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Archive 1Archive 2

Proposed rewrite on 21st June 2021

Hi, I noticed that a major rewrite was submitted yesterday (21st June) by Alpacacandle, and immediately reverted.

I took the time to read through the submission and concluded that it was well written and referenced; it looks like the author took a lot of time to try to improve this article.

Was there any particular issue which led to the immediate reversion? Llamabeast (talk) 08:38, 22 June 2021 (UTC)

Dreadful sources & WP:PROFRINGE throughout. Alexbrn (talk) 11:42, 22 June 2021 (UTC)

Can you clarify for me why they were dreadful sources? Mostly they were peer-reviewed papers from mainstream journals. Apologies if this an uninformed question, understanding this would be really helpful for me to make better contributions.

Personally I didn't find it to be pro-fringe, although I accept that this is subjective (I come from a very mainstream scientific background myself and am also allergic to fringe theories). I think the quality of the writing was good. If the whole rewrite won't be accepted then I'd like to try to adapt and incorporate some of the more informative parts of the contribution, but obviously want to do that in a way which will achieve consensus. I think there is some room for carefully considered improvement to the current article. Llamabeast (talk) 12:57, 22 June 2021 (UTC)

A lot of the initial sources were from functional medicine promotional sites, site by definition not WP:FRIND. Peer-review is not enough on Wikipedia; biomedical claims need WP:MEDRS sourcing and it needs to be relevant (not riffing around the periphery of functional medicine, a fraud which tries to legitimize itself by embracing some common sense to mix in with the woo). Dodgy stuff like PMID:25324467 in a predatory journal is particularly despicable. The current sourcing (what "personal blogs"?) seems very good for a fringe topic, per WP:PARITY. Finally, could you clarify what connection you have to the edit and/or editor under discussion? Alexbrn (talk) 13:10, 22 June 2021 (UTC)
Alexbrn is correct - I didn't look through every source, but the ones I did look at appeared to be 'in-universe', not mainstream scholarship. Girth Summit (blether) 13:16, 22 June 2021 (UTC)

Thank you both for the feedback, that's very helpful. I'll try to answer your questions in turn which will make my post slightly long; thanks for your time.

My assumption when discussing a fringe theory is that the structure might first state that it's a fringe theory, then explain the claims of the proponents, then explain the criticisms. When explaining the claims of the proponents, is it not reasonable to give sources from the proponents themselves? Thanks for the clarification either way.

I think the key learning for me is that secondary rather than primary sources are needed, which makes sense. As an aside I don't believe that PMID 25324467 is in a predatory journal; it is on PubMed, and it's my understanding that PubMed screens for predatory journals.

Re the "personal blogs", I'm referring to refences 1, 2, 6, 8 and 11, which so far as I can tell are just somebody's opinion. (Apologies by the way for editing away my reference above to personal blogs; I was trying to simplify my comment.)

Great question on my relation to the article and I'm sorry for not being clearer from the beginning. I'm a PhD physicist but I've made an unusual career switch and have just completed an MSc in Personalised Nutrition in the UK. One of the other finishing students just shared that she'd taken a week to research and write this updated article as she'd felt it could be improved. For her own part she's extremely on the ball (a Cambridge-educated vet) and, as it happens, quite vehemently anti-pseudoscience, but not familiar with wikipedia editing. I don't think she'll return to this discussion but I thought there was value to be salvaged here.

I understand the need for extreme care in these fringe medical topics. I would like to comment though that the claims of functional medicine are not in fact especially fringe, certainly compared to the rest of the "alternative medicine" category. Many (perhaps most) practitioners are MDs. Essentially the claims come down to "Nutrition and lifestyle can underlie the development of chronic disease", and "Understanding and modifying these root causes can improve disease progression". Functional medicine presents a framework for clinicians to try to identify root causes and in doing so it uses a bunch of jargon which I would agree is at times obfuscatory and problematic. Criticism and skepticism is appropriate. But we're not talking homeopathy here. It's essentially a different branding of lifestyle medicine. Llamabeast (talk) 13:46, 22 June 2021 (UTC)

Okay, so there's a WP:MEAT issue here. As to the other points:
  • No, Wikipedia does not include fringe theories other than as described in mainstream sources (which we do here now). See WP:GEVAL.
  • PUBMED does not screen for predatory journals, and Aging (journal) is dodgy as hell.
  • Science-Based Medicine is not a "personal blog", though WP:PROFRINGE editors have often tried to brand it as such, leading to many discussions over the years (see the entry at WP:RSP)
If you want somebody to tell you "Nutrition and lifestyle can underlie the development of chronic disease", you can go to a normal doctor and/or read Healthy diet etc. This is not something unique to Functional Medicine, which in all the things where it is unique, is essentially a health fraud. Wikipedia isn't going to be a brochure for it. Alexbrn (talk) 13:55, 22 June 2021 (UTC)

Hmm, I see that there is indeed a WP:MEAT issue. I'm not sure what to say about that other than to apologise for the context of my arrival and to promise to work in good faith. There is, at least, only one of me.

Thanks for the clarifications above, they are all helpful, and sorry for unwittingly retreading old ground.

Clearly I'm at least somewhat pro-Functional Medicine (I think aspects of it have merit), and clearly the majority of the editors here are of the opinion that it has no merit. How do we make improvements in a situation like this? I'm not an experienced editor, but otherwise am well qualified to make contributions, including the fact that I am very happy to follow wikipedia procedure. I would hope that it would be possible to make collaborative improvements to the article in good faith. I'm hope it's clear that I'm not proposing it should be a "brochure", but being reasonably factually accurate about the claims of and evidence for functional medicine would be good, even if everyone else here thinks the claims are false.Llamabeast (talk) 15:52, 22 June 2021 (UTC)

WP:GEVAL. tgeorgescu (talk) 15:40, 22 June 2021 (UTC)

I see - thanks, that makes sense. I was just thinking about it and had come to the conclusion that that would be the only reasonable policy. I guess I am in the nightmare position here where so far as you guys are concerned, I'm the climate change skeptic or the homeopath. Obviously you would not want to equally present both sides of the argument where one side of the argument is judged to be as mad as a fish.

There are a number of factual problems with the article which I hope I can fix while not changing the overall tone of the article, which I now understand and accept even if I disagree. How can I propose small changes? Is it best just to make the edit, or should I draft it or discuss it here first instead? Llamabeast (talk) 20:47, 23 June 2021 (UTC)

Llamabeast - please sign your posts, and indent your messages. See WP:THREAD for discussion of this.
You are permitted to make WP:BOLD changes to the article, but if they are reverted you need to come back here to discuss. Given the nature of the content that you were supporting above, you might prefer to propose them here first. You can format them as edit requests if you like. Best Girth Summit (blether) 11:12, 23 June 2021 (UTC)
That's really helpful, thanks. Llamabeast (talk) 20:48, 23 June 2021 (UTC)

“ Many (perhaps most) practitioners are MDs. Essentially the claims come down to "Nutrition and lifestyle can underlie the development of chronic disease", and "Understanding and modifying these root causes can improve disease progression". Functional medicine presents a framework for clinicians to try to identify root causes and in doing so it uses a bunch of jargon which I would agree is at times obfuscatory and problematic. Criticism and skepticism is appropriate. But we're not talking homeopathy here. It's essentially a different branding of lifestyle medicine.”

I agree with this. The criticism of functional medicine can often be summarised to a claim that practitioners trade in fringe or quackery, which is probably true, but the exact same assertion could be made about mainstream doctors. Maybe less frequently but still.

And if anything, medicine is itself trying to unearth more and more fundamental causes of diseases, you could in fact argue that the entirety of medical history has centered around identifying them. The issue with the article right now, is that it is wrong, it doesn’t explain what functional medicine is, or the framework behind it.

Also bear in mind, that intrinsic to functional medicine is a critique of how current clinical trial and research is conducted, critique, which I would say is definitely not fringe, and hence using such arguments to “debunk” it make no sense.

It would be better if the article said what functional medicine is (finding root causes of chronic conditions) and then critiquing the remedies prescribed (say “curing” aging with resveratrol). But bear in mind that David Sinclair has a Harvard lab, and the average doctor is not going to take away your glass of red wine Godal (talk) 17:11, 21 February 2022 (UTC)

finding root causes of chronic conditions, I don't think that's what functional medicine is. Anyway, you have communicated vague suggestions. You mentioned no WP:RS and no specific (concrete) change of the article. tgeorgescu (talk) 19:24, 21 February 2022 (UTC)

I don’t know what all the various Wikipedia rules are, and I don’t think I would be able get through.

I am just point out that lamabeast is basically right, and that the article as it stands is misinformative. Functional medicine is neither fringe nor pseudoscience, even if practitioners trade in such ideas. It’s just the age old idea of treating the ultimate cause. Which we often do not know, hence people are attracted to ideas such as the Mediterranean diet, ostensibly on an epidemiological basis.

As someone pointed out “if it works, it’s no longer alternative medicine, it’s just medicine”. Similarly, if non-functional medicine would discover some cause or treatment for a condition it would be readily absorbed. Godal (talk) 21:40, 21 February 2022 (UTC)

Potential additions to article

Just noticed that this article doesn't mention the top marketers of "Functional medicine", such as Mark Hyman, Jeffrey Bland, and the Institute for Functional Medicine. It might be a good idea to discuss them, if there are supporting reliable sources. ScienceFlyer (talk) 23:31, 28 March 2022 (UTC)

Detox

@Daniel Santos: People who endorse detox quackery are absolutely unworthy of being called "scientists". Yup, one can be a brilliant mathematician, yet speak batshit crazy stuff about medical sciences. tgeorgescu (talk) 23:00, 8 March 2023 (UTC)

Hello @Tgeorgescu! Look, I really don't care about your opinion of who is worthy or not of some title, I care about facts. Just because there is quackery in some area doesn't give license to abandon objective reality and FACTS. The FACT is that some (maybe "most", or "almost all") scientists think it's BS. It's my opinion that most of it *is* BS. But this is an encyclopedia so lets be accurate. Science doesn't know everything and fringe medicine will inevitably stumble into things that work prior to there being reasonable studies to discover that they got something right. One example is guanfacine + N-acetylcysteine though it has no citations yet and needs follow up studies with larger sample, etc.
So maybe quackery is a trigger for you and sets you off. We all have to deal with them. But one of *my* triggers is the propagation of cognitive distortions and logic fallacies. I feel it's more helpful to tear down something stupid in an accurate fashion. This invariably reveals any nuggets of truth within them -- whose existence is NOT a rationalization for the husk of BS that surrounded it. So please calm down and let's tear down BS constructively. <3 Daniel Santos (talk) 01:41, 13 March 2023 (UTC)
@Daniel Santos: I have never understood WP:PROFRINGE people who think they are more logical than rational skeptics and than debunkers of pseudoscience. You should know that WP:AE is just around the corner. tgeorgescu (talk) 02:05, 13 March 2023 (UTC)
@Tgeorgescu Yes, we should definitely initiate arbitration. My original edit was just to mitigate the problem. The sentence needs to be re-written and probably based on something other than a news article that, it's self, doesn't include any names or references.
And in the interest of devil's advocacy, medical science has clearly identified detox methods that work, such as desisting exposure to the toxin.
I think that there are also many areas of the functional medicine "ecosystem" that deserve to be examined. I learned (through verbal communication with a practitioner) that the supplement companies (e.g., Apex Energetics) only sell through these distributors like Fullscript (parent company HGGC?), who themselves will only show you prices for supplements once a practitioner has recommended one. The reason for this is that when the practitioner creates their account, they tell the distributor how large of a kickback they want -- which dictates the price you see! If we can find WP:RS on this, I think it needs a section! Daniel Santos (talk) 22:19, 13 March 2023 (UTC)

Article does not discuss what functional medicine is. Should it be deleted?

At the absolute bare minimum, an article on a given subject should define said subject as it is typically understood. This article does not do either, plunging immediately into criticism and only briefly surfacing to list, but not define, a few terms supposedly associated with functional medicine.

This isn't to say readers shouldn't be presented with the scientific consensus on a pseudoscientific practice in the lead. By all means, tell readers that functional medicine is bad. But not before telling them what it is. That's just lazy.

Someone will likely argue that this isn't possible. I think that's tantamount to saying the topic isn't notable. If it's so poorly defined that we can't discuss it, does it really exist? 2603:7081:1603:A300:E091:E8CF:A13:50E7 (talk) 09:40, 29 May 2023 (UTC)

"Functional medicine" is a marketing brand rather than a coherent and science-based approach to medicine. tgeorgescu (talk) 10:56, 29 May 2023 (UTC)
Do you have reliable sources that define it "as it is typically understood", as opposed to "a form of alternative medicine that encompasses a number of unproven and disproven methods and treatments" that "focuses on the 'root causes' of diseases based on interactions between the environment and the gastrointestinal, endocrine, and immune systems to develop 'individualized treatment plans.'", as the article seems to define it? --tronvillain (talk) 21:44, 30 May 2023 (UTC)
I concur that article is completely inadequate and does not describe what functional medicine actually is, and any effort that has been made so far to help define what functional medicine has NOT been admitted into this article.
I can't see how any improvements to this page can be made, if in the end, the only content that is permitted through by the Wikipedia gatekeepers is what is considered kosher in the name reductionism and scientism.
"You can't get the right answers if you ask the wrong questions."
The whole point of functional medicine is that it typically asks different questions about the root causes of dysfunction (we have germs; they make us up; what do they do for us?) than what Western allopathic medicine has traditionally asked (what causes disease? microbes!! kill the germs!! ALL OF THEM!!). Medicine is evolving, in paradigm, in its scientific approach, and its practice. Guess where all that is happening? Yes, you got that right, at the fringes, and with fringe ideas. There can be quackery, but, by focussing myopically on quackery, you're throwing the baby out of the bathwater, every time.
As the article currently stands, it baffles me how the opinions of an institution like American Academy of Family Physicians or one oncologist (David Gorski) should be considered valid and authoritative (well, I suspect it is precisely because they are anti-alternative medicine figures), while the large strategic investment decision made by the Cleveland Clinic Foundation is brushed off in a single sentence by a statement made by an arbitrarily chosen university (as 'unfortunate', 'quackery').
I can see this problem also in the page about Alternative Medicine. Gorski is given airtime, front and centre. For no particular reason that I can see, either.
This makes no sense. Completely divorced from reality.
Welcome to Wikipedia on medicine. Wokspoon (talk) 12:00, 7 June 2023 (UTC)
Nope, the SCAM industry is Completely divorced from reality. Not every new scientific idea is WP:FRINGE, and the proof is in the puding, i.e. in evidence-based medicine. tgeorgescu (talk) 12:40, 7 June 2023 (UTC)

recent edits

I recently found this article and made some edits, including after reviewing the article talk page, and had thought I had helped sharpen the article according to WP:FRINGE and WP:NPOV, but all of the edits were reverted [1]. Anyway, I had also thought there is more that could be done to enhance the article according to WP:FRINGE, e.g. state that Bland has a PhD, remove or incorporate what may be a promotional-seeming EL despite its source, and expand on the lack of scientific evidence based on some preliminary research I started yesterday [2] (the phrase "a first-of-its-kind study" in the press release stood out to me as an opportunity to find and add WP:MEDRS). But I think there are more productive places to focus my attention.

As a side note, there may be some potential WP:CLOP/WP:COPYVIO issues in need review, e.g. added in 2019 [3] (which appeared to have a possible origin at [4] - the phrase 'root causes' does not appear in source cited when I viewed and worked on the article, but on closer examination, the appearance of possible CLOP/COPYVIO may be related to the amount of back-and-forth editing this article has undergone and a source getting lost in the midst of that); and text added in 2015 [5], which could be compared to the source. Thank you, Beccaynr (talk) 16:09, 28 October 2023 (UTC)

There was an issue with attributing WP:SBM, which made many knowledgeable statement appear to be 'just' an opinion, which is problematic per WP:YESPOV. But yes, eradicating any copyvio-ish content would useful & necessary. Bon courage (talk) 16:18, 28 October 2023 (UTC)
From my view, I was thinking about readers, and how the tone and presentation of e.g. the SBM Quackademia update source (cited twice in one sentence in the lead) seems to undermine its credibility (such as the frequency of exclamation points, as well as references to Nazism, New Coke, etc). So from my view, as a basic way to strengthen this source, attribution and blue-linking the author seemed helpful. Also from my view, just because a source is green-lit at WP:RSP, this does not mean we should use what seems to be classic weasel wording through vague attribution for its descriptive secondary evaluation, e.g. "quackery." My intention with the attribution was more to help readers recognize that despite the presentation of the website, the author is notable, and to provide more direct access to their Wikipedia article, which I think helps strengthen the source - we're familiar with WP:RSP, but our readers likely are not. Beccaynr (talk) 00:01, 29 October 2023 (UTC)
I think it weakens things. Per WP:PSCI we are required to be upfront about pseudoscience and make sure it's prominent and clear when something is pseudoscientific. If you want to call FM quackery directly rather than indirectly, go ahead, but I find editors resist that formulation as having an odd tone for wikivoice. Bon courage (talk) 01:42, 29 October 2023 (UTC)
I think the editorial difference in perspective may be well-addressed by adding further sourcing - for example, peer-reviewed studies from reliable journals could help directly demonstrate the pseudoscience. I haven't taken a look at GScholar or the Wikipedia Library, but if I find sources I'll add them to the talk page. Beccaynr (talk) 02:49, 29 October 2023 (UTC)
Really this is just a brand for the usual altmed scamming. There's something in
  • Nunan D, Blane DN, McCartney M (May 2021). "Exemplary medical care or Trojan horse? An analysis of the 'lifestyle medicine' movement". Br J Gen Pract. 71 (706): 229–232. doi:10.3399/bjgp21X715721. PMC 8087320. PMID 33926883.
which makes the point this is just another name for something familiar. Bon courage (talk) 03:12, 29 October 2023 (UTC)
I would like to see this article expanded to follow the first line of the lead, e.g. perhaps with a section for unproven methods and a section for disproven methods. I think this article has the capacity to be a more specific educational resource than it currently is, and when I refer to 'editorial difference in perspective,' I am thinking about how to most effectively present content to readers. More emphasis on red-flag aspects might be helpful (e.g. as noted in the source above, "The affiliation between lifestyle medicine and non-evidence-based, fringe, and alternative tests, diagnoses, and interventions in many areas risks disrepute, conflict, and confusion for patients") and adding broader commentary, such as from the above source about public health and economic disparities, might also be worthwhile to include. Beccaynr (talk) 12:13, 29 October 2023 (UTC)
Not sure 'disproven' features much in medicine, as a very tiny number of things are amenable to disproof. The problem here is that FM is a vaguely-define brand (intentionally so), so will resist efforts to explain just what it is. It's really just another name for Integrative medicine with a couple of extra gimmicks (the matrix thing e.g.). It may, yes, be worth adding something on how this adversely affects its customers though. Bon courage (talk) 12:22, 29 October 2023 (UTC)
The lead currently says 'disproven,' and I was thinking about content currently in the article, such as adrenal fatigue, but this seems amenable to a slight rephrasing. Also, I started reviewing studies and I figure there are sources available to help explain how limiting various limitations can be, e.g. in "Functional Medicine Approach to Patient Care Improves Sleep, Fatigue, and Quality of Life in Patients With Inflammatory Bowel Disease" Crohn's & Colitis 360, 4 (3) July 2022, https://doi.org/10.1093/crocol/otac032 such as a lack of a placebo control, the existence of sampling bias, etc. Beccaynr (talk) 14:13, 29 October 2023 (UTC)

Article was in violation of principle of "Wikipedia is written from a neutral point of view."

Wikipedia:Five pillars

I understand that someone who is editing this takes great issue with functional medicine, but this is an inappropriate use of Wikipedia. I attempted to edit the article to contain neutral and factual information.

Wikiwriter43103840 (talk) 20:21, 13 February 2024 (UTC)

Hi, Wikiwriter43103840, I suggest that you read what WP:NPOV actually says instead of pontificating about what it might say. WP:NPOV does include WP:PSCI, WP:GEVAL, WP:REDFLAG, and actually entails WP:FRINGE and WP:MEDRS. tgeorgescu (talk) 22:31, 13 February 2024 (UTC)
Hi there, I’m unclear about why you are taking this abrasive tone with me. We’re all trying to improve Wikipedia. I stand by what I said. Wikiwriter43103840 (talk) 04:24, 14 February 2024 (UTC)
@Wikiwriter43103840: I'm not seeking to be rude, but saying Article was in violation of principle of "Wikipedia is written from a neutral point of view." means that you have understood nothing from the real WP:NPOV. tgeorgescu (talk) 04:40, 14 February 2024 (UTC)
what don't I understand? I am trying to help the article avoid stating opinions as facts and to avoid using judgemental language. I also want it to "present opinions and conflicting findings in a disinterested tone." Wikiwriter43103840 (talk) 13:26, 19 February 2024 (UTC)
Note: I reverted back the version that avoids stating opinions as facts. In my view, your continued insistence that your way is the only correct way and continuing to remove other people's edits is becoming vandalism. Wikiwriter43103840 (talk) 13:33, 19 February 2024 (UTC)
{{subst:uw-disruptive2}} Wikiwriter43103840 (talk) 13:35, 19 February 2024 (UTC)
You do not make the WP:RULES. You have to obey our rules, just like everybody else.
You cannot warn a talk page, and see WP:DNTR. tgeorgescu (talk) 13:38, 19 February 2024 (UTC)
Then you should ignore the tone and pay attention to the content. Read the pages tgeorgescu linked. WP:IDHT is also a good page. --Hob Gadling (talk) 08:13, 20 February 2024 (UTC)

Removal of content

Hi, Zefr: Could you explain the recent removal of content? At present, the lead sentence indicates that FM refers to "unproven and disproven methods and treatments". This statement is backed by three sources, the most recent of which is 15 years old. However, when I searched for "functional medicine" on PubMed, the first three articles I found discussing outcomes indicated that FM had statistically significant positive outcomes for three conditions. This seems in contrast with the entirety of this article, which primarily cites SBM. Are there recent literature reviews in more reputable publications that we can find and include instead?

Additionally, can you tell me what POV issues the following paragraph contains:

To allegedly treat and prevent illness, FM practitioners use systems biology to identify negative triggers that could be addressed (such as stress or poor diet), as well as improving factors known to improve health (such as sleep and relationships). After building a relationship with the patient, FM practioners developed individualized plans that include lifestyle and behavioral interventions to improve their health.{source included}

This was in the section describing what FM is. This information is provided in several peer-reviewed articles in medical journals that describe FM. While this could be considered as "promotional" (as you stated in your edit summary), I would argue that the use of words and phrases such as "according to FM proponents" and "allegedly" address such concerns.

Similarly, I'm curious why the following sentence is irrelevant for the lead: "Proponents emphasize a holistic approach and developing a relationship between the patient and practitioner." Again, this is repeated in multiple peer-reviewed articles in medical journals as a core component of FM. Given WP:LEAD, it feels like that would be important to include.

Lastly, you removed a source that you indicated was a "patient advocacy source" (and therefore, not reliable, I would guess). However, you removed the Knott source, which Bon courage indicated was a good source above. Is there a specific issue in the way it was used, or do you disagree with Bon courage?

I swear I'm not trying to cause drama. I'm here to create a good open educational resource. When I initially stumbled upon this article, I had no idea what FM is based on this page, which is contrary to its purpose. It makes far more sense to provide information about the thing and provide good sources that showcase whether it's valuable or not. Significa liberdade (she/her) (talk) 03:33, 7 March 2024 (UTC)

Reasons:
  1. WP:MEDRS strongly dissuades claims based solely upon WP:PRIMARY medical studies;
  2. WP:PARITY says that for WP:FRINGE topics, WP:RS of lesser prestige are allowed, so long as they're written by debunkers;
  3. WP:FRINGE, WP:PSCI, WP:GEVAL, and WP:REDFLAG;
  4. as well as noticing that some basic concepts of FM are not empirically operationalizable, so they are not even wrong. tgeorgescu (talk) 03:54, 7 March 2024 (UTC)
Most of what I've said above isn't trying to add sources or even claims to the article that would provide undue weight. Rather, I'm just trying to get a sense of what FM even is, which wasn't described here when I arrived. However, many reputable sources provide descriptions of FM--even those that discredit it. If we look at another alternative medicine article, such as acupuncture, we can get a sense of what acupuncture is. Same thing for acupressure, alkaline diet, anthroposophic medicine, and zero balancing, among many other articles listed as alternative medicine. I would say alkaline diet might be a great example of explaining what it is (even though it's not entirely clear), then explaining that it's not back by science. However, it seems like attempts to even explain what FM are according to the practitioners and others are being removed. There also doesn't seem to be consensus about what makes a source valuable among those invested in this article, given that Bon courage indicated the Knott source is good, but then Zefr discredited it. Significa liberdade (she/her) (talk) 05:20, 7 March 2024 (UTC)
I think the Knott source is useful for debunking per WP:PARITY. It's one of the few sources that attempts to describe what this particular species of bollocks actually "is"! Bon courage (talk) 05:29, 7 March 2024 (UTC)
And the Knott source was used to describe what FM is, though it was removed as a "non-secondary Patient advocacy source". The sentence read, "After understanding these mechanisms [i.e., triggers, etc.], FM practitioners develop an individualized treatment plan for the patient." If there are issues with the phrasing of the sentence, I get that, but that wasn't the stated concern. Significa liberdade (she/her) (talk) 05:30, 7 March 2024 (UTC)
The following sentence, stated in the Knott piece, was also removed: "Proponents emphasize a holistic approach and developing a relationship between the patient and practitioner". Again, this is part of the explanation of what FM is, which is helpful to understand the core concepts. Significa liberdade (she/her) (talk) 05:36, 7 March 2024 (UTC)
Yuck, that sounds airy-fairy. A while back, Knott was used for this description, which is more concrete and useful:

Proponents of functional medicine oppose established medical knowledge and reject its models, instead adopting a model of disease based on the notion of "antecedents", "triggers", and "mediators". These are meant to correspond to the underlying causes of health issues, the immediate causes, and the particular characteristics of a person's illness. A functional medicine practitioner devises a "matrix" from these factors to serve as the basis for treatment.

Bon courage (talk) 05:40, 7 March 2024 (UTC)
Wouldn't it be helpful then to have an edit summary that critiques the phrasing of Knott's work, rather than indicating the removal of a "non-secondary Patient advocacy source"? This makes it sound like the source is bad, not that the phrasing of the source's information is problematic. Significa liberdade (she/her) (talk) 05:48, 7 March 2024 (UTC)
It's a secondary source. I would prefer to see the description above than Bland's woo. WP:FRIND applies. Bon courage (talk) 05:50, 7 March 2024 (UTC)
As other editors stated, FM is just integrative medicine with the matrix and some other tricks added to it. tgeorgescu (talk) 06:08, 7 March 2024 (UTC)
Well, this has been unhelpful. I'm going back to my corner of Wikipedia. Significa liberdade (she/her) (talk) 06:26, 7 March 2024 (UTC)
If you want to expand the description section, you can use this article at the Skeptic magazine [6]. It's only used once on the article currently. Psychologist Guy (talk) 12:03, 7 March 2024 (UTC)
How does Skeptic magazine meet MEDRS? Levivich (talk) 16:13, 7 March 2024 (UTC)
It doesn't; but a description of what FM purports to be is not WP:BMI, so it's actually a pretty good source for that. Bon courage (talk) 16:17, 7 March 2024 (UTC)
It's OK to use non-MEDRS sources for a description of what functional medicine is? Levivich (talk) 17:34, 7 March 2024 (UTC)
Yup, so long as WP:BMI is avoided. Bon courage (talk) 17:38, 7 March 2024 (UTC)
That doesn't make sense to me. Saying that FM is "effective" or "ineffective" is definitely BMI, isn't it? Levivich (talk) 17:58, 7 March 2024 (UTC)
Well you were talking about using a source for "a description of what functional medicine is", ratther than whether "it" is effective or not. Bon courage (talk) 18:05, 7 March 2024 (UTC)
The first sentence is "Functional medicine (FM) is a form of alternative medicine that encompasses a number of unproven and disproven methods and treatments."
If the efficacy of FM is BMI, then saying FM is ineffective is BMI ("unproven," "disproven").
Do you disagree and if so why? Levivich (talk) 18:07, 7 March 2024 (UTC)
The word "ineffective" is not in the article. But for woo, pretty much any respectable scientific source is WP:MEDRS if you wanted to go there, I should think. Bon courage (talk) 18:16, 7 March 2024 (UTC)
That makes me even more confused. What do you mean any respectable scientific source is MEDRS for woo? MEDRS doesn't have different rules for woo and non-woo. MEDRS is what we use to determine what is and what is not woo, so it wouldn't make sense for MEDRS to treat "woo" as an antecedent rather than a consequent.
Also, "ineffective" is not in the article, but the article defines FM as encompassing "unproven" and "disproven" methods. So that means the same thing as "ineffective." We are saying in the opening sentence that FM does not work. That's BMI. We cite it to many non-BMI sources.
This version of the lead sentence just written by Significa liberdade, cites a 2013 survey article in a peer-reviewed index journal for a definition. It was reverted back to this version that cites in the lead sentence two SBM blog posts and a 22-year-old review article in a peer-reviewed journal which is also indexed (but not on PubMed AFAICT, for whatever that means).
I'm having a really hard time understanding why that reversion was made, or why the SBM blog posts are MEDRS-compliant when the 2013 survey article is not. Levivich (talk) 18:24, 7 March 2024 (UTC)
MEDRS is what we use to determine what is and what is not woo ← no, that is really a categorization question.
MEDRS doesn't have different rules for woo and non-woo ← of course it does. You don't need a strong source to say drinking bleach won't cure cancer. Read MEDRS again and look for the spinning plate! Bon courage (talk) 18:29, 7 March 2024 (UTC)
Where does MEDRS differentiate between fringe and non-fringe topics? I don't see the word "fringe" in MEDRS anywhere. The spinning plate caption says "Reliable sources must be strong enough to support the claim. A lightweight source may be acceptable for a lightweight claim, but never for an extraordinary claim."
The definition of FM is not a "lightweight claim." In fact, it's controversial, as demonstrated by the various high-quality MEDRS sources that have different definitions of the term.
This a textbook WP:NPOV issue: there are multiple significant viewpoints in reliable sources. But this article takes one of them and presents it as the mainstream view, based on shoddy sourcing like SBM blog posts, and editors seem to be removing any and all attempts to include the other view. In doing so, editors are asserting that the other view is "woo" but in doing so are ignoring, discounting, and removing from the article, the RSes, even MEDRSes, that say it's something other than woo. Levivich (talk) 18:37, 7 March 2024 (UTC)
As an outsider on this topic and looking at the conversations on this page, I think it would be beneficial to point to specific language in MEDRS when users are uncertain what guidelines you're referring to. I see many restatements saying, "Look at this guideline!" Clearly, people aren't sure which part of the guideline is being violated. Significa liberdade (she/her) (talk) 18:38, 7 March 2024 (UTC)
Levivich, look on MEDRS at WP:MEDASSESS, also read the article on evidence-based medicine. Functional medicine is not evidence-based it is pseudoscience, therefore the papers you have suggested on this article which are supportive of functional medicine are not reliable, they are indeed pro-woo. Psychologist Guy (talk) 18:42, 7 March 2024 (UTC)
Why don't you quote the part of MEDASSESS you think applies here?
Saying that because it's woo, anything that says it's not woo is not an RS, is not what our policies say.
The RS is how you decide whether it's woo or not.
High-quality RS ... at the top of that pyramid, including review articles in indexed, peer-reviewed journals, have been removed from the article. I've posted a bunch of those on this page in the other threads above.
Whereas the SBM blog, because it's not peer reviewed, is on the lower part of that MEDASSESS pyramid.
My whole point is that we're rejecting sources high on the pyramid in favor of sources low on the pyramid.
Y'all please stop telling me in so many words to RTFM. I've RTFM'd. Quote the policy if you want to say something violates the policy. Levivich (talk) 18:49, 7 March 2024 (UTC)
This all seems very confused. WP:SBM is a golden source for fringe stuff. Knott is a good WP:FRIND source for describing FM. If somebody has a specific recommendation, perhaps they could specify that as the vague hand-waving is getting dizzying! Bon courage (talk) 18:42, 7 March 2024 (UTC)
As a concrete example, what is your opinion of the following sentence: "Functional medicine proponents stress the importance of an holistic approach and of establishing a therapeutic partnership between the patient and the doctor"? Significa liberdade (she/her) (talk) 18:46, 7 March 2024 (UTC)
it's waffly and rather WP:PROFRINGE. That's what you get when you pluck words from Knott out of context. Bon courage (talk) 18:58, 7 March 2024 (UTC)
And this is where it can be confusing for people. You say that a source does a good job of describing what FM is, but when that source is used word-for-word to describe what FM is, you still don't like it. I understand contextualizing, but there's a difference between being "pro-FM" and providing a description of what proponents say it is. Again, this gets to my point about other alternative medicine pages. Significa liberdade (she/her) (talk) 22:13, 7 March 2024 (UTC)
And as I stated before, other alternative medicine pages have descriptions of the intervention, even when it's not entirely clear what the intervention is. Language such as "Proponents advocate for..." helps clarify that this is someone's opinion and shouldn't be taken as fact. Similarly, if we look at a page like Holocaust denial, we see detailed explanations of the associated beliefs, as well as evidence to show that the beliefs are ridiculous. I'm not sure why this page is an outlier. Significa liberdade (she/her) (talk) 18:43, 7 March 2024 (UTC)
OK here's my thought: I'm going to gather up some of the sources that are in the article, have recently been added and removed from the article, or posted on this talk page, and I'm going to rank them per the WP:MEDASSESS pyramid, and we'll see if we're on the same page up to that point. Levivich (talk) 18:53, 7 March 2024 (UTC)

Sources

I agree with the gist of the threads started on this page over the last couple years by Animalparty (#Does this article rely too heavily on SBM?), Beccaynr (#recent edits), and Wikiwriter43103840 (#Article was in violation of principle of "Wikipedia is written from a neutral point of view."), that this article relies too much on Science-Based Medicine and generally would benefit by being expanded with more sources. Towards that end, here are some more sources that could be used for expanding the article:

Hope this helps, Levivich (talk) 01:07, 23 February 2024 (UTC)

The Gorski chapter looks fine; good find! The articles in Physical Medicine and Rehabilitation Clinics of North America are in a "special issue" with a guest editor, which is suspicious. The next three are primary sources so not usable for WP:BMI. Bon courage (talk) 03:18, 23 February 2024 (UTC)
If you're curious about the guest editor, you can look her up: Elizabeth Bradley. She teaches at the Yale School of Public Health. None of her research has anything to do with functional health. What specific concerns do you have about the issue having a guest editor, specifically this guest editor? edit: She is also highly connected to functional medicine. Significa liberdade (she/her) (talk) 03:50, 7 March 2024 (UTC) Significa liberdade (she/her) (talk) 01:06, 8 March 2024 (UTC)
Err, she's "Medical Director for Cleveland Clinic's Center for Functional Medicine". Bon courage (talk) 20:51, 7 March 2024 (UTC)
Thanks for pointing that out, @Bon courage. I was just coming back to this reply to make an amendment given that she co-authored articled with Hyman. Significa liberdade (she/her) (talk) 01:05, 8 March 2024 (UTC)
4whirledpeas, you may find these sources - particularly the Gorski one - helpful in your editing. Your edits appear to be quite pro-functional medicine, so please remember to keep a neutral point of view especially when editing in contentious topics like alternative medicine. You can keep a balanced view without skewing too far to one side. Hope this helps. Schrödinger's jellyfish ✉ 05:58, 26 February 2024 (UTC)
The article as it is written does not maintain a neutral point of view. To describe functional medicine, one can go several sources that provide a definition and description that do not only present a negative perspective.
The first sentence is an example: "Functional medicine is a form of alternative medicine that encompasses a number of unproven and disproven methods and treatments." This presents functional medicine in a negative light only. A neutral point of view would describe functional medicine objectively, without implying that its methods and treatments are inherently ineffective or unsupported by evidence. There are methods used in functional medicine that are well supported by evidence (e.g., diet, exercise, sleep, stress management).
There are individual's opinions in the article; however, they only present one side and not the other. An example: "The opening of centers for functional medicine at the Cleveland Clinic Foundation and at the George Washington University was described by Gorski as an "unfortunate" example of quackery infiltrating academic medical centers." A more neutral point of view would also present the opinions of those who have positive opinions of these centers opening.
Also, since this is a discussion on sources, I agree that there is a need to diversify the sources for a more neutral point of view. Some references are outdated, and some of the information is outdated and inaccurate as well. "In the United States, functional medicine practices have been ruled ineligible for course credits by the American Academy of Family Physicians because of concerns they may be harmful." The AAFP began approving functional medicine topics focused on the scope and techniques in 2018. "Functional medicine practitioners claim to diagnose and treat conditions that have been found by research studies to not exist, such as adrenal fatigue and numerous imbalances in body chemistry." Functional medicine practitioners diagnose and treat a number of conditions that do exist, such as diabetes, heart disease, hypertension, and digestive issues.
I see various references listed above, but they do not seem to be included. How does one proceed to edit the article to present a more neutral point of view? 4whirledpeas (talk) 21:09, 26 February 2024 (UTC)
A more neutral point of view would also present the opinions of those who have positive opinions of these centers opening ← no, Wikipedia doesn't do 'both sides' for fringe topics. See WP:FALSEBALANCE. Bon courage (talk) 01:11, 27 February 2024 (UTC)
IMO, the problem with this edit is that it didn't present a more neutral point of view, it just replaced one not-very-neutral (negative) POV with the opposite not-very-neutral (positive) POV. Functional medicine is not whatever Bland says it is, but it's not whatever SBM/Gorski says it is, either. Neither of those two have a monopoly on this field, there are more sources out there about this, and an WP:NPOV summary will summarize the body of reliable, published material on the subject, not just any one or two authors. Levivich (talk) 01:49, 27 February 2024 (UTC)
WP:FRIND is a key consideration. Bland should be excluded except where discussed in third-party sources. The Knott source is quite good for what FM "is". Bon courage (talk) 02:29, 27 February 2024 (UTC)
A quick aside - thank you so much to everyone far more familiar with WP:FRINGE topics & editing around this area. I saw the edits in recent changes and wasn't sure the best approach aside from trying to get the other editor involved in discussion. Hopefully it's been productive in getting the article away from the "not-very-neutral (negative)" without skewing too far to the, quite obviously to someone otherwise unfamiliar with the subject, not-very-neutral (positive) POV. Schrödinger's jellyfish ✉ 23:26, 7 March 2024 (UTC)

Source review

Top tier: secondary/filtered

See above. 01:11, 8 March 2024 (UTC)

Middle tier: primary/unfiltered

Bottom tier: expert opinion etc.

Discussion

These sources are from the article (first paragraph), recent edits to the article, or this talk page (copied and pasted, which is why the citation format is all over the place), sorted into three tiers per WP:MEDASSESS pyramid, and listed in descending chronological order (newest first).

Are any sources above in the wrong category? Are there other sources, especially in the top tier, that should be added? Levivich (talk) 20:24, 7 March 2024 (UTC)

WP:MEDASSESS is about health effects and evidence levels, and a lot of the material in these sources is other than that, so there is a lot of not-even-wrong category error here. Bon courage (talk) 20:32, 7 March 2024 (UTC)
Let's just focus on the top tier: what material in which sources listed in the top tier above, is about something other than health effects? Also, what does "not even wrong category error" mean in this context? Bottom line, are you saying WP:MEDASSESS does not apply to the lead sentence of Functional medicine, which defines the term? Levivich (talk) 21:01, 7 March 2024 (UTC)
It doesn't apply to general discussion of (e.g.) the marketing tactics of health fraudsters. I'm not sure what you're wanting to ask: are you wanting to have some actual biomedicine in the article? As with most pseudoscience, the opening should probably focus on why it's a pseudoscience. I've just read the Gorski/MIT chapter; hardly any of it is about "health effects", the "effects" are more on the bank accounts of the people falling victim to the fraud. Bon courage (talk) 21:03, 7 March 2024 (UTC)
I'm saying what's listed above in the "top tier" section are the best sources put forward so far about functional medicine, particularly for the lead of the article, for the definition of the term.
Gorski/MIT 2018, pp. 311-312:

Functional medicine is a poorly defined branch of integrative medicine that claims, as does integrative medicine itself, to “address the under­lying ­causes” of diseases, particularly chronic diseases. On the surface, functional medicine sounds harmless enough, but if one digs deeper, one finds a vaguely defined “discipline” in which it is claimed that mea­sur­ing a ­whole laundry list of metabolic ­factors and other lab values ­will lead to a “holistic” approach to disease ... Unfortunately, the specific recommendations made by functional medicine prac­ti­tion­ers are rarely rooted in strong science.

Is this not about the health effects of functional medicine? Is it not content that is covered by MEDRS?
Gorski/MIT 2018 only has like one paragraph about functional medicine specifically (it's mostly about pseudoscience more generally). So I don't understand saying that Gorski/MIT 2018 is mostly about non-health-effects of functional medicine, when it's entirely about functional medicine health claims being pseudoscience.
The lead sentence of the functional medicine article, which defines what it is, should be sourced to WP:MEDRS-compliant sourcing, such as what I've listed here. Surely you don't disagree with this?? Levivich (talk) 21:13, 7 March 2024 (UTC)
I don't see any "health effects" in the passage you quote. A health effect would be a change in a person/population between state A and state B attributed to some cause. So far as I'm aware the only accepted health effects of FM are adverse effects from unnecessary testing; these might be worth mentioning somewhere. We don't need MEDRS for the opening sentence, no. Bon courage (talk) 21:23, 7 March 2024 (UTC)
To quote WP:BMI, Biomedical information is information that relates to (or could reasonably be perceived as relating to) human health.
These statements I quoted above:
  • "it is claimed that mea­sur­ing a ­whole laundry list of metabolic ­factors and other lab values ­will lead to a “holistic” approach to disease"
  • "the specific recommendations made by functional medicine prac­ti­tion­ers are rarely rooted in strong science"
relate to or could reasonably be perceived as relating to human health.
"specific recommendations made by functional medicine" are without a doubt related to human health, and so saying that those claims "are rarely rooted in strong science" is also biomedical information.
If someone argues in favor of X, and that's BMI, then the argument against X is also BMI. Claims that FM has beneficial health effects is BMI. Claims that FM does not have beneficial health effects is also BMI.
Claims regarding FM's effectiveness is, per BMI, about "attributes of a disease or condition," "attributes of a treatment or drug," "medical decisions," "health effects," and/or "biomedical research". Claims regarding FM's effectiveness is not any of the things listed at WP:NOTBMI: "commercial or business information", "economics," "religious or spiritual beliefs," "history," "society and culture," "legal issues," "notable cases," "popular culture," "etymology and definitions," "training," "regulatory status," or "medical ethics." Levivich (talk) 21:38, 7 March 2024 (UTC)
We're describing the beliefs/marketing schtick and general irrationality and unscientific nature of FM. I don't think there's any need to discuss effectiveness - I suppose it's taken as read that homeopathy etc. don't work. Care should be taken not to WP:CRYMEDRS. This is all horrifyingly reminiscent of the attempt to extend MEDRS to all 'COVID origin' questions because it was health-y.[8] If in doubt, check at WT:MED. Bon courage (talk) 21:47, 7 March 2024 (UTC)
Levivich, just look up the main spokes people for functional medicine. 1. Mark Hyman. 2. David Perlmutter. 3. Steven Gundry. 4. Jeffrey Bland. It's also endorsed by Dave Asprey. You can look each of these people up, how can I put this politely? They are basically peddling pseudoscience. Bland has been in trouble with the FDA [9]. Apologies if I have misunderstood your position but are you arguing in favour of this functional medicine nonsense? Psychologist Guy (talk) 23:07, 7 March 2024 (UTC)
@Significa liberdade: I'd be interested in your thoughts on the rest of that 2022 Physical medicine and rehabilitation clinics of North America 33(3) series (Beidelschies, Kharrazian, or Bharmal) or the journal in general, and whether it's independent/reliable or not? Levivich (talk) 14:33, 8 March 2024 (UTC)
I would question the articles that came out of the special issue guest-edited by Elizabeth Bradley, given that she's the Medical Director for Cleveland Clinic's Center for Functional Medicine and has published articles with Mark Hyman, a huge advocate for FM. Significa liberdade (she/her) (talk) 14:56, 8 March 2024 (UTC)
I agree and have struck the others from that issue. Not sure what to make of the Hudson 2020 article in the same journal. Levivich (talk) 15:07, 8 March 2024 (UTC)
The appropriateness of the other articles in the secondary/filtered list is questionable and would need more analyses. They're not clinical guidelines or systematic reviews, so they would not be considered in Proctor & Gamble's list of secondary/filtered sources. From my understanding, a lot of those articles are saying, "What if we apply FM to XYZ?", which is also not secondary/filtered. I'm coming from the social sciences, so my radar for medical articles would need some tuning. Significa liberdade (she/her) (talk) 15:10, 8 March 2024 (UTC)
Same here about tuning. I listed them there because either PubMed categorized them as "review" or the articles described themselves as a "review," not sure how much either of those are worth. Levivich (talk) 15:13, 8 March 2024 (UTC)
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