Talk:Alternative medicine/Archive 28

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Ruthless?

The following text has recently been added:

• In some states, CAM associations and practicioners have ruthlessly attacked medical licensing boards, demanding that their practices be given state sanction.

The first reference discusses one individual who is a CAM practitioner and is attacking medical boards, as well as mentioning numerous problematic physicians, many or most of whom are not CAM practitioners, but have various seedy or unethical practices. The second reference talks about CAM, but has no reference to any association or practitioner attacking licensing boards. The third reference discusses state legislatures granting recognition to CAM, again not mentioning attacks.

As far as I can see, it comes down to a single individual who has attacked a single licensing board. Clean Copy^talk 01:47, 2 May 2017 (UTC)

I agree that the language is a bit flamboyant and have changed it accordingly. Are you restricted from editing this page? If not you can edit the passage with an edit summary and mention the changes here if they are extensive. Edaham (talk) 05:09, 2 May 2017 (UTC).

Thank you for the less inflammatory language. It still goes way beyond the sources, which mention no cases of CAM associations and only one isolated case of a CAM practitioner engaging in this behavior.

I originally removed the entire passage as unsupported by the one source then quoted and the editor in question reverted the change and added two more sources whichever say nothing about such attacks. I am looking for consensus here and trying to avoid an edit warClean Copy^talk 09:23, 2 May 2017 (UTC)

May I suggest a cursory online search to see if other CAM doctors have engaged in similar behavior? It may be that the original passage just needs better sourcing. I don't think the original language was inflammatory, but I try to remove intensifiers from the encyclopedia where they are not required as per WP:PEA. Unless there's a case of very obvious vandalism or someone is trying to insert POV or hyperbole (which the edit in question is not), it's probably better to attempt to build on an editor's contribution rather than revert or blank their additions. You often find that in the act of building on an edit, the compromise you are looking for comes out in the long run. - additional: the search term "CAM lobbyists" returns quite a bit of varied info on similar activities. Edaham (talk) 09:39, 2 May 2017 (UTC)

Fine; I've removed the irrelevant references (which do not discuss licensing boards) and tagged the paragraph as needing further citations. Incidentally, if you found relevant sources, it would have been a good opportunity to include these! Clean Copy^talk 23:31, 2 May 2017 (UTC)

If we're going to stick close to sources (always a good idea), we should make sure not to overstate who's attacking whom (cf. WP:WEIGHT and Template:Who?) and to what degree (who says "ruthless"?). --Middle 8 (t • c | privacy • COI) 02:59, 4 May 2017 (UTC)

Who says "In some states"? QuackGuru (talk) 03:57, 4 May 2017 (UTC)

Commented out citations

@Johnuniq: My apologies for being late to notice, but I just saw that user:Johnuniq reverted my citation tag on the lead back on March 18 (https://en.wikipedia.org/w/index.php?title=Alternative_medicine&oldid=prev&diff=770879168). The reason given was that there were several citations given, but commented out. Please explain to me the reasoning behind such commented-out (invisible) references being acceptable. They do nothing to substantiate the validity of the claim to the casual reader, only to those savvy enough to wade through the source code, such as experienced editors. Indeed even the manual page on the topic of invisible text suggests that they be used for notes to other editors, with no mention of them being used for embedding references. --Foolishgrunt (talk) 16:09, 16 April 2017 (UTC)

Please see the link that started my edit summary (WP:LEADCITE). That is an accepted style. Johnuniq (talk) 23:22, 16 April 2017 (UTC)

I don't see any reference to commented citations in the manual page you cited. Perhaps it is an "accepted style," I admit that I am not the most versed editor. But perhaps you can answer my concerns more directly? Because I feel I have made clear my belief that this "accepted style" is contrary to the intended purpose of commented citations.Foolishgrunt (talk) 17:19, 22 May 2017 (UTC)

The "accepted style" is that the lead or introduction for an article need not have citations. The content of the lead should be summarizing properly cited information from the body of the article. If you see something in the lead which is not covered in the article, the fix is not to add the citation there. The proper fix is to add the material, with citations, at the proper place in the body of the article and, when appropriate, add or leave a summary - without citations - in the lead. Not everything in the body of the article merits mention in the lead.

I'd have to check, but Johnuniq has been around long enough that I would expect to find that the commented-out refs are simply duplicates of citations that appear later in the article. Commenting them out is not the way I would handle this situation (see prev paragraph - I would remove the citations in the lead if they were duplicates), but it's not a serious break, since the displayed text works the same for both approaches. — jmcgnh^{(talk) (contribs)} 18:41, 22 May 2017 (UTC)

Use of word "prove" in lead

As I understand it, empirical research doesn't offer proofs. In fact, Wikipedia's article on empirical research says, "It is important to understand that the outcome of empirical research using statistical hypothesis testing is never proof." The lead of this article seems to have been written by someone who doesn't understand empirical research, as it states: "Alternative medicine — or fringe medicine — includes practices claimed to have the healing effects of medicine but which are disproven, unproven, impossible to prove...." TimidGuy (talk) 17:13, 23 May 2017 (UTC)

The idea of scientific proof is commonly used as a synonymous with the sort of evidence you get in a properly run clinical trial. I therefore think it's quite clear that "impossible to prove" means impossible to demonstrate by experiment, "unproven" means that no suitably rigorous trial has been carried out, and "disproven" means that sufficiently rigorous trials have shown no benefit.

Also there's no need to go ad hominem with claims that the author "doesn't understand empirical research"; I have no idea if they do or not but please attack the article and not its writer unless there is strong evidence of bad faith. User:GKFX^talk 00:11, 29 May 2017 (UTC)

In very rare diseases (e.g. Cystinosis) conventional medicine does offer treatments where the level of of evidence is low by virtue of the small number of test subjects. As such the 'unprovable' differs in little or no way from conventional medicine with rare diseases and should be removed.

Further the lead is innpropriately long and should merely summarise the general content of the artile in the most balanced way possible. I have never seen a wikipedia article that gives three/four pages of content without a single reference. The earlier comment about leads not having references seems to be almost universally incorrect in Medical entries.--Leopardtail (talk) 12:21, 29 May 2017 (UTC)

Issues with definition in lede

Two things:

1. Lede used to include three definitions, which only partly overlap, but now only gives one (the "lacks evidence" aka EBM one). The other two have excellent MEDRS -- Harrison's; NAS (formerly IOM) -- which in fact dispute the EBM def'n (see Harrison's: [1], IOM: [2] pp.16-20). All three definitions belong in the lede based on the weight of these MEDRS.
2. Lede says "or fringe medicine" but where is the proof that e.g. Harrison's or IOM consider that term synonymous with CAM? (cf. WP:RS/AC)

Suggest restoring replacing current 1st sentence of lede with something like the original 1st sentence, which is now the first sentence under the Definitions and terminology section.

Addendum; clearer proposal: old version with better-weighted lede --Middle 8 (t • c | privacy • COI) 09:22, 7 February 2017 (UTC) || revision: rephrased last sentence for clarity and struck RS/AC 10:42, 7 February 2017 (UTC); addendum: old version 22:43, 7 February 2017 (UTC)

The lead is four large paragraphs long. I have no idea at all what you are asking here. -Roxy the dog. bark 09:45, 7 February 2017 (UTC)

Not the misrepresentation of WP:RS/AC ploy again! This applies to statements that specifically invoke consensus, it does not apply to general assertions. Alexbrn (talk) 09:47, 7 February 2017 (UTC)

@Roxy the dog Is the final sentence above now clearer? @Alexbrn RS/AC not central here, so for sake of argument, struck. -Middle 8 (t • c | privacy • COI) 10:42, 7 February 2017 (UTC)

No, because in fact your definition relies on misunderstanding and misrepresenting the sources. Experimental medicine ≠ alternative medicine. Carl Fredrik 💌 📧 11:40, 7 February 2017 (UTC)

You are suggesting we replace ...

"Alternative medicine or fringe medicine are practices claimed to have the healing effects of medicine but are disproven, unproven, impossible to prove, or only harmful."

with

"It is loosely as a defined set of products, practices, and theories that are believed or perceived by their users to have the healing effects of medicine, but whose effectiveness has not been clearly established using scientific methods, or whose theory and practice is not part of biomedicine, or whose theories or practices are directly contradicted by scientific evidence or scientific principles used in biomedicine."

Have I understood your question? -Roxy the dog. bark 12:51, 7 February 2017 (UTC)

(e/c) @Roxy the dog - Yes, that's the gist of it. Obviously we'd open with "Alternative medicine..." and we might improve the prose for (a) readability and/or (b) to stick closer to sources. --Middle 8 (t • c | privacy • COI) 14:49, 7 February 2017 (UTC)

No. Roxy the dog. bark 16:57, 7 February 2017 (UTC)

Why? --Middle 8 (t • c | privacy • COI) 17:41, 7 February 2017 (UTC)

Because it would be a retrograde step. Roxy the dog. bark 22:33, 7 February 2017 (UTC)

How is giving due weight to top-flight MEDRS [3][4] retrograde? (note: clarified proposal in thread-starter w/ older page version) --Middle 8 (t • c | privacy • COI) 22:39, 7 February 2017 (UTC) || revision: added note re clarification, 22:46, 7 February 2017 (UTC))

I don't believe that our current lead fails in that regard. -Roxy the dog. bark 23:01, 7 February 2017 (UTC)

That belief is inconsistent with the facts; cf. e.g. my and Carl's exchange just below. --Middle 8 (t • c | privacy • COI) 23:15, 7 February 2017 (UTC)

alternative text much less biased against alternative medicine as per Wikipedia guidelinesACN574 (talk) 23:39, 4 June 2017 (UTC)

@ CFCF You wrote: "No, because in fact your definition relies on misunderstanding and misrepresenting the sources. Experimental medicine ≠ alternative medicine."

Huh? Who mentioned experimental medicine? What do you mean by "your [Middle 8's] definition"? I'm arguing straight from cited material, e.g.:

• Harrison's, explicitly contradicting the lede: "Another definition, practices that lack an evidence base, is also not useful, since there is a growing body of research on some of these modalities, and some aspects of standard care do not have a strong evidence base."[5]
• IOM, summarizing: "This discussion of definitions shows that no clear and consistent definition of CAM exists" (but then they adopt a provisional one) [6]

Unfortunately the above material was disregarded when the lede was rewritten, without discussion, to portray a single definition: [7]. Those were your edits, so.... please be careful with sources, and AGF, OK? I'm not misrepresenting, and am sure we can get this right. --Middle 8 (t • c | privacy • COI) 14:54, 7 February 2017 (UTC)

I absolutely believe that you are acting in good faith, and misinterpreting things or relying on misrepresentations does not mean you are acting in bad faith. However, good faith does not compensate for lack of knowledge or want of ability to interpret sources correctly. Carl Fredrik 💌 📧 18:18, 7 February 2017 (UTC)

@ Carl Indeed. Which is why I don't doubt your good faith.  :-) Harrison's and IOM, above, could scarcely be clearer; I'm frankly amazed that anyone could imagine otherwise and be both (a) scientifically literate and (b) paying attention. (BTW, misrepresentation usually connotes deceit, hence the AGF concern, but thank you for clarifying that you didn't mean it that way.) --Middle 8 (t • c | privacy • COI) 21:10, 7 February 2017 (UTC)

Posted at Wikiproject:Medicine seeking input, here --Middle 8 (t • c | privacy • COI) 18:00, 7 February 2017 (UTC)
{{fixed}} — added:

"; and where scientific consensus is that the practice does not or can not work."

Carl Fredrik 💌 📧 18:25, 7 February 2017 (UTC)

I strongly support relying on an independent medical authority (e.g. the NIH's page on complementary and alternative medicine or the NHS's page on the same theme) to formulate the lede. Clean Copy^talk 02:44, 8 February 2017 (UTC)

• since the lead just summarizes the body, this discussion should focus on the definition in the body first, and if that is agreed upon, then a discussion about whether the lead accurately summarizes the body would be appropriate. Not before. I suggest this be tabled until the body is discussed. Jytdog (talk) 18:48, 7 February 2017 (UTC)
  • Jytdog, glad to see you here. The Definitions and terminology section covers a lot, and seems roughly OK in its weighting of different definitions, which IMO is sufficient to address the fact that the lede is not. But it used to be: old version; diff w/r/t current version --Middle 8 (t • c | privacy • COI) 22:28, 7 February 2017 (UTC)
• I generally agree with Jytdog, but I think that the first sentence in the lead is particularly (predictably) poor. It encompasses disproven (arthroscopic knee surgeries), unproven (codeine for cough suppression), impossible to prove (treatment of extremely rare diseases), or only harmful (hundreds of discontinued conventional treatments) treatments that have always been conventional medicine, but it excludes known-to-work unconventional treatments, such as honey for tickle-in-your-throat coughs and using a kitchen knife to cut off skin cancer, or self-inducing chemical burns to burn them off. Additionally, it completely fails to address the social issues that separate alternative medicine from conventional medicine. For example: a birth attended by a midwife (not a registered nurse who has subsequently specialized obstetrics) is still a form of alternative medicine in the US, but it's standard, conventional medical care in Sweden – and has been for about a century before the first RN was ever registered. How about Lamaze techniques, which were alternative then and conventional now? They don't work any better or any worse in 2017 than they did when the midwives started it in Soviet Russia, or when it became popular in the US during the 1960s. The definition of conventional depends upon what the society accepts, and therefore the definition of alternative depends upon the society, too.
  I believe that it's important to provide a basic (if perhaps sometimes oversimplified) definition of a subject in the first sentence. I think that this definition from the Merriam-Webster dictionary is worth using as a model: "any of various systems of healing or treating disease (such as chiropractic, homeopathy, or faith healing) not included in the traditional medical curricula of the U.S. and Britain". What's "alternative X"? It's the stuff that's sort of X, but it isn't the regular kind. It doesn't really matter whether "X" is medicine, rock, fuel, history, or facts: what makes it be 'alternative' is merely the fact that it's not the regular kind. WhatamIdoing (talk) 22:44, 7 February 2017 (UTC)
  • @WhatamIdoing -- just in case the discussion above your comment is getting tl;dr -- I think your concerns are largely addressed by the MEDRS I propose restoring: Harrison's and IOM (now National Academy of Medicine. (again; IOM's def'n is provisional; it's even more important to note that they concluded that there is no clear, consistent def'n of CAM) --Middle 8 (t • c | privacy • COI) 23:15, 7 February 2017 (UTC)
  • in these discussions it is a very, very bad idea to start with a ref that is not already used in the article. The LEAD summarizes the body (which, btw, does have extensive, sourced discussion that includes curricula and the differences among countries) Jytdog (talk) 23:38, 7 February 2017 (UTC)

*** but they ARE already in the article, Jytdog. Linked in my reply to WhatamIdoing. In the pertinent section, definitions. Which opens with a sentence modified from the old lede, which I propose restoring -- just that first, definitional sentence, reflecting the definition section. ("old lede" = four months old; the article hasn't changed enough to matter.) What's the problem? --Middle 8 (t • c | privacy • COI) 23:52, 7 February 2017 (UTC) || (added to cmt 23:57, 7 February 2017 (UTC))strike; never mind, I see you're replying to WhatmIdoing --Middle 8 (t • c | privacy • COI) 01:31, 9 February 2017 (UTC)

In the interest of not pointlessly replying to a reply that is only vaguely related to a different reply may I make a recommendation that an RFC would be in order if only so that some order can be brought to the conversation. Personally I think the information in the first sentence while true is not much of a definition and would do better as a second sentence. 2601:645:C201:5D0:7526:B28B:A5FD:67BE (talk) 04:06, 8 February 2017 (UTC)

In order to do that we have to have concrete proposals. Carl Fredrik 💌 📧 09:41, 8 February 2017 (UTC)

I certainly see no reason to engage in substantial rewrites just so that an acupuncturist is happier with it. Guy (Help!) 09:51, 8 February 2017 (UTC)

Heavens no, JzG, don't do it because of me, do it based on the weight of MEDRS in question. But if that's too much intellectual heavy lifting, yes, there's always a lazier route. --Middle 8 (t • c | privacy • COI) 10:05, 8 February 2017 (UTC)

@IP 2601... Point well taken; the language in the old lede is awkward, so better to start from a fresh proposal(s). Which I think should include refs and footnotes, so we can all tell what's sourced to what. --Middle 8 (t • c | privacy • COI) 10:17, 8 February 2017 (UTC)

No, much better to start fomr what we have and let reality-based editors propose any changes, rather than True Believers. You're an acupuncturist, Clean Copy is IIRC a Steinerite, essentially a believer in homeopathy. Both of you have ideological beliefs that are best served by watering down the facts. Guy (Help!) 10:53, 8 February 2017 (UTC)

• Specifics: "Committee on the Use of Complementary and Alternative Medicine by the American Public" is an industry-friendly group and not a MEDRS. The front matter of this report starts with the fallacious appeal to popularity and moves on from there. This can be viewed as much of a piece with OAM/NCCAM/NCIH - a politically-driven attempt to crowbar SCAM into reality-based medicine, promoted and funded by people with financial and ideological commitment to SCAM.

Harrison is a red herring since it merely recognises the fact that the SCAM industry has been successful in promoting quackademic medicine. The existence of quackademic medicine does not in any way offset the fact that the defining feature of SCAM is that it is not based in reality. Guy (Help!) 11:16, 8 February 2017 (UTC)

@Guy Re your beliefs about my beliefs, see our conversation on your user talk page.

Re sources: No. These are both gold-standard MEDRS that refute the lede's assertion of a single definition. (For specifics pls see green text above in my exchange with Carl.)

• Re IOM source. The "Committee on the Use of Complementary and Alternative Medicine by the American Public" was convened by the IOM to write this "consensus report" (see Details > Type). Such reports are "peer reviewed and are approved by the National Academies of Sciences, Engineering, and Medicine." So, yes, MEDRS, probably the strongest one we have for definitions.
• Re Harrison's: In the footnote we cite, the 1st and 4th sentences are the most pertinent. I believe you're referring to the 3rd, re "quackademic medicine".

Besides those sources, there's other stuff in the Definitions and terminology section that rejects a single def'n, despite which the lede goes ahead and asserts one anyway, running afoul of WP:LEDE and WP:WEIGHT. --Middle 8 (t • c | privacy • COI) 21:16, 8 February 2017 (UTC)

The problem here is that the world of quackademic medicine is full of flatteriing self-description. Its entire raison d'etre is to normalise quackery. So we should not use quackademic self-descriptions that undermine the fact that the foundational definition of alternative medicine is that it does not work. Minchin's Law applies. Guy (Help!) 21:53, 8 February 2017 (UTC)

That a definition is given does not in and of itself asset that only a single definition exists. It seems you read a lot of subtext that maybe doesn't exist. Your two sources while reliable do not seem very useful. The IOM source names every definition possible before deciding to just choose a working definition with the scope of just the report. The Harris source seems more interested in ducking the question than answering it. 2600:1010:B061:FE66:F13F:F6F7:946F:DF7F (talk) 01:11, 9 February 2017 (UTC)

@Guy I sense tigers afoot. There's self-evidently no scientific consensus on the def'n of CAM, and I can't think of anything that would justify discounting opinions endorsed by "the most recognized book in all of medicine" or a US National Academy (a nonprofit, nonpolitical NGO).

@ip260x:... On WP, asserting one view exclusively, such as a definition, is tantamount to saying that there are no other important ones. That subtext comes from NPOV. --Middle 8 (t • c | privacy • COI) 06:46, 9 February 2017 (UTC)

There will never be a scientific consensus on SCAM., because SCAM is defined by its rejection of the scientific method. By definition, alternative medicine either hasn't been proven to work, or has been proven not to work. The name for alternative medicine that is proven to work, is medicine.

SCAM, under its various brands, most recently "integrative medicine", is not scientific. You can see this very easily indeed by reviewing the quackademic medicine groups around the world. They variously include homeopathy, acupuncture, reiki, chiropractic, therapeutic touch and a number of other treatments that are based on entirely fictional concepts.

Don't take my word for it, go out and check. See what proportion of "integrative" departments you can find that do not use homeopathy, reiki or therapeutic touch. I pick those three because they should not raise cognitive dissonance for you, and because they are all comprehensively demonstrated to be bullshit.

If you integrate cow pie with apple pie, you don't make the cow pie taste better, you merely ruin the apple pie. Science knows that. There will never be a scientific consensus that the bullshit practices of alternative medicine are valid, because if they were, they would, by definition, no longer be alternative. Guy (Help!) 09:41, 9 February 2017 (UTC)

@Guy I understand what you're saying, but don't see where you're going content-wise. These other, "non-Minchin's-Law" definitions are silent on efficacy and pseudoscience. You can be the biggest CAM skeptic in the world and still use them. So I don't understand your objections. --Middle 8 (t • c | privacy • COI) 22:48, 9 February 2017 (UTC)

The article title is alternative medicine. Alternative medicine is defined by its lack of evidence. SCAM and integrative are rebrandings explicitly designed to co-opt possibly legitimate therapies in order to fallaciously assert that membership of a category which also contains legitimate therapies, thus makes illegitimate therapies, legitimate. That is the purpose of the rebrandings. And we're not going to fall for it. Guy (Help!) 09:38, 10 February 2017 (UTC)

@ Guy Are you saying that the "Minchin's-Law" definition of (C)AM ("treatments that lack evidence") is the only valid one? --Middle 8 (t • c | privacy • COI) 21:19, 10 February 2017 (UTC)

No, but it is the simplest and most concise one.

• Alternative medicine is defined as that which is either unproven or disproven (because otherwise it would not be alternative).
• Complementary medicine is any practice which complements that of reality-based medicine - such practices may be legitimate or not.
• Supplements, complementary and alternative medicine (CAM or SCAM) is a marketing ploy to co-opt the legitimate parts of complementary therapies in order to try to portray alternative medicine as sharing that legitimacy. It is an example of the categorical fallacy.
• Integrative medicine (aka quackademic medicine when found in medical schools) is a further rebranding, seeking to entirely remove the word alternative, without fixing the actual problem. I believe it was Dr. Gorski who popularised the aphorism that integrating cow pie with apple pie does not make the apple pie better.
• Holistic medicine is purest hogwash. All medical practice is holistic, or none is.

I don't think any of use are really confused about these things. Guy (Help!) 11:06, 14 February 2017 (UTC)

• just checking in. i've read the definitions sections about five times since i first posted above and am trying to think about how to summarize that content. this is not a simple problem. Jytdog (talk) 01:49, 9 February 2017 (UTC)

Minchin's Law is a good starting place. Guy (Help!) 09:41, 9 February 2017 (UTC)

yep the normative definition is discussed in the body, along with other things. Jytdog (talk) 09:47, 9 February 2017 (UTC)

Sidebar Q1: It's odd that Minchin's Law redirects to a target which doesn't mention it, someone have a usable source? Sidebar Q2: Do we have a concise name for conventionally accepted non-EBM interventions? LeadSongDog come howl! 17:44, 9 February 2017 (UTC)

Just google it :) it is ~a~ starting point but it is not the end point, should have mentioned that. One of my favorite comments ever on the relationship between alt med and conventional med was made by MastCell at a discussion at WT:COI. See here. Jytdog (talk) 20:22, 9 February 2017 (UTC)

Minchin's Law – which ought to redirect to Tim Minchin, the comedian(!) who started it – is the starting point of the True Believer. The only difference is that this true believer believes that the humans in conventional medicine can and do immediately accept data even when it contradicts their (biased) personal experiences and costs them both their livelihood and pride. In other words, they believe in a fairy tale that is every bit as pernicious to public health as the homeopaths'. The homeopath believes something that is scientifically laughable, but the skeptic believes that millionaire surgeons will stop doing the surgeries that made them millionaires just because researcher somewhere figured out that the benefits were all placebo effect. In reality, those surgeries are still happening, and the primary reason that fewer are happening is because the people in charge of the money refuse to pay for them now. There's not been a single report of a surgeon calling up a patient and saying "You know, we planned to do that surgery, but the data says it doesn't work anyway. I'm not going to do this surgery any more. Let's send you to physical therapy instead." Even people with solid scientific credentials and who believe that specific surgeries are inappropriate for a given patient will still perform them on demand, because they're humans instead of data machines.

Again, I think that the best starting point for a definition is to look at how professional definition-writers (such as dictionaries) and general sources (such as major medical textbooks) have defined it. I don't think that we should start with either group of true believers: neither the ones who think that most of it works, nor the ones who think that it's merely a question of scientific efficacy rather than (also) being a question of society's conventions. WhatamIdoing (talk) 23:01, 9 February 2017 (UTC)

WP:MEDRS, WP:FRINGE etc. clearly place scientific fact over societal convention. The most obviously applicable parallel is intelligent design. It's a religious belief which is objectively wrong, and that is exactly how we describe it. Guy (Help!) 09:34, 10 February 2017 (UTC)

I feel like we're talking past each other, so let me try again with a specific example:

• Fact: A planned home birth is "alternative medicine" in the US (in this century). Right? In parts of the US, it is actually illegal for a board-certified obstetrician to attend a planned home birth (Alabama, I'm looking at you).
• Fact: A planned home birth is "conventional medicine" in The Netherlands right now. 30% of Dutch women do it, it gets full social and insurance support, and it's normal. Right?

Given those facts, can we agree that the definition of "alternative medicine" is not exclusively a matter of scientific facts? Otherwise, we're going to have to re-write the definition of "scientific fact" to say that scientific facts depend on whether you're in The Hague or Montgomery. WhatamIdoing (talk) 21:39, 10 February 2017 (UTC)

A home birth isn't "alternative medicine" because it isn't medicine. Some of what happens at a home birth may be alternative medicine or conventional but the birth location itself is not. Lamaze for instance is no more conventional or alternative because they happen in your living room as opposed to a hospital bed. Turing down pain meds is going to have the same effect either place. You could argue it is an alternative practice but that would seem to be out of scope for this article. 137.254.7.171 (talk) 22:35, 10 February 2017 (UTC)

@ WhatamIdoing, ip 137... - Depends on which definition is used; e.g. home birth &c. could qualify if (C)AM is defined as care given outside the conventional medical system. In Germany, IIRC, midwives aren't part of the latter. --Middle 8 (t • c | privacy • COI) 00:25, 11 February 2017 (UTC)

Attending childbirth is practicing medicine, no matter what you do while you're there. If you attend a birth without a license and do everything according to the most perfectly scientific system, then you get charged with "practicing medicine without a license". If you attend a birth without a license and sacrifice a chicken while dancing around a flame, and tell the mother that your dance will save the baby's life, then you still get charged with "practicing medicine without a license". Medicine is not defined exclusively by its relationship to modern science (which is a good thing, because medicine existed long before modern science did).

Lamaze, of course, is a classic example of the problems with the 'Science über Alles' idea of defining alternative medicine purely in scientific terms. The science didn't change between the 1960s and the 1990s. The only thing that changed is how American society (=lay people, not researchers) felt (=as in "their emotional reactions") about it. If "stuff that works is medicine", then it isn't even theoretically possible for something to change categories (without re-writing the laws of physics). WhatamIdoing (talk) 03:50, 11 February 2017 (UTC)

So then we are in agreement that home birth is practicing medicine and not just medicine. You earlier referred to it as alternative medicine and not the practice of medicine and that is why I explained it was out of scope. I am sure there would probably be more alternative medicine at a home birth than at a hospital but each intervention would be judged on its own merits. I don't think the legality of an intervention has much to do with whether it is alternative or not. If a surgeon gets drunk before a heart transplant it doesn't mean that if he loses his license he was practicing alternative medicine.

I don't see why Lamaze would cause any issue with modern science except maybe ethically. It is a series of practices each of which could be tested if it wasn't ethically dubious to run tests during labor that effect pain. You can still do population studies to look at the whole system. As there doesn't seem to be much money involved though I doubt anyone will2601:641:4001:5C36:2156:FF19:1ADE:C996 (talk) 21:19, 11 February 2017 (UTC)

LeadSongDog, I think that there are two kinds of non-EBM conventional medicine:

1. Stuff that doesn't work, shouldn't be done, and gets done anyway: "Bad medicine". (Example: Over-the-counter cough syrup)
2. Stuff that hasn't been researched (to proper levels of evidence), and probably won't ever be: "Professional judgment". (Example: Multiple co-morbidities or extremely rare diseases)

WhatamIdoing (talk) 23:15, 9 February 2017 (UTC)

Thanks, WAID. (Jumping full into OR rant mode, here goes....) Certainly "Bad medicine" is a pretty massive sub-field. The persistent, widespread abuse of placebos or worse (e.g. using phenylephrine as a decongestant) is only one component.

I was rather hoping to find more specific terms to organize the overlapping subfields of bad, such as suboptimal-, ineffectual-, untested-, unproven-, untestable-, implausible-, dangerous-, et cetera. Obviously there are also the usual malpractice options of excessive ambition, blind incompetence, ignorance, fatigue, sloth, distraction, fraud, and so forth, but these are by no means specific to medical or even alt-med practice.

In altmed, one might consider energy medicine, faith healing, and homeopathy to be ineffectual, untestable, and implausible, but it's a bit of a reach to construe them as directly dangerous (save by omission to seek better options). Herbal treatments may tick off suboptimal, ineffectual, unproven, or even dangerous, but implausible doesn't always pertain: foxglove, belladonna, coca, opium, etc. have very well documented effects. Chiropractic or deep tissue massage are fairly safe and plausible for some specific indications, but are so routinely misapplied as to significantly discredit the whole of the practice. Acupuncture is rumored to work, but not very much, not verifiably using any blinding scheme yet devised, and no plausible mechanism has been elucidated.

There's lots of shame to go around. In conventional non-EBM, PSA testing and mammography are done regularly even though they are devalued as being both unreliable due to high false positive rates and even somewhat dangerous due to the stress or invasive interventions consequent to those false positives. Weight loss only rarely works long-term but it is still advised routinely, even including the use of some near-heroic interventions rather than reining in the fast-food monster. Esthetic plastic surgeries may achieve the physical effects sought, but how often do they really improve general health or self-esteem, and at what risk? Then there's the whole practice of patent evergreening, which has the effect of reducing access to effective medicines strictly for corporate profitability.

(Rant done.) By lumping all the alt-/comp-/integ-med fields together, we hide some of these distinctions. The same can be said about conventional non-EBM but we lack clear terminology. LeadSongDog come howl! 21:44, 10 February 2017 (UTC)

I believe that there's supposed to be a term for the 'argument from authority' issue in pre-modern medicine (from "Galen wrote..." through and including the "My attending said that in his experience..." model of medical education that persisted at least through the 1970s), but I don't know what the name is, and we don't have a separate article for it. WhatamIdoing (talk) 03:50, 11 February 2017 (UTC)

Not gonna lie, I've only skimmed through the above pages of discussion, but I also take issue with the lede as currently written -- I kind of like the NIH's definition of alternative/complementary medicine as being anything "non-mainstream". This allows for the inclusion of interventions with both scientifically-based rationales for efficacy and a slowly but surely growing body of trials (e.g. pretty much anything that decreases anxiety such as yoga, mindfulness meditation or pet therapy), while also encompassing interventions which have been disproven (like homeopathy). (Note: I came here from an article about a method that is, I think correctly, labelled as alternative medicine, but for which there is evidence of efficacy. If the Wikipedia definition of alternative medicine requires non-efficacy, then that and many other articles likely need to be changed and not link here.) -Kieran (talk) 22:25, 10 February 2017 (UTC)

What you "like" is not relevant; this isn't Facebook. The lead needs to summarize the body. Jytdog (talk) 23:32, 10 February 2017 (UTC)

@ Jytdog - NCCIH's definition is already in the article body under Definitions and terminology § Different types of definitions (not the exact page Kierano gave but essentially the same def'n). --Middle 8 (t • c | privacy • COI) 00:18, 11 February 2017 (UTC)

The lead needs to summarize the body. Jytdog (talk) 00:20, 11 February 2017 (UTC)

Jytdog FWIW, just saying that perhaps the lede's summary of definitions will eventually encompass NCCIH's, et. al. -- IIRC they're not the only ones to use it so it may be sufficiently weighted (but really no point in arguing over this now). --Middle 8 (t • c | privacy • COI)

proposed leads

• Alternative medicine is an umbrella term with unclear boundaries for a set of practices marketed or intended to improve or maintain human health, which are outside the norms, practices, or institutions through which medicine is practiced and taught in a given time and place. Some forms of alt med are continuations or adaptations of traditional medicines with prehistoric roots; some are based on folk medicine, and some of them are more recent inventions, but almost all of them are based on notions of the human body and mind, and their inter-relationship, that differ from those generated by science. Normative definitions characterize practices as constituting alternative medicine when, used independently or in place of evidence-based medicine, they are put forward as having the healing effects of medicine, but are not based on evidence gathered with the scientific method.

Something like that is how I summarize the body..... thoughts? Jytdog (talk) 04:15, 11 February 2017 (UTC)

• It's really long and difficult to understand. The last sentence in particular will be impenetrable to English-language learners and probably culture-bound to boot (but perhaps not in a bad way). How do you feel about splitting it into shorter sentences, like this?

Alternative medicine is any practice that users intend to improve or maintain human health, but that is outside the norms or institutions through which conventional medicine is practiced and taught in a given time and place.  It is an umbrella term with unclear boundaries.

I think that more, smaller sentences will work better. (Note that I've specified 'conventional medicine', since it is the contrast with conventional medicine that makes AltMed be 'alternative', and that is the only distinction that makes sense in historical [pre-existence-of-EBM] contexts.) WhatamIdoing (talk) 08:23, 12 February 2017 (UTC)

• Provisionally, looks very good; pace WAID, I don't have any problems with the prose. Sentence length and reading level are in line with other articles on en-WP. Am assuming that under this proposal the rest of the lede would remain as is. !vote is provisional because am still digest\ng Def'ns section, which is non-trivial; kudos to Jytdog for putting in the work. --Middle 8 (t • c | privacy • COI) 11:01, 12 February 2017 (UTC)

I disagree entirely and think that both those definitions are considerably worse than what we have now. They entirely ignore that part of the definition is that alternative medicine either: does not work; or is very unlikely to work — often with scientific consensus behind those positions or otherwise based on absolute faults or misunderstandings in the reasoning behind the practices (e.g. homeopathy). Any even potential effect of homeopathy is entirely due to placebo, and there is no dispute about this. All of is clear in the sources we cite, and is important enough to belong in the first or second sentence. Carl Fredrik 💌 📧 12:21, 12 February 2017 (UTC)

I agree however that something along the lines of Jytdog's "Some forms of alt med are continuations or adaptations of traditional medicines with prehistoric roots; some are based on folk medicine, and some of them are more recent inventions, but almost all of them are based on notions of the human body and mind, and their inter-relationship, that differ from those generated by science." should be added and that some rephrasing of the first paragraph can be done — just not by removing facts that are fundamental to the definition. Carl Fredrik 💌 📧 12:24, 12 February 2017 (UTC)

• In giving an example of how to write with shorter sentences, I did not mean to exclude the rest of the proposed sentences from the first paragraph.
• What makes something "alternative" isn't merely – or even most importantly – the absence of efficacy. Current conventional medicine has a long list of treatments that "do not work", and they're still conventional. Statistically, we know that most experimental drugs are "very unlikely to work", and they're still mainstream and science-based. Chiropractic was alternative even when conventional medicine was completely non-evidence based. The lack of scientific efficacy is (in modern times) a matter of strong correlation, not causation. WhatamIdoing (talk) 17:42, 12 February 2017 (UTC)

Okay, that makes more sense. However the first one or two sentences are potentially the most important in the entire article — many readers do not read more than to grasp a definition of the subject, and Google only includes two sentences. If we want to rewrite it we need to include that there is scientific consensus that alternative treatments don't work — whether this is based on statistics or a fundamental understanding of biological or physical processes is less important. Carl Fredrik 💌 📧 22:42, 12 February 2017 (UTC)

We might have to consider what "they don't work" means, given that the scientific consensus is that some do work (as well as highly effective placebos), others work (albeit worse than conventional treatments), a few work (about as well as the existing lousy conventional treatments), and still others work well (when the needs are emotional rather than biological). (On that last point, it's easy to dismiss this as lonely people seeking facetime by manufacturing medical symptoms, but it's more complicated than that. I remember reading a complaint from an oncology nurse that it sucked that her supposedly science-oriented hospital was doing reiki massage, but that in reality, patients needed to feel a human touch during their treatment, and signing them up for reiki massage was the only way the staff could guarantee that someone would have time to make that human connection happen. The hospital seemed to have chosen "add cheap reiki practitioner and get media love for doing cool altmed stuff" over "reduce the patient load for expensive nurses".)

On perhaps the more important point, Google Search is giving me between one and four sentences in the descriptions. It seems to depend partly upon sentence length, since there's a limit to how much can be displayed. I suspect that the choice of what to display depends more upon your keywords. But overall, I think that if the reader has gone to Google Search and is looking for just a definition of 'alternative medicine', then they're going to read the definition that Google provides in the big fat box at the top of the page. In that case/for that type of reader, it doesn't matter what we're putting in our articles. WhatamIdoing (talk) 06:55, 13 February 2017 (UTC)

• The Minchin definition is much clearer. Based on that:

Alternative medicine is any medical or pseudomedical practice whose efficacy is either unproven or disproven.

That is short and I believe 100% accurate. Guy (Help!) 11:11, 14 February 2017 (UTC)

It also has to be routinely used on patients as a treatment, as opposed to new medical practices which are still in the test stage - they are unproven too, at that time, but they are not alternative medicine. They can become alternative medicine if they are still used after they fail the test.

I think that those who contest the Minchin definition take issue with the implied statement that medical practices are automatically accepted by the medical community as soon as they are proven - SCAM proponents have a lower standard of proof and do regard SCAM practices as proven (by anecdote), but those practices still remain outside medicine. So, in their eyes, Minchin's definition is wrong. But that's just because of their wrong-headed definition of "proof". --Hob Gadling (talk) 11:52, 14 February 2017 (UTC)

@ Guy, Carl et al. - Ernst says some (C)AM's work.[8] He cites St John's Wort in two other refs as well [9]. There's another ref right in the article in which Ernst's methods found 7.5%, which he caveats as likely a "gross overestimate", but still, a good source saying some CAM's work refutes Minchin and makes the article contradict itself. At any rate Minchin wasn't the first def'n ever used, nor is there sci consensus it's the only or best one, or else our sci-consensus-level(ish) sources would all say so.

More important: As mentioned above but weirdly ignored/dismissed by proponents of Minchin, Harrison's flat-out contradicts Minchin (4th sentence) and our very best source (US Nat'l Academy of Med, née IOM) concludes that "no clear and consistent definition of CAM exists" so in light of the weight of these sources please indicate the basis in policy for solely asserting Minchin?? --Middle 8 (t • c | privacy • COI) 12:14, 14 February 2017 (UTC)

Well, there is no point using that — if we conclude that no definition exists we can only redirect to Quackery. That in turn wouldn't be too bad, but I don't think that is what you're looking for. Carl Fredrik 💌 📧 17:50, 14 February 2017 (UTC)

@ Carl Ah, better stick with giving primacy to Minchin, then, because all roads lead back to Minchin because I say so. That is one way to look at it. --Middle 8 (t • c | privacy • COI) 19:51, 14 February 2017 (UTC)

St. John's Wort is not alternative medicine, it is herbalism, which is the medical equivalent of historical re-enactment. Herbal remedies may indeed work. The reason St. John's Wort is not used in reality-based medicine is mainly due to dangerous interactions with other drugs: there are pharmaceuticals which have the same or similar effect with less risk.

And actually this is a perfect example of the fraud that is SCAM. St. John's Wort is not alternative, it has been investigated in the field of pharmagognosy and it would be used in medicine if it were not for the fact that safer alternatives already exist, but SCAMmers hold it up as if it validates entire categories of still-mainly-bullshit.

OAM/NCCAM/NCCIH has spent in excess of $3bn trying to validate complementary and (mainly) alternative therapies. The result? Nothing. Oh, except a post-hoc subgroup p-hacked out of possibly the most unethical clinical trial in modern history. At least they eventually stopped funding tests of homeopathy, which is something. Guy (Help!) 21:40, 14 February 2017 (UTC)

And there is the fact that each study corroborating the effect of St. John's Wort is out of Germany, while all studies from elsewhere equate it with placebo or worse than placebo. Carl Fredrik 💌 📧 21:43, 14 February 2017 (UTC)

@ Guy, Carl Yes, it is weird re St John's Wort; it seems to be better than placebo only in Germany, but as good as conventional antidepressants everywhere.[10][11] But here is the central point: Ernst defines herbal treatments, whether effective or not, as part of (C)AM because he uses a def'n different from Minchin's. It amazes me that you guys -- if I read you correctly -- are still arguing for Minchin as the main (or only?) definition when Ernst chooses a different one, IOM says there's no single best one, and Harrison's outright calls Minchin's "not useful". On what basis do you discount these good-as-they-get MEDRS? --Middle 8 (t • c | privacy • COI) 23:44, 14 February 2017 (UTC)

Again, this is tangential because herbalism is not alternative, it is proto-medicine, but the difference in results is to be expected given statistical variation and regional variations in standards of preparation of herbal products. The dose of active ingredient can vary wildly by season and by batch, because it's unevenly distributed around the plant and it varies according to growth cycles. The active ingredient works, but interacts potentially fatally with other drugs, so the dosage is incredibly important - and that's a real problem when the dose is not actually standardised at all. In the end, other drugs are less risky, which is why it's not used in the medical profession. And that is actually pretty much the only reason it's not used. Nobody has any ideological bias against it just because it's form a plant, whatever works and yields good treatment compliance is fine.

Your misunderstanding about Harrison is a simple and obvious one. Minchin does not say that alternative medicine is defined by lack of evidence, but lack of proof. There is an absolute mountain of evidence in respect of homeopathy, but it remains alternative because it is not proven to work (in fact isn as much as one can prove a negative it is pretty much proven not to).

Unproven or disproven does not have anything to say about the quantity of evidence, only the sum total of what that evidence says about efficacy.

Acupuncture is alternative because it's disproven for most conditions and unproven (with weak and often equivocal evidence) for a few. There's loads of evidence, but the evidence does not prove the claims. If it did, it would not be alternative any more.

Therapeutic touch is alternative because it is comprehensively debunked. A child of nine can design an experiment that disproves it.

Evidence is a part of the process by which proof is derived. Lack of proof in the presence of substantial evidence can be implied as disproof.

So your "good-as-they-get" MEDRS is not addressing the point. Nor is it addressing alternative medicine; it's talking about SCAM more generally. SCAM includes alternative medicine and also valid (and some not-so-valid) complementary therapies. And that's leaving aside the issue of whether it has succumbed to the dreadful postmodernist bullshit of "Integrative". Guy (Help!) 00:04, 15 February 2017 (UTC)

Guy: You keep asserting definitions as if they were settled, which is counter to the demonstrable scientific consensus (IOM) that they're not.

A) You're mistaken re Ernst.

• Ernst does address AM when he discusses CAM's: he says AM and CM are the same, the only difference being whether, respectively, they're used alone or along with biomedicine (see Question 1: [12]).
• Again, Ernst says that AMs can be effective, and he includes herbs; sources follow. To the question "So what areas of alternative medicine are helpful or effective, according to your research?" he replies "[s]ome herbs, like St. John’s Wort, are both effective and safe if used properly". (Also check out his answer to the first question -- provocative comparison, eh?) [13]. See also [14],[15],[16] (latter already in article).
• Ernst's def'n of CAM (also adopted by Cochrane) is relative to mainstream treatments, and is silent on efficacy, [17][18] in stark contrast to Minchin and the current lede. (Yes the therapies that come under each overlap to a great degree, but equating the two def'ns on that basis would run afoul of WP:SYN, of all things. :-)

So yeah, Ernst does address the point, and in several ways his opinion differs from yours.

B) You're mistaken re Harrison's.

• Harrison's also addresses AM: the same way Ernst does. Did you read the 2nd sentence? [19] Harrison's is also silent on efficacy (1st sentence).
• Yes, yes, "evidence (for efficacy)" is not exactly the same as an "evidence base". But Harrison's (4th sentence) still addresses the "unproven" part of Minchin, who defines AM as either unproven (i.e. evidence base absent or inconclusive) or disproven (evidence base conclusively negative).
• But it doesn't matter whether Harrisons (or any other MEDRS) outright criticizes Minchin: point is, they still differ. As with the demarcation of what is and isn't science, there are multiple credible, considered opinions, which are not to be depicted as facts.

So, yes.... Harrison's addresses the point too.

BTW, the UK's NHS agrees with IOM that "There is no universally agreed definition of CAMs" (and draws the AM/CM distinction as Ernst and Harrison's do) [20] .... so there's yet another gold-standard MEDRS telling us not to assert just one def'n, in case any doubt whatsoever remains after an unbiased reading of these sources. --Middle 8 (t • c | privacy • COI) 19:21, 19 February 2017 (UTC)

This article is not about SCAM. It's about alternative medicine. Of course there's no uniform definition of SCAM (or integrative), because they are deliberately designed to blur the lines by including potentially valid therapies with the deliberate intent to confer a halo effect on the bullshit that is alternative medicine and confuse the public into thinking that abject nonsense is no different from complementary therapies that have at least minimally plausible mechanisms of action. Guy (Help!) 21:54, 19 February 2017 (UTC)

Whatever Ernst and Harrison's (and NHS) say about CAM applies to AM. Read the sources I linked to. They do NOT say that CM includes anything that AM doesn't; that would be from someone else's definition -- enough already with the IDHT on this point. They say AM and CM are the exact same set of therapies, differentiated only by where they're used. Ernst makes this super-clear when he answers the "what areas of AM are helpful or effective" question with "herbs", above. That's Ernst saying there's an Alternative Medicine that is safe and effective, which totally contradicts your position. (BTW complementary medicine and integrative medicine happen to redirect here, so any lede that summarizes the body has to define those.) --Middle 8 (t • c | privacy • COI) 02:29, 20 February 2017 (UTC)

Ernst is certainly not under any illusion as to the difference between alternative medicine and SCAM. I know this because I have discussed it with him in person. This article is about alternative medicine, for which the Minchin definition is absolutely correct. SCAM and "integrative" are deliberate marketing ploys designed to create exactly the confusion you promote. Wikipedia's mission is to inform, not to assist the SCAM industry with its marketing, so we can and must make the distinction.

Alternative medicine was the original brand, and alternative medicine is defined by the fact that it either hasn't been proven to work or has been proven not to. That's why it is alternative.

After a while, they realised this was excluding them from lucrative areas of practice, so they co-opted complementary therapies in an attempt to claim a halo effect. That worked for a while but SCAM still includes "and alternative", and if we know one thing about alt-meddlers it is that they refuse to accept that their bullshit is anything other than ineffable truth (this is one of the main reasons I think alt-meddlers are actually a quasi-religious cult).

Thus we got "integrative" which drops the now-hated "alternative" altogether. But it doesn't change anything. Alt-med is still unproven or disproven. Selling it alongside things that are at least marginally plausible changes nothing.

Wikipedia is a reality-based encyclopaedia. We can describe the evolution of the marketing brand to minimise the impact of the alternative label, but we must not join the SCAM industry in pretending that because massage is plausible as a treatment for pain, thus homeopathy and acupuncture are too. That would be a dereliction of our foundational goals. We can tell the reader this is what happened, but we absolutely must not tell the reader that the rebranding changes anything, because it doesn't.

The SCAM industry has been doing fake news for decades via bullshit sites like Natural News, crunchy magazines, the FUD Babe and other such tools. Now is a great time to be really firm on not succumbing to that. The Trump presidency is the large-scale political manifestation of all the people who died because a supermarket tabloid told them baking soda cures cancer. Guy (Help!) 09:20, 20 February 2017 (UTC)

"It's alternative because it either hasn't been proven to work or has been proven not to" is not something that modern scholarly sources say. The comedian's definition is popular on the internet, but it's been explicitly rejected by scholarly sources. Instead, scholarly sources are saying that "it's alternative because it's not the regular kind". (One hopes that the stuff that doesn't work will never become the regular kind, but...) WhatamIdoing (talk) 22:05, 22 February 2017 (UTC)

I have to keep repeating this point. They are not addressing alternative medicine, they are addressing SCAM / integrative medicine, and the fact that some of SCAM is not obviously bogus is deliberate and by design: they co-opted legitimate complementary therapies in the hope of getting people to fall for a category fallacy. And it has worked rather well, as this discussion shows. Guy (Help!) 22:41, 22 February 2017 (UTC)

@ Guy and pinging WAID: Actually a number of them (Ernst, Harrison's, NHS) are addressing AM in the same breath as they address CAM. They define AM as "not the regular kind, used instead of the regular kind". They define CM as "not the regular kind, used alongside the regular kind", and they define CAM as the superset of the two. --Middle 8 (t • c | privacy • COI) 21:57, 2 March 2017 (UTC)

You can indeed make a case for a single article that traces the evolution, rather than separate articles for AM, SCAM and integrative. I don't dispute that. But Ernst absolutely does not consider AM and SCAM to be the same thing. This is obvious form his books and his blog posts and actually also you can ask him directly. So, I am happy to discuss the evolution in this article or separately, but I am absolutely not happy to buy into the SCAM industry's marketing ploy of bundling apple pie with cow pie and pretending this makes the cow pie a tasty treat. Guy (Help!) 09:45, 6 March 2017 (UTC)

@Guy As I said below, you'll need to produce those Ernst sources; the ones I've found say differently. [21] --Middle 8 (t • c | privacy • COI) 15:12, 16 March 2017 (UTC)

See below. Endlessly restating your interpretation of the sources does not change the documented facts. Guy (Help!) 10:55, 17 March 2017 (UTC)

• Support Jytdog's proposed lede as far superior to the current one. As observed by many, the current lede does not match the literature, which typically defines "fringe medicine" as medicine that is outside "Orthodox medicine". Jytdog's version correctly captured this distinction by the phrase "which are outside the norms, practices, or institutions through which medicine is practiced and taught in a given time and place." I did a Google book search on Fringe medicine and the first four sources all define "fringe medicine" this way. None of them simply define it as either unscientific or ineffective. There are statements such as:

"It would be historically misleading to imply that official medicine has always been competent where fringe medicine has been ineffectual or fraudulent."

"Orthodox medicine, for its part, has sometimes seen fit to assimilate fringe practices rather than lose patients en masse to marginal medicine....[e.g.] MESMERISM; it may be occurring today with acupuncture. In short, the historical distinction between medical quackery and orthodoxy has been more social than scientific." The Oxford Illustrated Companion to Medicine [22]

and

"The Faculty was obliged to recognise reluctantly that quack or secret remedies could do good. After a crusade against secret nostrums the BMJ was forced to acknowledge in 1912, 'It would be folly to deny that quack medicines ever did good. It would be strange indeed if they did not sometimes, as for the most party they are made of the materials in common use in medical practice.'[100 BMJ, 13 July 1912] And instances of serious illnesses, cited at this time as being untreated because of a recourse to nostrums, revealed several--TB and cancer amongst them--where contemporary medical treatment could have equally limited efficacy.[101 Report as to the Practice of Medicine and Surgery by Unqualified Persons, PP 1910 (Cmd 5422), p.20.]"

Digby, Anne, Making a medical living: Doctors and Patients in the English Market for medicine, 1720-1911, Cambridge Univ. Press. 1994, 2002. [23]

--David Tornheim (talk) 13:28, 15 April 2017 (UTC)

Alternative medicine vs. SCAM vs. Integrative

Complementary and alternative medicine redirects here. I don't know whether that is helpful or not, it certainly leads to the kinds of confusion Middle8 displays above. It seems to me that these are in fact two separate topics. Alternative medicine is relatively easily defined - I like the Minchin version but others exist. Alt-med includes things like homeopathy and Reiki, which are obvious bollocks. Alternative means unproven or disproven, this is simple and unambiguous.

A big chunk of the article is given over to the branding efforts of the SCAM industry. I would argue that this centre section describing things like complementary and integrative should be split out, with Complementary and Alternative Medicine and integrative medicine redirecting there. It's my view that alternative medicine is a useful categorisation, but as Middle8 has pointed otu at length above, SCAM is so vague as to be meaningless as a category, and it makes sense only as the marketing term which the facts show it to be.

I therefore propose that the content addressing definitions and classifications of SCAM and integrative, are spun out, in the interests of clarity and accuracy. Guy (Help!) 09:29, 20 February 2017 (UTC)

[I don't know how to contribute to this discussion, but I completely agree with the suggestion above.] — Preceding unsigned comment added by Lbertucci (talk • contribs) 07:09, 16 March 2017 (UTC)

In your personal opinion, is Cansema for skin cancer 'alternative medicine' or 'conventional medicine'? WhatamIdoing (talk) 22:12, 22 February 2017 (UTC)

It's alternative medicine. It's definitely not conventional medicine, because (a) it doesn't work and (b) its principal effect is disfiguring chemical burns and no doctor with even the most tenuous grasp of medical ethics would prescribe it. Guy (Help!) 22:38, 22 February 2017 (UTC)

It works better than placebo for superficial skin cancers (~10% permanent cure rate). That means "it objectively works", right? WhatamIdoing (talk) 03:12, 23 February 2017 (UTC)

That qualifies for a {{citation needed}}. Black salve is a caustic substance - it is possible that in burning out an area of skin it might also remove all signs of a low grade tumour, but that does not make it a sensible or safe way of doing so. There are surgical techniques that are much more accurate and do not damage the surrounding tissue. And of course a number of people who have "cured" cancer with escharotics never had a pathologically confirmed cancer in the first place. Final tip: don't do an image search for black salve unless you have a strong stomach. Guy (Help!) 08:28, 23 February 2017 (UTC)

PMID 24150196 (from Pathology of Royal College of Pathologists of Australasia) is one such source. And as you say, it's a biologically plausible mechanism. Any sort of caustic substance will cure some superficial skin cancers.

For anyone who wanders past this discussion later, let me point out that self-treatment with a kitchen knife gets a much higher cure rate for this condition, and a scalpel wielded by a trained person usually produces a cure rate that is very nearly 100%, usually with very minor scarring. Cansema is probably the least effective treatment that does anything at all.

So "it works" (better than denial, but not anything like as well as other options). Given that it does work (sometimes), is Cansema still "altmed" to you? I ask, because under the over-simplified definition you are supporting here, anything that "works" (even if it works poorly and has disfiguring side effects) is "not alternative". If we follow that definition, then Cansema is not altmed.

Personally, I'd rather have a better definition – one that easily includes Cansema. How about you? WhatamIdoing (talk) 17:48, 23 February 2017 (UTC)

Escharotics are not an effective treatment for cancer any more than a flame thrower is an effective treatment for cancer. Both will remove some skin cancers, but that's a side effect of the harm that they do and not a medically useful benefit. Guy (Help!) 21:59, 26 February 2017 (UTC)

If it "will remove some skin cancers", then it is effective for curing some skin cancers. That's what those words mean. We cannot say out of one side of our mouths that it removes some skin cancers and then say out of the other side of our mouths that it does not remove any skin cancers. If it removes any skin cancers, then it's an effective treatment for skin cancer.

Safety is a completely separate consideration. Relative efficacy, i.e., that the other options are better, are faster, have less scarring, are less likely to leave cancer cells behind, and even [for some of them] are cheaper than Cansema, which seems to be running around US $1 per gram online to give you a tenth of the curative chance that you'd get from two minutes with a doctor and a scalpel, is also a separate consideration. If it works at all = it is effective (to whatever degree it works). WhatamIdoing (talk) 04:44, 27 February 2017 (UTC)

No, it doesn't remove skin cancers. It removes skin. You might just as well say that a bath full of hydrofluoric acid bath cures cancer. Pretty much as per XKCD 1217, in fact. Guy (Help!) 09:39, 27 February 2017 (UTC)

It (cansema) removes both skin and skin cancer. A kitchen knife and a scalpel do the same; it's just each in turn removes a higher ratio of cancer cells to healthy cells, depending on how skillfully they're wielded. --Middle 8 (t • c | privacy • COI) 01:33, 2 March 2017 (UTC)

I point out here that the statement that Cansema "will remove some skin cancers" is a direct quotation from your immediately prior comment. I realize that we can all mis-speak, but really: it does actually cure a few skin cancers (through a particularly damaging mechanism that I wouldn't recommend even to people whom I dislike). It really does work (in a tiny minority of cases). And, in fact, it used to be mainstream medicine. Escharotics and other caustic approaches were the thing in mainstream medicine, for centuries – up until mainstream medicine decided that those barbers had a good idea, and they finally (after much kicking and screaming) gave up on it. (Cansema itself is strongly connected with the physician most famous for developing the Mohs surgery for skin cancer.) Cansema works (barely). It's still altmed (and a disaster for most people who use it). I conclude that we therefore need a more nuanced definition than "anything that works is mainstream medicine". WhatamIdoing (talk) 06:21, 2 March 2017 (UTC)

Again, XKCD 1217. Guy (Help!) 08:25, 2 March 2017 (UTC)

Unlike a bullet in a petri dish (which doesn't necessarily kill all the cancer cells; you could scrape the splattered cells up off the floor and put them back in a petri dish), Cansema works in real-world humans, and it's not fatal. But if you want to insist upon that silly example, then a perfectly placed gunshot can cure localized skin cancer, too (by physically destroying the cancerous tissue – which, unlike a culture of cancer cells in a petri dish, would not keep living if you scraped them up off the floor and put them back on the person's remaining skin). It would "work". That wouldn't make bullets a mainstream medical treatment for skin cancer.

We can do better than this simplistic definition, and we should. WhatamIdoing (talk) 16:08, 2 March 2017 (UTC)

"Cansema" (a bullshit marketing term for escharotics) works exactly as well as a flamethrower. It is not used medically for exactly the same reason that flamethrowers are not used. It is not clinically useful. It destroys tissue. If you point it at a cancer, some of the tissue it destroys will be cancerous, but this is pretty much incidental. It does not "work" in any meaningful sense. It is clinically useless. Guy (Help!) 18:14, 2 March 2017 (UTC)

Still it works, if only just. But if you want a safe and effective alt-med, just ask Ernst about St John's Wort. --Middle 8 (t • c | privacy • COI) 21:38, 2 March 2017 (UTC)

A flamethrower would burn the entire body. But if you said that it was as effective as those wimpy propane torches that they sell to home cooks who want to make crème brûlée, then I'd probably agree with you.

But: "it works". Minchin's definition doesn't require clinical relevance. It doesn't require specificity of action. It doesn't require anything except that "it works" better than random chance. (Even mainstream medicine has a 2% death rate for non-melanoma skin cancers, so perfection cannot be expected.) WhatamIdoing (talk) 07:14, 3 March 2017 (UTC)

Escharotics burn the entire body (or at least the bit to which they are applied). They are indiscriminate. People selling cansema pretend this is not the case, but they are lying. Escharotics "work" in the same way that chopping the affected body part off with an axe "works", which is to say, not in any meaningful sense. Middle 8 mentions St. John's Wort. That's not alternative, it's herbal. It's not used because the dosage is so hard to get right and there are substantial interactions with other treatments but there is active investigation into the active ingredient and safe ways to isolate and use it. That's the difference. Nobody is investigating escharotics, because they show no differential action in respect of cancer, they just burn indiscriminately. Guy (Help!) 15:25, 3 March 2017 (UTC)

@Guy Re herbs: look above where I posted "Again, Ernst says that AMs can be effective, and he includes herbs...", with sources. This is the 7th time I've mentioned this and the 0th time you've acknowledged it. --Middle 8 (t • c | privacy • COI) 04:28, 4 March 2017 (UTC)

Bored now. I have met Ernst, and neither he nor I nor indeed the sources consider herbs to be alternative - indeed, the desire of alt-meddlers to co-opt the occasional validity of herbal remedies is part of the reason for the SCAM rebrandings. There is an entire branch of science - pharmacognosy - devoted to the study of active substances in plants, it's not alternative. Herbalism, as a class, is distinct from alt-med, and the reason it si not mainstream is different. Herbalism would be mainstream if it withdrew remedies found to be ineffective (which it never does), and if it were able to demonstrate safety, efficacy and dosage of active ingredients for its products (which it also never does). This blog encapsulates it neatly. The stark difference between that and the usual "cannabis oil cures cancer" bullshit from hucksters is exactly what we're looking at here. Cannabis oil as a cancer cure, is alt-med (and based on alt-facts). Study of cannabinoids' potential to treat symptoms of chemotherapy-induced nausea, MS and the like, is science. Selling cannabis leaves is herbalism. There's an overlap but the differences are clear enough. Guy (Help!) 09:42, 6 March 2017 (UTC)

@Guy Bored you may be, but mistaken you certainly are. What you think, and what you claim Ernst thinks, make no difference here unless they help us track down (MED)RS, so I encourage you to start doing the latter. Recapping (the reader can decide for themselves): What I've found is that Ernst (and Cochrane) define CAM vis-à-vis the mainstream (and not efficacy)[24]; that Ernst defines alt-med and comp-med as CAM's used as replacements and adjuncts, respectively, to mainstream therapies[25]; and that Ernst explicitly classifies safe & effective herbal therapies under alt-med.[26][27]. That last one is from his blog, last October; has he recanted since then? Let's see those other Ernst sources that must exist, if you're correct. --Middle 8 (t • c | privacy • COI) 15:07, 16 March 2017 (UTC)

See below. Endlessly restating your interpretation of the sources does not change the documented facts. Guy (Help!) 10:54, 17 March 2017 (UTC)

Split

• "Alternative means unproven or disproven, this is simple and unambiguous.". Guy, there are two big things you need to do to get consensus for that assertion:

1. Please list the (MED)RS's supporting it, i.e. showing that the definition is in fact widely accepted.
2. Please square it with contrasting sources, starting with the fact that Ernst says that herbs, including ones proven safe and effective, are part of alternative medicine (note, not CAM, but specifically AM in these sources).[28][29]

Thank you. As for spinning out content, most sources use the phrase "complementary and alternative medicine" (and differentiate the two based only on sphere of use and not efficacy), so that's probably what the parent article should be. --Middle 8 (t • c | privacy • COI) 07:48, 23 February 2017 (UTC)

There is actually only one thing I need to do, and that is to get you to stop promoting the SCAM industry's deliberate conflation of alternative and complementary therapies. The difference is quite clear, and the problem is entirely down to the fact that the article has drifted in line with the SCAM industry agenda. It needs to be pulled back, and then SCAM/integrative treated separately. Alternative medicine is a class that can be easily described, and SCAM / integrative are marketing ploys designed to weasel alternatives to medicine into legitimate practice. Easy. And let's not forget that only one of us has a vested interest in SCAM, and it's not me. Guy (Help!) 08:15, 23 February 2017 (UTC)

Looking at the sources I'm unconvinced there is a significant different between complementary/integrative and alternative medicine. Many of the objections in this article address the interaction between medicine and alt/int/comp-treatments. I see no reason to split these up, seeing as they are ostensibly only different names for the same things. Carl Fredrik 💌 📧 11:48, 27 February 2017 (UTC)

There is a very important difference. Integrative (aka quackademic) medicine uses homeopathy, which is unambiguously alternative to pretty much anything including reality, but also uses exercise and physical therapy, which is complementary. That is the entire point, in fact. The woo-mongers are determined to get their beliefs misunderstood as valid. Guy (Help!) 12:38, 27 February 2017 (UTC)

Which demarcation system are you using? Note that Ernst says (emphasis mine) "Complementary describes the use as an adjunct to conventional medicine and alternative as a replacement. But it is important to realise that one modality can be used as either alternative or complementary medicine. This is why many use the term ‘CAM’ (Complementary and Alternative Medicine).".[30] (I guess exercise is a CAM but not sure about PT; I'm pretty sure that's part of mainstream medicine in the US - but as IOM and other good sources note, what's considered mainstream can vary, and boundaries are fuzzy.) --Middle 8 (t • c | privacy • COI) 01:45, 2 March 2017 (UTC)

I would not define exercise as complementary. In fact exercise can be prescribed by doctors in Sweden which will give you reduced fares at the gym or if needed sessions with a physical therapist free of charge (general sessions to for example promote weight loss or increase cardiac function and not specific for an injury). Carl Fredrik 💌 📧 08:15, 2 March 2017 (UTC)

Guy The two things I'm asking for are routine for any article, and the only reason I called them "big" is because they're almost certainly impossible to answer satisfactorily. The sources I've provided plainly demarcate CAM/AM/CM differently than you do, and it's fatuous to say that by doing so, they're somehow promoting CAM. (Or if they are, then promoting CAM has become the scientific consensus! -- cf. IOM, Harrison's, NHS, Ernst). They're silent on efficacy, which is not promotional.

Your comments above contain far too much "general discussion of the article's subject" and too few specifics, e.g. your refusal to answer my #1 and #2 above, which go straight to WP:BURDEN. That's bad for collaboration. In a good debate you address your opponent's/collaborator's best arguments, and stay as high on Graham's hierarchy of disagreement as you can. --Middle 8 (t • c | privacy • COI) 11:59, 28 February 2017 (UTC)

SCAM articles are not routine. The SCAM industry mastered fake news long before the alt-right discovered it, and we have to apply especial care to ensure we do not carelessly repeat industry marketing and PR as fact. Guy (Help!) 12:16, 28 February 2017 (UTC)

Oh, please. IOM, Harrison's, NHS, Ernst = sources that demarcate differently than you do ≠ SCAM marketing/PR. But you knew that, right? It's well past clear that this discussion with you is going nowhere, and not for lack of effort on my part. --Middle 8 (t • c | privacy • COI) 12:55, 28 February 2017 (UTC)

As usual, you are ignoring the history. As usual, the history is the important bit. As usual, that is the problem. SCAM = Supplements, Complementary AND ALTERNATIVE MEDICINE. The wider category includes the narrower. This article is about the narrower. The history shows the wider category exists solely in order to confer spurious validity on the narrower. And I can say with complete confidence that Ernst agrees, boith from his writings and from conversations with him. Guy (Help!) 13:06, 28 February 2017 (UTC)

If your position held water you'd have easily answered my #1 and $2 above. Reality-based indeed. --Middle 8 (t • c | privacy • COI) 15:03, 28 February 2017 (UTC)

Your repudiation does not qualify as rebuttal. Remember, only one of us has a vested interest in SCAM, and it's not me. Guy (Help!) 18:16, 2 March 2017 (UTC)

WP 101: Source your claims; account for sources that don't support them. You'll have to do better than "The Truth", cartoons et cetera. I'll wait. --Middle 8 (t • c | privacy • COI) 19:43, 2 March 2017 (UTC)

This is a talk page, so it's not necessary to footnote here, but if you want sources for the article discussing the evolution of SCAM as a marketing term to obscure the fact that alternative medicine doesn't work then there are plenty including Gardner, Randi, Ernst and others. It's not a controversial fact (unless you need it to be so for commercial reasons). Have a quick look at the article on the National Center for Complementary and Integrative Health, formerly known as the National Center for Complementary and Alternative Medicine, and before that the Office of Alternative Medicine. The evolution of the terminology is in there as clearly as the cdesign proponentsists left their footprints in Of Pandas and People. Guy (Help!) 20:06, 2 March 2017 (UTC)

Guy This is a talk page, where it's necessary to source your suggestions about content. You argue that the history justifies using Minchin's def'n, yes? If you're right, why isn't there general agreement among other MEDRS that in light of the SCAMmers' propaganda, Minchin's the way to go? --Middle 8 (t • c | privacy • COI) 22:31, 2 March 2017 (UTC)

Did you check the article I linked and note the evolution of the name? I understand that the world of SCAM would love to be able to say that Oceania was always at war with Eastasia, but the facts show very clearly the evolution of the term. Alternative medicine was the original, then complementary was added (the clue is in the word "and" in the industry acronym CAM), and then the rebranding was completed to "integrative" to fully remove the loathed term "alternative". But the alternative practices remain alternative, and for exactly the same reason: they either haven't been proven to work, or have been proven not to. SCAM and integrative are merely attempts to mix apple pie with cow pie in order to pretend that the two are equivalently tasty. Guy (Help!) 14:45, 3 March 2017 (UTC)

Yes, I did. And I don't see how that changes how we ought to weight strong (or stronger) MEDRS that define AM differently. --Middle 8 (t • c | privacy • COI) 06:38, 4 March 2017 (UTC)

They don't. They define SCAM. AM is alternative, SCAM includes the grab-bag of legitimate or quasi-legitimate practices that obscure the alternativeness. And this is obvious to everyone unless they are engaging in motivated reasoning. Guy (Help!) 23:03, 12 March 2017 (UTC)

@ Guy No; I addressed this two weeks ago,[31] and I know you read it because you replied.[32] I doubt that the MEDRS I've cited are "engaging in motivated reasoning". They just define it differently than you'd like, and you seem to find that difficult to accept. --Middle 8 (t • c | privacy • COI) 15:25, 16 March 2017 (UTC)

This is rather pointless. You "addressed" it by reference to a source that does not actually refute the documented facts. Alternative medicine, rebranding to include complementary, rebranding to exclude the hated "alternative" label as "integrative", and that is what the sources say, and you can see it in the development of the US government body. Exactly what that means for the structure and title of this article is a philosophical matter, but the facts are beyond dispute. The term alternative medicine existed before the term CAM, and CAM was coined specifically to obfuscate the reason that alternative treatments are alternative, which is that there is no good evidence they work. Guy (Help!) 10:51, 17 March 2017 (UTC)

Um no, Harrison's defines all three (CAM, AM, CM),[33] and I gave more than one source.[34] But over to user talk. --Middle 8 (t • c | privacy • COI) 20:02, 18 March 2017 (UTC)

• (I have no idea how to contribute, but please see the following link for the references showing that the definition of "Integrative Medicine" is widely accepted: https://en.wikipedia.org/wiki/Draft:Integrative_Medicine) — Preceding unsigned comment added by Lbertucci (talk • contribs) 07:11, 16 March 2017 (UTC)

Question: What does SCAM stand for? --NeilN ^{talk to me} 16:15, 2 March 2017 (UTC)

Supplements, Complementary and Alternative Medicine. Guy (Help!) 18:16, 2 March 2017 (UTC)

I'm sure that it was meant to be a bit of derogatory marketing by the anti-altmed activists, but it does deal nicely with the people who think "I'm not doing any altmed nonsense; I'm just taking sixteen dietary supplements". The downside is that it also includes and disparages medically appropriate dietary supplements, such as Vitamin C for people at risk of scurvy. It's a bit of a mixed bag. OTOH, the term is pretty effective as a social signaling device: it's very easy to identify the personal beliefs of the people who use the term. WhatamIdoing (talk) 07:14, 3 March 2017 (UTC)

It's quite easy to tell the difference between a worthless supplement and a medically useful one. A medically useful one is prescribed by a doctor based on pathology, usually a blood test, whereas a worthless supplement is either sold over the counter at a shop specialising in separating the worried well form their money, or is sold in the office of a quack (naturopath, chiropractor or whatever). Guy (Help!) 14:47, 3 March 2017 (UTC)

Yes, this. My best friend takes sublingual iron pills to help with iron deficiency anemia, brought on by stomach surgery done due to a possible cancer diagnosis. That's a PRESCRIBED supplement, based on all the available data and a medical diagnosis including blood tests that are done every few months to check the needed dosage. It's also a far cry from someone selling homemade supplements made from "herbs" that they claim will cure anything that the mark... er "patient" feels is ailing them. Morty C-137 (talk) 00:25, 5 June 2017 (UTC)

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Placebo effect section not about placebo effect?

Am I missing something? Much/most/all of the section "Placebo effect" appears to have nothing to do with knowingly using placebo effect as treatment in clinical practice, and using this as the excuse for using a treatment that in a controlled trial, performed no better than the placebo. David notMD (talk) 21:31, 4 September 2017 (UTC)

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Excellent source

Here's an excellent source for this article. It gives a lot of detail regarding the biological mechanisms underlying mind-body therapies. The journal has an impact factor of 9.4.[35] TimidGuy (talk) 21:59, 26 December 2017 (UTC)

Need for balance and NPOV

With all due respect to the people who put a lot of work into this very long and extensively sourced article, most of the writing comes off as polemical and one-sided. All forms of CAM are lumped together and condemned, often in ways that many readers would find insulting. If someone finds that a moist teabag soothes an eye irritation, is she a gullible fool who should buy Visine instead? If someone in Mexico or on an Indian reservation is having their daughters drink certain strong mint teas, an old tradition most likely originating in the desire to prevent pregnancy, are they gullible fools for not using modern hormonal birth control pills instead? If someone with arthritis or other chronic painful conditions finds that yoga, meditation, marijuana, etc. relieves their pain for them, are they gullible fools not to be taking opioids? Can someone in the health field (which I am not) please do some editing of this article to provide balance and NPOV? Thank you. (By the way, I'm a scientist who is strongly opposed to pseudoscience in any form.) NightHeron (talk) 00:17, 25 March 2018 (UTC)

You're much more likely to achieve success if you make specific suggestions, IOW exact wordings you find problematic, and better wordings to replace them. So suggest something better for a very limited target that you see as needing improvement. (I am in health care.)-- BullRangifer (talk) PingMe 00:23, 25 March 2018 (UTC)

I'd also like to remind you that it is the prerogative of any reader to feel insulted, that does not change the facts. Carl Fredrik ^talk 01:05, 25 March 2018 (UTC)

Just start with the long, unsourced (except for [1]) introductory section. Here's an example of what I'm talking about: "underlying logic is magical, childish or downright absurd" -- a quotation with no source or indication of whose judgment that is. Are you saying that, for example, all of the hypothetical people I mentioned (using teabags for eye relief, teas for contraception, yoga or pot for pain relief) are either believers in magic, childish, or absurd? Do you think it's a good idea to make your case by insulting people? Is that consistent with Wikipedia policy? I honestly wish success to my colleagues in the health field who are trying to combat quackery -- but isn't the best way to do that simply to state well-sourced facts (acknowledging a few areas where non-standard treatments have been shown to work) and avoid loaded and insulting language? NightHeron (talk) 02:17, 25 March 2018 (UTC)

Start by assuming good faith, instead of commenting on editors' motives. As we say here, "comment on content, not editors". Don't impugn the motives of other editors.

Whoever put that there presumably got it from a source used in the body of the article. Now we just need to find that source and add the reference to the quote in the lede, but only because you object. Otherwise, content in the lede doesn't always have to have the reference attached, because it is found in the body. A proper lede is supposed to summarize the body of the article, with nothing new that is not found below.

That's a good and specific thing we can work on. This may take some time, because life is also happening around us. Fortunately there is no deadline here. If no one else has found it before I can get back to this, I'll try myself. -- BullRangifer (talk) PingMe 02:38, 25 March 2018 (UTC)

Mystery solved!!! If you compare these two versions of the lede, you will notice a huge difference. The refs are visible in the first, and with the next edit they were all hidden. That means they are still there, but readers don't know it. I don't recall if there was some sort of consensus to do this, but editors need to know that they can simply undo the hiding (remove the <!-- --> symbols).

• Refs showing
• Refs hidden

I have now unhidden the ref for this one quote. -- BullRangifer (talk) PingMe 06:09, 25 March 2018 (UTC)

Do we really want all the refs in the lede to remain hidden, or should we undo this? -- BullRangifer (talk) PingMe 06:09, 25 March 2018 (UTC)

One of the problems with references in this lede is that they are so tight-packed that it would look like WP:REFSPAM, and only some of the statements in the lede have references there, others are present in the body. Of course referenced should be visible for quotations such as the one mentioned above, but the problem then is that it looks like the rest is not referenced (which it is). I wonder if there might be some way to group the references after each paragraph. Whichever way you look at it, it will be quite some work, and the lede is already very detailed. Carl Fredrik ^talk 12:37, 25 March 2018 (UTC)

Carl Fredrik, I understand your concerns and sympathize. Here are a few of my thoughts on the matter....

Ideally, a lede doesn't need any refs, but, when content is questioned, we are required to produce the refs, even in the lead. When that happens, I think we can do what we just did, and that is to unhide the ref when an item in the lead is questioned. Therefore no extra work needs to be done now. I think a notification box at the top of this page should explain this. I'll give it a try, and hope you'll improve it.  Done Look here. That is transposed to the top of this page.

As to moving refs to the end, I think that's a bad idea. The refs should be in immediate proximity to the word, phrase, or sentence(s) they support. I've seen such changes made, and later it was a nightmare requiring careful reading of every single source to determine whether a ref was used properly, and for which part of the content it applied. Therefore very close connection must be maintained at all times for several reasons.

I personally hate seeing the long, complete, form of the ref in the lead, as it makes editing more difficult. I prefer to only use the short "named" format in the lead. This also ensures that no refs are used in the lead before also being used in the body, as is required. Nothing should be in the lead which is not used in the body. My essay WP:How to create and manage a good lead section deals with this. -- BullRangifer (talk) 19:16, March 25, 2018‎ (UTC)

I much appreciate your prompt responses to my concern. But I wish you wouldn't accuse me of questioning editors' motives and failing to assume good faith. I've made it clear from the beginning that I have great respect for the editors and completely share their strong desire to combat quackery and pseudoscience. Obviously all the editors' motives are good. It's understandable that people feel angry about the quackery that makes up >90% of CAM (but not 100%). My point is that, according to Wikipedia NPOV, editors are supposed to avoid letting our emotions influence our wording, and we're supposed to provide balance. User CFCF correctly commented that if a reader feels insulted by facts, we shouldn't be bothered by that. But words like "childish" and "absurd" in reference to all of CAM -- even after you supply a reference for who said it -- are not facts, they're insults. Perhaps 90% of CAM advocates and users deserve to be insulted, maybe even 100%, but it's still not consistent with NPOV, as I understand the policy. So with all due respect I'm appealing to you to go through the article, change the tone to a neutral tone (one small example: no need for the comment about CAM-->SCAM), and acknowledge a few areas where CAM has been shown to work. NightHeron (talk) 12:50, 25 March 2018 (UTC)

The problem is that CAM has never been shown to work. Whenever larger studies are performed, the few positive results found in small studies are shown to be statistical flukes. The way modern medical science works is that you can get something published if you show that there is a less than 5% risk that your results are down to chance. Well, if 20 studies are published on a topic, odds are 1 will show a positive result when none really exists.

You may however be right about the quote about childish or absurd reasoning, it may be better to simply state that the reasoning is faulty.

One aspect that we fail to cover is placebo, but with an already very long lede I'm not sure how to best cover it.

The basic gist is:

• Placebo is a strong effect
• Placebo can even save lives
• Invoking placebo is not necessarily bad (even though it may be ethically questionable)
• Alternative medicine can help through placebo
• Alternative medicine can harm through a large range of factors, such as nocebo towards conventional treatment (a very real phenomenon, see Steve Jobs), drug interactions, financial toxicity (see Hallwang clinic), etc. etc.
• The alternative medicine lobby is strong and often ignores the real harms of alternative medicine and how practitioners prey on those who have little other hope (ethics and rational behind ban for marketing alternative therapies for cancer).

I'd really like to get in these points, and there are many good sources for them, but I'm at a loss how to start, with the lede being so packed with information. Maybe we could list down the points of information that it needs to get across, and then rework it from there? As it is now there I feel there is very little repetition, and nothing is superfluous, but it may be good to discuss. So, what do you think? Carl Fredrik ^talk 13:20, 25 March 2018 (UTC)

I'm very glad you agree that words like "faulty" are preferable to "childish" and "absurd". I much like your summary of the problems with CAM and also the placebo effect. On the question of balance, I believe it would really help the article to specifically acknowledge a few exceptions to the general rule that CAM is bogus. Let's take herbalism, which is not entirely analogous to prayer or energy transfer or other nonsense. There's considerable evidence, for example, that certain herbs have contraceptive and/or abortifacient properties and have been used for that purpose with a high degree of success for many centuries in many parts of the world. (Let me know if you want sources for that.) Contraception and abortion cannot be explained by a placebo effect. Looking at it historically, animals have been domesticated for thousands of years, and farmers have known that ingestion of certain plants leads to abortion and interferes with breeding. It stands to reason that women who observe this and who want to prevent pregnancy would try out those plants, and most likely that's the origin of folk knowledge of contraceptive/abortifacient herbs. In modern times there've been many cases (for which there are plenty of sources) of injury and death from misuse of these plants by people who lacked knowledge of how to use them safely and who believed that nothing "natural" could harm them. Nevertheless, even in our time such herbal approaches to contraception/abortion are being used in some (rural) areas of the world. Herbalism is not 100% pseudoscience, since in fact some of the ingredients in the plants are also used for the same purpose in modern pharmaceuticals. Do you agree that it would improve things to include some of this? Thanks, NightHeron (talk) 14:34, 25 March 2018 (UTC)

As I see it we already include that, because herbalism isn't alternative medicine per se. Rather it is traditional medicine, in which there is considerable knowledge that can be incorporated into modern medicine.

This is from the first paragraph of the lede:

Alternative treatments are not the same as experimental medicine or traditional medicine, although both can be used in a way that is alternative or fringe.

It becomes alternative medicine when it is used in defiance of any evidence spare anecdote, or when used outside a controlled experimental setting. A major difference between alternative medicine and experimental medicine (among many) is that experimental medicine is not marketed. Carl Fredrik ^talk 15:49, 25 March 2018 (UTC)

NightHeron, I see that our NPOV policy is causing you troubles, and I can understand that. It is often (always?) misunderstood by ordinary readers, and very often by experienced editors. The "neutral" does not refer to "no point of view" or "neutered point of view". It refers to editorial conduct when editing, and not to sources or content. Our content often comes from biased sources, and documentation of those biased POV will lead to content which appears biased.

If a statement is controversial, we will often attribute it. Sometimes only the reference suffices for that purpose, and at other times we must put it in the text: "According to the top researcher on this subject, professor Blah Blah, 'remedy Humbug is pure garbage and dangerous. Those who sell it are criminals and those who use it are gullible and foolish, and are putting themselves in harm's way'." We would never write such a statement in Wikipedia's voice, without quotation marks. We would quote it exactly and add context for who said it. (Editors are not allowed to add their own content, quotes, or POV.) Is it offensive? Yes, especially to the quacks who sell it, and to those who gullibly believe in it. Good. They deserve to be offended. Lives are at stake.

NPOV expressly allows for use of biased and non-neutral sources, and requires editors to remain "neutral" when documenting what those sources say. They must not remove, lessen, or censor the biased POV in the sources. In fact, they should not refuse to use such a source because its POV is at odds with their own. Good editors are supposed to be able to edit for their adversary. It is against policy for editors to censor content solely to spare readers' feelings. There can be other reasons for doing it, and sometimes we do, but it should never be done to actually hide an uncomfortable POV. Wikipedia is uncensored in many ways.

You can read more about this in my rather extensive essay: WP:NPOV means neutral editors, not neutral content. -- BullRangifer (talk) PingMe 20:09, 25 March 2018 (UTC)

Thanks, BullRangifer and CFCF, for your explanations. I don't have problems with any of what you say, but I still think there's an NPOV problem with this article, perhaps in part because it's long and written over a long period of time by many people, and so has inconsistencies. As you say, there is no violation of NPOV is using sources that are all very negative about something that is "fringe" in its entirety without any credible, mainstream defenders of any of it. However, several parts of the article (section 3.5, the discussion of the NCCIH classification, the discussion of the work of Edzard Ernst, and elsewhere -- near footnote 258 "herbalism" is lumped with "prayer") give the impression that herbalism as a whole is being included in your definition of "alternative medicine" and so is worthless and fringe.

Aside from that, the article states that about 1/3 of physicians use some kind of CAM in their practice, a large number of medical schools give courses in it, and a U.S. government agency is pushing it. So it's hard to believe that there are no credible sources that could present a less negative POV on (some of) CAM. As I understand it, NPOV means that sources that editors personally disagree with should be included in a reasonable balance, provided that they are serious mainstream sources.

A lot of readers rely on Wikipedia for an unbiased overview of something that they know little about. If we want to give an entirely negative (and strongly worded) coverage of something, we should be sure that the topic of the article is clearly defined so that it does not include anything about which there can be a reasonable difference of opinion.

Thanks again for your thoughtful and prompt responses to my concern. NightHeron (talk) 21:07, 25 March 2018 (UTC)

CFCF and Bullrangifer please look at Wikipedia's discussion of CAM in Cuba. What do you think? Thanks. NightHeron (talk) 23:01, 26 March 2018 (UTC)

I've touched it up a little bit, removing non MEDRS sources. I think what has happened is that the NFAM source (http://www.nfam.org/2004yearendnewsletter_cuba.html) mixed up what an alternative treament is with an alternative medicine treatment. Having gone through meta-analysis and proper scientific inquiry, policosanol and related treatments may be an alternative to the more expensive statins, but are not under any circumstance alternative medicine. Also much of that information was built on sources from the early 2000s, it seems likely there are better sources, or in the absence of updated sources the statements are likely discredited. Carl Fredrik ^talk 23:15, 26 March 2018 (UTC)

My guess about what's happening in Cuba (this is anecdotal, based on talking with people there, not based on any printed sources) is that the Ministry of Health decided to coexist as much as possible with CAM, including forms they disapprove of (but might be okay for psychological/placebo effects in reduction of pain or stress, if properly supervised), and try to keep an eye on things. They've definitely incorporated traditional herbalism, and I was told that in recent years they've trained their physicians in the use of medicinal herbs, including the interactions between such herbs and modern pharmaceuticals. Although they did this only out of necessity (largely because of shortages caused by the U.S. embargo), they seem to think it's worked out to be not such a bad idea, rather than having a rigid division (as in the U.S.) between scientifically established medicine and everything else (and not regulating the "everything else"). Since I'm not in the health field, I can't make an independent judgment -- just reporting what I was told. NightHeron (talk) 00:11, 27 March 2018 (UTC)

A failure of mainstream medicine

reset: changes can be suggested along with their corresponding medical reliable sources in the next thread.Edaham (talk) 18:17, 22 April 2018 (UTC)
The following discussion has been closed. Please do not modify it.
The edit at https://en.wikipedia.org/w/index.php?title=Talk:Alternative_medicine&oldid=prev&diff=833011740 suggests that what I added was Soapboxing. If BullRangifer can explain what parts of it were soapboxing, and exactly what that means, that would be helpful. Dscotese (talk) 20:52, 21 April 2018 (UTC) I think it was simply overly long and while relevant I think it needs to be balanced and better explained. The failure should be defined as coming from the perspective of seeing alternative medicine as a public health risk, not as actually serving some real purpose. Carl Fredrik talk 21:45, 21 April 2018 (UTC) Dscotese, what I deleted violates WP:SOAP, WP:TALK, WP:ADVOCACY, and giving medical advice (not sure of the policy acronym). Here are a few phrases from your post: educate people on this talk page So I'll explain a few things here you have to experiment on yourself. Explore homeopathic remedies. There is a book by Dr. Joel Fuhrman called "Fasting and Eating for Health" which has tons of references to articles that show NeilN's claim to be BS, (in case you want to disabuse yourself of that claim, Neil). Maybe NeilN can tell us whether or not fasting is "alternative medicine." If we are going to try to introduce Wiki readers to anything that is better than mainstream medicine, we will have to be very subtle and gentle about it. Your sarcasm was beautiful and much appreciated. I'm about to make an attempt. Wish me luck! What part of that is a legitimate use of Wikipedia? Not.one.single.bit. You're welcome to explain your beliefs on your own talk page IF someone asks you, but to preach, advocate, and sell fringe ideas really isn't a welcome activity here. I'll ping a few admins who can explain this to you: NeilN, MastCell, Jzg. -- BullRangifer (talk) PingMe 01:53, 22 April 2018 (UTC) Took me a bit to figure out what Dscotese was complaining about. My statement, ""Alternative medicine practices have little scientific evidence supporting their claimed efficacy" summarizes Alternative_medicine#Efficacy. If there is scientific evidence that proves the efficacy of certain practices then editors are welcome to present it. Obviously a self-help diet book isn't scientific evidence and comes nowhere close to WP:MEDRS. I am emphatically not interested in being lectured on or debating editors' personal viewpoints on this subject (pro or con) - that's not what this talk page is for. --NeilN talk to me 02:32, 22 April 2018 (UTC) Bingo! "that's not what this talk page is for." That summarizes the essence of WP:TALK. Article talk pages have a specific purpose, and what you wrote was not in line with that purpose, which is to develop and improve content. That normally starts with what RS say, and for the medical content in any article, WP:MEDRS is the rule to follow. -- BullRangifer (talk) PingMe 02:55, 22 April 2018 (UTC) Dscotese, there are many ways of defining alternative medicine (AM), but one of the most entertaining is found in Tim Minchin's 9-minute beat poem "Storm". It's funny, and also makes some very serious points. One part is this very concise definition of AM: "Alternative Medicine...has either not been proved to work, or been proved not to work. Do you know what they call 'alternative medicine' that's been proved to work? Medicine." It's a catch-22 definition that condemns AM to always be on the fringe as unproven or disproven. That makes it unethical, and sometimes illegal, to market it, but that's what quacks do. The co-founder of Wikipedia, Jimmy Wales, has written about this: "No, you have to be kidding me. Every single person who signed this petition needs to go back to check their premises and think harder about what it means to be honest, factual, truthful. Wikipedia's policies around this kind of thing are exactly spot-on and correct. If you can get your work published in respectable scientific journals - that is to say, if you can produce evidence through replicable scientific experiments, then Wikipedia will cover it appropriately. What we won't do is pretend that the work of lunatic charlatans is the equivalent of 'true scientific discourse'. It isn't." — Jimbo Wales, March 23, 2014. See: Wikipedia:Lunatic charlatans I suggest you read the definitions in the article. We have a good section on this. -- BullRangifer (talk) PingMe 03:17, 22 April 2018 (UTC) Without meaning to show any disrespect to Jimmy Wales, there's a real problem in taking the POV that every healing modality either has been verified in scientific publications or else is lunatic charlatanism. Are all "home remedies" lunatic charlatanism? Using a moist teabag rather than Visine to soothe an eye irritation? Does Wikipedia have to see a scientific study in order for an article to acknowledge that something like that is used around the world by people who are not idiots? My hope is that an article on CAM would also acknowledge the reasons why an intelligent person might be drawn to it. For example, in many countries (including the U.S., which has millions uninsured or underinsured or underserved by physicians) many people have difficult access to modern health services. In addition, there have been well-publicized cases of the failure of our system of medical research (COI of researchers, fraudulent methodology -- discussed, for example, by Marcia Angell in connection with psychotropic drugs for children). And in the U.S. there's the opioid "epidemic". Is it really so bad if someone uses some form of CAM (yoga, meditation, a placebo) instead of an opioid to relieve their pain?NightHeron (talk) 08:10, 22 April 2018 (UTC) Are all "home remedies" lunatic charlatanism? Using a moist teabag rather than Visine to soothe an eye irritation? Yes. Does Wikipedia have to see a scientific study in order for an article to acknowledge that something like that is used around the world by people who are not idiots? Yes. My hope is that an article on CAM would also acknowledge the reasons why an intelligent person might be drawn to it. But to do that you need articles to cite. This is my hope as well, but it is false to do this based on poor sources. I think you're falling into the trap of equating "using alternative medicine" and "promoting alternative medicine". One side is misguided and absolutely includes a fair share of sane people, whereas the other are de facto the "lunatic charlatans" that Jimmy Wales was referring to. I'm all for viewing alternative medicine in the light of a failure of medicine, but we need to balance that so that it doesn't justify alt-med, but rather shows what a problem it is. Right now no one seems to be doing this. It's either "that's WP:SOAPBOXING" or "alt-med is justified", neither of which are true. The added text was unbalanced and non-neutral, not much more to it. Carl Fredrik talk 08:35, 22 April 2018 (UTC) I think also NightHeron that we aren't getting the full picture here, I had mixed up this slighly problematic edit with this very problematic edit. We should let this cool down and instead discuss what we could include and where. Dscotese is obviously WP:NOTHERE and an WP:ADVOCATE, which makes their edits problematic. Carl Fredrik talk 08:39, 22 April 2018 (UTC) @CFCF: Are you saying that the widespread belief that a moist teabag is effective (in absorbing and removing from the eye certain irritants such as dusk and pollutants) has been scientifically shown to be wrong? Or that a promoter of this home remedy -- such as a blogger who advises that for eye irritation "first try a wet teabag, and if that doesn't work go to the store and buy Visine" -- is an anti-scientific charlatan? Jimmy Wales' dramatic statement quoted by User:BullRangifer is an opinion, not a fact proved by science. In some parts of the world people often use treatments whose safety and effectiveness have been neither proved nor disproved by rigorous scientific study. Are promoters of such treatments (such as in many cases local doctors) "lunatic charlatans"?NightHeron (talk) 15:02, 22 April 2018 (UTC) Quite frankly, your questions are not addressing the real points of relevance here: how article talk pages must not be used to advocate fringe POV, our content must be sourced to RS, and that WP:MEDRS is the specific guideline to follow. -- BullRangifer (talk) PingMe 17:01, 22 April 2018 (UTC)

Possible new section on reasons for CAM's appeal to many

Start of an outline (but really should be written by someone in health sciences, not an outsider like me):

• Failures of modern medicine
  • David H. Freedman, "Lies, damned lies, and medical science" in The Atlantic, Nov 2010
  • Marcia Angell, "Industry-sponsored clinical research: A broken system" in JAMA 2008, and her article "Drug companies and doctors: A story of corruption" in NY Review of Books 2009
  • I didn't see what was wrong with the quote from the Ernst source that was recently deleted by User:Zefr
  • (historical) Early birth control pills had not been adequately tested for harmful side affects (sources not hard to find), also Dalkon Shield
  • (historical) Opinion by the distinguished gynaecologist/obstetrician Frederick J. Taussig, who in the 1930s wrote that "therapeutic" abortions (legal, performed by doctors) were more dangerous than illegal abortions performed by midwives (see Wikipedia article on him for the reference)
  • (historical) Historians of women and medicine have written that a central objective of the AMA's campaign against irregulars, culminating in the Flexner Report, was to reduce women's role in the health field.
  • Failure of modern science to adequately investigate (and incorporate the positive elements of) traditional medicine and deal with the various (often badly distorted) versions of traditional healing modalities that have survived urbanization and modernization. An area where I can supply some sources is herbal abortifacients (sometimes called "menstrual regulators").
• Failures of society to provide modern medicine equitably
  • Even a rich country such as the U.S. has millions uninsured or underserved, along with spiraling costs (sources easily available)
  • In many developing countries most people do not have access (WHO, other organizations have reports on this)
  • Cuba, which is acknowledged to have one of the best health care systems among poor countries, still has shortages caused by the U.S. embargo, and for that reason has incorporated certain types of CAM (my sources are informal, but probably better sources are available)
• Growth of anti-science movements broadly as part of political "populism" (this has been written about a lot, especially in the U.S. in the Trump era, and some sources have grouped together climate change deniers, evolution deniers, and scientific medicine deniers), along with failures of educational systems even in some of the wealthy countries.NightHeron (talk) 11:47, 23 April 2018 (UTC)

sounds like a different article. This article is about alternative medicine. The material you are suggesting might be worth a sentence in the lead, but you can imagine what the article would look like if, for example, we were to put all of the material written on why people use guns, in the Wikipedia article on guns. It would be very easy to stray into a sociological ramble. I don’t think that populating this article with reams of material about the failings of the medical profession does much to tell people about the subject of this entry. Our scope isn’t to build a justification for AM, it’s just to say what it is. Edaham (talk) 16:00, 23 April 2018 (UTC)

@Edaham: After a previous discussion was criticized for not focusing on sources and specific suggested changes, I posted the above concrete suggestion. Despite the famous quote from a co-founder of Wikipedia about "lunatic charlatans", that does not mean that the Alternative medicine article gets a dispensation to ignore WP:NPOV, WP:GLOBALIZE, and WP:EDITORIALIZING. At present the article is extremely polemical and one-sided. Look, for example, at the chart about "traditional ethnic systems" (mainly in China and India). Although one sentence in the lede seems to exclude "traditional medicine" from CAM, the main body of the article is from the POV that all traditional medicine (except for a small part that's already been incorporated into scientific medicine) is, in the words quoted in the lede, "magical, childish, or downright absurd." The truth is much more complex. Consult, for example, works by the eminent historian of medicine John M. Riddle. My suggestion was designed to help bring this article into compliance with Wikipedia policies about avoiding editorializing and systemic bias (such as Eurocentrism). As I've said before on this talk page, the anger of people in health fields toward quackery, fraud, and pseudoscience is fully justified. But in my opinion a polemical article that over-reaches is much less effective in educating people than a balanced article that acknowledges complexities.NightHeron (talk) 19:58, 23 April 2018 (UTC)

it doesn’t get a dispensation to ignore NPOV, but it does get a dispensation to ignore huge amounts of material which is outside the scope of the subject. Also you’ve put so much stuff into your last suggestion it’s hard to see (per due) what could be condensed into an actual piece of article text. I think testing the water by returning to a “replace x with y” or “insert c between a and b” format would be productive. In short, it’s difficult to agree or disagree with your suggestion because it is widely overarching and very general. If you believe that the whole article needs a rewrite based on your approach to it then it’s going to be you who does the work (and defends it), but rather than try to slay that dragon on your own I rather suggest you try to offer suggestions piece by piece. Edaham (talk) 23:57, 23 April 2018 (UTC)

@Edaham: Okay, fair enough. Here are two specific suggestions to start with:

• Delete quotes that have no scientific content but are just angry opinions, starting with the one in the lede about "magical, childish, or downright absurd"; and whenever possible replace insulting words such as "lunatic" and "charlatan" with factual words such as "untested" or "unproven" or "not based on the established scientific principles of physiology". Also, delete the word "fringe" from the beginning of the article or any other reference to the entirety of CAM, in order to be consistent with the following information from the section on definitions of CAM: "alternative medicine is taught in more than 50 per cent of US medical schools and increasingly US health insurers are willing to provide reimbursement for CAM therapies.[78] In 1999, 7.7% of US hospitals reported using some form of CAM therapy; this proportion had risen to 37.7% by 2008." It's hard to justify the use of the word "fringe" for the entirety of CAM if some CAM is taught in more than half of all US medical schools.
• Make the main body of the article consistent with the following two places in the lede: "Alternative practices, products, and therapies – range from plausible but not well tested, to..." and "Alternative treatments are not the same as experimental medicine or traditional medicine..." These phrases suggest that there's a large set of treatments (some typically called "traditional medicine" or "folk medicine" or "home remedies" or in some cases "herbal medicine") which might plausibly be safe and effective, but have not (yet) been scientifically shown to be so (or perhaps there's controversy about the quality or the interpretation of the scientific studies that have been made). The section in the main body about "traditional ethnic medicine" should be consistent with an open-minded POV on practices in China, India, and elsewhere. Herbal medicine and traditional medicine should not be lumped in with New Age mysticism, energy transfer, magnetism, faith healing, etc. These parts of the main body can probably be improved without much work by a few positive statements and positive sources for parts of herbal/folk medicine, such as John M. Riddle's writings about herbal abortifacient use historically and in the present. I'll be happy to supply exact references concerning herbal abortifacients if you want, but my role as an outsider is limited.NightHeron (talk) 02:01, 24 April 2018 (UTC)

That's the same amount of stuff divided by two arbitrarily placed bullet points. Going on the first thing I can pick out of there, I do think that according to your suggestion, a part of a lead sentence could be removed. It's in the middle of a point being made about medicine which works being medicine and disrupts the flow of the concept which is being presented. perhaps we could take that point first. Edaham (talk) 09:03, 24 April 2018 (UTC)

• Support removal of the part of the sentence reading: , and the problem with the idea of "alternative" treatments in this sense is that they teach "underlying logic [which] is magical, childish or downright absurd" Edaham (talk) 09:03, 24 April 2018 (UTC)
• @Edaham: Thanks. Would you support putting back the quote by Ernst that was removed by User:Zefr on 21 April?NightHeron (talk) 11:57, 24 April 2018 (UTC)

I removed the section on "failure" and Ernst reference and quote because they are clearly WP:UNDUE and, by given prominence in the article as a subhead, mislead the reader. To my knowledge, there is no reputable systematic review - even by CAM authors - that mainstream medicine fails. The Ernst statement, "much of the popularity of CAM is a poignant criticism of the failure of mainstream healthcare", is simply nonsense. --Zefr (talk) 13:08, 24 April 2018 (UTC)

@Zefr:@Edaham: I disagree. The previous sentence to the part you quote is: "Providers of CAM tend to build better therapeutic relationships than mainstream healthcare professionals." The context makes it clear that Edzard Ernst is talking about failure in one particular area (what is colloquially called "bedside manner"), not systemic failure of all of mainstream medicine. There are certainly reputable critiques of large parts of the methodology of mainstream medicine, for example, the article by Marcia Angell I cited above (in JAMA with title "Industry-sponsored clinical research: A broken system"). Both Ernst and Angell, both of whom are actually prominent strong critics of CAM, are cited approvingly in other parts of the article, and are even pictured. What they write is not "simply nonsense".NightHeron (talk) 14:08, 24 April 2018 (UTC)

I find I agree with NightHeron here, but I disagree with removing the sentence on absurd logic without replacing it with something else. There is a danger in promoting alternative medicine because it acts to distort peoples worldviews, promotes false reasoning and spreads misconceptions about science. This needs to come across in the lede.

I also agree with Zefr in that I think any new section regarding the view of alternative medicine as "a failure of conventional medicine" needs to be more balanced, and based on more than one source, even though Ernst is excellent. Carl Fredrik ^talk 14:25, 24 April 2018 (UTC)

The magical thinking problem is nothing new. The inimitable Oliver Wendell Holmes Sr. put it very well in 1871, and nothing much has changed. "It always does very great harm to the community to encourage ignorance, error, or deception in a profession which deals with the life and health of our fellow-creatures." (2nd paragraph here).LeadSongDog come howl! 16:19, 4 June 2018 (UTC)

New section entitled "Shortcomings of mainstream medicine"

The section below is removed to here for further discussion and consensus which was not established before it was reinserted into the article; WP:CON. The three sources are cherry-picked assumptions that do not establish what the proposed section title asserts: there is no quality evidence provided that mainstream medicine has shortcomings or that altmed provides something better. The content and sources are op-eds with no WP:MEDRS-quality substantiation, and therefore are WP:OR suggesting nonexistent widespread expert views having the same opinions, i.e., not usable for the article. --Zefr (talk) 15:23, 26 April 2018 (UTC)

In a paper published in October 2010 entitled The public's enthusiasm for complementary and alternative medicine amounts to a critique of mainstream medicine, Ernst described these views in greater detail and concluded:

[CAM] is popular. An analysis of the reasons why this is so points towards the therapeutic relationship as a key factor. Providers of CAM tend to build better therapeutic relationships than mainstream healthcare professionals. In turn, this implies that much of the popularity of CAM is a poignant criticism of the failure of mainstream healthcare. We should consider it seriously with a view of improving our service to patients.

Similarly, David H. Freedman has said that an explanation for the appeal and commercial success of CAM in the United States is "its adherence to a 'healing' model of patient care" -- a model that is too time-consuming and inefficient for most physicians working under the constraints of the standard American health care system.

Writing in Quartz, Annaliese Griffin attributes CAM's disproportionate appeal to women in part to women's experience of childbirth:

For some U.S. women, the experience of childbirth creates a permanent distrust of the medical system. Many American mothers experience birth in a hospital setting in which they are given very little control over their care and which procedures they are subjected to. The national C-section rate is about 30%, triple the World Health Organization’s target of 10%. And U.S. hospitals have one of the worst maternal health track records among developed nations. When women’s preferences and individual needs are dismissed in the process of childbirth, it’s no surprise that they may face physical and psychological scarring—and that they will seek out alternative methods of health care where they feel listened to and in control.

References

I can only applaud this approach, and while you're right that those sources are inadequate, there are others by Ernst that could be used. There is also some literature of epidemiology of CAM that treats CAM use as a public health problm. There should be quite a few interesting comments from that literature. I will take a look at this some time during the next week, if I haven't responded feel free to ping me. Carl Fredrik ^talk 16:27, 26 April 2018 (UTC)

I don't see the basis for User:Zefr's disparagement of these three sources. Ernst is a leading expert and outspoken critic of CAM, and the other two sources are also mainstream publications. The subsection in question is in a section called "Appeal" that deals with the appeal of CAM to patients. I could change the subsection title to "Perceived shortcomings..." in order to emphasize that the subsection deals with patients' perspectives, not the perspectives of physicians or medical researchers.NightHeron (talk) 22:48, 26 April 2018 (UTC)

Proposed edits to lede

I'm hoping for comments on whether the above subsection on "Shortcomings of mainstream medicine" can be put back, perhaps with changes such as replacing "shortcomings" by "perceived shortcomings" in the title. I'd also like to know whether the following edits to the lede are okay. I give brief explanations in brackets.

• second sentence of lead: change "such therapies" to "most such therapies" [The statement does not necessarily apply to all therapies in the "plausible but not well tested" category, see two sentences later.]

• right before the last sentence of the first paragraph of the lede insert

In certain specific cases, however, treatment methods that were once common among practitioners of alternative medicine were later found to be sound and were incorporated into science based medicine; for example, in the 1990s the recommendation of exercise in lieu of surgery for back pain was considered "alternative," but 20 years later such recommendations had become part of mainstream medicine.

[Novella's article is written in a respectful tone toward an emailer who was defending parts of CAM, and this tone is more effective than an insulting tone. His article also gives an example that suggests that a (small part of) today's CAM may become tomorrow's science based medicine.]

• second sentence of second paragraph of the lede: change "from quackery to" to "from being anti modern medicine to being" [this eliminates an insult-word and replaces it with a factual description]

Thanks.NightHeron (talk) 20:03, 29 April 2018 (UTC)

References

No, this steps too far from the evidence. We are not ignoring reality to pretend that some alt-med works. It by definition does not work. It is important that we equate quackery with alternative medicine, and to call it an "insult-word" is just the point. I think we should strengthen the section on alt-med rebranding to point out that there is no difference whatsoever between quackery, snake-oil and modern alt-med. Carl Fredrik ^talk 13:45, 1 May 2018 (UTC)

@CFCF: If you haven't already read Novella's article and also the Wikipedia article Traditional medicine, please do, and please note the difference in tone between those articles and this one -- in particular, the absence of insult words and the care taken to distinguish between two parts of CAM: (1) the small part that is "plausible but not well tested" (in the words in the lede) and so may some day become part of mainstream medicine, and (2) implausible nonsense. Lumping (1) and (2) together and using insult-words for both is, in my opinion, bad strategy if you want to convince people (other than those who are already convinced) of what the facts are. Following suggestions of other editors, including yourself, I'm trying to proceed slowly and suggest small edits that cite only non-CAM authors. Novella, if I'm not mistaken, is a leading opponent of CAM. It is incorrect to say about all CAM that "It by definition does not work." What's correct (and consistent with the lede) is to say that "It by definition has not been shown by modern science to work." An example of (1): contraceptive/abortifacient herb usage has arisen independently in disparate locations around the world over thousands of years through a "folk knowledge" process that can be called Protoscience, and there have been modern experiments to verify the abortifacient properties of several of them in animals. However, I'm not aware of rigorous clinical studies that would be used as a basis for incorporating them into mainstream medicine.NightHeron (talk) 14:16, 1 May 2018 (UTC)

It by definition does not work.

=

It by definition has not been shown by modern science to work.

Of that there is no argument — they are one and the same, and even arguing that they should be separated is WP:NOTHERE.

There is a difference between not wanting to provoke readers, and of distorting the picture so thoroughly that what is written is a meaningless mass of jargon and excessively guarded statements. In fact you do note a problem with a formulation in the lede: alt-med is never plausible; and that statement should be removed. There is a big difference between plausible and possible — and if it were plausible it would be experimental medicine, not alt-med. Some alt-med is possible — but that is a different thing from plausible.

EDIT: I wrote too quickly, because whether alt-med ever has plausible effect or only ever possible effect sort of depends on the definition used, and many agree the use of experimental medicine in ways that are poorly regulated, such as in German, Mexican etc. private oncology clinics is alt-med. That is plausible, but without studies it is also extremely dangerous, damaging and exploitative.

I will read the paper as soon as I have time, but the above change is just not acceptable. Carl Fredrik ^talk 15:19, 1 May 2018 (UTC)

I don't want to remove the word quackery because its an insult. I want to remove it because the term is a little dated and less descriptive than saying "fraudulent". "Fraudulent medical practice/practitioner" instead of Quackery/quack is more descriptive as well as being less idiomatic for people reading in their second language and/or using a translator. The question as to which is more damming/flattering is a moot point which falls outside of Wikipedia's objectives since each term can be easily sourced and we aren't censored. Edaham (talk) 01:40, 2 May 2018 (UTC)

I have no objection to that. Carl Fredrik ^talk 11:58, 2 May 2018 (UTC)

@CFCF: (Regarding the above = between the two sentences) Sorry if it seems I'm harping on this. If we think about history of medicine, it's clear that the two statements that you joined with an equal sign are not equivalent. Novella's article gives an example of something that was alt med 20 years ago but has since been incorporated into mainstream medicine. It's reasonable to think that, by the same token, some things that are now classified as alt med will in 20 years be med. It's also reasonable to refer to candidates for "CAM today, med tomorrow" as "plausible but not fully tested". They have not been proved by science to work, but they might work. Earlier I believe you said that "home remedies" are a subcategory of CAM, which I guess should mean that none of them work. How would you interpret the following story that was told to me? In the 1980s a physician (a very good one at a leading medical center and also professor of medicine) told a patient "For your urinary tract infection I'm recommending that you drink cranberry juice, which is as likely to be effective as anything I could prescribe. If it doesn't work, come back and we'll do something else." On another occasion the same physician told this patient "The course of antibiotics you're taking often causes a yeast infection, but you can reduce the chances of this by eating yoghurt -- plain, not flavored." Please correct me if I'm wrong, but I think that at the time (and perhaps now?) neither cranberry juice nor yoghurt had been proved effective by a rigorous clinical study. Was there such a study? Assuming this had not been done, and cranberry juice and yoghurt were not an established part of mainstream medicine, then what's your opinion of the physician's recommendations to the patient? NightHeron (talk) 10:08, 2 May 2018 (UTC)

We're losing the point here — and you're conflating alt-med with two entirely different things:

1. Non-functional ≠ alt-med. Multiple studies show that acetyl-cysteine doesn't really work, yet it's prescribed because there are those that feel it helps with consistency of expectorate. The same is true of carbonated water and a hoarse throat, or sour drinks and UTI. These all have some plausability and are not given with the intent to mislead about basic facts of science. Alt-med is. Alt-med also ignores disproving evidence, which medicine does not — we see for example that acetyl-cysteine is less prescribed today, whereas homeopathy is on its way up or unchanged despite being debunked over 100 years ago.

2. Not fully studied ≠ alt-med — the concept of medical experience or proven experience relies on often many years of work by physicians showing or indicating that something works. Surgeries can often not be subject to RCTs, but that doesn't mean we call surgery alt-med. This is one of the major differences between traditional medicine and alt-med. Traditional medicine has a core of proven experience, while alt-med does not. Traditional medicine can become alt-med when used in spite of more current evidence invalidating treatments.

There is a profound difference between those practices that are either of dubious effect, or not fully studied; and alt-med. Alt-med is promoting things which have no evidence on the basis of "this feels right" — and not on experience or evidence. Alt-med is the idea that "natural is always better", or "traditional is better", or "experimental is always better". That is regardless of whether they are used instead of or in addition to other treatment. We also should not forget that many things that doctors do are strategies to get patients on board — such as suggesting cranberry juice instead of slightly acidic water, because a patient is more likely to take it. Carl Fredrik ^talk 11:58, 2 May 2018 (UTC)

P.S. I just read that blog, and I find it does not support the suggested addition — and nowhere does it suggest that what was alternative 20 years ago is mainstream today. It states that standard physiotherapy was functional then, and that is just in line with the evidence. It just happened to be an alt-meder who prescribed the standard physical therapy.

And we should never conflate the American insistence to perform surgery on every minor thing as an alt-med vs. medicine issue. The rest of the world knew this long ago, and had evidence for it. That medicine is imperfect and sometimes driven by greed and dubious practices is never a reason to promote alt-med. Alt-med is nearly always worse in this regard, and it is worse not only because it scams people, but because it spreads a false world view that misleads both practitioners and patients. You can use the Novella source to reference that last sentence. Carl Fredrik ^talk 12:06, 2 May 2018 (UTC)

@CFCF: Thank you for your thoughtful and interesting comments.

• Concerning the Novella piece, what happened 20 years ago was that what his emailer got from U.S. mainstream medicine was the recommendation for surgery. What he got from his CAM source (John Sarno) was the recommendation for certain exercises. An American mainstream physician at the time would not have been likely to give that recommendation. As Novella points out, the CAM source had plenty in it that was wrong/implausible, but the particular recommendation for exercises was not wrong, and in fact is what 20 years later coincides with Novella's own recommendation to such a patient. In other words, a certain part of U.S. CAM of the 1990s (Sarno's recommendation for exercise rather than surgery) is part of standard medical practice in the U.S. in the 2010s. I appreciate your point that the "rest of the world" was perhaps way ahead of the U.S. in this regard, but that doesn't affect the point I'm making. From the perspective of the patient (in the U.S. in this example) what's relevant is the common medical practice in the U.S. at the time. In other words, the emailer probably would not have gone to Europe for better medical advice, and so would have been worse off if he hadn't read and followed (that part of) Sarno.
• The distinctions you make do help to narrow the definition of alt med to something that can correctly be described as bad now and always. Perhaps a reader of the alt med article who's in the medical field will automatically make the distinctions you're making and won't interpret the term "alt med" to mean anything that could possibly be good. But the vast majority of Wikipedia readers are not in the medical field, and their experience of medicine is as patients, not as experts. A serious defect in the article is that there is no coherent and consistent definition of alt med for a non-expert. That's partly because it's a very long article that's been written and edited by many people, and partly because the medical editors are not sensitive to how their writing comes off to people outside the field.
• For example, many would classify drinking cranberry juice as a "home remedy" in the sense that in certain communities generations of (mostly) women have passed down that advice for urinary tract complaints. Other "home remedies" (tea or boric acid for minor eye problems, glycerine for the ears, etc.) have a long history of laypeople using and recommending them and (in many cases) being satisfied with the results. Most of the time no one is profiteering off of these home remedies, which are generally much cheaper (at least in the U.S. and other countries with poor health insurance) than pharmaceuticals.
• In many countries (not only the U.S.) the popular image of mainstream medicine centers around pills and surgery, so there's a tendency to regard anything else as "alternative" even if you would not call it alt med. The absence of a clear definition in the article -- combined with the blanket condemnation of things like acupuncture and herbal supplements -- reenforces the impression that the article is adopting a broad definition of alt med (more or less "anything other than surgery and pharmaceuticals").
• As a result, a common reaction among readers is "Are they saying my doctor who recommended cranberry juice is a quack?" "Are they saying that I'm a gullible fool for using teabags rather than Visine for a minor eye irritation?" "Are they saying that the only rational thing to do when a problem arises in the middle of the night is to go to the ER, never to use a home remedy?" "Are they saying that my grandmother who had me drink certain teas as a teenager to avoid pregnancy was a fool?"
• If you want to be effective with Wikipedia readers who are intelligent but somewhat susceptible to the appeals of CAM (like Novella's emailer), the current style of the article (which many people would perceive as arrogant and polemical) is counterproductive. I've tried to suggest ways to change this, little by little, but there's been a tremendous amount of pushback of the form "let's delete/revert" rather than "let's improve what you've done".NightHeron (talk) 21:22, 2 May 2018 (UTC)

@CFCF: Because of your comment on cranberry juice to treat UTI, I looked at more sources. The Wikipedia article on UTI says that there is no good evidence that it works (two sources are cited), and from that I conclude that this home remedy is CAM, not medicine. Is that correct? There are some websites that give a less negative judgment on the use of cranberry juice, but mainly as prophylaxis, not treatment: "Can cranberry juice stop UTI?". and "Cranberry juice fights urinary tract infection quickly"..

So what would you say about the physician's advice in the 1980s that the patient should first try drinking cranberry juice to rid herself of UTI, and if there's not significant improvement in 3 days, then to come back for antibiotics? The physician explained that she believed in prescribing antibiotics only when clearly necessary, because of the danger of antibiotic-resistance (she was more aware of this danger than most physicians at the time, because she was also a professor in the medical school). As it happened, the patient got better quickly and didn't return for the antibiotics. It's possible, of course, that the patient would have recovered just as fast with no treatment; and it's also possible that a careful examination of the more recent clinical studies would show that they don't completely rule out effectiveness of the cranberry juice treatment for a small percentage of patients with mild cases of UTI. The patient's perception is that the cranberry juice -- which, as I understand it, we're classifying as CAM -- worked. In your judgment, is the patient being gullible? Was the physician being irresponsible? NightHeron (talk) 20:46, 3 May 2018 (UTC)

Problems with the lede

Please look at the beginning of the article, containing a definition of "alternative medicine," which, it seems to me, is unclear and contradictory. If we can replace it with a clear definition, then it might be easier to reach consensus on which parts of the article are fine and which need editing/clarification. It currently reads:

Alternative medicine or fringe medicine are practices claimed to have the healing effects of medicine but which are disproven, unproven, impossible to prove, or are excessively harmful in relation to their effect. Scientific consensus states that such therapies do not, or cannot, work because the known laws of nature are violated by their basic claims; or that the treatment is so much worse that its use is unethical. Alternative therapies or diagnoses are not part of medicine or science-based healthcare systems. Alternative practices, products, and therapies – range from plausible but not well tested, to having known harmful and toxic effects.

If alt med includes practices which are "unproven" and which are "plausible but not well tested," then it is not possible for scientific consensus to know that in all cases they do not work because laws of nature are violated by the claims for them or because treatment is "so much worse." How could there be a definitive scientific consensus about something that is unproven, plausible, and not well tested? A good definition needs to be clear to non-experts and internally consistent. It should enable us to know which treatments are med, which are alt med, and which are neither -- that is, in some third category, such as "traditional medicine" or "home remedies," unless you want to include that in alt med and reject the notion of a third category altogether. But if there is no broad "third category," it follows that any general statement about alt med that occurs anywhere in the article must apply to all traditional medicine and all home remedies, and no statement about alt med being unethical (based on lies, marketed aggressively for huge profits, appealing to the gullible or uneducated, etc.) can be given without explicitly excluding large parts of traditional medicine and home remedies from the condemnation. On the other hand, if there is a third category, it needs to be clearly defined so that we can distinguish between alt med and treatments that are in that third category (e.g., "traditional medicine"). Hopefully the definitions will be reasonably close to common use of such terms as "alternative medicine" and "traditional medicine," as given in other tertiary sources such as dictionaries (e.g., "Alternative medicine".). Do you agree that an improved definition in the lede would make other editing easier? Such a definition to go in the lede should be supplied by medical science editors, not by outsiders such as me. Thanks. NightHeron (talk) 00:39, 5 May 2018 (UTC)

The lede looks to have a reasonable summary of the material in the "Definitions and terminology" section. So I don't agree there is a problem. Alexbrn (talk) 03:45, 5 May 2018 (UTC)

I agree that the first part of the "Definitions and terminology" section is well written. However, there is still a problem because the lede is supposed to be clear and well written. A reader who is made confused and annoyed by the lede is likely to stop reading and give up on Wikipedia as a source of information about alt med. The passage I quoted is polemical and unscientific, because a scientific definition of something does not contradict itself (by stating that there's a scientific consensus on something that's not yet tested).

There's a large "burden of proof" -- in this case, a burden to be clear, consistent, and convincing -- on any Wikipedia editors who define a term in a way that's very different from the standard definition available to the public from reputable online sources. A reader who is confused by the passage I quoted from the beginning of the article is likely, for example, to consult dictionary.com (which gets its "content...based on the Random House Unabridged Dictionary, with other content from the Collins English Dictionary, American Heritage Dictionary and others," according to Wikipedia) and read that "alternative medicine" means

healthcare and treatment practices, including traditional Chinese medicine, chiropractic, folk medicine, and naturopathy, that minimize or eschew the use of surgery and drugs.

Then the reader is likely to look back at the lede of the Wikipedia article; decide that it's inaccurate, polemical, and POV; get annoyed; and stop reading.NightHeron (talk) 11:14, 5 May 2018 (UTC)

If you think that the lede reasonably summarizes the "Definitions and terminology" section, please look at [n 4] (quoting from reference [18], which is Harrison's Principles of Internal Medicine 2015) and [n 5] (quoting from [19], which is from WebMD). Both of those are completely inconsistent with the POV in the lede on what the definition should be. My preference would be to replace the definition in the lede with the definition in Harrison's Principles of Internal Medicine 2015 and make the rest of the article consistent with that definition.NightHeron (talk) 14:59, 5 May 2018 (UTC)

Short answer: There can be scientific consensus that something does not work without testing it. We were for example pretty sure that the moon was not made out of cheese, without actually going there first. Taking surface samples and analyzing them did not strengthen that assertion — as it was already a certainty. There was never a doubt, and as such knowledge on the make-up of moon-rock is irrelevant. The same is true for such alt-med procedures.

We also do not use dictionary definitions, with that one being astoundingly horrible. Are physiotherapy, expectance and non-invasive procedures alt-med by definition? ... No... Just No...

There is something to be said about readability in the lede, but there is no contradiction, and anyone who sees contradiction is unlikely to take heed the message anyway.

I agreed with you when the discussion touched upon making the lede easier to understand, improving flow in the article, and perhaps toning it down to imply that people are misguided rather than stupid for using alt-med. However, I'm not okay with pretending that alt-med works, because anything alt-med is per definition bunk. The same is true for home-remedies, at least under the common definition of the term. Using olive oil in your ear if you have excema is not a home-remedy, because it works — while using a garlic clove in your ear is, because it doesn't. Carl Fredrik ^talk 02:38, 7 May 2018 (UTC)

@CFCF: Could you comment on the definition in note 4 here? NightHeron (talk) 03:02, 7 May 2018 (UTC)

Harrison's, while a very good textbook has very little to say on these practices. As for there being an evidence base, it does not imply that there is evidence that it works.

The following is from Consumer Health 9th edition, which devotes 4 or 5 chapters to the subject:

It makes more sense to classify alternatives as genuine, experimental, or questionable.6 Under this system, genuine alternatives are comparable methods that have met science-based criteria for safety and effectiveness; experimental alternatives are unproven but have a plausible rationale and are undergoing responsible investigation; and questionable “alternatives” are groundless and lack a scientifically plausible rationale. Classifying proven therapies as “alternative” is advantageous to proponents who suggest that if some work, the rest deserve equal consideration and respect.

(Emphasis mine) — This is very much on point to the debate here, and the book is probably the definitive resource, so it's a surprise it isn't used here. I will work to incorporate it, because this article is terribly outdated. Carl Fredrik ^talk 03:52, 7 May 2018 (UTC)

Also directly related to your comments on a failure of main-stream medicine, same source:

It is often suggested that people seek “alternatives” because doctors are brusque, and that if doctors were more attentive, their patients would not look elsewhere. It is true that doctors sometimes pay insufficient attention to the emotional needs of their patients. But some people’s needs exceed what scientific health care can provide. A Canadian study of children attending an outpatient clinic found that word of mouth, fear of drug side effects, and persistence of a medical problem were more significant than dissatisfaction with conventional medicine in influencing their parents’ decision to seek “alternative” care.

Carl Fredrik ^talk 04:29, 7 May 2018 (UTC)

@CFCF: Whether or not Harrison's goes into any detail on the subject, it does give a definition that is probably read and remembered by many physicians and med school students. The last part of that passage directly contradicts the lede, and this leads me to the conclusion that the lede does not accurately reflect scientific consensus. Concerning your earlier comment about scientific consensus: yes, there can be scientific consensus about something that is implausible, such as the moon being made of cheese. But how can there be scientific consensus about something that is plausible but not fully tested (such as many home remedies and folk medicine treatments)? They can't really be classified as experimental medicine if they're not currently being actively tested.

I didn't mean to suggest that you need to use the dictionary.com definition of alternative medicine. What I said was that if you use a definition that differs sharply from ones that are most easily available to the public from reputable sources, then you have a special burden of being clear, consistent, and convincing. The dictionary.com definition also shows that I was correct when I said earlier that to many people "modern mainstream medicine" essentially means pills and surgery, and they're a bit surprised (pleasantly so in my case) when their physician prescribes physical therapy (which as a result is covered by insurance).

People use various forms of CAM for a complex variety of reasons. I've read that studies show that most would not interpret their use of CAM as a direct rejection of mainstream medicine. Rather, they see it as complementary. These people are not necessarily uneducated. I know university professors (mainly in non-science subjects) who believe in various types of CAM. Even people who have an overall very positive view of medicine often perceive it as having great limitations, and for this reason look for something else to try. In most cases they're wrong, getting at most a psychological boost or placebo effect (and hopefully not suffering harm or losing too much money). Sometimes they're right to do this. For example, in the 1970s if a young woman's physician recommended the Dalkon Shield or the birth control pills of the time, and she instead decided to follow the advice of a curandero somewhere in rural Latin America who told her about a strong tea made of abortifacient herbs, that would have been very wise.

The quote you put into boldface is an interesting one, and it shows the difficulty of finding completely satisfactory terminology. For example, the article uses "CAM," although the C stands for "complementary," which is a concept you reject. Just because something could be used by charlatans in an illogical way (for example, the existence of an article in Wikipedia titled "Criticisms of medicine"), that doesn't mean it's wrong. A simple solution is to clearly explain the different subcategories of "alternatives" to standard medical treatments, and give examples of each. There are implausible ones, based on religion, superstition, or pseudoscience. Then there are ones that come from folk traditions, although in their modern form they're "home remedies" and might differ in important ways from the versions in the pre-scientific era. Many of these are plausible but untested. Because of problems with dosage and proper use, there are also dangers. When used for minor complaints, many are safe as well as plausible (such as wet teabags for minor eye irritations or glycerine for a minor ear discomfort). Expensive forms of CAM that are being aggressively promoted for profit are in general more dangerous than inexpensive home remedies used for minor complaints. In other words, not all CAM is equally bad, and some small part of CAM might in suitable circumstances be safe, effective, and a good alternative if standard medical care is unavailable. It should be possible to say this without giving aid and comfort to the charlatans and lunatics.NightHeron (talk) 12:31, 7 May 2018 (UTC)

1. Scientific consensus can be achieved without testing, and there are a number of widespread fallacies that relate to alt-med and testing. First off, there is shifting of the goal posts (same source as above):

When advocates of questionable methods are challenged about their lack of supportive scientific evidence, they typically claim that they lack the money or time to do research. However, preliminary research is simple to carry out and can be incorporated into clinical practice. The principal ingredients are careful clinical observations, detailed record-keeping, and long-term follow-up “to keep score.” “CAM” practitioners rarely do these things. If rigorous clinical trials are conducted and come out negative, proponents often claim that the studies were conducted improperly or that the evaluators were biased.

There is also basic scientific theory and logic (Introduction to Logic 14th Ed. Irving M. Copi Carl Cohen, p. 132 — relates to similar topics regarding treatment etc.):

In circumstances like these we rely, not on ignorance, but on our knowledge, or conviction, that if the result we are concerned about were likely to arise, it would have arisen in some of the test cases. This use of the inability to prove something true supposes that investigators are highly skilled, and that they very probably would have uncovered the evidence sought had that been possible.

Other related fallacies are: disconfirmation bias, confirmation bias, and unfalsifiable claims.

2. As to your assertion that people are surprised when they are prescribed physical therapy, that is not my experience at all, and I should know. If anything they are relieved that they do not need to medicate or go under the knife. But this is an aside, as I haven't seen any evidence or source for your statement.

3. Regarding "complementary" treatments, this is not something I reject, it is something that is rejected by evidence. There is no evidence that alternative medicine "complements" anything. There is however evidence of harm, both in decreased compliance to treatment, decreased efficacy, and increased and additional side effects.

4. That educated people use these things is true, but that does not mean they are making intelligent or informed decisions. Knowledge in one field has even been shown to predispose for bad decisions in other fields, sort of like an extended Dunning-Kruger effect, one which has been referred to as "professoriasis" — where a competent person feels competent about everything. Just for anecdote, doctors are just as stupid, if not even worse, in their personal lives when compared to everyone else, as are psychologists. Educated ≠ makes correct decisions at all times. If anything this suggests the need to add an "epidemiology" section to this article where we include studies that dive into why people use alt-med. Maybe certain forms of education predispose, whilst others are protective.

5. Regarding the variable negative effects of alt-med practices, it's true that many aren't very dangerous — but what is dangerous and what I think we ought try to get across — is that the rejection of science is dangerous. And there is evidence that such a rejection of science predisposes towards alt-med or "CAM" use. I've never heard of using wet tea-bags, and I don't think it's been studied — but to me it sounds like a supremely bad idea. Getting tea where it ought not be is a bad idea, and it could give rise to infections as well as a number of different diseases. I don't really understand the purpose, so I can't say what should be used instead, possibly just splashing water or maybe even better: nothing. To me it does not at all sound plausible, as I can't understand at all when why or where it would be used. Such practices are alternative in so far as there is no rationale for their use — or at the very best, there are other options that are so much better that the "remedies" become alt-med. The definition of home remedy isn't that you can do it at home, but that you can do it at home and that it isn't recommended. Recommended treatments you can do at home are not home remedies. Take for example glycerin: using it for excema is neither a home remedy nor "alternative", because it is recommended, even though oils are preferred.

6. Again regarding the failings of medicine, that is never an argument for alternative medicine. So another quote:

The reason we should defer to experts is not that the experts know everything. Of course they don’t. It’s just that they know more than non-experts do. It’s not that science has all the answers. It doesn’t. It’s just that astrologers, shamans, and natural healers have none of them. — David Frum

Carl Fredrik ^talk 13:27, 7 May 2018 (UTC)

@CFCF: There is little in anything you say that I disagree with.

• I'm glad to hear that glycerine for the ear is not CAM. The source of the suggestion of using wet teabags for minor eye irritations was a friend, who in turn heard it from her mother and grandmother. It is probably a "home remedy" in certain countries and ethnicities and not in others. The teabags seemed to work, although I certainly cannot rule out the possibility that doing nothing would have worked equally well.

• In America (perhaps not elsewhere) a lot of people are disappointed if the result of a medical appointment does not include a prescription for drugs. That is one of the reasons why pharmaceuticals are over-prescribed in the U.S. --- physicians feel pressured by their patients to prescribe pills. Physical therapy requires time and effort on the part of the patient; taking a pill does not. Most Americans, given the choice of doing something that requires effort and something that doesn't, prefer the latter. Hence the popularity of various scams for weight loss that don't require the effort of exercise and improved diet. Basically, a patient who goes to a physician expecting to need surgery will probably be pleased to learn that physical therapy is recommended instead. A patient who expects to be prescribed a pill (say, an opioid for back pain) will probably be displeased to learn that time and effort -- that is, physical therapy -- will be required instead. (Again, I'm talking about the U.S.)

• The reason I was a bit surprised at my physician's prescription of physical therapy was that in earlier times that would have been unlikely. Novella's article comments on this.

• The failings of medicine are not a justification for using alternatives to current medical standards. But they are a justification for investigating them. For example, in circumstances where modern medicine is not available, it is not irrational to ask one's mother and grandmother about what might help. In the case of minor complaints (not serious disease) it might even be a good idea to ask them, assuming that science-based medicine is not immediately available. The point is that there are treatments that have some mild plausibility and some mild protoscientific basis (word passed from generation to generation about alleged positive outcomes). This is far short of rigorous science, but it has some value in some circumstances.

• Asking one's mother or grandmother for advice, as described above, is not a rejection of science.

• I completely agree that people who are very knowledgeable in one area are often ignorant in other areas, and I didn't mean to imply that a professor's belief in CAM is in any sense an indication that such a belief is correct. But it does indicate that one should be careful about any statement that the market for CAM is just uneducated people. Novella also makes this point.

• Returning to the question of the lede, there is clearly a contradiction between the lede and the last part of the definition in Harrison's. The authors of Harrison's say that their definition is more up-to-date, and they explain why definitions such as the one in the lede might have been okay before about 10 years ago but are no longer correct.NightHeron (talk) 14:29, 7 May 2018 (UTC)

Pinpointing issues with the lede

Let me try to pinpoint some concerns about the lede and the contents.

• A "rule of thumb" for the lede (not policy, but probably a good idea) is given in User:BullRangifer's essay on the subject: If a topic deserves a heading (including subheadings), then it deserves short mention in the lead. At present there is no summary of content in the lede. Since there are almost 40 subject headings/subheadings in the contents, following this rule of thumb would be difficult without making the lede excessively long. That suggests maybe trying to shorten the article. WP:SIZESPLIT points out that most readers' attention span does not go beyond 30-50 KB, and says that an article that is more than 100 KB "almost certainly should be divided." This article is around 260 KB. It could be shortened, for example, by eliminating repetition and by linking to other pages for most of the details (for example, in the cases of Ayuveda and CTM).

• I understand that exposing CAM fraud (or anything else that's fringe) does not violate NPOV. The view that most CAM is useless/fringe/fraud is scientific consensus, but the view that all CAM is useless/fringe/fraud is not, as we see from the following passage (quoted in Note 4 in the article from a widely respected book written by leading physicians and professors of medicine):

The phrase complementary and alternative medicine is used to describe a group of diverse medical and health care systems, practices, and products that have historic origins outside mainstream medicine. Most of these practices are used together with conventional therapies and therefore have been called complementary to distinguish them from alternative practices, those used as a substitute for standard care. ... Until a decade ago or so, "complementary and alternative medicine" could be defined as practices that are neither taught in medical schools nor reimbursed, but this definition is no longer workable, since medical students increasingly seek and receive some instruction about complementary health practices, and some practices are reimbursed by third-party payers. Another definition, practices that lack an evidence base, is also not useful, since there is a growing body of research on some of these modalities, and some aspects of standard care do not have a strong evidence base.

Thus, the view that all of CAM is fringe and doesn't/couldn't work is not scientific consensus. The view that some (small) part of CAM is useful/possibly-useful-some-day/plausible is not fringe, and so needs to be represented in the article.

• One way to start doing this would be to change the lede as follows. Begin with a definition that's consistent with the one above from Harrison's (but shorter). Then say something like "Many in the medical community have expressed alarm at the increasing popularity and commercial success of products and treatments that have no scientific basis and are often very harmful." Then the strong statements condemning CAM can be presented from the sources rather than in the voice of the editors. That removes the NPOV problem in the lede and also makes it clear that the main cause of alarm and the main threat to public health are the forms of CAM that are being aggressively promoted for profit (rather than, say, home remedies for minor complaints that have been around for generations).NightHeron (talk) 00:50, 10 May 2018 (UTC)

Harrisson's is a great resource, but we're not going to base this article off a 1 paragraph definition, when there are books that spend chapters to define what alternative medicine is. Also, I struck a massive portion of the history section, which should potentially be merged with the history of alternative medicine article. Carl Fredrik ^talk 10:45, 10 May 2018 (UTC)

The definition section needs to be shortened considerably. I do not think this can be split out. Carl Fredrik ^talk 11:20, 10 May 2018 (UTC)

@CFCF: I see that you've put a lot of work into edits, and that's much appreciated. Because the article purports to advance a scientific agenda in opposition to a pseudoscientific one, it's especially important that it be logical. If you adopt the definition in the first sentence, which conflicts with commonly accepted definitions in RS (such as Harrison's and Dictionary.com), you have a special burden to be completely clear. At present there's a big logical inconsistency/gap. The second sentence gives a list joined by "or" that includes "unproven". That means that one subcategory of CAM consists of "unproven" treatments (as opposed to disproven or impossible to prove). It does not make logical sense to include this subcategory in a category that is defined as consisting of treatments that are known ("scientific consensus") not to work.

One way to fix this would be to edit out the word "unproven" (and anything similar in the rest of the article) and stick with the definition in the first sentence. In that case you have to make it clear that there are many treatments that are not part of mainstream medicine but fall in an intermediate category. Perhaps there is some evidence that they are safe and effective, but not enough evidence to meet current standards; perhaps they are usually safe and effective when used appropriately but it would not be practical to include them in modern medicine because of difficulty standardizing dosage and other problems (an example: certain contraceptive/abortifacient herbs); perhaps there is still controversy about interpretation of the studies that have been done; perhaps there are unscientific methods that are important to use for many patients because of the placebo effect (such as bringing in a traditional healer to calm a patient before surgery, so as to reduce stress and lower blood pressure).

It is also important to acknowledge the RS that say that certain areas of modern medicine rest on a very questionable scientific foundation -- the most obvious example being psychiatry (Thomas Szasz, Marcia Angell). This points to another problem with the definition in the first sentence (mentioned in the last sentence of the Harrison's quote above). Some RS would argue that certain parts of medicine then satisfy your definition of alt-med. My point is not that Harrison's or those other sources are necessarily correct. My point is that they are not fringe, and so need to be accounted for in the article.

There's of course nothing wrong with quoting a source as saying, for example, that they agree with Jimbo Wales that everything is either standard medical practice or lunatic charlatanism. Many readers (not just CAM supporters) would interpret such a statement as an emotional outburst borne of frustration at the popularity of CAM, not a logical statement. Such a simplistic dichotomy can be quoted as the opinion of a particular RS (if it's balanced by also quoting RS that say very different things, such as Harrison's), but such an opinion should not be presented in the voice of the editors, in view of WP:NPOV.

Thanks again for responding thoughtfully to my comments and for your recent editing.NightHeron (talk) 12:21, 10 May 2018 (UTC)

My own strong preference, as I've stated, would be to change the definition of CAM so as to include everything that is commonly understood to be alternative or complementary, that is, to include the large intermediate category I described above. But it would be possible to stick with your current definition without violating NPOV, provided that you make it clear that many things included in CAM in the common definition in other sources are classified in the article as falling in an intermediate category between "medicine" and "alternative". Also you need to be aware of the possible confusion that could result from using the word "alternative" in a way that excludes many alternatives.NightHeron (talk) 12:35, 10 May 2018 (UTC)

You're right about the logical inconsistency, but it's difficult to adress, because alternative medicine is logically inconsistent. There is the off chance that an alternative treatment might work, for example if you give 1000 herbs, one might just have an active ingredient that is useful. However, with any alternative treatment, there is never a reason to believe it should work (except through placebo, regression to the mean, etc.).

It's further complicated by the fact that any treatment that is shown to work de facto becomes medicine — which means that alternative medicine is only that which does not work. And since Wikipedia presents what is scientifically proven as factual per WP:NOTCRYSTAL, etc. this distinction is fully viable here. Going to far to explain that what we mean when we say it works is that modern science has proven it to work — undermines the factual basis of the article. We don't need to express that gravity is understood by modern science as a force of nature, just that it is a force of nature.

So I guess it boils down to whether alt-med by definition does not work or should not work.

We're also touching upon problems with the definition of "works", which is adressed a little further down in the lede. Namely, in that there are treatments for skin cancers and the like which burn the skin with chemicals — different tars which are considered "natural", which do in fact get rid of the cancer. However, they leave the target maimed and with big fleshy sores. In one sense, this works, as it gets rid of the disease, but in another it's horribly dangerous, pretty unethical and mostly downright stupid — which is also an argument that it doesn't work at all. (Here is an article from the American Association of Dermatologists on Black Salve: https://www.aad.org/public/diseases/skin-cancer/natural-treatments-for-skin-cancer-not-as-safe-as-you-think — It's pretty damning and goes so far as to say that it doesn't work at all, even when it's burned off someone's nose, like in the example.)

I guess we can skirt around this by saying that alt-med either does not or should not work, but I feel that solution is less than ideal.

On a side-note, what do you make of the graphic I prepared? It doesn't cover these cases, but pretty much all other cases where alt-med is perceived to work. Is it easy to follow? I feel the concepts are complicated, so a graphic is useful. Carl Fredrik ^talk 13:31, 10 May 2018 (UTC)

@CFCF: Concerning the graphic, I agree that it's a good idea to explain visually some of the ways that personal testimonials for alt med arise. I think part (a) is pretty clear, although the use of "pill" to stand for alt med somewhat conflicts with popular perceptions (many people think of physicians as people who prescribe pills and alt med practitioners as people who do something else, as in the Dictionary.com definition). Perhaps an image of a small bottle (that might contain herbal supplements) or a jar with a cork (that might contain some ointment) would be more likely to suggest alt med. The symbolism in part (b) is inconsistent with part (a), since in part (a) you're using red for a sick person and green for a well person, and on the right in (b) you're using green for a person who feels cured and red for a person who does not feel cured (at least I think that's the symbolism). In part (c) you're returning to the red/green symbolism of part (a), and you're using an unclear symbol (a face with both upward and downward curving mouth) to represent both conventional treatment and also side effects. In summary, part (a) is clear (although I'd suggest getting another symbol for alt med besides "pill"), whereas (b) and (c) need some adjustments.

The issue you raise of an alt med that "works" in a limited sense but causes more harm than good is also an issue in some standard medicine -- the "cure being worse than the disease" (Iatrogenesis). That's not what makes up what I call the "intermediate" category. The intermediate category first of all contains treatments that are unproven but might work. It is not scientific to state that anything in that category "cannot work" or "should not work" or could only work in a limited sense that conflicts with good medical practice. There are some questions that have not yet been resolved by science. To use a very mundane example, apparently science cannot say whether using a moist teabag when dust and pollen has irritated the eyes is a stupid idea (your opinion) or probably a reasonable thing to do (my opinion). Is there any scientific evidence that dabbing one's eyes with a teabag is likely to cause infection?

The intermediate category also includes "complementary" protocols that in a given situation should be used with certain patients even if there is no scientific basis for them. For example, the book The Scalpel and the Silver Bear (by the first Navajo woman surgeon, Lori Alvord) describes her use of shamans to win over the cooperation of patients and calm them before surgery.

For those who have studied the history of medicine there is plenty of reason to be skeptical of simple dichotomies. To get a quick impression of the state of American medicine in the 19th century (when the AMA started fighting against the "irregulars"), I recommend the Wikipedia article on the assassination of U.S. President Garfield in 1881. At that time U.S. mainstream physicians did not yet believe in antisepsis (although in Europe they did), and Garfield's physicians probed his insides with dirty hands looking for the bullet. Some historians believe that if he'd been treated by homeopaths (whose treatments in general were pretty nonsensical, but who by and large believed in cleanliness and in less intrusive procedures), Garfield might have survived.NightHeron (talk) 18:09, 10 May 2018 (UTC)

The lede should have a short factual definition that's as neutral as possible, even though the vast majority of the content of the article points out everything wrong with CAM. For example, the beginning of the Harrison's quote has such a definition, basically any healing modality that did not arise from standard medicine. Then the rest of the lede should summarize the content. At present the lede contains statements that are plainly misleading and contradict other parts of the article. Please look at the sentence "Alternative diagnoses and treatments are not part of medicine, or of science-based curricula in medical schools, nor are they used in any practice based on scientific knowledge or experience." The fact is (see Harrison's; and elsewhere in the article "In 2002, at least 60 percent of US medical schools have at least some class time spent teaching alternative therapies") that many mainstream medical schools do include CAM in their curriculum, and this trend is increasing. The first part of the sentence tries to convey something that is contrary to fact, namely, that mainstream medical schools uniformly share the viewpoint of the article that CAM is all bad. Certainly you could defend the statement by saying that, since CAM has been defined to be entirely contrary to science (no exceptions), it logically follows that it could not possibly be part of science-based anything. But in that case the statement is vacuous. A statement that is either vacuous or misleading does not belong in the lede. The second part of the sentence is simply false as stated. Many practices that are based on scientific knowledge or experience also use CAM in a "complementary" way. An example I've given is of a well-known science-based physician (Lori Alvord) who brought in a shaman to help prepare certain Native American patients for surgery. Another example is a physician who had someone try cranberry juice for UTI (at a time when its effectiveness as a cure for UTI was considered to be plausible but unproven). The article itself says that many mainstream hospitals use CAM ("In 2008, more than 37% of American hospitals offered alternative therapies"). The lede should not contain statements that are false or misleading.NightHeron (talk) 11:16, 11 May 2018 (UTC)

All the above is disruptive, and is not aimed at improving the article, but is intended to try to improve the perception that ALT-Med can actually be useful in health care. The facts are simply that ALT-Med is useful in making ALT-Med practitioners wealthy, and patients poorer. Text above like "At present the lede contains statements that are plainly misleading and contradict other parts of the article." are just nonsense, and deserve to be ignored. The fact that our article annoys ALT-Medists shows that at least we have something right -Roxy, the dog. barcus 11:45, 11 May 2018 (UTC)

Roxy the dog — I don't think it is disruptive, at least not intentionally so. For the vast majority, these concepts are difficult, and few have read as much on the topic as you have. NightHeron I will respond to your longer comment above in depth, but for now to focus on this piece regarding Harisson's.

Harrison's "definition" isn't really a definition — it merely demarcates medicine and "alternative" treatments. It tells us that "alternative" treatments are not part of medicine, but it doesn't explain why this is — that it is because medicine includes treatments which work. If medicine (i.e. "any practice based on scientific knowledge or experience") de facto includes that which is shown to work — then "alternative" treatments are excluded on the premise that they do not work. For this reason Harrison's skirts around the problem, saying that "alternative" treatments aren't part of "standard" medicine, while "standard" medicine is anything science-based and proven to work. When we know that "alternative" isn't the same as "experimental" this is even more evident — "alternative" by definition does not work — and Harrison's doesn't dispute this, it just doesn't touch upon it.

The fact is, and this is supported by the sources I use — that most doctors never discuss "alternative" treatments, because they see it as a waste of time. I would have a really good quote here, but I can't seem to find it, and need to go in 5 minutes: so here is are a few articles on the topic: What do doctors say to 'alternative therapists' when a patient dies? Nothing. We never talk Doctors need to speak out against treatments that have no evidence of success (these are okay, but not source material for Wikipedia).

The other problem is that non-evidence based medicine, (by medicine I mean "standard" medicine) is claimed to exist. The difference there is that this type is still science-based, though the evidence-base is less than ideal. And this still doesn't mean that the evidence is null, because had it been, it would not be medicine, and medicine continually discards non-evidence based pracitces. "Alternative" treatments lack both a basis in science and a basis in evidence, as well as being used despite strong evidence they do not work, i.e. refuting attempts at being falsified. Medicine allows for falsifiability, and medicine ends being medicine when falsified, while "alternative" treatments do not. Carl Fredrik ^talk 12:47, 11 May 2018 (UTC)

I wish to respond to User:Roxy the dog, who is accusing me of bad faith ("disruptive...not aimed at improving the article") and being one of the "ALT-Medists". Besides violating WP:GF, the accusation is simply wrong. As I've said from the beginning, I fully support well-designed efforts to combat all forms of pseudoscience (including the aggressively promoted CAM for profit that's become a plague in the U.S., climate change denial, creationism, anti-vaccine nonsense, and the like). At the same time I believe that scientists have an obligation to be careful and factual, so as not to lose credibility. I believe that this article will be much more effective in disputing pseudoscientific claims if it doesn't have anything in it that is false, misleading, exaggerated, unclear, or contradictory. There is nothing "disruptive" about continuing discussions about improving the article.NightHeron (talk) 13:06, 11 May 2018 (UTC)

@CFCF: I agree that the first sentence of the passage in Harrison's falls short of a full definition and only does part of what a definition should do, namely demarcation. A full definition would be too long for the lede, and there's a whole section of the article dealing with definitional issues.

Please look at the first two paragraphs of the lede of Traditional Chinese medicine. The first paragraph gives a neutral definition. The second paragraph makes it clear -- from RS and with no editorializing and no use of a skewed or non-standard definition -- that there is no good evidence supporting TCM, and readers who go further will see more explanation in the sections on efficacy and safety. The tone and organization are NPOV, and I doubt that any disinterested, rational reader would find the lede or the article as a whole to be polemical, misleading, or confusing. (I'm not saying it's perfect -- its length is outside the guidelines of WP:SIZESPLIT and the lede fails to mention most of the section topics, but these are minor issues compared to NPOV.)NightHeron (talk) 16:50, 11 May 2018 (UTC)

SIZESPLIT

(Please address topics of discussion in manageable chunks: the above discussion is very difficult to follow...) The recommendation at WP:SIZESPLIT pertains to the length of "readable prose", not the full wikitext of the article. It excludes refs, titles, and markup. At present there's less than 70 kB of readable prose in this article, not the 260 kB stated above. Certainly some pruning could help, but it isn't in need of a clearcut.LeadSongDog come howl! 15:21, 16 May 2018 (UTC)

@LeadSongDog: Thanks for the correction. Is there a simple way to determine the length of "readable prose" that shows 70 KB? I clearly looked at the wrong place (the history page). The context for my comment on length was not that I or anyone else was suggesting a full split. It was in a discussion of the lede. The length of the article, especially the large number of sections and subsections, would make it hard to rewrite the lede so as to mention all the topics covered in the article without the lede becoming too long.NightHeron (talk) 16:46, 16 May 2018 (UTC)

I'm not aware of a convenient tool for the purpose. I just copypasted the rendered text sections from my browser into TextPad and then cull the major overheads (titles and templated text) to get a rough estimate, but there really ought to be a handier way, and someone has likely built it already. LeadSongDog come howl! 20:22, 16 May 2018 (UTC)

@NightHeron: Aha, there is a tool: User:Dr pda/prosesize. After following the instructions a "Page size" entry appears on the "Tools" menu. Works a treat, though it's estimates are a bit on the high side. LeadSongDog come howl! 17:43, 4 June 2018 (UTC)

Quotes from non-fringe sources

• "Western medicine. A system in which medical doctors and other healthcare professionals (such as nurses, pharmacists, and therapists) treat symptoms and diseases using drugs, radiation, or surgery. Also called allopathic medicine, biomedicine, conventional medicine, mainstream medicine, and orthodox medicine." (National Cancer Institute, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/western-medicine) This quote shows that the statements by editors at the end of subsection 1.1 and in subsection 1.3 regarding the terms Western medicine and allopathic medicine do not reflect a consensus of RS. Note that historians of medicine, especially when writing about the 19th century, have used the term allopathic medicine non-pejoratively, in opposition to homeopathy; some prefer that term to Western medicine because modern homeopathy actually originated in the West.

• "Another definition [of `alternative medicine'], practices that lack an evidence base, is also not useful, since there is a growing body of research on some of these modalities, and some aspects of standard care do not have a strong evidence base." (Harrison's Internal Medicine), quoted in [n 4] in the article.

• National Center for Biotechnology Information (https://www.ncbi.nlm.nih.gov/pubmed/15994475): Abstract: "Family physicians in Cuba and the United States operate within very different health systems. Cuba's health system is notable for achieving developed country health outcomes despite a developing country economy. The authors of this study traveled to Cuba and reviewed the literature to investigate which practices of Cuban family physicians might be applicable for US family physicians wishing to learn from the Cuban experience. We found that community-oriented primary care (COPC) and complementary and alternative medicine (CAM) are well developed within the Cuban medical system. Because COPC and CAM are already recommended by US family medicine professional bodies, US family physicians may want to learn from the Cuban experience and perhaps incorporate elements into their individual practices." (J Amer. Board of Family Practice 2005 Jul-Aug;18(4):297-303. "Family medicine in Cuba: community-oriented primary care and complementary and alternative medicine.")

• There are U.S. government sources (such as https://nccih.nih.gov/health/integrative-health) that state that parts of CAM can/should be incorporated into mainstream medicine. I realize that several Wikipedia editors in WikiProject Medicine believe that NCCIH is a waste of money and ill-advised. But it strains credibility to use the term "fringe" for the viewpoint of a U.S. government agency that is part of the National Institutes of Health.

• The U.S. government and the Cuban government have had hostile relations for six decades. Yet the two governments seem to agree on one thing: both have agencies that believe in incorporating parts of CAM into mainstream practice. Thus, a positive view of (parts of) CAM cannot be described as "fringe."

• The point is not to agree or disagree with these sources. The point is that they are not fringe sources, and so their viewpoints have to be represented. Opposing viewpoints also have to be represented, with a balance that's roughly in proportion to the amount of agreement with each viewpoint among experts (meaning mainstream physicians and medical scientists). The problem with this article is that some of it is (1) unscientific because it makes self-contradictory or illogical statements (such as that a scientific consensus exists that plausible but unproven treatments cannot work); (2) ahistorical because it fails to recognize that there has been a historical trend, which is likely to continue, for some treatments that at one time were part of CAM to later become part of standard medical practice (and so those treatments were never in the "do not work" or "cannot work" category); and (3) in clear violation of WP:NPOV.

• Would anyone object to my asking for a RfC on whether I'm correct about this?NightHeron (talk) 20:56, 15 May 2018 (UTC)

An RfC is a good idea. Instead of focusing on the wording of the lede, it might be better to decide which definition of "alternative medicine" covers the scope or topic of the article. Looking through this talk page, there are a number of No true Scotsman type comments along the lines of "If it's being studied or used by the medical establishment, then it's not alternative medicine." There seems to be strong support among RS, as well as among WP editors, for a more wide-ranging definition. –dlthewave ☎ 22:07, 15 May 2018 (UTC)

An RfC is a horrible idea unless we have a clear and simple question. Whether or not the medical establishment subscribes to a No true scotsman model is frankly irrelevant — for three reasons. (1) No true scotsman problems are only informally fallacious, and are often not applicable to semantic definitions, nor are they definitively false. (2) If it is widely accepted we have no place questioning it on our analysis of a fallacy. (3) Lastly, there is no indication that any therapy has ever made the leap from alternative to accepted — see below.

Please read my detailed responses. Carl Fredrik ^talk 22:32, 15 May 2018 (UTC)

(edit conflict)

1. The entry on "Western medicine" is cherry-picked, and is quite problematic. It also ignores the fact that watchful waiting is a legitimate medical intervention. The use of physical therapy or most allied health professionals is also considered conventional medicine. Regarding the endings of sections on Alternative_medicine#Alternative_medicine and Alternative_medicine#Allopathic_medicine — there is no contradiction. That a term is used is no indication that it is used accurately. This dictionary definition does not state that the term is not a pejorative, or that it is accepted. The sources used are of higher quality than dictionary definitions.
2. We've discussed the lack of evidence base and contrasted it with the lack of both evidence base and base in science. These are not equivalent, and the sources we use are more in depth than Harrison's, which while an excellent source is quite lacking in this field. There is also the issue here of a major logical fallacy. To state that all alternative medicine is lacking in evidence — is not the same as to state that everything that is lacking in evidence is alternative medicine. This is text-book association fallacy. Harrison's does not imply that alternative medicine ever works, it simply states that the fact that something does not work does not de facto make it alternative medicine. You accurately point out that the lede fails to clearly state that alternative medicine in a near-obligatory fashion derives from religious belief, tradition, superstition, belief in supernatural energies — only that they "may" (as in it may derive from any of them). This should be rectified, and has been overlooked, presumably because many different alternative medicine practices are widely know and no one has pointed that out until now. I will take a look at what I can find. Consumer health suggests the following: "Whether something should be considered “alternative” depends not only on the method itself but also on how it is used and what claims are made for it." I find this a satisfactory addition.
3. I have to be completely honest and state that I don't understand at all how this is relevant. There is nothing in your quote to indicate that alternative medicine differs from what is stated in the lede.
4. I beg to differ here, and do so on the grounds of a number of sources:

First two from Consumer Health:

Special commercial interests and irrational, wishful thinking created NCCAM. It is the only entity in the NIH devoted to an ideological approach to health. To correct the situation, Congress must consider at least interrupting funding of NCCAM while results of work in progress mature. NCCAM could be dissolved, its functions returned to other NIH centers, with no loss of knowledge, and an economic gain. Funds could be invested into studies of how such misadventures into “alternative” medicine can be avoided, and on studying the warping of human perceptions and beliefs that led to the present situation. More public money for investigating methods with negligible promise is foolish economics and even more, is unwise public policy. —Wallace I. Sampson, M.D.

In 1991, at the urging of a former congressman who had used “alternative” therapies after undergoing conventional treatment for Lyme disease and prostate cancer, Senator Tom Harkin (D-IA) spearheaded passage of a law ordering the National Institutes of Health (NIH) to foster research into unconventional practices. To carry out the law’s intent, the NIH established an office of unconventional medicine, which was later renamed the Office of Alternative Medicine (OAM). From 1992 to 1998, the OAM’s budget increased gradually from $2 million to $19.5 million. In 1998, Congress transformed OAM into NCCAM, giving it more independence and funding that rose steadily from $49 million in 1999 to $129 million in 2010. None of this money has been used to identify or oppose quackery promoted as “CAM.” The NCCAM Web site has never said that any “CAM” method is so implausible that it should be discarded. “CAM” proponents have trumpeted the involvement of NIH as evidence that whatever they espouse is valid. Its main impact so far has been as a magnet for the press. The resultant press reports have contained little criticism and featured the views of proponents and their satisfied patients. Few reporters make any effort to determine whether the “alternative” or “complementary” methods they mention are useful, promising, or nonsensical. Even physicians and medical students are exposed to a steady flow of misleading “CAM” promotion through journals whose editors don’t understand how “CAM” proponents misrepresent what they do.

Followed by Edzard Ernst: http://edzardernst.com/2016/12/the-mainstreaming-of-quackery-the-role-of-the-nccih/

It was founded in the early 1990s because some politicians were bent on promoting quackery. Initially the institution had modest funding but, after more political interference, it had ample cash to pursue all sorts of activities, including sponsoring research into alternative therapies at US universities.

He has also stated:

Anatomy, physiology, and pathology are not ‘Western medical systems.’ They are generalizable truths that apply to all humans.”

There are also a number of quotes from heads of other NIH branches, which I can share if this isn't enough. There are extraordinarily few outside "alternative medicine" groups who dispute that the NCCIH is fringe. Their association to the NIH is inconsequential, and the NIH has multiple times attempted to shut down or change the NCCIH.

5 I don't see the logic in this argument. How does the fact that Cuba and the USA being enemies and both doing something make it logically sound? We could just as well list all the countries that do not have such agencies.

6 I don't get this point either. Which sources are you referring to? Those are 2 as contrasted with the hundreds that are present in this article, which clearly express the medical consensus. As for your two points here: (1) It no longer suggests that alternative treatments are plausible — there was no source to back up this statement, so it was removed. (2) It is frankly impossible to suggest that there is a trend of alternative treatments which have entered into medicine — seeing as the concept of alternative treatments arose in the 1970s and 1980s, and no treatments have moved from one category to the other since then.

We're also getting back to the distinction of "work". To state that there is evidence that something does not work — is roughly equivalent to it not working. We should not go into the semanitics of "work" in the lede, and I find it interesting that the debate keeps running into this. Consumer Health states:

[Q]uestionable “alternatives” are groundless and lack a scientifically plausible rationale. Classifying proven therapies as “alternative” is advantageous to proponents who suggest that if some work, the rest deserve equal consideration and respect.

Regarding (3) — the fact that evidence may change and we may end up being wrong about something — does not mean we should reject what we know today. That would mean that every article on any medical subject would be filled with excessive qualifiers of ors and ands and maybes etc. The fact is that alternative medicine has been systematically found to be far less likely to ever prove to have any merit — than even the most strongly established medical facts are likely to change.

7 For an RfC to have any use there must be a single actionable result, which requires a clear question. For now there isn't really such any question, and RfCs won't help us formulate an adequate lede. An RfC now would only lock everyone from editing for an extended period, likely not result in anything — and then have us restart in a months time. Carl Fredrik ^talk 22:26, 15 May 2018 (UTC)

@CFCF: Sorry if I wasn't clear about what the RfC question would be. I have in mind something like: We disagree on whether or not parts of Alternative medicine, including the lede, violate WP:NPOV. I think a disinterested editor can read the discussion, look at the article, and come to a judgment. If such editors agree with you and some others that there is no problem, then nothing has to be done. If they agree with me, then some editing has to be done to make the article neutral in tone and content. The point is not to debate the substance of the issue of alternative medicine. I quoted from those non-fringe sources for the purpose of showing that the topic of the article is controversial and complex from the standpoint of RS. In its present form the article states opinions in the voice of the editors, that is, in the voice of Wikipedia -- opinions that are disputed by many mainstream sources. Those opinions can of course be included as opinions of your sources, and then balanced by opinions of other RS. But they should not be stated in the editors' voice as if they are fact.

• I made the point about the U.S. and Cuba only to illustrate that there are governments across the political spectrum that do not share the article's POV about CAM. The article mentions that 88 percent of Americans think that "there are some good ways of treating sickness that medical science does not recognize." Someone could react by saying that that just shows how backward Americans are. However, I wonder if there is any country in the world where fewer than 50 percent of the population would agree with that statement. Whether it's correct or incorrect, how can a belief shared today by that high a proportion of people be classified as "fringe"?

• Earlier I gave an example, quoting Steven Novella (editor of a prominent anti-CAM journal), of a treatment option (exercises rather than surgery for back pain) that 20 years ago was a common recommendation of CAM sources and not of mainstream physicians. Now, as Novella points out, such treatment advice is completely mainstream and no longer CAM. Another example I gave is cranberry juice for UTI. In the 1980s it was classified as CAM, meaning that, despite plausibility, it had not passed rigorous scientific testing. As I understand it, subsequent scientific studies showed that it is effective as prophylaxis, but not as treatment. So it has passed (partially) from CAM to mainstream medicine.

• Alternative treatments to mainstream medicine arose well before the 1970s and 1980s. As the article states, homeopathy started 200 years ago. In the U.S. in the 19th and early 20th centuries the A.M.A. fought fiercely against the "irregulars," as CAM practitioners were called then. Certain types of irregulars (such as midwives) believed in the importance of cleanliness in the late 19th century, whereas mainstream physicians, such as those who treated President Garfield, unfortunately did not. Antisepsis later was finally adopted by mainstream medicine in the U.S. (it had been adopted much earlier in Europe). That's another example of a practice of irregulars later becoming a practice of mainstream medicine.

• The term "medicine" applies not only to medical science, but to medical practice. Many people speak of "Western medicine" as opposed to other traditions of medical practice. Different traditions of medical practice might all be based on sound scientific principles, but with some disagreement about how to interpret the results and how to weigh scientific considerations along with other considerations -- such as cost, shortages (e.g., those caused by the U.S. embargo in Cuba), patient psychology, quality-of-life issues, etc. The article says that the term "Western medicine" is an example of loose language that's used in order to suggest that there are two types of medicine, whereas in reality there is only one. That's an opinion about the term "Western medicine" that does not seem to be shared by many who use the term. Such an opinion should not be stated in the voice of Wikipedia.

• Subsection 1.3 gives the misleading impression that, except in India, the term allopathic medicine is a pejorative. Of course the term can be used derisively by some people -- the same people who would say "mainstream medicine" or "orthodox medicine" with a negative tone in their voice -- but many other people, especially historians of medicine, use it neutrally.NightHeron (talk) 02:31, 16 May 2018 (UTC)

Concerning the quote from Ernst about physiology, anatomy etc. not being "Western medicine" but being universal medical science: Certainly. But the term "medicine" means not only physiology and anatomy, but also medical practice. Medical practice is not constant across cultures. One can use the term "American medicine" in saying, for example, "Over-prescription of opioids is a feature of American medicine." Constraints, pressures, and incentive systems vary from country to country, and so medical practice also does. But there's no such thing as "American anatomy" or "American physiology."NightHeron (talk) 04:32, 16 May 2018 (UTC)

I'm going to go out on a limb here and state that the reason and RfC won't help regarding that question is that there is a general consensus that there are NPOV issues in this article. There is however little agreement which issues these are, where they are found and how to solve them. An RfC won't guide us anywhere. Your point here are more constructive than the lasts ones and I can respond a little clearer to them and what we can do about them.

• There are a couple of good sources regarding those statements, and that a general acceptance among the population has nothing to do with whether something is fringe or not in the scientific community. First of all there is some disagreement regarding the numbers, with some estimates "inflated by counting exercise, relaxation, self-help groups, and commercial weight-loss clinic as “alternative,” even though they involve practices that are medically accepted." (Same source as above). It's also well established that popularity or even satisfaction with treatment is not a proxy for scientific rigor or acceptance in science.

Every system—be it based on the position of the stars, the pattern of lines in the hand, the shape of the face or skull, the fall of the cards or the dice, the accidents of nature, or the intuitions of a “psychic”—claims its quota of satisfied customers. — Hyman, quoted in the same source

The following is from the excellent book: Nonsense on stilts, How to tell science from bunk — Massimo Pigliucci, University of Chicago Press

Bandwagon appeal: since so many people believe in UFOs, there must be something to it. But of course widespread belief is no scientific argument at all, since many people believe all sorts of bizarre and unfounded things. Just remember that for a long time the majority of the earth’s population sincerely believed that our planet was at the center of the universe. They were all wrong. Moreover, the three cases briefly discussed above make it clear why so many people may sincerely believe that they saw a UFO while in fact they were mistaken. — p.76

Wikipedia presents scientific consensus as per the best sources, and this is policy: WP:N, WP:V. That the lay public thinks one thing is irrelevant. If it were not so, we could never have an article on List of common misconceptions.

There are a number of other quotes on that topic, and it is an excellent introduction that I think anyone who edits Wikipedia should read.

• We disagree that Novella implies that the treatment was alternative, simply that an alternative practitioner had prescribed it. Generally alternative practitioners also prescribe function and standard treatments, this does not make them non-alternative. I'm very willing to take up any examples of treatments which have passed from the realm of alternative into conventional on the condition that we use high quality and WP:MEDRS compliant sources. That means secondary medical literature reviews published in reliable journals or books published by well regarded academic publishers. So far we have no such sources, I am very open to being directed to some.
• This article does not relate to the various problems within medical history. Medicine today is not predicated on humoral theory, nor is it related more to historic western concepts such as heroic medicine than it is to eastern or other non-western conceptual models. As a distinct phenomenon and a term "alternative" arose in the 1970s and 1980s, which is supported by my above sources, as well as any number of other academic sources on the topic.
• It is not possible to be both based on sound scientific principles and to disagree with the fundamental empirical results. However, different approaches to other aspects such as cost, availability and psychology are all found within medical discourse — and are in no way unique to "alternative" practices. These are often instead lacking in "alternative" practices, as expressed by the quote from CH: "[M]ost who label their approach holistic use methods that are nonscientific, narrow in focus, and less likely to be individualized to fit their patients." There is quite a lot more to be found there on just this topic, but I will leave it at this quote. I profoundly object to the relabelling of medicine as "Western medicine". There is no such concept, and a multiple of sources state (in fact many of the ones quoted above) that it is simply a false dichotomy as medical principles are not bound by any geographic location. I will also take a leaf from Hans Rosling and state that any distinction of "the West" and "the Rest" is not only profoundly wrong but implicitly racist. These concepts are general, and while there may be non-medical systems that label themselves as medicine, that does not mean medicine itself is something else.
• This is not wrong — it is a pejorative. The section is if anything too lenient, in explaining that homeopaths use it — but not for what reason. I have seen no indication that any historians of medicine use this term.

I find I've been quite courteous in responding to your comments — and I hope we are able to reach some constructive way forward. These last two posts are slightly problematic because you've made assertions without providing sources, which I think bars us from reaching any consensus. Just as an example, the very last statement you make "but many other people, especially historians of medicine, use it neutrally" — must be sourced for us to have anything near a balanced debate. The current text is sourced, and very reliably so. Carl Fredrik ^talk 05:31, 16 May 2018 (UTC)

@CFCF: I think you're missing my main point. I have never said or implied that the widespread support for alt-med indicates that any of it necessarily is scientifically sound, or that opinion surveys can substitute for scientific studies. Obviously I don't believe that. My main point is that the view that some of it is plausible and potentially useful to complement or replace certain current treatments is not a fringe view. Saying it's not a fringe view is not the same as saying that it's necessarily a correct view. It's not just a matter of popular belief (that is, the 88 percent of Americans in the survey referenced in the article). The article also says that 60 percent of U.S. medical schools include some CAM in the curriculum. It's very possible that they're wrong to do this. But that is controversial. It would not be credible to say that 60 percent of U.S. medical schools are fringe, i.e., run by lunatic charlatans (to use Jimbo Wales' famous formulation).

• In answer to your request for sources to support my statement that the term allopathy is not always used pejoratively outside of India, here are some books that use the term allopathic in a neutral, non-pejorative sense. Two books on medicine in Iran written by the American physician Agnes Loeffler: Allopathy Goes Native: Traditional Versus Modern Medicine in Iran; and Health and Medical Practice in Iran: Traditional Culture and Modern Medicine. Another reference: Good Manufacturing Practices for Pharmaceuticals, Sixth Edition, ed. by Joseph D. Nally. That book refers to allopathic drugs. I have heard that such non-pejorative usage is common among historians talking about 19th century medicine, but I haven't yet located written sources of that sort.

• I've heard (but know no published sources to back this up) that the reason why some historians use the word allopathic is that they do not like the common term Western medicine because it is simplistic, potentially can be construed in racist ways, and in any case is historically inaccurate because so many varieties of alt med originated in the West. Certainly a lot of people agree with your view that "Western medicine" is a bad term. However, that is an opinion which some RS do not share. In fact, the term is frequently used in RS. That is why the POV that Western medicine is a bad term should not be stated as fact in the voice of Wikipedia.

• Common terminology often changes from time to time, but historians are not thrown off by that. The battle of mainstream medical people against alternative medicine goes back very far, although CAM practitioners used to be called by other names, such as homeopaths and irregulars. In the U.S. the Flexner Report of 1910 is often regarded as a turning point in that battle. There was a new wave of alt med around the 1970s, often called New Age.

• Some alt med, as you say, is based on utter nonsense, and this includes (as far as I'm aware) all of the New Age stuff. Some other alt med, such as many home remedies and herbal remedies, have been around for generations, are scientifically plausible, do not come out of superstition or nonsense theories, and might (or might not) some day have their safety and effectiveness established rigorously. My reference for cranberry juice: https://health.clevelandclinic.org/can-cranberry-juice-stop-uti/

• Novella's anecdote concerns a man whose physicians would recommend only surgery. Novella acknowledges that 20 years ago American physicians over-prescribed surgery and rarely prescribed physical therapy. That's why the man had to get good advice from a CAM source. Novella also emphasizes that at present the man probably would get the same good recommendation from a mainstream physician as he got 20 years ago from a CAM source.

• I do appreciate the fact that you've been courteous, in line with WP:GF.NightHeron (talk) 07:38, 16 May 2018 (UTC)

@CFCF: (1) Here's a reference to a history of medicine article that uses allopathic in a neutral, non-pejorative way: Bryan S. Turner, "The history of the changing concepts of health and illness: Outline of a general model of illness categories," in The Handbook of Social Studies in Health and Medicine, Sage Publications, 1999. (2) I don't understand your comment that "there is a general consensus that there are NPOV issues in this article. There is however little agreement which issues these are..." Can you clarify? The NPOV issue that I raised is that the article lumps together all alternative treatments and condemns all of them, disregarding some RS that have a different viewpoint. What do you (and others) see as the NPOV issues that concern you with this article? Thanks. NightHeron (talk) 17:02, 16 May 2018 (UTC)

No. Allopathy is a term of art coined by Samuel Hahnemann, inventor of homeopathy, to describe the opposite of homeopathy. His belief was that diseases were caused by miasms and could be cured by things that caused similar symptoms, versus what he described as "allopathy" which sought to address the miasms (or humours, in the normal parlance of the time) by opposition. Allopathy is bloodletting, purging and the like. We absolutely should not use this term. Nor should we refer to "Western medicine". There is medicine, and there is everything else. China uses medicine, and also used "traditional Chinese medicine", a hangover from Mao. That's not Western versus Eastern medicine, it's medicine versus superstition. Guy (Help!) 07:28, 23 May 2018 (UTC)

The heart of the problem

The heart of the problem here is that there are several concepts considered together which are in some cases only loosely related.

• Alternative medicine is normally interpreted as whole medical systems like homeopathy which offer a claimed alternative to medicine. By definition, these things do not work (satirically referred to as Minchin's Law). If they worked they would not be alternative. It is also usually valid to characterise this as pseudomedicine.
• Fringe medicine is things like chelation for heart disease, long term antibiotics for "chronic Lyme" and the like. These are medical treatments that have been investigated, found to be incorrect, but are still doggedly promoted, with extensive lobbying resulting in things like TACT (whose authors are probably the worst collection of charlatans ever seriously funded by the NIH) and the "legislative alchemy" that protects "Lyme literate" doctors from being disciplined by medical boards despite gross departures from the standard of care. Fringe medicine is unambiguously problematic.
• Complementary therapies, many of which are entirely mainstream (massage, relaxation therapy etc) but which were deliberately suborned by the alternative brigade under the umbrella "complementary and alternative medicine" (CAM) and now "integrative medicine" (IM) - aka quackademic medicine - in order to provide a halo effect and allow bullshit in through the back door. Massage became massage plus acupuncture, bingo, quackery "integrated".
• Terms like "Western medicine" or "allopathy" come entirely from the quack fraternity, aiming to cast their alternative beliefs as separate-but-equal. We should avoid these like the plague, because they are tools for psychological framing and inherently violate NPOV.

I actually think we need separate articles on alternative medicine and CAM/IM. I think it is important to distinguish between alternative medicine, which is, to a good first approximation, always quackery, valid complementary therapies, and and CAM/IM which seeks to promote quackery by "integrating" with reality-based approaches.

We also need to distinguish between science and politics. NIH has spent billions testing alternative treatments without validating a single one, the existence of the pages on these therapies in NCCIH is evidence of political lobbying, but not evidence for the treatments themselves. Guy (Help!) 07:49, 23 May 2018 (UTC)

Spot on, JzG — very well put in your characterization of the problem. The only concern I have is your point on "Complementary therapies" that are ostensibly mainstream, such as massage, relaxation therapy, etc.

The problem with these is that they are often either not supported by evidence, or just as other alt-med, supported by "quasi-evidence" or in fact "found to be incorrect". The section on Massage#Beneficial_effects is a mine-field that should be looked over.

To be truly neutral we would not suggest their be either alternative or mainstream, as they are simply not medicine at all — and when they purport to serve medical purposes without any support at all (that they "have the healing effects of medicine") they are most certainly "fringe" or "alternative".

Personally I: enjoy massage; do yoga; and use perfume and scented candles (aromatherapy). I do so because I like it, and because it feels nice — not because I believe it will have any positive effects on me beyond: other physical interaction; other exercise; or eating a nice meal (also olfactory stimulation). Stating that their health effects go beyond such general claims is something I think we should be very careful about, because it quickly invites the wishy-washy alternative crown that justifies these effects to be "magical". It requires strong sources, of which as far as I am aware, there are none. (There are quite a few sources that state massage to be ineffective though.)

Regarding splitting out articles on CAM/IM — the issue quickly arrises that we will have several venues that need to be policed for nonsense and NPOV SPA-editors. If you look at the histories of those articles before they were merged here you will see that they were horrible — and I think the current solution is actually better for that fact. Carl Fredrik ^talk 14:53, 23 May 2018 (UTC)

I mostly agree with both of you, but there are some realities which are inconvenient. The real-world practice of medicine does observe traditions above evidence (just consider the shift hours that interns work). Pharmacies still handle a wide variety of non-EBM cough & cold products, for one glaring domain. Many interventions simply cannot be tested in a true randomized double-blind trial: subjects know if they got the placebo, practitioners know what they administered, or both. That does not mean that those interventions are useless, but that they can only have lower-quality evidence. Many more trials could only be done by ignoring ethical constraints. Some trials are underpowered or entirely unfunded for want of a sufficiently profitable market, while simultaneously vast sums are being spent on profitable non-diseases and cosmetics. If we are unable to acknowledge and address such limitations of evidence in a structured way there's little hope of convincing the quackademics to think more rigorously, and politicians will continue supporting the NCCIH. LeadSongDog come howl! 15:35, 23 May 2018 (UTC)

LeadSongDog — It has been lost in the wall of text above, but what I outlined somewhere above is that implying that (1) alt-med does not work — does in turn not logically lead to (2) everything that doesn't work is alt-med, nor that (3) anything that works is medicine leads to (2). Carl Fredrik ^talk 19:00, 23 May 2018 (UTC)

CFCF Clarifying the vague lexicon is certainly part of the problem. Is something that is no longer the gold standard still called medicine, or does it become alternative? Will personalized (N=1) genomic-based interventions ever have an evidence base sufficient to be considered more than experimental? Where is the boundary between "supportive measures" and "integrative medicine", and which side of that boundary is chicken soup? LeadSongDog come howl! 19:46, 23 May 2018 (UTC)

CAM = Nice

@CFCF: It's interesting (in view of your fierce defense of the POV of the article) that you yourself use CAM because it makes you "feel nice." It has long been known that a patient's psychological state can have medical consequences. For example, stress reduction can be important (i) to control pain or (ii) to lower blood pressure before surgery. Of course, there are pharmaceuticals that tranquilize or lower blood pressure. But if you were about to undergo surgery, wouldn't you prefer to use yoga and aromatherapy to calm yourself and reduce stress, rather than getting drugged? If your answer is "yes," then you should support changing the article so as to acknowledge that certain forms of CAM are medically beneficial under certain circumstances.NightHeron (talk) 15:40, 23 May 2018 (UTC)

NightHeron — I under no circumstance have ever professed to using CAM. Making someone feel nice is not the same as being medicine or CAM, and those practices do just that, they feel nice. If your argument were to hold, reading a book would be classified as medicine — and any of those previous things I mentioned are of the same characteristic. They turn into quackery (or as you refer to it CAM) — when they profess to have the healing effects of medicine. Now, what "healing effects" are is debatable, but if you seriously wish to assert that because something is on par to: reading a book, wearing a nice shirt, or listening to music, sitting under a tree, or smelling a flower — with regards to calming people down or promoting positive psychological states — it must be medicine, I must question your capacity to engage in this debate. Carl Fredrik ^talk 19:00, 23 May 2018 (UTC)

@CFCF: The article uses alt med to mean something that is claimed to have the healing effects of medicine, and that's what I'm using when I refer to yoga and aromatherapy as forms of CAM. Reading a book or wearing a nice shirt or listening to music are not normally classified as CAM. Yoga and aromatherapy are forms of CAM that might be recommended to a patient by a surgeon who happens to know that the patient uses those methods to reduce stress. Why do you question my competence for saying that? A civil debate is better than an angry one.NightHeron (talk) 19:37, 23 May 2018 (UTC)

The point is that neither yoga or scented candles are by definition CAM, but are so used because they are said or believed to have "healing properties" beyond what is expected of something of a similar nature that only professes to make you feel nice. To say that yoga is CAM is in fact a pretty damning insult to anyone who does it because it is fun and relaxing. Yoga and aromatherapy are neither recommended by any credible surgeons, nor would they be CAM if recommended to reduce non-pathological stress. They're simply whatever suits your fancy. Having a nice cup of tea or running the mile, or dancing are just as valid, and are not either CAM unless they are said to promote non-realistic ideas of "healing". I question your competence because you imply that yoga de facto CAM, despite just being an exercise form — which is a nonsensical proposition based on circular reasoning. Yoga is CAM because yoga is CAM is not logical — and to suggest that anything which relies on such criteria for whatever is CAM or isn't implies that there is no way in which we could define CAM. The definition can not read CAM is CAM. Carl Fredrik ^talk 20:12, 23 May 2018 (UTC)

@CFCF: Please read Alternative medicine#Prevalence of use of specific therapies, which lists both yoga and aromatherapy as commonly used forms of CAM. What you call a "damning insult" is already in the article, not something I said out of incompetence.NightHeron (talk) 21:11, 23 May 2018 (UTC)

@CFCF: Concerning your "[not] recommended by any credible surgeon" comment, a friend who had a hysterectomy at a major U.S. medical center was told by them that in the event of adhesions she would be better off not getting another surgery but rather using yoga and meditation (which is what she did).NightHeron (talk) 21:26, 23 May 2018 (UTC)

How can you be so intentionally oblivious to what I'm saying? I quoted you this before:

["CAM" is] "inflated by counting exercise, relaxation, self-help groups, and commercial weight-loss clinic as “alternative,”

This is with regards to both prevalence of use and the definition of what "CAM" is. Let me follow with a few more quotes from the same chapter (I don't know if these are already on this page or not, something similar most certainly is):

Whether something should be considered “alternative” depends not only on the method itself but also on how it is used and what claims are made for it.

For all its worth I can use acupuncture or bonesetting all the time without it being "CAM". I in fact crack my knuckles maybe 5-6 times a day, just because it feels nice, that does not make me an adherent of chiropractic.

Lastly:

Classifying proven therapies as “alternative” is advantageous to proponents who suggest that if some work, the rest deserve equal consideration and respect.

That is my last word on the topic, and I'm through discussing this nonsense, and I'm through countering your anecdotal pretences. NightHeron — I can draw no other conclusion than that you are being intentionally obtuse and thereby violate WP:DISRUPTIVE and WP:NOTHERE. I would suggest you disengage from this before being actively shown the door. As for Roxy the dog, JzG I can not recommend the book Consumer Health enough. Carl Fredrik ^talk 09:03, 24 May 2018 (UTC)

Does anybody else think that getting Alt-Med treatment to calm yourself before surgery is a good idea. I think that to do so is batshit insane. -Roxy, the dog. barcus 15:47, 23 May 2018 (UTC)

No, I agree with you Roxy the dog — that does sound like a horrible idea. Carl Fredrik ^talk 19:00, 23 May 2018 (UTC)

(edit conflict)

@NightHeron: Using aromatherapy *IS* "getting drugged", just by a drug without the evidence to show it works safely (or at all) for the claimed indication. Yoga, or several other forms of exercise, might help with relaxation but they'll do nothing for surgical pain. Biting a stick on the other hand... LeadSongDog come howl! 15:54, 23 May 2018 (UTC)

@LeadSongDog: Yes, Aromatherapy does involve inhaling aromas, which could be called being "drugged." Perhaps User:CFCF could defend it as having calming effects without negative side-effects. I can't, because I know little about it and never use it. It wouldn't work for me, because I have a visceral negative reaction to anything associated with New Agism, and so it would probably just make me annoyed and raise my blood pressure; personally I'd need pharmaceuticals. But I'm open-minded enough to recognize that it might work for User:CFCF and others. Also, I'm sorry if I was unclear in my numbered points (1) and (2); in (1) I meant relief of relatively mild pain (back and joint pain, e.g., from arthritis), and in (2) I meant lowering blood pressure before surgery. I did not mean CAM in place of anaesthetics during surgery. @Roxy the dog: If you want an RS for belief in "batshit" before surgery, please see Lori Alvord's book The Scalpel and the Silver Bear. Bringing in a Navajo medicine man turned out to be very effective in calming elderly patients from the Navajo reservation before surgery.NightHeron (talk) 19:17, 23 May 2018 (UTC)

The point is that none of this can be constituted as "medicine", and if the definition of "work" is "to make you feel good" we're just talking about personal preference in recreation. I profoundly dislike football, but I would never suggest it "works" for me — but according to you we could say that "watching the 110m hurdles works for me", because I happen to like doing that. Carl Fredrik ^talk 20:20, 23 May 2018 (UTC)

Is Alvord's book MEDRS? -Roxy, the dog. barcus 21:30, 23 May 2018 (UTC)

@Roxy the dog: I think not, because WP:MEDRS says that "Primary sources should generally not be used for medical content," and the book is a primary source, namely, the memoirs of the first Navajo woman surgeon. It describes her practice and what she found helpful. It is not a source for recommended medical practice of anyone else. If I were going to have surgery, and my surgeon read her book and concluded that he should bring in a Navajo medicine man for me, I would definitely not be calmed or reassured by that, to put it mildly. But to get the best possible medical outcome it's sometimes a good idea to be respectful and accommodating to the patient's belief system -- that's one of the points of her book. In particular, maybe it's best to avoid the temptation to call it "batshit." Sometimes physicians might recommend a form of CAM to patients for whom they think it will help accomplish a medical objective, such as reducing pain, lowering blood pressure, improving the patient's attitude, etc. Not if the patient is you or me, but maybe for others.NightHeron (talk) 22:20, 23 May 2018 (UTC)

One is not immune from condoning quackery for being a physician. After all Dr. Oz and Deepak Chopra are both physicians yet are still totally deluded. Carl Fredrik ^talk 09:07, 24 May 2018 (UTC)

One obvious problem with aromatherapy is that there appears to be little to no credible evidence it is actually therapeutic. Guy (Help!) 06:45, 24 May 2018 (UTC)

Yupp, I made a mistake to say that — what I meant is I like scented candles. It strikes me how these debates always start on such stupid little issues. "It's got the word therapy in it, therefor it must be legitimate". Human psychology truly is fascinating. Carl Fredrik ^talk 09:09, 24 May 2018 (UTC)

Achieving civility in discussing NPOV --> take to mediation?

In my comments I have maintained a respectful tone, and done my best to engage the arguments that other editors were making. Nevertheless, various serious accusations have been made against me here and on the NPOV noticeboard, mainly in recent comments by User:CFCF: anti-science, incompetent, intentionally obtuse, disruptive. Earlier I was accused of being an altmedist. Now User:CFCF is threatening to "show me the door" (which I guess means getting me banned). I'd really like to have a constructive discussion of this issue that complies with WP policy on civility of discussions, and so I'm proposing here (and I also proposed this on the NPOV noticeboard) that the discussion of NPOV in the article be taken to mediation, as per WP:Mediation. Would others be willing to participate in that? Thanks.NightHeron (talk) 16:45, 24 May 2018 (UTC)

Complementary and Integrative Medicine

This whole article is crazy to me and seems to be written 30 years ago by old school folks trained in conventional medicine. The new term used by the National Institutes of Health is Complementary and Integrative Medicine (CIM). Although it is true that SOME CIM lack adequate scientific evidence, that is clearly not part of their definition. The National Center for Complementary and Integrative Medicine (NCCIH), the Veterans Affairs Health care System (VA), and the US Department of Defense (DoD) have all been funding high quality research on CIM therapies for 20+ years, and this research has increased dramatically in recent years with the prescription opioid drug crisis. This article talks about AM as if they are harmful unproven practice, so crazy. How about the harms of conventional medicine such as opiate prescriptions?

Anyway, I don't want to just rant the other way, but saying that the energy acupuncture is designed to control or affect is "supernatural" displays the massive naivete and bias. I have published studies of yoga for back pain done with large scale randomized controlled trials. Botanical and herbs are used to create medicines all the time, as noted above. Almost all of the top universities with medical schools have faculty and Centers for CIM research, teaching, and clinical practice. Look at UCSF, Harvard, Stanford, UCLA, Duke, etc. Normally I would ignore this stuff on Wikipedia but I do realize it's importance role in providing balanced and accurate information tot he world.

We need to heavily edit and change this page to provide a current and balanced article. There can be different opionions, but we can cite all of the high quality research supporting many but not all CIH treatments. There is quackery and even fraudulent products and advertising and there always will be with financial gain available. — Preceding unsigned comment added by Epsych2 (talk • contribs) 18:29, 23 August 2018 (UTC)

Please note that this page is not a forum (WP:NOTFORUM) to discuss the topic in general but that the focus should be on article improvement. I do see that you're making suggestions in relation to the article but they are not very specific. If you have worked, or are working in the field you may have a conflict of interest (WP:COI). In any case, what we are looking for are secondary and tertiary reliable sources (WP:RS) which we can then summarize. This means avoiding primary research papers, self published works (WP:SPS), user generated content websites (WP:USERGEN, including Wikipedia) and blogs, except for WP:PARITY when necessary. Since the article is also touching medicine, for any health claims a medical reliable source would be needed (WP:MEDRS) with more requirements. Non-medrs are fine for surveys of history, etc. I suggest to go one step at a time and to be careful to WP:CITE new edits. Per WP:BRD and WP:CONSENSUS you may edit the article directly. If contested, this is the right place to pursue the discussion. You can also suggest sources here for review or at the reliable sources noticeboard (WP:RSN) for assessment by more people. I hope this helps, —PaleoNeonate – 23:09, 23 August 2018 (UTC)

Sources!

Hi everyone! I'm trying to fix the sources of the article and to remove unnecessary repetitions from the article. To anyone who's (planning on) editing this article, I'd like to kindly ask you to read wp:medcite and wp:medrs first, to avoid adding more undesirable sources (like MSNBC)(see wp:medpop). Your help is much appreciated.Doanri (talk) 16:12, 17 June 2018 (UTC)

I see you're getting some blowback for your many undiscussed edits. Keep in mind that the article's state is the result of the work of myriad, far more experienced, editors, and there are actually reasons for much of what you see. Instead of treating the article as if it was your own blog or website, respect what's there and ask about any oddities you see, rather than just attempting to fix what may not actually be broken, even though it seems (to you) to be broken. -- BullRangifer (talk) PingMe 19:06, 17 June 2018 (UTC)

Not WP policy, see WP:BEBOLDDoanri (talk) 19:54, 17 June 2018 (UTC)

(edit conflict) — While we can agree that we should avoid MSNBC for medical statements, etc., you've been going against consensus by showing all the lede sources that have been hidden for a period of several years — and you added "unreliable medical source" tags to what are the best sources out there. This is all highly controversial and should be discussed here on the talk page before any implementation. Carl Fredrik ^talk 19:07, 17 June 2018 (UTC)

Bingo. -- BullRangifer (talk) PingMe 19:46, 17 June 2018 (UTC)

Awfully sorry for the editing after the first revert, I didn't see that. I didn't mean to go against community consensus, however, I must point out that in medical articles lead citations are considered desirable and good practice (WP:MEDCITE#Citations_in_the_lead)(it also breaks a bunch of other citations further on in the article).

On the hidden and unclear citations (Ernst meta-analysis?) and comments throughout the article code (which you can't see without looking at the code), I have never seen this, and if it is actually accepted common practice I'd love to see where that consensus was established.

Although I think we all agree on AM being a heap of nonsense, I don't think that this means we should be more lax with what citations we allow to be used.

PS: The WHO Report doesn't define AM as represented in the current (19:45 UTC) article, but gives the reported definition as an alternate, only used in some countries. I'd love to keep improving this article, so please do let me know what you think.Doanri (talk) 19:48, 17 June 2018 (UTC)

The problem is with WP:Overcitation, where the number of citations needed to keep the lede in check from being challenged — severely disrupts either its readability, or editability.

• If the lede is cited properly for each statement, it is so full of numbers that it severely impacts reading.
• If it is cited with grouped sources at the end of each paragraph it can't be edited, rearranged or at all improved without a massive amount of extra work moving and rearranging the citations, beyond just figuring out which citations supports which statement.

The hidden citations serve limited purpose and are more a rest, as the sections of the lede without citation are still cited in the article body.

So, with that said, I think we should focus on the main point here:

Why did you mark Consumer Health as unreliable? — That speaks of WP:Bad faith to me.

Carl Fredrik ^talk 20:18, 17 June 2018 (UTC)

Firstly, I'd never seen wp:bad faith, and I must say it's absolutely brilliant! But back to the points you made.

• Consumer Health is not a reliable medical source in my reading of Wikipedia:Identifying_reliable_sources_(medicine)#Books (§2).
• Apparently the lead does not have to include inline citations by force of Wikipedia policy (MOS:MED#Lead) (therefore I'm not going/able to force their appearance), however, I would appreciate it if you could take a look at the essay I previously mentioned, WP:MEDCITE and perhaps also read WP:UNDERKILL. Even if you still don't agree, let's at least collaborate to fix the broken refs.
• Please do tell me where I can read more about hidden citations and comments being accepted on Wikipedia.
• I would appreciate it if you could address the concerns I stated before, i.e. mainly the misrepresentation of the content of the 2002 WHO report and the invisible and unclear sources such as the "Ernst meta-analysis". Doanri (talk) 20:56, 17 June 2018 (UTC)

Consumer Health is published by McGraw Hill and is one of the best and only high quality textbooks to cover the topic in any detail. The other being More Good Than Harm?, which came out this year. The evidence has actually moved extremely slowly in the field — and there is very little if anything that is out of date, so I'm not at all convinced by this argument. The fact is that the evidence has only moved to definitively discredit more and more "alternative" treatments, so the book remains excellent. If we have newer sources that tackle the problem we might use them, but so far none have been suggested, and the book is certainly not unreliable.

It surprises me that it was singled out as unreliable when neither the other book sources were, nor were the 1999 journal sources.

There is no explicit statement that hidden references are allowed, but the frequently occur in medical articles, and certainly do no harm. They allow for readability to remain acceptable, while also allowing a simple way to change in the lede without breaking everything and some remaining verifiability. I'd also like to tell you that I wrote large parts of WP:UNDERKILL, so I find this to be one of few exceptions where it can not properly be applied simply due to technical constraints. It would be best if we could cite properly, but there isn't any way to do so that doesn't break either editing or reading.

As for broken sources, they should be fixed — I'll take a look about that meta-analysis, but for the 2002 WHO report, I don't really understand your comment and would appreciate if you clarified your objection a bit more. Carl Fredrik ^talk 21:29, 17 June 2018 (UTC)

Issues with shamanism

Hey. I noticed that the table including shamanism (in the "Religion, faith healing, and prayer") is blank in the issues section. I'm not an expert in the area, but I was wondering whether this source may be useful in discussing the issues surrounding this. There also seems to be some good criticisms on the shamanism article, although I'm not aquainted enough with WP:MEDRS guidelines to add this info to the article.

Just thought it seemed odd that this section remained blank; we don't want to give a misleading impression to Wikipedia's readers as to its effectiveness! --Bangalamania (talk) 16:45, 24 June 2018 (UTC)

Is {{Medicine}} due?

I noticed that you reverted my edit, Roxy the dog, which added the {{Medicine}} navigation template to the bottom of the page alongside the others. My basis for doing so is that the Traditional medicine article also has a {{Medicine}} (not added by me) at the bottom, despite it also not being "real medicine" (by which I take you to mean contemporary evidence-based medicine, or "scientific medicine" per this article's piping of Medicine). I assume the transclusion of {{Medicine}} at both Traditional medicine and this article are appropriate given the three are strongly interrelated topics and anyone reading about traditional or alternative medicine should probably be directed to mainstream medicine, as well. What specifically is inappropriate about the transclusion of {{Medicine}} on this article? I don't think it's implying anything about medicine or the contents of that template. It is simply a relevant navigation template, like the others.

If you do still maintain that the template ought to be excluded (or consensus otherwise supports that, if others comment), then the template probably should also be removed from Traditional medicine, as well, on the same grounds. Moreover, if so, then my edit to {{Medicine}} adding Alternative medicine and Traditional medicine to its "Related topics" section should also be reverted. I only added them for the same rationale as above and because they are related topics. If that rationale is insufficient for the transclusion of {{Medicine}} here, then it is also insufficient for the inclusion of the articles that would no longer have the template in that template. Thank you for your time. —Nøkkenbuer (talk • contribs) 11:02, 23 July 2018 (UTC)

The point of alternative medicine is precisely that it isn't medicine. Guy (Help!) 11:23, 23 July 2018 (UTC)

What Guy said. -Roxy, the dog. barcus 11:27, 23 July 2018 (UTC)

Sure, but I don't see how that's relevant. That doesn't respond to anything I said. The point of transcluding {{Medicine}} in Alternative medicine is precisely that the latter is a closely related topic to that which is covered in the former. My edit seems like an uncontroversial application of WP:NAVBOX.

The only navboxes on Antireligion are {{Religion topics}} and {{Philosophy of religion}} despite how antireligion is precisely neither a religion nor a philosophy of religion, yet I doubt that would be considered acceptable grounds to remove them from that article. Similarly, Antiscience's only navbox is {{Science and technology studies}} and Antipositivism includes {{Positivism}}. In every case, they are included in each other because they are topically related to each other and form a coherent set of relevant articles that cover a defined topic. I think the same applies here. —Nøkkenbuer (talk • contribs) 12:02, 23 July 2018 (UTC)

As regards your second paragraph, so what, WP:OSE ... and if you cannot see how Guy's point is relevant, then perhaps you should not be editing here. -Roxy, the dog. barcus 12:39, 23 July 2018 (UTC)

And WP:OSE unambiguously states that such arguments "can be valid" and that "these comparisons are important as the encyclopedia should be consistent in the content that it provides or excludes", so "[t]rouble arises when legitimate comparisons are disregarded without thought or consideration of the Wikipedia:Five pillars." As that very same essay also explains, some stuff exists for a reason. This seems like one such case.

I do not think that Guy's point is relevant because I see no reason why it would be. No attempt has been made to explain it to me, nor explain why our guideline for navboxes does not support transclusion of {{Medicine}} in this article. Thus far, I have been met with hostility. If you are unwilling to cooperate and discuss this, then what are you here for? —Nøkkenbuer (talk • contribs) 14:54, 23 July 2018 (UTC)

Antireligion is a religious perspective. Alternative medicine is to medicine as Ponzi schemes are to investments. Guy (Help!) 13:35, 23 July 2018 (UTC)

Yes, I get that your point is that alternative medicine is antithetic to medicine or otherwise a fraud thereof. My point is that I do not understand how that is relevant because positions antithetic to the topic of a navbox are sometimes included in that navbox, and those navboxes are sometimes transcluded in articles that are antithetic to them. This is because the determinative considerations for inclusion are the topical relevance of the subjects to each other and the extent to which their inclusion fills a gap in coverage within a defined group topic. If I am incorrect, then how am I incorrect?

Alternative medicine is very relevant to medicine, so much so that many unfortunate people mistake the former for the latter and the latter dedicates a significant portion of scholarship to analyzing and refuting the former, as evinced by this article. Both are also crucial components of the larger topic of medicine as a concept, which includes pseudomedicine for the same reason why antiscience is included in the broader topic of science and antipositivism in positivism. Consequently, I think navbox inclusion is appropriate. Why not? —Nøkkenbuer (talk • contribs) 14:54, 23 July 2018 (UTC)

Antireligion (and indeed atheism) is part of the core philosophical framework of religion. Alternative medicine is connected to medicine only in as much as its practitioners are desperate for the respect that medicine gets. And the money. It's an asymmetric relationship. Medicine is relevant to alt-med, because it is the nemesis that at-medders constantly try to stave off, but alt-med is not relevant to medicine. Guy (Help!) 15:14, 23 July 2018 (UTC)

Thanks for explaining, Guy. I'm not entirely convinced about the "asymmetric relationship" point, but I think I understand how it might sometimes occur. Regardless, it seems that there is at most no consensus for including {{Medicine}} (unless two against one counts as consensus), so I'll just drop it unless further commentary develops. —Nøkkenbuer (talk • contribs) 15:45, 23 July 2018 (UTC)

I would add my voice to the existing consensus - I didn't revert the addition when I saw it, but I winced. It risked giving an air of unwarranted credibility to the subject, which we should try to avoid.Girth Summit (talk) 20:38, 23 July 2018 (UTC)