Talk:Integrative medicine

Funding Impact Edits

I know I'm coming late to the party here, but I've been watching this page for a long time. I wholeheartedly agree that Integrative Medicine is not the same thing as Alternative Medicine, with the major difference being the required evidence for efficacy and effectiveness of treatment. However, I felt the need to add a section regarding the impact of funding on the amount and structure of evidence. Many treatments don't have a lot of evidence for their effectiveness NOT because they are not effective, but rather because there are no large money-making corporations who might fund them. Evidence points to Tai Chi and Yoga being an excellent treatment for high blood pressure, for example, but there are no organizations capable of making a profitable health product out of it, so ther is no one to fund the definitive research articles necessary. Since I think this is an important issue that impacts the "acceptance" of Integrative Medicine, I think it needs to be included here. Please let me know here if you object and why rather than just undoing my additions.

BTW - excellent work on the definition. CJ (talk) 00:56, 9 January 2014 (UTC)

UPDATE I am making well thought out improvements and valuable additions using peer-reviewed journal articles, and people are undoing my changes with no explanation. Please discuss the matter and don't just remove my additions without some sort of reason. CJ (talk) 01:46, 9 January 2014 (UTC)

Hello, actually the reasons were given in the edit summaries see here and here, the first paragraph you added has no source and the second show a potential COI which is problematic. Per WP:BRD, it is your job to explain why you want those changes and gain consensus before re-adding.--McSly (talk) 04:44, 9 January 2014 (UTC)

Indeed, edit summaries gave reasons for reversions very well, (except for my horrible spelling errors of course.) --Roxy the dog (resonate) 06:01, 9 January 2014 (UTC)

I was not aware that it would be considered a conflict of interest for an expert on a subject who has published in peer reviewed journals to quote from their own articles. If I were an Integrative Health Provider, and made a living from doing Tai Chi or Qigong, I would consider that a conflict of interest. I am just a researcher. My qualifications are stellar. I have a Doctorate (though, admittedly, not a Doctor of Medicine, but just a Doctor of Education) from Lehigh University, a Masters Degree from Temple University and I teach at Kutztown University. I have no vested interest in promoting Integrative Medicine other than the fact that I have been personally helped by it. Since I am a scientist at heart, I started delving into research to figure out why it worked on me, and under what other circumstances it works. I'm deeply curious as to EXACTLY how and why it works, and am extremely skeptical of esoteric explanations not based on high quality research. I've been watching research on this topic for the past ten years hoping to see some real high-quality data, and have just recently begun to see it. I want more of it. Because of that, I am trying to encourage people to understand the difference between high quality research and justifiable conclusions, but also to explain why there hasn't been evidence provided before (despite the numerous case studies and small study data).

Having said that, I must apologize. I did not realize where your explanations for why you were reverting my changes were; I was seeing the fact that my changes were deleted over in a box on the left of my screen with half of the text cut off (I don't know why) and a single button to undo the reverts if I wished. So I am sorry for not knowing the protocols, and for failing to look at the right place to see why you made the changes. I hope that you will be patient with me as I stumble around trying to follow all the rules.

Nonetheless, - if your only evidence that I have a conflict of interest is that I wrote a peer-reviewed journal article on the topic, then I would submit that this is not a conflict of interest unless the article were self published, or unless there were some financial gain for stating my point of view. However, if you would feel more inclined to accept my edits if I find another article that states the same thing, I would understand, and would do so as soon as I have time.

Comments? CJ (talk) 22:29, 9 January 2014 (UTC)

To begin, you should read WP:SELFCITE and all of WP:COI. As regards your inexperience editing wikipedia, I promise you we have all been there, and I am only just half a step ahead of you in the long learning curve. Please accept my apologies for being brusque and hard nosed, I'm actually much worse in person !! --Roxy the dog (resonate) 00:17, 10 January 2014 (UTC)

I do think the material could be better integrated into the article, perhaps as a counterpoint in the Reception section. But I don't see anything in the cited guidelines that forbids this editor from citing her published study. TimidGuy (talk) 16:29, 10 January 2014 (UTC)

Woo etc.

WRT recent edits: if a source says "woo" and we quote it accurately, that's not necessarily "unencyclopedic". We should give prominence in the definition section to independent views (Gorski's is such) rather than "in universe" views. Alexbrn ^{talk|contribs|COI} 07:38, 22 November 2014 (UTC)

Woo is not being used in scientific and medical literature so we shouldn't be using it -A1candidate (talk) 10:07, 22 November 2014 (UTC)

The point is, our (good) sources informs us that critics of IM call it "woo", and that's absolutely correct (sometimes it's called "woo-woo"). We have some responsibility I think to inform our readers of the contempt that scientists hold for this stuff. Alexbrn ^{talk|contribs|COI} 10:30, 22 November 2014 (UTC)

This responsibility would be best taken up by informing the intelligent reader of the statistical assessment outcomes of various integrative medicines while minimizing the usage of non-scientific terms.-A1candidate (talk) 12:52, 22 November 2014 (UTC)

Well, we've got a wikilink to homeopathy; we could add some more to reiki, TCM and so on. Then the reader could go off and read about these various species of woo for themselves; it seems a bit undue - coatracky even - to rehearse a full debunking here too. It's the contempt scientists show which is the point here (which is embodied in the term "woo). Alexbrn ^{talk|contribs|COI} 13:27, 22 November 2014 (UTC)

The data could be suitably displayed in tabular format. As for the contempt, a representative survey of attitudes among scientists would be more desirable. -A1candidate (talk) 14:04, 22 November 2014 (UTC)

I agree with A1candidate that we need to present the information in a neutral way that allows the reader to assess. We can communicate the issues with unproven health claims while remaining professional in our word choices. Just because a source says something and it could be quoted doesn't mean it belongs in an encyclopedic article. Most scientists do not feel "contempt" for unproven methods. That's the Skeptic bias. Scientists are more likely to express curiosity than contempt, when it comes to methods that have a plausible basis (such as chiropractic and various forms of bodywork), and simply disbelief - but not contempt - at less plausible claims (energy work, homeopathy), yet be open to surprise when something implausible like acupuncture does show some clinical effectiveness. Scientists are characterized by a fundamentally neutral-yet-curious attitude.

(I disagree with A1 about the data though; it's not our place to provide the data but rather to summarize the conclusions based on sources.) --Karinpower (talk) 04:01, 25 November 2014 (UTC)

There is a bloke from Wikipedia who had a rant recently about certain lobbyists and then there is Prof Brian Cox, (the young whippersnapper is about fifteen years younger than me) who said ... "The problem with today’s world is that everyone believes they have the right to express their opinion AND have others listen to it. The correct statement of individual rights is that everyone has the right to an opinion, but crucially, that opinion can be roundly ignored and even made fun of, particularly if it is demonstrably nonsense!" There are lots more, but wikipedia should be framing itself from the mainstream scientific pov, and woo as woo. -Roxy the dog™ (resonate) 08:29, 25 November 2014 (UTC)

Wait until the word is used in scientific/medical literature first before pushing to use it. -A1candidate (talk) 17:09, 25 November 2014 (UTC)

I agree that we need to frame from *mainstream science* as a POV but that is absolutely not scornful Skeptic POV. Neutral language is essential. Our reliance on mainstream science is why we state health claims as *claims* until proven, and state a lack of evidence when that's the case.

Accusing methods of being "snake oil" is to say that the intention is to defraud. While that was a big thing in past times, I don't think that is the motive for alt-med these days - fraudsters have switched to much more lucrative options and usually it involves selling a product rather than taking the time to provide a service. Service providers are typically motivated by a desire to help, and if their work is effective, eventually the science *might* follow to back them up - if someone bothers to invest the vast sums of money required. A lack of evidence does not equal snake oil. --Karinpower (talk) 02:59, 27 November 2014 (UTC)

Your problem here is that "integrative medicine" is not actually a scientific or medical practice, it's a brand. It is the rebranding of Complementary and Alternative Medicine (CAM), also known as Supplements, Complementary and Alternative Medicine (SCAM), previously known as Alternative Medicine, and all the brandings suffer the identical problem: they are all attempts by quacks and charlatans to make money selling bullshit, by grabbing onto the coat-tails of any random passing therapy they can. You can call exercise, diet and the like "integrative" if you like, but that will never validate reiki, homeopathy, acupuncture or any of the rest of the garbage that "integrative" advocates support. If you integrate apple pie with cow pie, you do not make the cow pie edible, you just spoil the apple pie. Guy (Help!) 00:56, 5 December 2014 (UTC)

So most hospitals and clinics are overrun by scammers? -A1candidate (talk) 12:25, 5 December 2014 (UTC)

Many are. They call it "integrative medicine", but SCAM is what it is. Guy (Help!) 10:40, 11 December 2014 (UTC)

No, if it's used in a modern hospital or clinic, that would only be in cases where conventional treatments have failed. -A1candidate (talk) 13:41, 11 December 2014 (UTC)

Even if that were true - and the evidence suggests it is not - that would still not make it a good idea. Integrative medicine exists purely as a crowbar to get unproven and disproven therapies into a clinical setting. The sole valid route for integrating an alternative practice, is good quality studies with strong methodology that show the intervention to work - at which point it will, by definition, no longer be alternative.

"Integrative" medicine most commonly brings things reiki, homeopathy and acupuncture into play. The first two have zero credibility, zero plausibility and their inclusion is a 100% guaranteed red flag for the absence (not lack, absence) of proper standards of critical thinking and treatment evaluation. The last is barely defensible: it is known to a high degree of certainty that acupuncture does not do what its major proponents claim (there is no such thing as qi and there are no such things as meridians) and the evidence base is building that not only does it not matter where you put the needles, the actual needles don't seem even to need to be inserted. It's extremely difficult to fully blind a patient to whether acupuncture has been used (even if you use stage dagger needles, acupuncture needles often leave bruising and other signs that let you "break the code" and work out if you are in the Tx or placebo group).

I know you are a believer in acupuncture, as are the authors of virtually ever positive study. Those who are not emotionally an/or financially vested in acupuncture - and indeed in every single other form of SCAM - tend to conduct trials to prove their beliefs, not to test them. That's not good science. A real effect should be markedly different from a null intervention, a weak positive evidence base is inevitable in the case of a null treatment, as Ioannidis has shown. Guy (Help!) 12:06, 14 December 2014 (UTC)

Acupuncture is neither alternative nor integrative. According to 5-Minute Clinical Consult, treatment for chronic pain "should always include nonpharmacologic therapies such as exercise, cognitive behaviorial therapy (CBT), patient and family education, yoga, massage, relaxation techniques, support groups, meditation, and acupuncture." -A1candidate (talk) 14:10, 14 December 2014 (UTC)

Weight

Why is a comment from a skeptic in a blog being giving more prominence than a consensus definition by 57 of the nation's top medical centers? TimidGuy (talk) 16:26, 22 November 2014 (UTC)

See WP:FRIND. I'm not sure why you call the opinion of a CAM industry consortium the "consensus definition by 57 of the nation's top medical centers". (I suppose you meant the USA). Alexbrn ^{talk|contribs|COI} 16:59, 22 November 2014 (UTC)

Self-published blogs are not RS. -A1candidate (talk) 18:16, 22 November 2014 (UTC)

Gorski's piece is obviously RS for Gorski's opinion. SBM is not really a "self-published blog" since it has multiple editors and contributors; it's an excellent source for topics such as health fraud, and dubious altmed stuff in general. But in any case we have WP:PARITY allowances when it's necessary to treat fringe topics. If there are better independent sources, bring them forth! Alexbrn ^{talk|contribs|COI} 18:24, 22 November 2014 (UTC)

Not if the blog's "managing director" is Gorski himself. Talk about independent editorial control! -A1candidate (talk) 18:34, 22 November 2014 (UTC)

So you think Gorski is misrepresenting himself? Alexbrn ^{talk|contribs|COI} 18:54, 22 November 2014 (UTC)

I think it's basic courtesy to inform the editors at this talk page before bringing the discussion to another place. -A1candidate (talk) 19:13, 22 November 2014 (UTC)

A1candidate: SBM in general and Dr. Gorski in particular are noted authorities on the problems with so-called "integrative" medicine. They lecture on this internationally. Guy (Help!) 00:49, 5 December 2014 (UTC)

If they publish their work in a serious scientific journal such as Nature or BMJ, we can cite it. If they self-publish their work on a blog, we cannot use it. -A1candidate (talk) 12:26, 5 December 2014 (UTC)

This is not true. We can use the opinions of known authorities on a subject, from sources which would not otherwise meet RS. In fact we do this all the time. As it happens, SBM is generally considered a pretty reliable source for critique of SCAM, they have fact-checking and an editorial board, but the basis for inclusion is that the writers are noted authorities on SCAM and pseudoscience. I would not cite Gorski's own blog, Respectful Insolence, but have no hesitation in citing SBM - and the difference in style between the two is a big part of the reason why.

MEDRS sources rarely discuss quackery, for the same reason that architecture journals did not discuss the 9/11 Truther claims - it was left to Popular Mechanics. There is nothing in most of these SCAM interventions that merits coverage by MEDRS journals, other than the documented incidents of harm (chiropractic-induced stroke, acupuncture-induced infection and cardiac tamponade etc). Guy (Help!) 10:46, 11 December 2014 (UTC)

Most, if not all, of these interventions are covered by MEDRS sources, many of which are written by the same "authorities" you mentioned above. The problem with SBM is that their contributors and editorial team consists of the same group of people. -A1candidate (talk) 13:37, 11 December 2014 (UTC)

• Notification - This topic is also being discussed at Wikipedia:Fringe_theories/Noticeboard#Integrative_medicine right now. -A1candidate (talk) 19:13, 22 November 2014 (UTC)

Reorganization of Content and Attempt to Reflect Multiple Viewpoints

Divided the reception section to praise and criticism to better reflect various perspectives on the practice. I also changed proponents to practitioners and advocates to have a more neutral point of view. Expanded history, added additional citations, and two graphics. AshleyStruempfler (talk) 14:18, 7 December 2015

We need independent secondary sources, and those need to be focused on "Integrative medicine" in particular rather than CAM in general. I have trimmed some additions. Alexbrn (talk) 19:57, 7 December 2015 (UTC)

Proposed merger with Holistic health

I oppose the proposed merger of holistic health into this article. Integrative medicine means something very specific in the U.S.: the adoption by major medical centers of an approach to treatment that includes evidence-based alternative approaches. It would be better if this article not become a coatrack for topics related to holistic health. TimidGuy (talk) 16:10, 7 October 2016 (UTC)

I think you'll find that "evidence based alternative approaches" is an oxymoron — and when it comes to differences between the terms I don't find them to be substantial enough to merit two articles.Carl Fredrik 💌 📧 20:01, 7 October 2016 (UTC)

agree w/ CF[1][2] Ozzie10aaaa (talk) 20:54, 7 October 2016 (UTC)

Merge both articles into Alternative Medicine, there shouldn't be three articles on the same topic, ie "Medicine that doesn't work" -Roxy the dog™ bark 06:58, 8 October 2016 (UTC)

Sorry, you can't rewrite reality. The sources are there. The adoption by scores of major medical centers is there -- and all of them use the term "integrative medicine." This includes all the top medical centers in the United States, such as Mayo Clinic, Johns Hopkins, and Duke University. I know you have a strong bias, but in this case integrative medicine is a fact, and its acceptance is widespread. Do a search in Google on "integrative medicine," and you'll see how common the term is and the top medical centers offering it. Do a search on "integrative medicine" in Google Scholar, and you'll find many sources, including textbooks from top academic presses. TimidGuy (talk) 10:55, 8 October 2016 (UTC)

This very article cites sources saying it's just a rebranding of "alternative medicine". That a term exists or is used is no argument for it to be an independent article: WP:NOTDICTIONARY. So far no argument has been held forth that it is an independent phenomenon.
For clarity I support a merge of both articles to Alternative medicine. Carl Fredrik 💌 📧 10:59, 8 October 2016 (UTC)

Integrative medicine is an established discipline, taught at, and provided by, major medical centers nationwide in the U.S. You can't wish it away with a few biased opinion pieces and blogs. TimidGuy (talk) 11:26, 8 October 2016 (UTC)

You've so far not been able to explain how it at all differs from alternative practices apart from in name. You can't wish it to be distinct by using the same blogs and opinion pieces in your favor. And in fact the only side currently without strong citations in its favor is yours — Ozzie10aaaa graciously provided us with a definition from NCCIH (not a blog or opinion piece) that equates the terms to mean the precise same thing. Carl Fredrik 💌 📧 12:26, 8 October 2016 (UTC)

yes, per the reference it is clear (NCCIH is a very good source)--Ozzie10aaaa (talk) 13:33, 8 October 2016 (UTC)

Support merger of both articles into alternative medicine. TimidGuy's arguments are simply special pleading. Famous_dog (c) 08:39, 7 November 2016 (UTC)