.

This whole section below is not NPOV "Treatment delay Those who have experienced or perceived success with one alternative therapy for a minor ailment may be convinced of its efficacy and persuaded to extrapolate that success to some other alternative therapy for a more serious, possibly life-threatening illness.[105] For this reason, critics argue that therapies that rely on the placebo effect to define success are very dangerous. According to mental health journalist Scott Lilienfeld in 2002, "unvalidated or scientifically unsupported mental health practices can lead individuals to forgo effective treatments" and refers to this as "opportunity cost." Individuals who spend large amounts of time and money on ineffective treatments may be left with precious little of either, and may forfeit the opportunity to obtain treatments that could be more helpful. In short, even innocuous treatments can indirectly produce negative outcomes.[106]"

The whole below section is weird where it says "well the Dutch government...." is that a typo?Its not professional looking and sloppy to start a sentence with "well the...." Also why is only Dutch mentioned and not funding in USA or Australia or other countries?

Research funding "Well the Dutch government funding CAM research between 1986 and 2003 it formally ended funding in 2006."

This is all not NPOV below

"One of the most critical is the placebo effect, which is a well-established observation in medicine.[113] Related to it are similar psychological effects such as the will to believe,[110] cognitive biases that help maintain self-esteem and promote harmonious social functioning,[110] and the post hoc, ergo propter hoc fallacy"

Severina123 (talk) 17:01, 19 February 2010 (UTC)

Severina123, as a newbie I'm sure you mean well, but your comments reveal that you haven't a clue as to how Wikipedia articles are built up, or why they are built the way they are. They are constructed according to certain rules and policies which are applied by those who edit the article and create it. The way an article looks often reflects its history, including long and heated discussions, disruptions that have resulted in editors being blocked and banned from Wikipedia, compromises, wordings that exist because of prior agreements as a condition for merging other articles into this one ("Complementary medicine" and "Complementary and alternative medicine"), and many other factors which you can't know about. Instead of making a long list of changes you'd like to make, how about finding something that you think violates policy? That way you'd be making suggestions based on policy. Other types of suggestions based on personal preference don't usually get any traction because our arguments have no weight if they aren't based on policy. Read the policies that are linked at the top of your talk page. -- Brangifer (talk) 07:15, 20 February 2010 (UTC)

That sounded a bit rude Brangifer.i dont know why you decided to be abrupt to me. I was only trying to help and suggested those changes not to try to take anything away from the article-history etc,but just to try to make it more reader friendly and organised.Some readers might be overwhelmed by articles that arn't written clearly and are unorganised.I thought condensing it and making clearer specific titles would make the article an easier read.I was hoping that this would be done in a way that nothing from the article was lost but that it also wasnt repeating and longwinded as it is in some places. Sometimes if i come across an article on the internet that repeats things or that is unorganised and jumping from one place to another instead of things that go together fitting neatly into one section i will feel overwhelmed and will look for another article on the subject that is written more eloquently and i thought some other readers might feel the same. Apart from what i have written above on the other titles (eg:Davis quote title) and maybe two paragraphs or so regarding NPOV issues,i dont really have any issues with the article at all,my objective was simply to make the article more streamlined and organised. Does every suggestion need to be about policy violations?Cant some suggestions just be about other things like aesthetics? If my suggestions regarding organising it wasnt agreed with by the majority,that was ok,it was just a suggestion i was putting out there. I didnt think that they were any major or controversial changes that anyone would have much opposition to,they were mainly just aesthetic and organisational change suggestions,although i understand that if much discussion,compromise,arguments etc have occured which has made made this article what it is now,that due to this, large changes might not be welcome even if they are only organisation/layout style changes.

I am not sure if i have used the Edit Summary box correctly now.Hopefully i did:) Severina123 (talk) 13:14, 20 February 2010 (UTC)

Dear Severina. I am truly sorry that I offended you. That wasn't my intention. I am often too direct. Actually your concerns aren't over the top. Articles can easily evolve, because of their histories, into a collection of sourced snippets that, seen by new readers, are a confusing jumble. If that's what you are experiencing, I'm not surprised. I suggest that you try suggesting one thing at a time. What you wrote contained so many concerns and suggestions that I was overwhelmed, a concern that has been mentioned on your talk page. You are seeing this with new eyes and thus see things that the rest of us don't notice, so I'm interested in hearing your suggestions. Just take it slower. BTW, you used the edit summary quite nicely! -- Brangifer (talk) 17:01, 20 February 2010 (UTC)

This article is both nauseatingly long and appallingly badly written. Sadly, however, speaking from recent experience, I have little faith that its self-appointed owners will see fit to allow very much in the way of significant changes to it. Still, one can live in hope... Vitaminman (talk) 13:30, 22 February 2010 (UTC)

No one owns this article. Instead of making a vague and imprecise complaint, which no one can really address, how about being specific and suggesting something constructive? I made such a suggestion above. -- Brangifer (talk) 15:33, 22 February 2010 (UTC)

Well I have done exactly that, and as I have said already, all hell broke loose. And the article still opens with a quote from a non-medical person, a folklorist!, with "or "that which has not been shown consistently to be effective."[2] And as I said a long, long time ago, if that were the case you'd have to throw antidepressants (and plenty of others) into that catagory. I agree with Vitaminman, good luck to anyone that wants to try to make this article more accurate, but I'm not going to waste anymore time on it. Perhaps that will eventually be deleted, but how many people can spend endless hours and days on a project that should have obviously been corrected in short order? Gandydancer (talk) 15:45, 22 February 2010 (UTC)

OK, GD, that argument has been raised repeatedly, and it seems to be purposed towards disallowing the proposition that alternative medicine is readily distinguished from scientific by canons of testing. In response to the last raising of this hairspliitter, by Strmlbs, I offered responsible professional medical opinion to the contrary. Please do not raise the issue again until you find responsible professional medical opinion in support of your view, at which point we can incorporate both documented views into the article (it'll be tricky and clunky, but it's the appropriate wikiprocedure). Repeating, to spare you the trouble of searching: "It is important to recognize that off-label use of medication is not the same as non-evidence-based used of medications."[5]; "In a 1993 article on alternative AIDS therapies, Carola Burroughs defines "alternative" as a "catch-all phrase" used for "various treatments which simply have not been accepted by the medical establishment."2 Terms like unconventional or unorthodox make a political distinction. Distinctions like modern medicine, versus traditional or folk medicine denote cultural variations and imply a superior level of advancement. Unproven is another often-used distinction. However, there are standard medical treatments used today that have gained their acceptance through history of use, rather than formal clinical testing. Drugs tested and approved for one use can be prescribed off-label for a new use when preliminary outcomes look hopeful and the physician feels the situation warrants the risk. Although not yet thoroughly tested and proven for that use, off-label uses are common in clinical practice." [6]

Yeah, Gandy... perhaps you and I and severina should simply begin editing the article and see what happens. as long as the three of us maintain proper communication in talk, we should be able to circumvent any non-communicative reverts. shall we plan out the first move? give me a bit, and I'll make a new section with some proposals. --Ludwigs2 16:09, 22 February 2010 (UTC)

No. Brangifer will not admit it, but he does own this article. I have learned the hard way that every wiki guideline meant to keep wiki honest and fair can be used to keep an article dishonest and biased if one person is an experienced editor who is determined to have his way. If every twisted quideline fails they will just doggedly refuse to accept change and drag the discussion on till other editors give up, as Brangifer has done. Here is my original post regarding this change which resulted in endless discussion, but to date, no change:

Here is what I removed: ...or "that which has not been shown consistently to be effective."[2], and it is from the opening sentence of the article, and it is a quote of an MD that nobody's ever heard of from a book that nobody's ever heard of either. When I said he is not noteworthy, I am NOT using my own definition, I am using the Wikipedia definition. Compare that statement to the balanced Cochrane definition. Are we, in the opening sentence of this article, going to use the statement of an unheard of person/book or a Cochrane review? If Brangifer can find a guideline that suggests this, I'd like to see it. Not that you'd need to check the guidelines as it's only common sense. Furthermore, as I said, to suggest that the definition "everything that has not been shown to be consistently effective" would have to include medications used in mainstream medicine as well. For instance recent studies have shown that antidepressants are effective for severe depression but not effective for mild depression--interestingly, it has been found that St. John's wort HAS been found to be effective for mild depression, but not severe depression. I am tempted to get into a discussion about accusations of vandalism and the suggestion made so frequently that editors to this article are creating editing wars, but I will not further stir the pot for now. Gandydancer (talk) 12:09, 26 January 2010 (UTC)

Gandydancer, notability is not a requirement for inclusion of references, only for the creation of articles. The subject of an article must be notable, but the content can be from V & RS, including unnotable ones. There are numerous definitions of alternative medicine, some of them conflicting, and we are including some of them from various sides of the debate. That's what NPOV requires. If this article were to make it seem like there are clearcut definitions and that there are only two sides to the debate, it would be misleading, because that's not the way it really is in the real world. -- Brangifer (talk) 14:53, 26 January 2010 (UTC)

The only thing different today is that I learned, through discussion, that Davis is not even a medical doctor, but (if I remember correctly) a doctor of philosophy! And he hasn't even written a book, but that the quote is from a web page about folk medicine from some state! This experience has certainly opened my eyes to a few things about wikipedia and why so many editors lose interest in attempting to edit. I certainly will not be wasteing any more time on this article. Even if Dr. Davis' quote were deleted today, who has that sort of time and energy to waste on getting a change that should have been so obvious? Gandydancer (talk) 13:23, 23 February 2010 (UTC)

Ludwig and Gandydancer (addressing you together, since in the last few posts you have made common cause) this is really unhelpful. It’s unhelpful when a new editor shows up and wants to launch into a wide-ranging series of changes on just the points that are in dispute for you (Ludwig) to say “yes, let’s do that, and see what happens.” And then for you (GD) to accuse BullRangifer of ownership – s/he didn’t lock the article, an admin did, because of edit warring, in which you (both) were active participants. BR has put numerous concrete and specific suggestions forward, to which you (two) have not responded. Instead, you (GD) continue to harp on a settled point – there has been consensus for a long time that a folklorist’s view, while of significance for folklore-connected subjects, is not as strong as that of a medical person for the specific case of altmed, but you have steadily declined the opportunity to discuss the numerous options that have been put forward. Instead, you just keep saying that “nobody has ever heard of” the folklorist. Since the one who keeps whipping this dead horse, let’s get it settled. Please PROVE, using WP:RS, that nobody ever heard of this person (those are the exact words you have used, repeatedly). Simply demonstrate that nobody has ever heard of this person, that this person has never published a book. Now demonstrate that everybody has heard of Cochrane group (I most sincerely have not, but I’m willing to be the outlier). Prediction – you’re not going to be able to. So stop, OK? And try instead saying responsible and demonstrable things like “I have never heard of this person,” and/or “I do not ” Wouldn’t that be much better, much easier to defend, much more likely to move us forward? Please too re-think your false dichotomies (you seem to have the idea that only one source is permitted, though the point has been made (repeatedly) that the complex subject requires more than one quote. OK, if you’re aware of a policy that dictates for cases of dispute, a single quote and POV must be represented, bring it forward. Otherwise, pitch in and help identify the alternatives. And if you cannot do these things, then stop this unproductive complaining about matters already long settled and please turn your energies to some productive discussion and editing. It is unhelpful when you say that we need to have all old conversations all over again and you have no obligation to look at archived discussions. DavidOaks (talk) 15:40, 23 February 2010 (UTC)

David: because this is a contentious page, I have decided it's best to stick close to policy on matters of talk-page content. Therefore, I have decided to studiously ignore and avoid the following types of comments, and suggest that all other editors do so as well:

arguments that focus on an editor's characteristics or qualifications (including length of editorship, previous bad behavior, ascriptions of group membership, and etc.)
assertions of consensus that are not specific to particular points of content and are not backed up with links to previous debates
comments of any sort that do not deal specifically with article content.

I don't see any other way to maintain civility on this talk page except strict adherence to those rules.

WIth those rules in mind, I'm having a hard time seeing what can be responded to in your previous post. something about Davis and Cochrane, perhaps, but I don't understand what 'people having heard of them' has to do with their use in this article. can you explain that, please? --Ludwigs2 16:44, 23 February 2010 (UTC)

There is really strong evidence in the padlock admins placed on this article that past behavior is very much an issue, and I took the liberty of pointing out serious defects in current behavior and communication likely to take us to exactly the same place, and soon. Your rules sound like good resolutions; by all means follow them if you think they will help you keep on track. Now, how about saying which of the many quotes BullRangifer put forward appeals to you, and why, or if none of them is acceptable, why not. DavidOaks (talk) 17:14, 23 February 2010 (UTC)

As I have said numerous times in the sections above, BR's quotes are (almost without exception) quotes from the perspective of skeptics that are designed to refute or denigrate Alternative Medicine as a whole. I object to these quotes on the grounds that (a) trying to make a clinical judgment about all AM practices as a group is absurd given the diversity of practices that are lumped under this umbrella, and (b) this is an article about AM, not an article against AM, so we should not begin the article with a fairly pointed effort to poison the well. good enough? --Ludwigs2 19:14, 23 February 2010 (UTC)

(outdent) The reason for that is because AM is a controversial topic. The reason for THAT is because it is only definable as that which has not (yet) gained acceptance by normative institutions. The reason for THAT has to do with the scientific method and the process of reasoning from evidence (with a sidebar to off-label use, please see above before recurring to that argument). Now, perhaps there is a definition of AM which does not include these things. Let's have it. But most definitions of AM have these things, and excluding them would be whitewashing so we must have them AS WELL AND IN THE LEAD. I think an MD would be rhetorically strongest, because some readers are too stupid to understand that the MDs are in effect talking about semantics and philosophy, subjects outside their realm of expertise, but there is such a thing as the labcoat-fetish. If your position is that the lead cannot tip readers to the fact that a lot of responsible people think that AM isn't medicine at all, we aren't going to get consensus, any more than we can get consensus on a lead for Bigfoot that raises the question of whether there is such a thing -- THE TOPIC IS NOT DEFINABLE WITHOUT REFERENCE TO CONTROVERSY. DavidOaks (talk) 19:43, 23 February 2010 (UTC)

David Oaks, please review the talk pages. If the article was locked because of an editing war, I was not even posting at that time, so could hardly have been involved in it. As for your insistance that I PROVE that nobody has ever heard of Dr. Davis, can you PROVE that anybody (obviously beyond the small circle of friends/family/students/and readers of some state's website),has? As for the Cochrane Collaboration, if you don't even know who they are perhaps you should do some research. Wikipedia clearly states that certain types of research are more notable than others. The Cochrane review studies studies and publishes the results. They are well-known to any person that has done much posting in medical articles, but I'd bet that not 99%, but 100% of wikipedia editors, other than the few involved in this idiocy on these talk pages, has never heard of Dr. Davis, and especially so since he's not even a medical doctor. And, as for your suggestion that I instead say, "I do not think a folklorist’s view is optimal for the lead", THAT IS EXACTLY WHAT I HAVE SAID OVER, AND OVER, AND OVER. Please read the discussion before you decide what I may have or may not have said! Gandydancer (talk) 17:39, 23 February 2010 (UTC)

(outdent) Gandydancer, I insist that you prove that no one has heard of Davis because 1) you have repeatedly made the claim (I certainly never claimed anyone HAD heard of him, although such a modest claim is readily proved with google and bibliography) and 2) you seem to be operating from the idea that “no one ever heard of him” is some sort of relevant standard. I am aware of no such wikipolicy, and am asking for you to bring it forward. You also seem to be under the impression 3) that we have to choose one and only one definition/quote/POV. By all means, bring that wikipolicy forward, or show me evidence that we came to consensus on the point. And if you are aware of consensus that a 4) folklorist has nothing of relevance to say on a topic closely connected to folk medicine, please show us that. Yes, you have asserted yourself. You have not said why anybody should agree. Perhaps it is self-evident to you, but that’s not how the process works. For myself, it seems to me that in fact we HAD reached consensus that this quote should be exchanged for one by an MD, primarily for rhetorical reasons having to do with easily scandalized readers. You’re the one who keeps raising the issue, when what you’ve been invited to do, repeatedly, is help choose a replacement. DavidOaks (talk) 18:10, 23 February 2010 (UTC)

How many times do we have to go over this??? Again, PLEASE READ MY POSTS BEFORE YOU DECIDE WHAT I HAVE SAID OR HAVE NOT SAID! I made a suggestion thousands of words ago. Please quit just making stuff up! Gandydancer (talk) 19:39, 23 February 2010 (UTC)

Gandydancer, relax and let it go. when David catches up with the conversation you can move on from there. this is a distraction: please keep your eye on the ball, and we can move things forward. --Ludwigs2 20:45, 23 February 2010 (UTC)

Reboot and proceed

Minchin quote in the lead [7]

One objection has been to the inclusion of Tim Minchin's quote. While a comedian's comment is perfectly appropriate as a documented opinion within a medical article, it really doesn't add anything that isn't already said by more authoritative sources in the article. It therefore seems superfluous.

Now, instead of deleting it, let's discuss my proposal to delete it. When we are agreed on what to do, then we can do it or not do it. I'm adding it here so we know exactly what we're talking about -- Brangifer (talk) 15:15, 28 January 2010 (UTC)

"Australian comedian Tim Minchin, in his nine minute beat poem "Storm", states that alternative medicine is medicine that "has either not been proved to work, or been proved not to work." He goes on to ask "You know what they call 'alternative medicine' that’s been proved to work? Medicine.”

My view is that it should stay, at the end of the lead par, as a succinct expression of the key question as to whether there is a an objectively identifiable body of things we can point to and say "CAM," or whether the term is mainly a rhetorical operator, a cluster of associations, connotations. DavidOaks (talk) 15:23, 28 January 2010 (UTC)

In light of recent deletion and cooperative if sarcastic resotration, I'm changing my stance and suggesting we remove him from the article altogether. I have not changed my view that the concept of altmed is a sociolinguistic problem rather than or at least as much a scientific one, and therefore a language-person has a v legitimate view, but we have the same idea expressed by people whose credentials don't present a stumbling block in this way. Keeping Minchin at this point seems to me wp:pointy. DavidOaks (talk) 14:30, 2 March 2010 (UTC)

Needless to say I'm disappointed that you cave in to non-policy-based excuses. This isn't a MEDRS matter, but an attempt to document the POV of skeptics. You would be justified if you at least substituted his quote for equal ones by better known skepics. That's not happening, and may be difficult to do, because he summarizes things very concisely. Instead of improving the situation, the whitewashing is allowed to happen. -- Brangifer (talk) 21:27, 2 March 2010 (UTC)

(comment added later for historical purposes.) The above quote was mistakenly used. It was from the body of the article, while the discusion was about quotes in the lead. -- Brangifer (talk) 06:09, 2 March 2010 (UTC)

May I suggest that you all take a look here for quotes by even more authoritative persons which make the same point?:

Alternative medicine critics

Brangifer (talk) 15:33, 28 January 2010 (UTC)

This quote is inaccurate and superfluous. I'm more than happy to see it go. leading off a serious encyclopedic article with a quote by a comedian is pointy at best; it smacks of an attempt to ridicule the subject matter. leading with any skeptical comment would produce an unnecessary POV - the lead should start of with a simple, neutral description of the subject matter, and prominent critical opinions should be saved at least until the subject itself is properly defined and lain out (I'd say third paragraph). --Ludwigs2 18:21, 28 January 2010 (UTC)

Thanks for finally giving a reason. I hope we can continue the streak. I can accept the argument for avoding the appearance of ridicule. Now, I do not accept the argument that the lead should not include expressions of skepticism, because in this case, the very concept is tendentious. Example: the lead for Fibromyalgia notes, as it must, that there are serious doubts among credentialled experts about whether there is such a thing. The issue here is more semantic, which is why what you want is a language person with some knowledge of medicine or a medical scientist with some cred in language analysis.DavidOaks (talk) 20:26, 28 January 2010 (UTC)

David - you're welcome, though I did make comments to this effect above. but never mind that. I do think that qualifying statements are necessary in the lead, but I don't think they should lead off the lead. your fibromyalgia page is a good example: the first paragraph is a simple, factual explanation of what fibromyalgia is, and critical commentary is saved for the second paragraph. I think in this case third paragraph might be better (since altmed is more diffuse than fibromyalgia and takes more explanation to get the sense of it), but I have no objection whatsoever to critical commentary appearing in the lead. frankly, I'd insist on it myself if it wasn't there. I just want to get an en clair description on the page first before we start poking it. --Ludwigs2 20:41, 28 January 2010 (UTC)

I agree for the comics comment to be edited out.As mentioned there is already criticism in the article towards Alternative Medicine from more authoritarian persons. What is the point of placing a comment by a comedian?Is it just an attempt to make the Wikipedia reader feel ridicule towards alternative medicine?The purpose of the comment appears to be more an attempt to make a play on emotions rather then anything professional, genuine skepticism from people in medical field. A comment by a comedian doesnt add or detract any weight from the history of Alternative medicine,what it involves,groups for and against it,adds nothing to the article that a reader needs to know etc.Severina123 (talk) 13:01, 19 February 2010 (UTC)

(Late comment for historical purposes.) After several reverts, on Jan. 28 it was finally deleted from the lead, but kept in the body of the article. -- Brangifer (talk) 06:09, 2 March 2010 (UTC)

I've tried to improve its wording further, per WP:NPOV, in an attempt to make it more encyclopaedic. But I have to say that on balance I would tend to throw my hat in the ring with those who seriously question whether a comedian is really an appropriate authority to quote here. Vitaminman (talk) 16:22, 2 March 2010 (UTC)

Your rewording that was made to hide the fact that he's a skeptic who uses comedy to present his message is a whitewashing attempt. By deemphasizing his skeptical status, it makes it somehow easier to remove him as a comedian, even if what he wrote was dead serious and in no way disagrees with other skeptical POV in the article. The idea that he's not an authority isn't legitimate either. That's not necessary for content, just that it's published in a RS, but since he's a noted skeptic, his notable expression, when written so clearly, happens to be pretty good for content in that section. You need to use policy as a reasoning, not whitewashing attempts. This isn't a MEDRS matter, but an attempt to document the POV of skeptics. -- Brangifer (talk) 21:27, 2 March 2010 (UTC)

I agree... honestly, the only reason I haven't been more aggressive about it is that it's so obviously over the top it tends to cast doubt on the other skeptical silliness in the article; in a weird way it defuses all the other efforts at defamation. but that's not really good reasoning... --Ludwigs2 16:52, 2 March 2010 (UTC)

You're right. Your whitewashing reasoning isn't good wikipedian practice. His statement happens to be a good summation of comments said by many others, but in a very concise manner. It's easier to use his quote than quote a whole lot of others. Although hundreds of websites quote him, I've linked to the official trailer for his upcoming animated film. The original content in the lead has been deleted for some time now, but at least the content in the body had remained. Now your whitewashing attempts are deleting it as well. I'm just pointing out that your openly expressed reasoning reveals your motives, and they stink. They aren't legitimate reasons. I really have a hard time taking you seriously. -- Brangifer (talk) 21:27, 2 March 2010 (UTC)

look Brangifer, I am tired of your accusations. I'm trying to create an NPOV article seemingly in spite of your efforts, and I wish you would quit this crapulence get on the program. Minchin is a frigging comedian, for Christ's sake: how in heaven's name do you justify citing him as a reliable source on a serious article. are you going to whip out Henny Youngman next? Woody allen has some great pro-AltMed jokes; should I offer those as a contrasting medical opinion?

you said you had an authoritative source that says the same thing - so great! stop defending this idiotic comedy routine and pull out that decent source, and we can leave this stupid, stupid, stupid argument behind. --Ludwigs2 00:21, 3 March 2010 (UTC)

Look, if you don't like having your fringe POV pushing and whitewashing agenda hung out for all to see, then don't write things like you wrote. It's your own fault. Don't complain to me. As for Minchin, his quote is notable because he's a skeptic, not because he's a comedian. What he said isn't a joke. -- Brangifer (talk) 01:37, 3 March 2010 (UTC)

So Verbal has unilaterally reinstated Minchin's statement without bringing his reasoning to the talk page first before doing so. This is regrettable, but raises an interesting question. In short, if it is acceptable to quote a little known comedian from down under (I had never previously heard of him) who is sceptical about alternative medicine, is it also acceptable to quote other celebrities who are supporters of it? Logically, it should be. Moreover, it is not difficult to find examples of such celebrity supporters speaking out in WP:RSs. Vitaminman (talk) 00:30, 3 March 2010 (UTC)

(outdent) Controversy over the Minchin quote exposes the whole problem here. AltMed is NOT a subject within medicine. It's a word. The subject is language. Note that we have not succeeded in saying what it designates. That should be pretty clear evidence that what we have here is a semantic field. Language people have as much authority over it as people who claim to be medicos. Minchin doesn't belong, not because he doesn't have authority -- he is objecting to the use of a word and a concept, and he has professional authority for doing so -- but because including him gives opening to people who are looking for a wedge to discount objections to scientific claims from outside of institutionally recognized and validated science. The reason to drop him is not that he doesn't speak with authority, but because the things he's saying are said by others whose authority the charlatans can't so easily trump. The reason to drop him, in short, is rhetorical: to satisfy the stupid and/or dishonest; there are other soruces that will serve as well. DavidOaks (talk) 03:55, 3 March 2010 (UTC)

I can understand that kind of logic. It's not based in policy, and it's a caving in to the elements who .....(censored), but I realize that it's pragmatic at times to just get on with things. A better solution would be to replace it with two statements from others covering the first part and the second part. Hmmm... -- Brangifer (talk) 05:09, 3 March 2010 (UTC)

I wouldn't object to that, I don't think (depends on what sources you chose). why don't you suggest a rewrite here - with luck, we'll all agree to it and this little festive intereaction will be dead and gone. --Ludwigs2 05:49, 3 March 2010 (UTC)

Davis quote in the lead

We may be able to find a different author to a quote that substantially says the same thing. Let's try that and and see if we can agree on an alternative. -- Brangifer (talk) 15:42, 28 January 2010 (UTC)

Yes, I think this statement about alternative medicine in the lead being from a Professor of English is not an appropriate source. stmrlbs|talk 16:01, 28 January 2010 (UTC)

OK, now is that because you think that folklorists have nothing to say on the subject of the definition of or the claims made for folk medicine? I'm asking on wikiprinciple, and kinda puzzled/amused by the readiness to assert, the reluctance to explain. Myself, I think the lead needs a strong statement of skepticism, and it would be better coming from a physician. Bullrangifer has given us a lot of them. Here are some that I think would work best in the opening paragraph. Angell and Happle are physicians (good cred) and speak to the operational distinctions. Novella is also a physician. Some would say that gives him cred when he is talking about language, but I was just talking to a linguist, who never heard of him (LOL). Carroll has pretty good phrasing, IMHOP. DavidOaks (talk) 16:15, 28 January 2010 (UTC)

I didn't say that they should have nothing to say, but just that this shouldn't be the lead, the definition of alternative medicine. Folk medicine is part of alternative medicine, not the whole. Also this statement is not a very good definition of alternative medicine: "alternative medicine is any healing practice which has not been shown consistently to be effective", as many healing practices in conventional medicine are not consistently effective - look at conventional cancer treatment, or even treatment for something as common as acne or the common cold. Imo, the difference is not "conventional medicine works and alternative medicine does not", but more that conventional medicine tries to quantify the rate of effectiveness (small or large) and of risks (small and large) of many of its healing practices and use these scientific findings to determine the best treatment. Alternative medicine does not. And, I think this is what Marcia Angell is saying. stmrlbs|talk 03:26, 29 January 2010 (UTC)

So far it looks like we have three voices in favor of the Marcia Angell quote (not counting votes, just announcing trends thus far) -- do other people want to weigh in specifically on the question of building her quote into the lead?DavidOaks (talk) 19:46, 30 January 2010 (UTC)

Marcia Angell, an American physician, author, and the first woman to serve as editor-in-chief of the New England Journal of Medicine (NEJM).

"What most sets alternative medicine apart . . . is that it has not been scientifically tested and its advocates largely deny the need for such testing. By testing, we mean the marshaling of rigorous evidence of safety and efficacy, as required by the Food and Drug Administration (FDA) for the approval of drugs and by the best peer-reviewed medical journals for the publication of research reports. Of course, many treatments used in conventional medicine have not been rigorously tested, either, but the scientific community generally acknowledges that this is a failing that needs to be remedied. Many advocates of alternative medicine, in contrast, believe the scientific method is simply not applicable to their remedies. . . ."^[4]

Robert Todd Carroll, philosopher. Author of The Skeptic's Dictionary book and website.

"A health or medical practice is called "alternative" if it is based on untested, untraditional, or unscientific principles, methods, treatments, or knowledge. "Alternative" medicine is often based upon metaphysical beliefs and is frequently anti-scientific. Because truly "alternative" medical practices would be ones that are known to be equally or nearly equally effective, most "alternative" medical practices are not truly "alternative," but quackery. If the "alternative" health practice is offered along with conventional medicine, it is referred to as "complementary" medicine."^[5]

"Complementary medicine is another expression for "alternative" medicine, though the two are often linked as complementary and alternative medicine and referred to as CAM. The term 'complementary' seems to have been introduced by the purveyors of quackery in an attempt to produce the bias that untested or discredited treatments should be used along with conventional medical treatments. There really is no such thing as "alternative" medicine; if it's medicine, it's medicine. 'Alternative medicine' is a deceptive term that tries to create the illusion that a discredited or untested treatment is truly an alternative to an established treatment in conventional medicine. By adding 'complementary medicine' to the repertoire of misleading terms, the purveyors of quackery have improved on the illusion that their remedies somehow enhance or improve the effects of standard conventional treatments.^[6]

Rudolf Happle, German dermatologist.

"When deliberating on the essence of alternative medicine we should simultaneously reflect on the intellectual and moral basis of regular medicine. . . . (1) alternative and regular medicine are speaking different languages; (2) alternative medicine is not unconventional medicine; (3) the paradigm of regular medicine is rational thinking; (4) the paradigm of alternative medicine is irrational thinking; (5) the present popularity of alternative medicine can be explained by romanticism; (6) some concepts of alternative medicine are falsifiable and others are not; (7) alternative medicine and evidence-based medicine are mutually exclusive; (8) the placebo effect is an important factor in regular medicine and the exclusive therapeutic principle of alternative medicine; (9) regular and alternative medicine have different aims: coming of age vs faithfulness; (10) alternative medicine is not always safe; (11) alternative medicine is not economic; and (12) alternative medicine will always exist. The fact that alternative methods are presently an integral part of medicine as taught at German universities, as well as of the physician's fee schedule, represents a collective aberration of mind that hopefully will last for only a short time."^[7]

Steven Novella, neurologist. Founder of the New England Skeptical Society and host of The Skeptics' Guide to the Universe podcast.

"The fundamental intellectual flaw of “CAM” as a concept is that it is made to include modalities that are extremely diverse, even mutually contradictory, under one umbrella. Very deliberately modalities which are scientific and mainstream, like the proper use of nutrition, are often included under the CAM umbrella by proponents in order to make it seem like CAM is a bigger phenomenon than it actually is, and as a wedge to open the door for the more pseudoscientific modalities."^[8]

"The dichotomy between alternative and conventional medicine is artificial and confusing. It should be given up. "Medicine is what works," the best methods known should be used. Any kind of medicine which adheres to this maxim is to be taken serious."^[9]

Well, many of these definitions are explicitly skeptical (e.g., people trying to define AltMed/CAM in terms of the fact that it doesn't work rather than in terms of the pragmatics (they originate in modalities outside modern scientific medicine). aren't their any neutral (non-skeptic, non-advocate) definitions out there? --Ludwigs2 18:31, 28 January 2010 (UTC)

It appears that the definition of altmed is a semantic field between the polarities represented by skeptics and proponents. That's why the lead needs both. DavidOaks (talk) 21:19, 28 January 2010 (UTC)

I don't know where you're getting that belief. Most altmed practitioners don't worry about mainstream medicine; most medical practitioners don't worry about alternative practices. there is a notable group of people trying to debunk/refute/redefine alt med, and another notable group trying to legitimize it, both using semantic games, yes. but I don't think you can reduce the whole issue to their tempest-in-a-teapot. as I've said before, alt med is easily defined as 'practices which are not derived from the conventional assumptions of western scientific medicine'. that's a clear, descriptive, and (as far as I can see) entirely accurate representation of the material. what's wrong with it? --Ludwigs2 21:54, 28 January 2010 (UTC)

I do not know where you are getting the belief that "Most altmed practitioners don't worry about mainstream medicine; most medical practitioners don't worry about alternative practices." If you can find a WP:RS that says so, propose adding it. I am looking at bunches that show and say explicitly that it's controversial. Failure to announce the controversial nature of altmed, in the lead, would be as inappropriate as failure to include skepticism in other articles on controversial topics. If it weren't controversial, it wouldn't be "alt." My conviction grows that the article is about semantics, ideology and rhetoric rather than about science. Bullrangifer has brought forward sources that diretly address the rhetoric, ideology and history of science. I have identified several I think well-suited for the lead. DavidOaks (talk) 01:04, 29 January 2010 (UTC)

I am going to correct you a second time - I never said that we shouldn't shouldn't include skepticism in the lead. if I need to correct a third time, I will begin to think that you are intentionally misrepresenting me. that won't turn out well.

(outdent) thanks for the warning. You're not the only one involved, therfore not the only one addressed.

I can point to any number of research articles in conventional science, and any amount of writing in alternative medicine sources, that makes no mention of the other.

Alt med practices existed long before the term alt med was coined - some alt med practices existed for centuries before scientific medicine was invented - and for most of that time and in most modern cases the two sets of practices exist in parallel, with little or no cross-referencing between them. there has been a growing awareness, of course, and a sizable group of people on both sides who are trying to deal with the question of their relationship, but for the most part, Altmed gets along fine without thinking about conventional medicine, and vice-versa. of course people who are concerned with the inherent problem are going to write more about it; that doesn't mean that the inherent problem is what defines the classification.

(outdent) That's a joke, right? That there exist conventional science articles that don't mention altmed, altmed articles that don't mention science, as a proof that there's no particular controversy? Apply that logic to astonomy and astrology, and you will see that it doesn't advance things. If altmed exited prior to science, then it is a list of practices. Very well, let's have the definitive list, and be done. I think you will have trouble finding one, because the term exists to contrast altmed to something else. That makes it a matter of semantics. DavidOaks (talk) 01:38, 29 January 2010 (UTC)

I don't think the article is about semantics, rhetoric, ideology, or science, though I think all of those things need to be discussed. I think the article is about alternative medicine. do you disagree? --Ludwigs2 01:26, 29 January 2010 (UTC)

(outdent) Yes, I disagree. The more I observe the discussion, the more certain I am that it needs to be about semantics, the more certain I am that language authorities are what's needed. DavidOaks (talk) 01:38, 29 January 2010 (UTC)

ok, again this is an article about alt med, not about the controversy of alt med. If all you're looking at is the controversy, then I can understand why you think it's all semantics. but if that's all you're looking at, then you are seriously working on the wrong article.

No, that's hardly all I'm looking at. But I am curious how anybody's going to define this thing w/o reference to controversy, since, far as I can tell, the only way we know it's altmed is that there's disagreement as to its inclusion in scientific, standard, institutional med (terms are another thing we have to settle on). That is, semantically, it is not definable except by opposition. 12:44, 29 January 2010 (UTC)

further (for the third time) you misrepresented what I said. where do you see me saying there's no particular controversy? are you discussing this issue with me or with some preset argument in your own head that you've convinced yourself I'm making? should I take your misrepresentation as intentional this time, or would you like to claim that it's an unfortunate error? --Ludwigs2 02:39, 29 January 2010 (UTC)

I apologize for unintentionally giving offense. I recognize that you acknowledge controversy. I think the difference is, I'm pretty sure that the subject of altmed is not definable in a positive way, that is, it can't be defined without reference to something it is NOT, and that's where controversy enters -- not way down in the subject. "Alternative" implies some other thing to which it is, well, an alternative. DavidOaks (talk) 14:10, 29 January 2010 (UTC)

[QUOTE]this is an article about alt med, not about the controversy of alt med.[/QUOTE] Brilliant. I am embarrassed to admit that the obvious had not occcurred to me. This article does need to be split to altmed and altmed controversy. Gandydancer (talk) 03:20, 29 January 2010 (UTC)

This is an article about the subject of alt med, the whole subject from all possible angles. We cover it all right here. Only if one aspect warrants so great coverage that its inclusion would unbalance the article because of a lack of space would a fork article be allowed. A content fork article now would be very inappropriate and against our policies. If there's anything that characterizes alt med, it's controversy, hence the name. -- Brangifer (talk) 07:45, 29 January 2010 (UTC)

So Brangifer: it's seriously your contention that there is nothing to Alt Med except the controversy about its relationship to scientific medicine? or am I misunderstanding your position? --Ludwigs2 15:38, 29 January 2010 (UTC)

You are doing more than misunderstanding, you're misrepresenting what I wrote above. I really don't see how you can get that out of what I wrote without totally ignoring the first part of my paragraph. Controversy just happens to be an inevitable part of the subject, and therefore belongs in this article, not in a fork. There is obviously much more than controversy to the subject, but many aspects of the subject are disputed and will therefore need to be dealt with in the article. A separate "controversy" section has been disparaged, so the controversies and disagreements are spread throughout the article. I'm not always comfortable with that approach, but that's the preferred format. -- Brangifer (talk) 21:14, 29 January 2010 (UTC)

I'm sorry, I didn't mean to misrepresent - I was just working with your "If there's anything that characterizes alt med, it's controversy, hence the name" which seems to imply you think it's all about the controversy. I agree that controversy needs to be part of the article and not in a fork. I just happen to believe that the controversy is a secondary (or possibly tertiary) part of the article, not the primary part.

let me be clear - I always prefer a 'describe first; qualify second' approach to fringe articles. I don't want to remove or minimize critical perspectives, I just want to get the actual subject matter of the article out to the reader before we start telling the reader why the subject doesn't work. do you see what I mean? --Ludwigs2 05:38, 30 January 2010 (UTC)

(outdent) I'm assuming you're addressing me, DavidOaks, rather than Bullrangifer. I'm not sure I know enough about the subject to assert that there's nothing to it except its relationship to scientific medicine. I am saying that I do not yet see a way to define the subject except in contrast to scientific or institutionally recognized medicine, which in turn is defined by being subject to scientific method and rigorous testing procedures (and other implications of the scientific method, e.g., subject matter separate from organization, falsifiability of hypotheses, an articulated theoretical model subject to confirmation and disconfirmation. The only other way of defining that occurs to me is lists, which would be arbitrary and subject to much disagreement, hence more controversy...but maybe that's just my lack of imagination/insight. So yes, I do not (yet) see a way to define this subject that does not depend upon its status as dissent or departure from a field which in turn regards it with skepticism. My present view is that it is not definable except as a field of dispute.DavidOaks (talk) 16:14, 29 January 2010 (UTC)

Actually, David, I was taking to brangifer - see his comment directly preceding mine. but since you responded... I have to ask, seriously - do you simply not read all the way through my posts? I've dealt with this issue 3 or 4 or 5 times already. I'm really getting sick of repeating myself on this page; if it continues I will have to revise my editing approach.

so, again, here's a perfectly feasible definition of alt med (in sarcastically highlighted text, so that you can't miss it)

'Alternative medicine' is a conventional term for an assortment of healing practices which are not derived from the conventional assumptions of western scientific medicine.

simple, straight-forward, easy. what problem do you have with this? --Ludwigs2 17:09, 29 January 2010 (UTC)

That's one of the worst and most POV laden definitions I've ever seen. And your presentation and style is decidedly rude, so I hope you do revise your approach. Best, Verbal chat 18:57, 29 January 2010 (UTC)

again, you're welcome to make an actual argument, but your feelings on the matter are largely irrelevant. please explain in what way this statement is POV? --Ludwigs2 19:49, 29 January 2010 (UTC)

I think this is getting somewhere and is also illustrating the point that I in turn have tried to get through to you quite a few times. Your proposed definition uses "not" -- that is, it's a negative definition, a definition in terms of what alt med is NOT. That's been my point all along. Now, when we start in on how we determine that a given thing is altmed vs scientific (standard, institutional, etc) the determination actually is not historical. Nobody says of a given drug or therapy, "did this come outta Asia? Was this in use before 1600? Whoa, none o' that!" They ask "has this been proven to be safe and effective?" which leads to another question, "has this been empirically tested under controlled conditions?" Yes, the testing is what makes it Western scientific medicine, and the insistence on using it despite lack of evidence or coutnerindications of safety or effectiveness make it altmed. It's not altmed if a)it's clinically proven or b)nobody's using it (as far as I know, there is no trepanning going on. If there were, it would definitely qualify). DavidOaks (talk) 19:01, 29 January 2010 (UTC)

that is a marvelous example of wp:synth. my sentence is purely descriptive; yours relies on an interpretation of what's going through people's minds when they think about AM. yes, scientists test modern drugs empirically; yes AM is not tested empirically in the modern sense of the term; combining those to make an assertion about how people see AM is synthesis. --Ludwigs2 19:47, 29 January 2010 (UTC)

Certainly if what I wrote immediately above were pasted in the lead, that would be wp:synth. However, we have comedians, folklorists, physicians, statisticians, philosophers, physicists all saying the same thing, and it's a matter of choosing the best quote. If we have WP:RS for the formulation you're putting forward (altmed is defined by non-westernishness) that belongs too, in a lead that would explcitly acknowledge the difficulty and multiplicity of definitions of a controversial subject. DavidOaks (talk) 16:52, 30 January 2010 (UTC)

You don't need to cite that the sky is blue. no one is going to disagree with the statement that AM is a collection of practices which are not derived from western scientific medicine (because disagreement would mean one believes that AM is derived from western medicine, which is prima facia incorrect). This is not a thing that needs to be proved, and citations to that effect are irrelevant and unnecessary. Your statement, however, is a statement designed to advance an opinion (an opinion about AltMed from the perspective of western medicine) - that's why it needs reliable sources, that's why the sources come into question, and that's where the danger of synthesis arises. sure, a number of people say what you cite - that's what makes it a notable perspective - but I could easily find numbers of people with medical degrees (as well as comedians, philosophers, and social scientists) who come out with favorable statements of AM as a whole or of specific practices. You simply have no grounds to assert that inner dialog you attribute to people above is actually the inner dialog that scientists, doctors or people in general use. --Ludwigs2 17:59, 30 January 2010 (UTC)

(outdent) This is not a "sky is blue" case, i.e., common knowledge, common understanding. Citations are absolutely necessary. I'm not offering any inner dialogue, and I am not offering my own wording (though I'm making good faith efforts to explain things). I am offering quite a few quotes from WP:RS that say altmed is definable as practices which have not demonstrated safety or effectiveness. DavidOaks (talk) 18:36, 30 January 2010 (UTC)

if that definition is used, then mainstream medicine's off-label use of medicines is alternative medicine. stmrlbs|talk 18:56, 30 January 2010 (UTC)

This point has been made repeatedly. I see it as hairsplitting; the common sense test would be to ask whether this is what people ahve in mind when the term altmed is used, or to run in the other direction, whether most people would consider the use of drugs which have been tested for one therapeutic use to amount to altmed when used in another. Here's an authoritative response to the proposition at hand, that under the "not tested for safety and effectiveness" standard, off-label use of drugs means that all medical practice is altmed (an absurdity of course, to have an alternative with no possibility of a thing to which it is alternative): "It is important to recognize that off-label use of medication is not the same as non-evidence-based used of medications."[8] This one is really thorough:

"In a 1993 article on alternative AIDS therapies, Carola Burroughs defines "alternative" as a "catch-all phrase" used for "various treatments which simply have not been accepted by the medical establishment."2 Terms like unconventional or unorthodox make a political distinction. Distinctions like modern medicine, versus traditional or folk medicine denote cultural variations and imply a superior level of advancement. Unproven is another often-used distinction. However, there are standard medical treatments used today that have gained their acceptance through history of use, rather than formal clinical testing. Drugs tested and approved for one use can be prescribed off-label for a new use when preliminary outcomes look hopeful and the physician feels the situation warrants the risk. Although not yet thoroughly tested and proven for that use, off-label uses are common in clinical practice." [9]

I am not proposing this for inclusion in the lead or anywhere else, simply bringing it forward to do away with the claim that we can't have a testing-standard as part of the definition because of off-label use. DavidOaks (talk) 19:30, 30 January 2010 (UTC)

Some more: You don't put something in scare-quotes if it's the generally understood usage -- here's a guy who thinks off-label use is an ethical problem (and that's what makes it look like altmed, which he clearly doesn't admire).http://sols.asu.edu/symposium/2006/authors/schaninger_39.php] Here's one that treats off-label use as something other than altmed, and subject to scientific testing[10] DavidOaks (talk) 19:40, 30 January 2010 (UTC)

@ DavidOaks: I don't think you're really understanding the synthesis issue here. you have a number of quotes from reliable sources, yes, but you are using them to advance a position that is not present in reliable sources.

@ stmrlbs: actually, that's not true, and is the reason I used the 'derived from' language. an off-labal medication is clearly a medication that was derived from scientific medicine - this particular use may not be (currently) approved, but the drug was assumedly created and tested in a lab, and approved for some purpose. This is entirely different from something like (say) Chinese medicine (derived from a completely different medical model) or magnetic healing bracelets (derived from some modern semi-spiritual beliefs unrelated to medical science). see the point? --Ludwigs2 19:21, 30 January 2010 (UTC)

Yes, you are correct, I do not understand the issue you are raising. Here are many authoritative voices defining altmed. How is choosing one of them to use in the lead, for the purpose of defining altmed, wp:synth? DavidOaks (talk) 19:58, 30 January 2010 (UTC)

it's not inherently synth, unless the quote is used in such a way that it becomes an implicit critique of AM. that quote from Carola Burroughs you used above is not half bad, and you'll notice, is more or less a paraphrase of what I said, only replacing the 'derived from' bit with 'accepted by'. I'm really just trying to do as she suggests - keep the political distinctions aside until we've developed a proper description of the topic. then we can introduce critiques and other political distinctions (in, as I said, maybe the third paragraph). f you go on to start using the 'doesn't work' type quotes tight up front, however, then I'm going to object, because that is synth - it would be us as editors trying to advance a political opinion about altmed before we've even talked about what altmed is. --Ludwigs2 20:34, 30 January 2010 (UTC)

(undent) I think it comes down to this: there is a view that noting, in the lead, that CAM is controversial would be POV and that failure to do so would be WP:POV. Does that capture it? If so, we sit around and wait for others to talk up a consensus. DavidOaks (talk) 21:08, 30 January 2010 (UTC)

David - again - nowhere, ever, anywhere, period did I say that the controversy should not be mentioned in the lead. I said that the lead should not begin with the controversy. of course the controversy should be discussed in the lead, but not until the second or third paragraph. --Ludwigs2 21:51, 30 January 2010 (UTC)

I think it definitely belongs in the first paragraph, because the subject is not definable without reference to what it claims to be but is not acknowledged as (effective medical practice), and that because of failure to successfully demonstrate safety and effectiveness. DavidOaks (talk) 22:07, 30 January 2010 (UTC)

well, that's simply not true. Traditional chinese medicine, again, can be discussed very thoroughly without talking about western medicine. eventually you'll have to get to the point where you mention that western scientific medicine has no verification of its practices, but you certainly wouldn't start there, if for no other reason than TCM predates western medicine by about 1600 years. it's kind of hard to define something by its failures according to a system that occurred 1600 years later. or why should we define something like (say) Reiki by western medicine, when neither the medical community nor the Reiki community care (from the medical perspective it's non-invasive and non-harmful; from the Reiki perspective, medical testing misses the point). you keep treating AM as though it were a thing which could be analyzed, labeled, and refuted, when in fact it is a collection of independent, unrelated things which have no commonality except that they are outside normal medical purview. --Ludwigs2 00:15, 31 January 2010 (UTC)

What's simply not true? There are many topics under discussion. I'm guessing it's the assertion that these things cannot be defined except in terms of what they are not (?) I hold to it. We're talking about all these unrelated things, which have nothing in common except that they have no empirical basis, and have not been evaluated for safety or effectiveness. That's the ONLY thing holding them together. So it should be in the first paragraph. It's their definition. Wikipedia does not deal in truth, but verifiability. We have definitions of altmed from WP:RS under discussion. Please address these. DavidOaks (talk) 02:18, 31 January 2010 (UTC)

Just to clarify, I believe the current proposal is to include the definition which you regard as neutral, but which I regard as a proponent's view, as well as a critical view from a scientist, in the first paragraph, including a note that the field is highly contested. In practical terms, this means the status quo, plus getting a WP:RS for something like the formulation you propose, and replacing the folk-medicine-specialist's view with a physician's quote. Right now the Marcia ANgell wording seems to have the most support. Respond to that, please. DavidOaks (talk)

(e/c) sorry, what wasn't true in the first case was your statement "because of failure to successfully demonstrate safety and effectiveness." Few AltMeds have failed tests of safety or efficacy; most are simply untested by western procedures and some are outright untestable. Of those that have been tested, some have passed muster. in your second post you changed it to "have not been evaluated for safety or effectiveness", which is better, but which is also true of many conventional medical procedures which have never been formally evaluated; the phrase does not really distinguish between conventional and alt medicine. again, the real distinction between conventional med and alt med lies in the fact that they are derived from different models. that's it. this may (and probably does) translate to more reliable treatments from conventional medicine, but that is something to be discussed later in the lead and farther down in the article. it is not a definitive characteristic of every form of alt med. --Ludwigs2 03:05, 31 January 2010 (UTC)

to the 'current proposal': I don't think that works for me - I see it as an effort to defame the topic even before the topic is established. in exaggerated terms it would be like saying "Alternative medicine is a stupid idea, but lets go ahead and talk about it anyway," which is not the correct way to begin an article. --Ludwigs2 03:09, 31 January 2010 (UTC)

Getting Focus

Here's where it's at: right now, we've got one side saying the lead can't say anything negative about AM and another offering a wealth of very responsible, authoritative voices saying that doubts about the legitimacy of these things as medical practice is the very thing which defines them. I recommend everybody drop everything else and deal with those issues. DavidOaks (talk) 20:19, 23 February 2010 (UTC)

piffle. that's not where we are at all. --Ludwigs2 20:46, 23 February 2010 (UTC)

Then explain where you think we are, and suggest something concrete and specific. I say we settle on an authoritative quote to capture the critical view which distinguishes altmed from med. Say yes or no to that; if yes, nominate something. If no, say what you think we should do. DavidOaks (talk) 20:50, 23 February 2010 (UTC)

ok. we are in the middle of a discussion that is not served well by these kinds of rhetorical declamations. why don't you go back to the above section and respond to the points raised, rather than continuing to harp on some perceived (and largely incomprehensible) flaw in logic that you think Gandy is making. sound like a plan? --Ludwigs2 21:05, 23 February 2010 (UTC)

Please identify what particular "points" you refer to. So far, here are the “points” I see “above” – (from Strlmbs): “Imo, the difference is not "conventional medicine works and alternative medicine does not", but more that conventional medicine tries to quantify the rate of effectiveness (small or large) and of risks (small and large) of many of its healing practices and use these scientific findings to determine the best treatment.” To which we respond, great – until you get an authoritative quote for the view, IMO=WP:OR. Next: We have quotes by Angell, Carroll, Novella, Happle, to which Ludwigs replies (only one of many such): “Well, many of these definitions are explicitly skeptical (e.g., people trying to define AltMed/CAM in terms of the fact that it doesn't work rather than in terms of the pragmatics (they originate in modalities outside modern scientific medicine). aren't their any neutral (non-skeptic, non-advocate) definitions out there? “ That is, if it’s skeptical, it’s not neutral. However, I do note that you immediately deny having said that we shouldn't have skepticism in the lead. Here’s what’s been said over and over again – in an intrinsically controversial subject, you do not achieve NPOV by finding a single POV, you do it by balancing POVs. Now, if you have a wikipolicy that opposes that, please bring it forward.

In short, we've got one side saying the lead can't say anything negative about AM and another offering a wealth of very responsible, authoritative voices saying that doubts about the legitimacy of these things as medical practice is the very thing which defines them. DavidOaks So let's choose a skeptical quote, and you can go find an authoritative source for your nonskeptical, i.e., supportive quote (treating the controversial as noncontroversial is not to me NPOV but whitewashing, and necessarily requires the balance of skepticism to achieve NPOV). Then we craft a lead which contains BOTH. DavidOaks (talk) 23:04, 23 February 2010 (UTC)

Well, I was really thinking about my answer to your question in the section above (which you never responded to). however, if you want to paint in broad strokes, allow me to point out that I have explicitly said, at least eight times that I do not have a problem with some critical perspectives in the lead, and at least half of those comments were written explicitly to you. what I said was that the lead should not begin with criticism. do you want diffs?

as far as alternatives go, I believe I stated in big bold letters above that the best lead line would be "'Alternative medicine' is a conventional term for an assortment of healing practices which are not derived from the conventional assumptions of western scientific medicine." what is your specific problem with that statement? --Ludwigs2 23:46, 23 February 2010 (UTC)

If it comes from WP:RS I have no problem with its being presented as part of the definition in the lead. So who said exactly those words? It is defective if it is presented as the whole, since it does not reflect the fact that AM is by definition, intrinsically and essentially a field of dispute, and that the subeject of dispute is efficacy and safety, and that the means by which efficacy and safety are evaluated is by acceptance in the scientific medical community, and that they generally determine those things with regard to the scientific method, i.e., objective testing -- with sidebars, if people insist, for therapies in process (cancers) and off-label uses based on previous approval for other purposes and a preliminary history promising for further empirical investigation. DavidOaks (talk) 00:10, 24 February 2010 (UTC)

I would largely agree with Ludwigs2's proposal but would reword it slightly, to take account of WP:NPOV, as follows: "'Alternative medicine' describes an assortment of healing practices which are not derived from conventional western scientific medicine." Vitaminman (talk) 00:12, 24 February 2010 (UTC)

OK, same question -- what WP:RS does this come from? DavidOaks (talk) 00:45, 24 February 2010 (UTC)

@ David: I disagree that AM is 'intrinsically and essentially a field of dispute', and the remaining statements in your post. again, as I said above: (a) AM is far too broad and covers far too many divergent practices for any blanket judgements of its status to be made, and (b) some forms of AM predate scientific testing by millennia, and continue to exist in many places in the world without any conflicts with scientific medicine. as far as I can tell, AM is only 'in dispute' by a fairly small number of skeptics who have decided they need to fix something that no one else knew was broken. that is certainly a notable view, but hardly constitutes the deciding view by which all AM should be judged.

@ Vitaminman: I tend to prefer the 'conventional assumptions of' wording because is distinguishes Alt Med from certain non-standard western medicine practices (such as off-label drug use). Off-label drugs are clearly derived from the assumptions of WSM, but it's debatable whether they are derived from WSM directly. I don't suppose it makes all that much difference, though - maybe we can find a compromise position? --Ludwigs2 00:40, 24 February 2010 (UTC)

Fine -- find a WP:RS that treats AM as something that can be defined in the absence of questions as to its legitimacy, and that definition can certainly accompany whatever we choose from the multitude of highly authoritative sources that treat it as definable mainly by the absence of approval from the scientific community. Continuing -- find a WP:RS that says only a small number of skeptics treat it as a field of dispute, and we can put that in the lead as well. Otherwise, the things that you've just said are simply your views, WP:OR. As to treating off-label uses of drugs otherwise recognized as therapeutically sound, find WP:RS for that view; similarly with the view that because there are treatments for cancer that don't always seem to be effective, those too amount to AM, find a WP:RS for those as well. I think these are objections to the definition that belong in the body rather than in the lead, where they will appear as inappropriately fine-tuned, but if consensus demands their placement there, I can live with it. But the key is, in this contentious article, whatever you claim has to come from WP:rs, not from our own ideas of fairness or our own formulations. If I say that it's basically a semantic field and a sematic problem, I do so only to explain my reasoning, not because I think those things need to go in the lead or anywhere else in the article. DavidOaks (talk) 00:54, 24 February 2010 (UTC)

Every reliable source on the topic defines AM as something that exists outside western medicine, and therefore outside any considerations of western medical legitimacy. find me a source (one single source) that says AM is a product of western medicine. I mean seriously - you could criticize Aristotle for failing to understand Newton's laws of gravity, but that strikes me as an odd and misguided approach.

The fact that you have an assortment of sources in your bag of tricks is a good thing; the fact that you are using those sources to engage in synthesis is not. and that is (as I have said before) most assuredly what you are doing. I don't really care how many sources you have when you are trying to make those sources support positions they cannot effectively support. --Ludwigs2 01:14, 24 February 2010 (UTC)

(outdent) Well, that's great. Then you have only to pick one out of this assortment. I propose that we choose the best-expressed example from the most estimable authority to represent the view that AM is defined mainly by distance from western canons of scientific legitimacy. You have only then to find a source that says western canons of legitimacy are irrelevant, or whatever it was you felt needed to be expressed. But what you can't do is formulate it in your own words, for so contentious a topic as this. Get a quote. If you wish to discuss who's engaged in synthesis, by all means open a fresh section to do so. Here, it would be a distraction. DavidOaks (talk) 01:38, 24 February 2010 (UTC)

I'm not really interested in hyperbolic assertions (who said anything about 'western canons of legitimacy being irrelevant'). but if you want a good solid sourced quote to use, let's use the one Gandy provided at the beginning of the #Continued from above... section: "Complementary and Alternative Medicine (CAM) is a broad domain of resources that encompasses health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period. CAM includes such resources perceived by their users as associated with positive health outcomes. Boundaries within CAM and between the CAM domain and the domain of the dominant system are not always sharp or fixed." (gandy, we seem to have lost the citation for this - can you recover it?). As I said then, it's hellishly wordy (mine is much simpler, and says the essentially the same), but at least it's a straight-forward description.

we'll deal with synth as it arises. --Ludwigs2 02:46, 24 February 2010 (UTC)

As a definition, it's not so bad. I found a blog that cites "the Institutes of Health" and an advocacy site that cites "The Institute of Medicine in the USA in 2005." The same site sloppily and vaguely cites other defs from the World Health Organization and the Cochrane Complementary Medicine Field.[11] These are some workable definitions, but they are obviously partial. I'd really like to see them better sourced, and they will need balancing, but any of them might do for the approving view. I got suspicious when I found this def sourced to Wikipedia in March 2009, but that allowed me to trace this: Committee on the Use of Complementary and Alternative Medicine by the American Public. (2005). Complementary and Alternative Medicine in the United States. National Academies Press. A government committee report. Definitely WP:RS if reported as the result of a definition they agreed upon because it "reflects the scope and essence of CAM as used by the American public [...and] avoids excluding common practices from the research agenda [...and is] patient centered and includes practices that people perceive to have health benefits [...and] encompasses the potential for change" V much an activist agenda, not widely replicated, and much in need of a balancing view. DavidOaks (talk) 03:29, 24 February 2010 (UTC)

There is no 'approving view' here. there is a definition of Alt Med, and the is a critique of Alt Med. continuing to insist that there is some intrinsic dispute here is not going to get you anywhere; you have no foundation for it. sorry. --Ludwigs2 03:53, 24 February 2010 (UTC)

Your views on what qualifies as neutrality have been made clear, L. Balancing those views with other perspectives to achieve NPOV is how it works. You will have to accept this, or we will simply enter another round of lockdown. DavidOaks (talk) 13:01, 24 February 2010 (UTC)

DavidOaks, I am having trouble understanding your post. Are you saying that the Cochrane and the WHO definitions are partial (biased)? Gandydancer (talk) 13:31, 24 February 2010 (UTC)

I said that specifically of the Institute of Medicine definition, which follows several skeptical/critical views (including the one from Carroll) which they identify as partial; the committee crafts a view which EXCLUDES those viewpoints, for the purpose of balance. (see pp 17-20) I'd say that's the very definition of partiality, though it's the honest form that we're trying to get in the lead here, where partialities are in balance. I would however say that as well of the others, which are explcitly trying to get around skeptical attitudes -- do we drive around mountains that don't exist? It seems to me somewhere between silly and dishnest to deny the simple, obvious, repeatedly demonstrated fact that there are multiple ways to define CAM, and the primary divide between those definitions is between those who regard it in a positive light and those who are skeptical. Denying either one of these things space in the lead would be irresponsible. This is the one thing that's really quite evident: the definition of CAM is far from a matter of a single, settled consensus. The question now on the table is whether there is agreement that NPOV will be achieved in the lead by balancing POVs. If "yes," we can proceed and choose one of BullRangifers nominees. If "no," we probably need some form of arbitration. —Preceding unsigned comment added by DavidOaks (talk • contribs)

You make some good points, David. An additional concern that I have is that whilst there is now abundant evidence that alternative medicine is becoming mainstream (see my post of 21:09, 14 January 2010 [12]), the article does not cover this to any significant or meaningful degree.Vitaminman (talk) 14:47, 24 February 2010 (UTC)

Agreed; that should have a section by itself, and be part of the overall rewrite once we get the lead shipped into shape. DavidOaks (talk) 15:05, 24 February 2010 (UTC)

So David, let me get this straight: You insist that no definition of AM is possible unless it poisons the well, you back that insistence up by engaging in synthesis from published sources, you threaten to edit war (i.e. "get the page locked down") in order to retain this otherwise insupportable position, you consistently and tendentiously misrepresent my position on the topic (here are six diffs - [13], [14], [15], [16], [17], [18], including one from a day ago - where I explicitly tell you that I am not trying to deny the skeptical perspective), and now you suggest mediation? hell, I'm beginning to think that I should open an RFC/U against you for abysmal editing practices, but if you want to mediate the issue instead that would be fine by me. otherwise it is rapidly coming to the point where consensus on this article will require us to ignore your input entirely and begin editing over your (frankly specious) objections. --Ludwigs2 14:54, 24 February 2010 (UTC)

L, if you think I'm engaged in synthesis or posioning the well, abysmal editing, making threats of lockdown, by all means please go make your case to whatever authorities you wish. Meanwhile, these accusations are a distraction. I have put a very simple and direct question: we now have a short list of highly respectable WP:RS's for each view. Shall we seek NPOV by balancing supportive and skeptical views of CAM in the lead? I think you can give that a simple "yes" or "no." DavidOaks (talk) 15:05, 24 February 2010 (UTC)

D, I'm just going by your (fairly unambiguous) words in your previous post. if you think that I am wrong in those assertions, then we can discuss the matter. However, I will not accept any definition of AltMed that begins by poisoning the well, particularly not when we have a perfectly serviceable, well sourced definition that doesn't. do you have a problem with that? --Ludwigs2 15:42, 24 February 2010 (UTC)

I think the lead must include a definition of CAM that recognizes widespread skepticism as well as the one you think is neutral and I think is affirming. I do not think that a lead which fails to seek NPOV by balancing the skeptical with the affirming is acceptable. If you do not agree, say so, wait for others to weigh in, seek arbitration, etc. DavidOaks (talk) 16:10, 24 February 2010 (UTC)

There is no single definition that can do the subject justice. Leads aren't definitions, but often include them as part of their summarizing of the entire article. Sometimes we even deliberately don't use existing definitions because they don't sum up the article. Instead we synthesize them from the article's content. Thus Wikipedia's definition ends up becomeing better than any other existing ones, simply because our definitions cover a subject from all angles. We already have a pretty good section on definitions. Is there something in that large section which isn't represented in the lead? If so, let's try to fix that. As far as "poisoning the well" goes, well, that's one individual editor's subjective feeling and has no relation to policies, except possibly one about "not censored"...;-) No, it's a simple and properly sourced statement that nicely sums up a number of statements and sources in the article. We've seen similar attempts at the homeopathy article, where attempts (by a now banned editor) to remove the word "quackery" from the lead were unsuccessful. Let's just let the sources speak, follow policy, and not let overly sensitive personal feelings control the editing. Editorial censorship based on personal feelings isn't a good editing method, is very unwikipedian, and if anyone should be ignored, it would be one who edits in such a manner (but we shouldn't treat each other in such a manner). Instead of making uncollaborative statements like "ignore your input entirely", why not calm down and seek consensus? -- Brangifer (talk) 03:43, 25 February 2010 (UTC)

I'm all for consensus. --Ludwigs2 18:08, 25 February 2010 (UTC)

Proposed lead

I propose the following for the lead, followed by a new section that discusses the problems of definition:

Alternative medicine is a term used to designate practices aimed at relieving pain and suffering caused by disease and injury, but distinguished from medicine by its lack of acceptance by the institutional authorities recognized in the relevant geographic areas. The term, and the wide and shifting modalities it may designate are subject to contention and debate. DavidOaks (talk) 01:35, February 25, 2010 (UTC)

This is a good start, which I would edit slightly as follows:

Alternative medicine is a term used to designate practices evolved to maintain and restore health by the prevention and treatment of illness. It is distinguished from orthodox medicine by its lack of acceptance by mainstream institutional authorities. The term, and the wide and shifting modalities it may designate, are subject to contention and debate. Vitaminman (talk) 08:28, 25 February 2010 (UTC)

well, sorry, but that simply isn't true. alternative medicine is not 'distinguished from orthodox medicine by its lack of acceptance', not in any general way. I mean, there may be a few AM practices of which that is true, but there is a broad range of AM practices that were defined long before 'conventional' medicine existed, and have been developed without any reference to 'conventional' medicine at all. --Ludwigs2 14:49, 25 February 2010 (UTC)

L, what VM is trying to do is achieve a descriptive lead that captures the two perspectives from which AM is regularly defined, trying to do it in original wording while at the same time avoiding the trap of WP:Synth That trap can easily be avoided by simply laying out quotes of irreproachable authority, without connecting them with logical operators. The result is clunky, and you have already indicated your opposition to any such action by referring to it (incorrectly, I believe) as "poisoning the well." Anything new and concrete to suggest? DavidOaks (talk) 14:58, 25 February 2010 (UTC)

Addition: if you can find WP:RS that says what you have said (something like "the problem with defining AM in terms of its nonacceptance by institutional medicine is that many of these practices predate institutional medicine") by all means let's incorporate it. I fear you will not find any such quote, because it's a nonsequitur -- it's entirely possible to reject something which predates the rejecting body. If the quote simply says that many of these things predate or exist outside of western medical practice without specific reference to any other definition, using the quote to modify another definition becomes WP:Synth. What you're saying is WP:OR until it's properly sourced. At that point, it becomes one of a number of POVs we will have to find a way to incorporate in order to achieve NPOV. DavidOaks (talk) 15:23, 25 February 2010 (UTC)

well, to your first point (which is what I've been advocating all along) I suggest that we start with a pure definition of alternative medicine (e.g. something along the lines that it is a collection of practices that have not been derived from the assumptions of conventional western medicine). once we have that definition established, than I'm perfectly happy to state that many of these practices are not accepted or tested by conventional medicine. If you'd like me to make a specific suggestion, how about the following (based on VM's suggestion above): Alternative medicine is a term used to designate a diverse assortment of health practices which have evolved independently from orthodox medical practices. It includes practices derived from traditional medicine, folk knowledge, spiritual or religious beliefs, and non-standard medical models or assumptions, though the application of the term is often debated. Practices classes as alternative medicine generally lack acceptance by mainstream institutional authorities, though this may range from practices which are rejected as dangerous or ineffective to practices which are untested, untestable, or otherwise unconsidered by the medical community.

To your other point: again, this isn't an article about 'the problem of alternative medicine', this is an article about 'alternative medicine'. the claim that AM isn't/shouldn't be accepted by western medical practitioners is part of the 'critique' of alternative medicines, and is certainly notable, but it is not part of the 'definition' of alternative medicine. if you'll pardon the reductio ad hitlerum, we do not define Jews as 'the race that Nazis thought were inferior', and we do not define socialism as 'the system that capitalism proved wrong in 1989', and we do not define Christianity as 'the religion that people use to justify shooting abortion doctors'. why should we indulge in that with Alternative medicine? --Ludwigs2 18:05, 25 February 2010 (UTC)

Correct me if I'm wrong, but is your basic objection directed against a "negative" description being placed before a completely neutral description? If that's it, then I have no problem with interjecting a more neutral description right before the current ones (but not to deleting them). Am I correct in my assumption? -- Brangifer (talk) 03:31, 26 February 2010 (UTC)

That is precisely what I've been asking for, yes. If we can do that (give a completely neutral description first, before getting into the obvious and necessary critiques) I'd be happy. --Ludwigs2 06:44, 26 February 2010 (UTC)

RfC: Proposed new section "Alternative medicine as mainstream"

It is proposed that a new section be created: "Alternative medicine as mainstream". Brangifer (talk) 15:02, 26 February 2010 (UTC)

I therefore suggest that the lead should incorporate some text from the multitude of material (per my post of 21:09, 14 January 2010 [19]) relating to the fact that alternative medicine is becoming mainstream. Vitaminman (talk) 21:25, 25 February 2010 (UTC)

I support that suggestion. In keeping with our content rules for the WP:LEAD, the full content from which a short summary would be developed must be included in the article first. I think there are several of us who have already expressed an interest in such development. Please start a new section and make a basic proposal with sources. Then we can work on it together. -- Brangifer (talk) 03:31, 26 February 2010 (UTC)

My basic proposal for a new section, with sources, would be as follows:

Proposal by Vitaminman

Some evidence suggests that alternative medicine is becoming more mainstream.^[10]^[11]^[12]^[13]^[14]^[15]^[16]
In the United States, for example, according to a federal study sponsored by the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health, more than one in three adults and nearly one in eight children used some form of alternative medicine in 2007, such as self-prescribed nutritional substitutes to repeat visits to alternative health care practitioners. Chiropractors and acupuncturists are now licensed by most states in the U.S., whilst many traditional medical doctors have signed up for training in alternative therapies or added alternative professionals to their staffs.^[17] Similarly, over 40 U.S. medical schools now require students to learn about alternative therapies,^[18] whilst a 2006 survey of nearly 1,400 U.S. hospitals showed that more than one in four now offer therapies such as acupuncture, homeopathy, and massage therapy.^[19]^[20]
Americans spent about $33.9 billion on alternative medicine in 2007, accounting for about 11.2% of the public's total out-of-pocket health expenditures.^[21]
In Europe, a 2007 report by market analyst Mintel stated that herbal and homeopathic remedies are becoming mainstream in the United Kingdom, with echinacea and green tea-based treatments among the most popular remedies.^[22]
Jocelyn Noveck, a national writer for the Associated Press, has cited alternative medicine as having become "became more mainstream than ever" since the beginning of the millennium.^[23] Well known alt-med advocates Deepak Chopra, Dean Ornish, Rustum Roy and Andrew Weil, writing in the Wall Street Journal, have expressed a similar view, adding that “Integrative medicine approaches such as plant-based diets, yoga, meditation and psychosocial support may stop or even reverse the progression of coronary heart disease, diabetes, hypertension, prostate cancer, obesity, hypercholesterolemia and other chronic conditions.”^[24]
Some experts are calling for tighter regulation, saying that because of how many people are using alternative medicine it's important to have some kind of surveillance system in place.^[25] Some critics charge that Government actions and powerful interest groups have left consumers vulnerable to flawed products and misleading marketing, and that dietary supplements do not have to be proved safe or effective before they can be sold.^[26]

End of proposal. Vitaminman (talk) 09:13, 26 February 2010 (UTC)

Comments

Without commenting on individual points, I commend Vitaminman for a nicely written proposal. I suggest we start examining it, make any tweaks we might feel necessary, and then using that as a new section. Since it is likely to attract some criticism at first, let's try to reduce the chances of outright and immediate reversal by editors who haven't been following the talk page discussion by waiting a few days before adding it. Wider input is necessary so it ends up being a truly consensus addition. This should actually be made into a formal RfC and announced on the relevant projects. I'll take a crack at that. Otherwise good work. -- Brangifer (talk) 14:46, 26 February 2010 (UTC)

Agree -- great start. Agree too that it should be a section of the article, and once it's in place, should get the usual notice in the lead. One caution -- and it has to do with encyclopedic tone rather than with content -- declaring something "mainstream" is a judgment, one that journalists allow themselves, and the sort of thing that gains illusory momentum as the services do that topic-copying thing that the news cycle encourages. I'd keep to claims that are more obviously related to factual documentation, thus: "increased use by physicians" or "1/3 of cancer patients now using some form of AM" rather than "mainnstream" -- that has the potential to lead to another series of arguments about terminology. DavidOaks (talk) 15:00, 26 February 2010 (UTC)

I'm a bit worried about levels of OR and SYNTH, and giving an (uninteded) false impression. For example, is alternative medicine more popular now than 10 years ago? 20? 100? 200? 300? This needs to be made clear, and the rises and falls made clear, with a global perspective. Another example, "over 40 U.S. medical schools now require students to learn about alternative therapies" without knowing why they are teaching it, this is misleading. Also, is this an increase? We'd need comparative figures. Also note that the Channel 4 ref is actually PA copy of a press release put out to support alternative medicine. These are just the initial problems I noticed. Verbal chat 15:18, 26 February 2010 (UTC)

Good points. This may end up being more about acceptance and use, rather than "mainstreamness", but let the discussion determine that. The sources will lead us. Since the very idea is obviously very controversial, and there are numerous skeptical commentators, their input would also need to be included, but the basic idea of this section is very good.

One could say that the very idea of the section, and the sources themselves, make for an excellent proof that alternative medicine isn't mainstream, but is attempting to become accepted. It is accepted by a minority of the public, and by a very small minority of mainstream medical personnel, but that deserves mention. When one takes out the obviously mainstream concepts of dietary and lifestyle changes, as well as prayer, then the actual numbers who are accepting the more clear "alternative" concepts is actually not very big, and for chiropractic it's actually getting smaller as the utilization rates for chiropractic show they are losing ground and/or stagnating in the last few years (I don't remember the exact numbers right now). -- Brangifer (talk) 15:14, 26 February 2010 (UTC)

I'd also tend to worry a bit about overgeneralization (same worry I've expressed above, except in the opposite direction). Some AM practices are becoming more mainstream, for divergent reasons, while others aren't. for instance, I'd suggest rewording the first line to say something like: "Evidence suggests that some alternative medical practices are becoming more mainstream." --Ludwigs2 15:33, 26 February 2010 (UTC)

I don't think we should use the imprecise term "mainstream" here. Reading the text above, it is talking about two issues.

Popularity of alternative medicine has increased over recent decades.
Some alternative medicines are being / have been trialled by medical science.

It would be false to assume that just because something is being trialled it has become mainstream. However, if it gets through numerous, rigorous trials then you could call it mainstream. Of course, that would just be that treatment, not the whole of alternative medicine.

It is also false to assume there is some kind of trend towards alternative medicine being accepted by medical science or the world at large. A search for "homeopathy" on the BBC news website gives five stories - four negative and one "What is homeopathy" Take this on as an example

Yaris678 (talk) 15:35, 26 February 2010 (UTC)

Yes, once an originally "alternative" method is proven, it becomes mainstream and is no longer "alternative". As for homeopathy, the latest report from the UK House of Commons Science and Technology Committee totally disses it, recommending it not be sold, researched, included in the NHS or anything. Read the latest at the homeopathy article. -- Brangifer (talk) 15:51, 26 February 2010 (UTC)

How is this a new section as opposed to items that can be added to Contemporary use of alternative medicine? Hipocrite (talk) 15:39, 26 February 2010 (UTC)

Good point. I think the main objective from the proposer (not myself), is to get the word "mainstream" associated with "alternative medicine". To some degree there are RS which do that, but that may not justify the creation of a whole new section. It might be best to incorporate those sources in the existing section you mention. -- Brangifer (talk) 15:46, 26 February 2010 (UTC)

We have a couple of issues. First is with definitions. What is "mainstream"? It does not appear to be encyclopedic but a term frequently used in an attempt to justify legitimacy were it may or may not exist. As what is "alternative medicine"? Alt med claims vitamins under their domain but the evidenced based uses of vitamins are medicine. Thus how are these numbers defined? Message therapy is its own college is practiced by physiotherapist who would not a least in my country consider themselves alt med practitioners. I have serious concerns with this material. Yes lot of people use non evidence based practices such as the BRAT diet in GI upset and putting ice on the back of the neck when your nose bleeds but these practices do not fall into one health care paradigm or another. They teach it in medical school yes but they also teach about the historical use blood letting ( in the same class in which one learns about alt med ). Alt med is not one approach but many. It use in China for example is currently decreasing. Moa turns to alt med after the great revolution as he had promised health care and realized that they could not afford any medicine other than traditional medicine. Now as China become more wealthy they are using medicine.Doc James (talk · contribs · email) 16:39, 26 February 2010 (UTC)

I'm concerned about creating needless confusion with 'mainstream'. Does 'mainstream' mean "actively supported by non-AltMed practitioners"? Does it mean "common"? Perhaps a less ambiguous choice of words would be helpful. WhatamIdoing (talk) 21:09, 26 February 2010 (UTC)

As the proposer here, I have to begin by saying that it is not at all true to claim that my "main objective...is to get the word "mainstream" associated with "alternative medicine"." Instead, I am starting from the perspective that this article is both nauseatingly long and appallingly badly written. But on the specific issue of alternative medicine becoming mainstream, there are now numerous WP:RSs to demonstrate this. Some of these are included in my proposal, and a little research using a search engine turns up many more. As such, rather than argue whether or not this justifies the creation of a whole new section, I would simply point out that this aspect is barely, if at all, covered in the article.

Finally, and though many of us would clearly very much wish it to be otherwise, the credibility of Wikipedia as a reliable source of information is not anything like as good as it either could or should be.[20] Whilst I do of course recognise that some subjects, including the one dealt with in this article, are open to a variety of interpretations, the fact that this article barely if at all recognises the extent to which alternative medicine is becoming mainstream – regardless of how misguided or not its proponents might be – is greatly to its detriment. Vitaminman (talk) 22:00, 26 February 2010 (UTC)

I agree with WhatamIdoing, mainstream is being overused here and should not be in the section header at all. As BR suggested, a regulation and prevalence section might be better and avoid these POV issues. Clearer words such as common or popular should be used to avoid misleading our readers. Verbal chat 22:19, 26 February 2010 (UTC)

The WSJ title is "'Alternative' Medicine Is Mainstream The evidence is mounting that diet and lifestyle are the best cures for our worst afflictions." When did diet and exercise become the exclusive domain of alt med? Medicine has been recommending these since the Ancient Greeks if not before.Doc James (talk · contribs · email) 22:29, 26 February 2010 (UTC)

Whilst Hippocrates may indeed have recommended food as medicine (although I note that the WP article on him makes virtually no mention of this), the unfortunate fact is that in modern-day medicial practice this aspect plays a very poor second fiddle, at best, compared to drug-based treatments. But to what percentage of your patients do you personally recommend diet and lifestyle as being the best cure for their worst afflictions? And to what percentage do you recommend a drug as the best cure? The fact that alternative practitioners mostly take the opposite approach to orthodox medicine in this respect is precisely what makes them "alternative". Vitaminman (talk) 10:48, 2 March 2010 (UTC)

I recommend lifestyle interventions ( smoking cessation, exercise, diet changes ) and conservative measures in about 80% of the people I see. Probably only 10% do I indicate meds as the best treatment.Doc James (talk · contribs · email) 10:52, 2 March 2010 (UTC)

Then I commend you and can only say that, with total annual drug sales now being valued at over three-quarters of a trillion dollars globally, I wish your approach was shared by more in your profession.[21] Vitaminman (talk) 13:58, 2 March 2010 (UTC)

All right. When I said much the same thing, commenting on the socially-changing role of vitamin D and bed-rest recommendations in medicine, vs. the rise of drug therapy, my comments were labeled "off topic" and compressed into a little off-topic box (see below). You don't like specific evidence or case-arguments, evidently, but you don't like evidence-free generalizations, either. Well, what do you like? Would you mind telling me what it is that you're trying to discuss here? It's apparently not whether or not "alternative" topics shift back and forth to and from the mainstream, over the years. Of course they do. So what do you want to do about it? S B H arris 18:02, 2 March 2010 (UTC)

The labeling of off-topic comments is not my doing, so please check the log. And please don't accuse me of not liking specific evidence, case-arguments or evidence-free generalizations, as I am not responsible for the moving of anybody's comments. I did make the proposal here, of course, which you can read above and which was formatted and arranged for me by Brangifer. As for what I would like, it is simply to improve this article by means of utilising some of the very many WP:RSs contained in my proposal. After that, we should also deal with the fact that the article is both nauseatingly long and appallingly badly written. Based upon the comments thus far, however, I am not overly optimistic that even Hippocrates himself would have much success in attempting to improve this article... Vitaminman (talk) 19:37, 2 March 2010 (UTC)

Just because my comment went under yours, Vitamin, doesn't mean I was accusing you specifically. S B H arris 20:37, 2 March 2010 (UTC)

(Undent) From a JAMA paper "There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is "Eastern" or "Western," is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for historical purposes and cultural interest." [22] Doc James (talk · contribs · email) 20:18, 2 March 2010 (UTC)

Ah, the AMA and their journal. They are often wrong, but they never lose their arrogance. It does no good to try to define "alterntive medicine" away, since we'd still need a term to replace it. The problem is not some clear line which separates "scientifically proven, evidence-based medicine supported by solid data" from "unproven medicine, for which scientific evidence is lacking." The problem is in comparing STANDARDS of evidence Cochrane-style, and then attempting to compensate for the terrific bias introduced by fad, fashion, hype, and advertising driven by patented-product and unpatented product sales dollars.

Example: your 50 y.o. male well patient with no relevant cardiovascular history, is found on routine screening blood testing to have a fasting triglyceride level of 500 mg/dL. On repeat testing, it is much the same. It is so high you can't say much about his other cholesterol numbers. His spun serum looks like milk. Okay, while you're waiting to do a cardiac stress test on him, do you: A: send him to Costco for cheap fish oil capsules, which he must pay for out of pocket? B: prescribe him Lovaza, an expensive prescription EPA supplement, which his insurance will cover, or C: start him on fenofibrate, which not only will his insurance cover, but also is the same stuff the mellow aging hippy photographer guy on the TV commercials takes (Dude!). Is this an "alternative medicine issue"? It certainly was ten years ago, before "Lovaza" existed (although people were still being given then-brand name Tricor). What would JAMA say? Do you think they think that after the FDA has spoken, the science is in? And not before? But always afterward? Why the need for all those "consensus" recommendations in cardiology, unless there wasn't any consensus before? You know, standard medicine is a lot like wikipedia in many regards. S B H arris 20:53, 2 March 2010 (UTC)

When dealing with controversial characterizations of a movement it is often useful to break it down by which group says what as is done on Transcendental Meditation [[23]]. We have the self characterizations of alternative med, we have the scientific and medical characterization, we have government description / definitions and we have descriptions found in the press. I would support the reorganization of this section along these lines. If this was done I would be more inclined to support a description of "mainstream" in a "the press" section.Doc James (talk · contribs · email) 21:13, 2 March 2010 (UTC)

The above suggested approach would meet with my support. Vitaminman (talk) 00:07, 3 March 2010 (UTC)

It certainly would seem to be a step in the right direction rather than have the article open with the definition of a professor of English from the Missouri Folklore Society and then have a definition by a comic as well... Gandydancer (talk) 00:31, 3 March 2010 (UTC)

Keep in mind we're not talking about the lead but a possible new section, and the Minchin quote is no longer in the lead. -- Brangifer (talk) 01:43, 3 March 2010 (UTC)

Oh my! Now we have the renown Dr. Davis speaking not only for The Show Me State, but all of Western Culture! Now that's progress! I do have one small complaint. While we make fun of these Latinos for squandering their money on this useless stuff, couldn't we get their other misguided leanings correct? The statues are mostly of The Blessed Mary Ever Virgin, not "the saints", and on the candles, you will not find prayers, but again The Blessed Virgin. Pray to the Virgin for 30 days and your wish will be granted, at least that is what I was taught. It works every bit as well, if not better, than Lunesta's promise to bring you sleep, which science has shown does not work at all. A whole lot cheaper too! Gandydancer (talk) 02:13, 4 March 2010 (UTC)

Comments that strayed off-topic

The following discussion has been closed. Please do not modify it.

What about considering alternative medicine, simply anything that is alternative to "local standards of practice"? This is the standard physicians are held to, in malpractice cases. And it's also been historically the standard by which local medical societies used to judge who was practicing "alternative medicine" in a way that should result in loss of a state license to practice, as for example, many "I.V. chelation" cases. Such standards are quite different from the "best medical practice at Mass. General." Or even the best medical standards of your state. Rather, it's the average thing that doctors in your area (which might be the wilds of Montana, not the wilds of Manhattan) are expected to do. So it is departure from those standards (which again are LOCAL and again are AVERAGE) which I think are a better definition of "alternative medicine." Those local guys may have been reading about diet and exercise since Galen, indeed, but it's not the local standard of practice for a family physician to spend 45 minutes talking to a patient about diet and exercise. That kind of thing is its own punishment-- the local medical board won't become incensed, but the physician will go broke. So in that sense, it's "alternative." To get your patients to go through an Ornish Diet Clinic, the main alternative part is the funding-- your people have to be well-to-do financially or even wealthy, and thus not mainstream.
And has been pointed out, these things change. In the US, for many latitudes, there's essentially no UV in the 295 nm vitamin D synthetic range for 5 months of the year. During that time, more than half of people have blood 25-OH-vitamin D levels in the "low concern" range, despite a 400 IU multivitamin and some milk drinking. Canada has recently recommendended 1000 IU supplementaion for everybody. In the US, despite some quite similar problems, that's not standard of practice, nor is regular blood testing to see if this higher level of supplemention is enough. As such, all this stuff is "alternative medicine." If a doctor did this testing on every one of his or her medicare patients, and charged medicare for it, he or she might even risk medicare fraud charges in 2010. But maybe that will not be the case in 2020.
It is necessary that part of the understanding of what practices are "standard," and what are "alternative," is not science, but sometimes fashion. S B H arris 02:02, 27 February 2010 (UTC)

The foregoing paragraph is astonishing nonsense, involving the deliberate or ignorant misrepresentation of nearly every concept mentioned: the attitude of primary doctors to the value of lifestyle changes, the source of constraints on the time they spend on the topic, the legal definition of standard of care, the applicability of standard of care to distinguishing alternative and scientific medicine, the source of the changing understanding and recommendations about vitamin D, the current canadian RDA for vit D, the risk taken by primary doctors who test vitamin D levels of Medicare pts... Is there any assertion in the whole paragraph that is neither a misrepresentation nor a misunderstanding? I cannot see a single one. alteripse (talk) 03:59, 1 March 2010 (UTC) My God, I just looked at his user page. He may think he's channeling Diderot but it really must be BJ Palmer, and he's badly in need of an exorcism. I want to cry.

Well, pick out a specific you disagree with and name it. Don't just say you disagree with the entire thing. State your reasoning.
My thesis is that medical standards of care are not only local, but are often social and not scientific. Thus, it seems over-the-top to define "alternatives" to standards of traditional care in terms of science-only, when it surely was not science-only that went into formulating them.
In order to really have a discussion, we need a specific example and not generalities. So, what do you want to talk about? I see on your userpage that you created the article on bed rest in standard medical care. Okay, but how much do you know about it, O critique of my own medical understanding? I see no good historical references for bed rest and coronary care. You do know that prior to 1951, if you were diagnosed with what was then called a coronary thrombosis, you got treated with 3 to 6 weeks of "complete bed rest"? Not with "bedside commode privileges,"-- I mean your feet were not allowed to touch the floor. And of course, when your feet were allowed to, you had a reasonable chance of having a thrombotic embolism before you got out of the hospital. The "evils" of the medical standard of complete bedrest were starting to be complained about, as early as 1944, in JAMA, but only on an anecdotal basis. These complaints were not applied to cardiac rehab until late 1951, when Dr. Samuel A. Levine, who has a stub on WP which doesn't mention this, suggested anecdotally in the American Heart Journal that patients who were allowed to rest in an armchair next to bed, sometimes did better. That was a shocker. Thus, when President Eisenhower had his celebrated M.I. in 1955, his cardiologist suggested that the "take charge" guy might be allowed the "radical" Levine treatment of "armchair-rest" after a time. There was still no data on this, and had Eisenhower flopped over and died, Dr. Paul Dudley White would have been a goat, because this was NOT standard of care at the time. The case helped to promote the idea, however.
Fast-forward 55 years, to today. Do we know how much complete bed rest to prescribe after uncomplicated ST-elevation M.I.? No. The ACC/AHA recommend at least 12 hours, but their reasons are unclear, because there are no good data or trials. One or two weeks of greater rest of some kind is somewhere around the standard, but nobody knows which is better. All this is true because there is nobody to fund good trials. Bed rest is not a drug. There is a lot more data on low molecular weight heparin (or pick your other treatment). Why not? Well, you tell me. Would it help if I told you that length of hospital stay for M.I., as with childbirth and many other conditions, began to rapidly decrease in the U.S., after 1984? Were you practicing in 1984, so you could see this happen? What was the driving force, do you think? Do you think I'm somehow talking about... chiropractic? Glad you liked my userpage. You are now more and more deeply relaxed. S B H arris 06:10, 1 March 2010 (UTC)

I usually stay away from the arguments here, but I strayed in response to the RFC and then reacted to the paragraphs above. Why ask me to pick out a specific thing to argue about? I listed 7. But I think I agree with Brangifer in the next paragraph-- this is not the place. Let's just drop it. alteripse (talk) 17:32, 1 March 2010 (UTC)

Honored doctors, would you mind taking this discussion to one of your talk pages? It's interesting speculation, opinion, and OR, but isn't based on sources, and it's definitely straying off the topic of this thread. If you'll agree, then we can place a hat on this and get on with the subject of the thread. -- Brangifer (talk) 06:49, 1 March 2010 (UTC)

Oppose, agree mainstream is not encyclopedic. Alternative medicine with evidence and acceptance is not alternative. You can talk about how prevalent a non evidenced based practice is or if scientists are investigating it for evidence. Is becoming more mainstream is nonsense. MiRroar (talk) 14:55, 1 March 2010 (UTC)
Oppose due to a couple reasons. Mainstream is not a definable term therefore adds little to the topic at hand. And mainstream among whom? The sources used are not sufficiently reliable to make this sort of assertion.Doc James (talk · contribs · email) 06:26, 2 March 2010 (UTC)

Organized

I took what was there and attempted to organize it, removing duplication of content, formatting references, and summarizing the long quotes. Comments?--Doc James (talk · contribs · email) 10:20, 3 March 2010 (UTC)

sorry, everything is zooming along so rapidly here, I missed this new addition and put my response in the section above. carry on!!!Gandydancer (talk) 02:17, 4 March 2010 (UTC)

Add Link

Okay to add link to Livingston-Wheeler this article, linking to Wikipedia article Virginia Livingston (same individual)? The Virginia Livingston article is in-depth, including negative results with clinical trials of her therapy but possible biasing factors as well. Thank you Ronsword (talk) 15:12, 23 April 2010 (UTC)

What is conventional medicine?

The more positive definition offered here for alternative medicine, "any healing practice that does not fall within the realm of conventional medicine", has alternative medicine depending for its coherence on the idea that there is a coherent "conventional medicine" that has excluded and excommunicated its healing practices. But there is no Pope, no hierarchy, in medicine, to separate out what is conventional from what is alternative to conventional. The healing practices that have achieved currency as Medicine, have done so on their own, not because there is any formal apparatus policing the borders of any sort of "conventional medicine".

It seems to me that that point is tolerably clear except to people who need to imagine that there must be an expertise, (perhaps as yet undiscovered) with clear answers to all at least important questions, and some hierarchy of experts who hold the secrets (or will hold them once the secrets are discovered) of that expert knowledge. The tell on the paradoxically greater than normal faith in rationalism that informs people who think that there's anything to alternative medicine, is that second definition that is touted, "that which has not been shown consistently to be effective." Well, as a practitioner of "conventional medicine", I'm here to tell you that most of what I do, and everything that I do that couldn't be replaced by an algorithm, totally lacks any basis in the quantitative evidence that is used by "evidence-based medicine", and would therefore have to be classified as "alternative medicine" under this definition. Before you can even begin to count apples and oranges, do quantitative methods to generate the evidence, you have to distinguish apples from oranges, and the pattern recognition involved in generating a nosology, then applying those patterns to the individual patient (diagnosis) is qualitative, not subject to quantitative evidence.

Quit trying to be more Catholic than the Pope. Physicians aren't much like physicists. Practitioners of medicine freely accept all sorts of practices that have no basis in quantitative evidence.

Where's the Wiki article on "conventional medicine"? That's the article I'ld like to see, would need to see, before I even consider giving "alternative medicine" any attention. Let's explore the terra incognita that we know exists, that we can actually walk across. Speculations about the nature of medicine would be much better focused on actual medicine, not medicine as hyper-rationalism imagines it should be. —Preceding unsigned comment added by Glen Tomkins (talk • contribs)

I think your point that "conventional medicine" contains, for historical reasons, a mixture of evidence-based and evidence-free practice is a valid one. But the evidence-based fraction will gradually increase through time because new treatments are now forced to jump through evidence-based hoops, and long-standing practices are beginning to be scrutinised through evidence-based eyes. So, yes, the boundary between "conventional" and "alternative" medicine is somewhat blurry. I don't think anyone seriously disputes this point. But, at the same time, it's safe to say that there are a number of identifiable (and ostensibly medical) practices that do not conform to known laws of chemistry, physics and biology, or which have been demonstrated as no more effective than placebo (or are even dangerous). So while there may (currently) be no definitive, hard-and-fast distinction between "conventional" and "alternative" practices, there are certainly some that clearly fall into the latter category. --PLUMBAGO 09:53, 13 April 2010 (UTC)

What is Conventional medicine ?, part 2

WP:NOTFORUM, please. - 2/0 (cont.) 23:14, 20 May 2010 (UTC)

My PDR tells me that roughly 17% (or so ) of prescriptions are written for "off-label" use. Is this alternative medicine ? Beats me. The point that technically most physicians practice some sort of "alternative medicine" is well taken, as is the point that persons who are not medically-trained often have difficulty understanding the wierd combination of science, empiricism, and plain old voodoo that docs traditionally practice.

Ya learn early on that trials (favorable or not ) must be carefully examined. People are not white mice. Come to think of it, white mice are not white mice. My favorite example is the stroke drug NXY-059. Gave pretty good results the first leg of its phase-3 trial, but then failed the second leg. The active drug may have been a contaminant that got cleaned up.

Point being that docs generally tend to be more forgiving of "alternative" methodologies than those less experienced with the vagarities of disease. So you do not see a lot of denouncements of it in the formal medical literature. Which is why the anti-alternative medicine folks here must often rely on questionable sources like "quackwatch". True, professional bodies will put out position statements aimed at keeping (say) cancer patients going to us regular docs. Yet the regular docs may use the same methodologies as adjunct treatment.

Similarly, alternative medicine may become mainstream. High-dose time-release niacin is now a standard treatment for hypercholestrolemia and hyperlipidemia. It started out in "alternative medicine". Interestingly, while other treatments have come and gone, essentially the only change in over 50 years of use has been the addition of statins (and sometimes fibrates ). Similar things have happened with (e.g.) acupuncture, now a well-accepted treatment modality for (e.g.) musculoskeletal pain. It helps that mechanisms of action are pretty-well defined. OTOH, is psychotherapy merely the placebo effect writ large ?

So what it alternative and what is conventional? An old joke goes that an alcoholic is anybody who drinks more than his doctor. Similarly, my definition of "Alternative medicine" is any treatment methodology that somebody else uses that I don't, particularly if that person is not a physician. Drjem3 (talk) 03:55, 19 May 2010 (UTC)

Lacking any citations, this is original research and contains no suggestions to adjust the main page. Talk pages are not discussion forums and should be reserved for discussions regaring improvements to the main page. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:09, 19 May 2010 (UTC)

Er, that s what I thought I was doing. Point being, that "alternative medicine" is hard to define. I can't do it. Medicine is a "art", as well as a "science", with training and experience integrated into the book learning. Anyway, the review articles and text-books are written by docs who are as confused as the rest. Been there, done that. E.g., FDA-approval of a certain drug for a certain indication can't be used to define something as "conventional" when 17% of prescriptions are written "off-label". Anyway, the PDR says so.

Another example: the anti-alternative medicine folks like to use www.quackwatch.org as authentication. The rationale for using a source that breaks the usual wikirules is that the regular scientific literature is often slim on backup for their positions. This is no accident. Much of the stuff denounced by www.quackwatch.org is either generally accepted with literally thousands of literature sources and a relatively-well-defined mechanism of action ( like accupuncture ) or minimally the subject of significant on-going research. A good example is Redox-directed cancer therapy. Review: Redox-Directed Cancer Therapeutics: Molecular Mechanisms and Opportunities, Georg T. Wondrak, Antioxidants & Redox Signaling. December 2009, 11(12): 3013-3069. Free on line [24]. All wiki authenticatable, naturally. I suppose I could post this to the article, but prefer to discuss it here first. No point in getting into some sort of silly edit war. Drjem3 (talk) 14:56, 20 May 2010 (UTC)

This is not a forum. If you wish to explore your own thoughts on alternative medicine, you should publish an article in a peer-reviewed journal. Wikipedia is based on what can be verified by reliable sources. It's not based on idle musings by editors. The page has 102 citations, an extensive further reading section, and a large number of external links. The page is past the point at which editors should debate how to define it. The definition for alternative medicine sourced on the main page is "any healing practice 'that does not fall within the realm of conventional medicine', or '"that which has not been shown consistently to be effective'". We do not need to add to that an idiosyncratic definition that one editor believes has merit. I have my own definition of alternative medicine, but I am not discussing it on the talk page. As has been repeatedly pointed out to you, for medical articles, Quackwatch is an acceptable parity source regarding fringe perspectives, topics and theories. It should be replaced where better sources, that require no interpretation can be found. Pulling out primary sources on redox-based cancer therapy, that don't mention, say, megadose vitamin C chemotherapy, and using them to vindicate megadose vitamin C chemotherapy, is original research and particularly egregious at that. When secondary sources (review articles, textbooks, statements by mainstream medical bodies) discuss specific chemotherapeutic interventions as mainstream, effective or even paradigm-breaking, then that can be placed on the chemotherapy page. It shouldn't be placed on alternative medicine (or Abram Hoffer for that matter) as if it vindicated the entire approach.

The best quality trials of acupuncture have consistently found that it doesn't matter where you stick the needles, whether the needles penetrate the skin, whether you use needles at all, or what "theory" backs it up. Though many suggestsions have been made as to how or why acupuncture works (elaborate, dramatic placebo acting on two very subjective and liable sensations - pain and nausea - that are easily modulated based on perception, the pain gate theory, circulation of qi, etc.) no single theory has been universally accepted or proven. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:24, 20 May 2010 (UTC)0

Straw. Little in medical science is "universally accepted or proven". The point about Quackwatch.org as a source is that Dr. Barrett bases much of what he says purely on his personal opinion. Often the equivalent of " I don't understand how it works, so it is quackery ". Often, this is in direct opposition to what the literature says. Go over to www.pubmed.gov and do a literature search-- " Acupuncture " was merely the first thing alphabetically that I searched. But likely the same treatment could be done to many other things he considers "quackery". Dr Barrett also hits people who question his assertations with a SLAPP suit. This is not conducive to rational discourse. What really peeves me is that the same editors who use Dr Barrett as a source will wikilawyer to deny the validity of legitimate literature sources which happen to contradict his naked opinion.

Similarly, If all these other "literature sources" agree with Dr. Barrett, why use him as a source? Surely, it should be easy to find something better. We are all supposed to be operating under the same wiki-rules, no matter how expert ( or not ) we all are. Otherwise, the door gets opened to POV-pushing. Lot of that going around recently.

Also see Off-label use. This wikipedia article cites sources indicating that about a fifth of all prescriptions are written "off-label", climbing to 30% or so for use in psychiatry. Is such use "alternative medicine"? I doubt most physicians would agree. In fact, enforced, it would result in a lot of malpractice suits, "standard of care " being a slippery thing. Minimally, this should be introduced into the article.

The other physician here also notes that much of what docs do in the real world is technically "unproven". He also notes that people sometimes assume that there is some sort of "Pope" in medicine who decides what is and what is not "alternative". Likely, many such get their knowledge of medicine from TV shows-- true, "Scrubs" is pretty accurate about the ambience, if not very factual.

As for me, I've got about as good credentials as you can get in the trade. More degrees that a thermometer, etc. However, if ignorance were bliss, I'd be very happy. I make the assumption that if I can't figure out what is "alternative" ( except at the margins, naturally), nobody can. Stated-simply-- Docs use whatever seems to work. Again, I refrain from posting anything to the main article because I understand the need to vet it here first. But the article does need some work to bring it into line with real world practice, all wikipedia-consistent, naturally. Drjem3 (talk) 17:41, 20 May 2010 (UTC)

You're right about the difficulty of defining the topic except as the negative of mainstream medicine, which does have a meaningful core, and significant institutions with both formal and informal sanctions. This is a point I have made again and again. It's a semantic problem. But difficulty of definition does not render the term meaningless. The "off-label" canard has been brought forward time and again, as has the rejoinder ("It is important to recognize that off-label use of medication is not the same as non-evidence-based used of medications.""). DavidOaks (talk) 20:56, 20 May 2010 (UTC)

Sometimes this is true, depending upon what you mean by "non-evidenced based". And it is true that medicine has a "meaningful core". But opinions among physicians ( much less the medically-untrained ) differ on just what this is <Grin>. When I determine what it is, I'll let you know-- I've spend several decades trying to figure it out.

But often enough, your statement is simply wrong. As for the "off-label" use business being a canard-- by the definition you-all give, it is definitely "alternative". E.g. Off-label use states that " A study published in 2006 found that off-label use was the most common in cardiac medications and anticonvulsants. This study also found that 73% of off-label use had little or no scientific support. ( giving cite ) "

Ya con't define something away just because it falsifies your position or because there is a wild inconsistancy in defining what most physicians do as "alternative medicine". People might start asking questions. Anyway, In the science trade, we call selective use of data "cherry-picking" and it is definitely an abuse. Drjem3 (talk) 22:30, 20 May 2010 (UTC)

You can't define something based on your opinion. You appear to be asserting that alternative medicine incorporates off-label use. There are sources to support alternative medicine being a poorly-defined set of interventions that lack proof and are considered outside of mainstream medicine. Despite off-label use of medications being less well-supported than their on-label use, you have not provided a source to support the idea that off-label medicine is considered "alternative" the same way meditation, acupuncture, homeopathy, shamanism, traditional chinese medicine and other interventions are. Without that source, you are wasting everyone's time. Your opinion is not sufficient to adjust a page, and arguing closely to the definition of two words separately does not invalidate the use of those same words when used together. Per the sources on the page, alternative medicine is not off-label use. Lacking a source, the rest of your comments are irrelevant. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:36, 20 May 2010 (UTC)

Wikipedia:Consensus " Consensus is not immutable. Past decisions are open to challenge and are not binding, and one must realize that such changes are often reasonable. Thus, "according to consensus" and "violates consensus" are not valid rationales for accepting or rejecting proposals or actions. While past "extensive discussions" can guide editors on what influenced a past consensus, editors need to re-examine each proposal on its own merits, and determine afresh whether consensus either has or has not changed. " Drjem3 (talk) 02:30, 21 May 2010 (UTC)

Endorse closure by 2/0. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:21, 20 May 2010 (UTC)

I second the motion, but express respect for the reservations eloquently and authoritatively laid-out. These need to be foregrounded in the lead. It's contested ground, by definition. DavidOaks (talk) 01:25, 21 May 2010 (UTC)

Against closure. My understanding is that this is reserved for either resolved matters or people who clearly don't know what they are talking about or are causing deliberate disruption. Not the case here. Anyway, this seems a bit hurried. Just perhaps, I have stepped on some toes. Drjem3 (talk) 02:30, 21 May 2010 (UTC)

Please feel free to start a new discussion making reference to reliable sources and proposing specific changes to the article. I have not been paying much heed to this page of late, but the above discussion was veering far from the topic at hand. There are any number of general discussion sites elsewhere on the internet where that sort of discussion is welcomed. The definition of alternative medicine genuinely *is* a thorny issue - that is why we have to resolve it using sources instead of rhetoric. - 2/0 (cont.) 02:54, 21 May 2010 (UTC)

Endorse new section, and need for sources as the essential first step. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:41, 21 May 2010 (UTC)

The above caution states: " This is a controversial topic that may be under dispute. Please discuss substantial changes here before making them ..." ( emphasis-added ). Which is what we are attempting to do, rather than enguage in some pointless edit war. It is also contrary to claims that such matters are not to be raised on the discussion page. Ya can't have it both ways.

For late-comers-- the issue documented by the only two "real" doctors who post here ( and now hidden ) is that regular medical practice often involves what the article claims is "alternative medicine". It is true that the uses of any one such tends to be limited. But collectively, use of technically "unproven techniques" represents a large part of clinical medicine. Drjem3 (talk) 19:00, 21 May 2010 (UTC)

The discussion advocated by the talk-page header needs to be based on sources, not personal opinions. I think that's what 2/0 and WLU are getting at - not that the topic shouldn't be discussed, but that the discussion shouldn't take the form of free-range exposition of one's personal opinions on the topic.

As an aside, it's probably not worth continually presenting yourself as a "real" doctor. I've no doubt you are, but since editors are pseudonymous, such assertions of personal expertise tend to be hard to verify and, even if true, accorded little weight. For example, I could tell you that I'm a "real" doctor as well, or even a tenured professor of religion at a major Northeastern university, but in the end I still need to follow this site's policies. Meaning that I need to find and cite sources and use talk pages to discuss source-based improvements rather than as a forum for general discussion. MastCell ^Talk 19:19, 21 May 2010 (UTC)

The "I'm a real doctor" statements are both worthless and insulting. The criteria for being able to edit wikipedia includes finding, summarizing, and referencing sources. "Being a doctor" isn't one of them, and gives no-one's opinion any more weight. Deepak Chopra is a doctor who has ostensibly written books on quantum physics, but I wouldn't trust his opinion on either, even if I could be reasonably sure that it was actually he who was posting a message. By failing to find and cite sources, you are essentially guaranteeing that your post on this controversial page will be reverted. In other words, by continuing to post opinions on the talk page rather than sources, you are wasting your, and everyone else's time. MastCell has exactly grasped my point and frustration. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:52, 21 May 2010 (UTC)

WLU, you're starting to slip into forum talk here. If you've already said something and aren't adding anything to the discussion (in this case, repeating MastCell in a more emotional manner), think about whether you should just hit random page and edit an article. You do a lot of good article work but your talk page comments tend to be long and overly personal, IMO - and I'll I can get overly personal too when there's frustrating things. And I agree with everyone else that this discussion could be closed. I think it's also notable that this sentiment is reflected in the statement "some researchers state that the evidence-based approach to defining CAM is problematic because some CAM is tested, and research suggests that many mainstream medical techniques lack solid evidence", which is in the lead. II | (t - c) 20:50, 21 May 2010 (UTC)

In my defence, I've been dealing with these same issues, from the same editor, on other pages. Part of my exasperation is that I've been banging my head against this wall for longer than anyone else, and based on that experience I don't see this going anywhere except WP:DEADHORSE unless we start seeing sources. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:20, 21 May 2010 (UTC)

In my defense, I have provided sources, ad nauseum. I understand what the rules are. Further, I see sources used here ( e.g., www.quackwatch.com ) that would never be acceptable on any other page. The rationale seems to be that "Well, we can't find much in the regular scientific/medical literature that agrees with us. Since we know we are right, there must be something wrong with the regular medical literature. " Just perhaps, the problem is not with the medical literature. Which is the point I am trying to make-- collectively physicians practice a lot of "alternative medicine". Yet good stuff from the main-stream medical literature gets questioned by WLU. Seems (well) unfair.

I have also had other wikilawyering problems with WLU. E.g., After discussion, I thought I had permission from WLU to post some cites to one page, Abram Hoffer. Basically, he doubted I had them, so dared me to post them. Which I did, " assuming good faith ". In doing so, I inadvertantly did a third revert. I immediately got a banning threat from WLU, just for doing what he had essentially told me to do. Naturally, I felt sandbagged.

Anyway, this is all getting to be an enormous waste of time. It is pretty clear that any attempts to bring a little NPOV to the page will not be effective. Drjem3 (talk) 02:13, 23 May 2010 (UTC)

What attempts? It's still not really clear to me what concrete changes you'd like to see in the article. I might support them, if I knew what they were. You were interested in exploring the semantics of "alternative" medicine, which is indeed interesting but not really suitable for this particular forum. It would be most useful to find and discuss definitions used by reliable sources - for example, how does NCCAM handle the demarcation question? How about Edzard Ernst or other well-known scholars on the topic? I get that you're peeved about Quackwatch, but as best I can tell it is used for one (1) citation, out of >100, which hardly seems like excessive reliance. What specific changes do you want to see? MastCell ^Talk 04:26, 23 May 2010 (UTC)

^ http://archinte.ama-assn.org/cgi/content/full/166/9/1021
^ http://www.npr.org/templates/story/story.php?storyId=95985619
^ "Why is off-label use of drugs so common in cancer treatment?". National Cancer Institute. Retrieved 2009-07-12.
^ Cite error: The named reference Angell was invoked but never defined (see the help page).
^ Robert Todd Carroll. "alternative" health practice. Skeptic's Dictionary
^ Robert Todd Carroll. Complementary medicine. Skeptic's Dictionary
^ Happle R. "The essence of alternative medicine: A dermatologist's view from Germany." Archives of Dermatology 134:1455-1460, 1998.
^ Steven Novella. National Health Interview Survey 2007 - CAM Use by Adults. Science-Based Medicine
^ Steven Novella. Alternative Medicine: a skeptical look Capital District Humanist Society
^ Alternative medicine is becoming mainstream Los Angeles Times. Published November 9, 2009. Accessed 14 January, 2010.
^ 'Alternative Medicine' Goes Mainstream Star Tribune, Minneapolis - St. Paul, Minnesota. Published August 5, 2009. Accessed 9 January, 2010.
^ Alternative Medicine Goes Mainstream CBS News. Published July 20, 2006. Accessed 9 January, 2010.
^ Alternatives Enter the Mainstream Washington Post. Published September 16, 2008. Accessed 9 January, 2010.
^ Alternative medicine now mainstream Channel 4 News. Published July 27, 2007. Accessed 9 January, 2010.
^ 'Alternative' Medicine Is Mainstream Wall Street Journal. Published January 9, 2009. Accessed 9 January, 2010.
^ Alternative therapies moving toward the mainstream CNN. Published February 23, 1999. Accessed 14 January, 2010.
^ Path to Alternative Therapies Is Littered With Obstacles New York Times. 13 November, 2009. Accessed 9 January, 2010.
^ 'Alternative Medicine' Goes Mainstream Star Tribune, Minneapolis - St. Paul, Minnesota. Published August 5, 2009. Accessed 9 January, 2010.
^ Alternative Medicine Goes Mainstream CBS News. Published July 20, 2006. Accessed 9 January, 2010.
^ Alternatives Enter the Mainstream Washington Post. Published September 16, 2008. Accessed 9 January, 2010.
^ Alternative medicine is becoming mainstream Los Angeles Times. Published November 9, 2009. Accessed 14 January, 2010.
^ Alternative medicine now mainstream Channel 4 News. Published July 27, 2007. Accessed 9 January, 2010.
^ 50 things that changed our lives in the aughts. Associated Press. Published 22 December, 2009. Accessed 9 January, 2010.
^ 'Alternative' Medicine Is Mainstream Wall Street Journal. Published January 9, 2009. Accessed 9 January, 2010.
^ [ http://query.nytimes.com/gst/fullpage.html?sec=health&res=9401E4D91638F93BA1575AC0A9629C8B63&fta=y Acupuncture Moves Toward the Mainstream] New York Times. Published September 28, 2004. Accessed 14 January, 2010.
^ Alternative medicine meets mainstream hospitals USA Today. Published June 8, 2009. Accessed 14 January, 2010.

[1] ttp://archinte.ama-assn.org/cgi/content/full/166/9/1021

[2] ttp://www.npr.org/templates/story/story.php?storyId=95985619

[cancer01-3] "Why is off-label use of drugs so common in cancer treatment?". National Cancer Institute. Retrieved 2009-07-12.

[Angell-4] Cite error: The named reference Angell was invoked but never defined (see the help page).

[Carroll_altmed-5] Robert Todd Carroll. "alternative" health practice. Skeptic's Dictionary

[Carroll_complementary-6] Robert Todd Carroll. Complementary medicine. Skeptic's Dictionary

[Happle-7] Happle R. "The essence of alternative medicine: A dermatologist's view from Germany." Archives of Dermatology 134:1455-1460, 1998.

[Novella_CAM_use-8] Steven Novella. National Health Interview Survey 2007 - CAM Use by Adults. Science-Based Medicine

[altmedskepticallook-9] Steven Novella. Alternative Medicine: a skeptical look Capital District Humanist Society

[10] Alternative medicine is becoming mainstream Los Angeles Times. Published November 9, 2009. Accessed 14 January, 2010.

[11] 'Alternative Medicine' Goes Mainstream Star Tribune, Minneapolis - St. Paul, Minnesota. Published August 5, 2009. Accessed 9 January, 2010.

[12] Alternative Medicine Goes Mainstream CBS News. Published July 20, 2006. Accessed 9 January, 2010.

[13] Alternatives Enter the Mainstream Washington Post. Published September 16, 2008. Accessed 9 January, 2010.

[14] Alternative medicine now mainstream Channel 4 News. Published July 27, 2007. Accessed 9 January, 2010.

[15] 'Alternative' Medicine Is Mainstream Wall Street Journal. Published January 9, 2009. Accessed 9 January, 2010.

[16] Alternative therapies moving toward the mainstream CNN. Published February 23, 1999. Accessed 14 January, 2010.

[17] Path to Alternative Therapies Is Littered With Obstacles New York Times. 13 November, 2009. Accessed 9 January, 2010.

[18] 'Alternative Medicine' Goes Mainstream Star Tribune, Minneapolis - St. Paul, Minnesota. Published August 5, 2009. Accessed 9 January, 2010.

[19] Alternative Medicine Goes Mainstream CBS News. Published July 20, 2006. Accessed 9 January, 2010.

[20] Alternatives Enter the Mainstream Washington Post. Published September 16, 2008. Accessed 9 January, 2010.

[21] Alternative medicine is becoming mainstream Los Angeles Times. Published November 9, 2009. Accessed 14 January, 2010.

[22] Alternative medicine now mainstream Channel 4 News. Published July 27, 2007. Accessed 9 January, 2010.

[23] 50 things that changed our lives in the aughts. Associated Press. Published 22 December, 2009. Accessed 9 January, 2010.

[24] 'Alternative' Medicine Is Mainstream Wall Street Journal. Published January 9, 2009. Accessed 9 January, 2010.

[25] [ http://query.nytimes.com/gst/fullpage.html?sec=health&res=9401E4D91638F93BA1575AC0A9629C8B63&fta=y Acupuncture Moves Toward the Mainstream] New York Times. Published September 28, 2004. Accessed 14 January, 2010.

[26] Alternative medicine meets mainstream hospitals USA Today. Published June 8, 2009. Accessed 14 January, 2010.

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