Talk:Alternative medicine (theories)

What this page is and what this page is not

I started this page and set out its aims clearly - it is all in the original first paragraph plus the link differentiating this page from the Complementary and Alternative Medicine page. The focus of this page is on the social, cultural and philosophical aspects and dimensions to health policy, only in the briefest sense with scientific and developmental questions.

Let me be more clear. It is not concerned with scientific debates. Please do not rehearse them here. Nor is it concerned with detailed historical developments in medical treatments, so do not bring that discussion here either.

What is of interest only is the brief description of the wide range of appraoches to 'health and well being' over thousands of years. The page should describe:

what this myriad of theories and approaches are their historical origins and cultural significance/ roots the philosophies/ methodologies/ paradigms (if you like) behind the approaches it does not attempt or need to offer a contemporary scientific evaluation of their efficacy

Too much of the editing done recently has sought to introduce psudo technical 'complexities' at the expense of offering a broad sociological/ philosophical insight into health issues. Martin Cohen 21:39, 25 December 2008 (UTC)

Respectfully, Martin, you may state your preferences for what you wish this page to be, but you do not have the authority to force it to comply with certain criteria that you unilaterally set. You are a Philosophy Editor, which gives you the same authority over Health Sciences and Healing Arts that I, as a Military, Engineering and Computing Editor, over Music or Economics.

I do not believe it to be possible to separate social, cultural and philosophical aspects from health policy. "Health" policy, necessarily, is pertinent to Health Sciences, and, in many cases, to Politics, Economics, and other disciplines. The article, in its present form, contains many assertions that do bear on sciences, and, as does any Citizen, I and others have the right to criticize them. If it addresses contemporary medical practices, mainstream or complementary, then it is clearly not limited to your authority under Philosophy.

A paragraph, such as the following, has very little to do with sociology or philosophy, and a great deal to do with the history of medicines. If you don't want scientific disussion, than don't make assertions about what "clinicians and public health reformers" thought. Public health is the scope of the medical specialty, preventive medicine, as well as a major political issue.

The public health reforms that were initiated during this period were designed and enforced because thinkers of the time adhered to the view that decomposing matter and excreta were vectors of spirit-like entities that accounted for the epidemic nature of diseases like cholera. In the minds of clinicians and public health reformers, the miasmatic theory of disease allowed to design concerted efforts against major sources of disease.

Further, I believe your definition of this page, as well as much of its substance, is decidedly non-neutral, and, under the neutrality policy, a Citizen has every right to present other positions, especially phrased in an unemotional manner and sourced appropriately. As long as the page addresses health policy, I will continue to offer criticism based on science and on political matters, relating to such things as informed consent, misleading advertising, and the social good of public health.

If this page were entitled "Philosophical views of life", indeed, you might be able to, subject to Citizendium checks and balances, make rulings within the scope of the Philosophy workgroup. It is, however, not so titled, and I dispute your assertion of authority over it. I am quite willing to take that matter before the Editorial Council should you so desire. Howard C. Berkowitz 21:53, 25 December 2008 (UTC)

Reserve judgement

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

Source?

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

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

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

Furthermore, Kathleen Karlsen, MA, writes:

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

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

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

I really am somewhat puzzled about the emphasis on Kathleen Karlsen. The web publications I see [1] and [2], as well as her entry on LinkedIn, describe her primarily as an artist. She does, indeed, have commentary on alternative medicine through Bach flower therapy, visualization, and other fields. Chris, or someone with the access to an appropriate citation tool -- how widely is her work in alternative medicine cited in other research?

The question is why she is apparently being considered an authoritative source. She may be, but I don't have information one way or the other. For what it's worth, she is not cited in MEDLINE. Howard C. Berkowitz 04:20, 23 December 2008 (UTC)

Fair use provisions

(The text quoted appears at the front of books too.)

As I understand it, International copyright laws allow a certain amount of direct quotation and accredited paraphrasing, (indeed non-accredited quoting and paraphrasing too), and the accredited kind is all that we have here. Any finding that this article breaches copyright would be very worrying, in that it would seem to destroy the basis of reference works such as CZ which rely on such fundamental academic tools. Someone, indeed many do, can write 'no one may quote me' on their internet page, but that does not make it so. One might well ask KK for her' sources - can she copuright views she has assuredly borrowed from others - in a legitimate knowledge gathering exercise. Martin Cohen 22:41, 22 December 2008 (UTC)

I have added some references to more traditional book sources making the same (possibly the original) points as KK. Martin Cohen 20:22, 25 December 2008 (UTC)

Plato vs Democritus and atomism

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

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

Looks interesting. quote:

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

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

Comments

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

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

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

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

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

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

It seems pretty much standard Kuhn fare- and it seems, re. Gareth, that Kuhn's original point was not as novel or radical as all that anyway - so he ended up 'defending' his position at the expense of not really saying anything. It's not a problem to take his 'received point' further than his 'intended' one. ...said Martin Cohen (talk) (Please sign your talk page posts by simply adding four tildes, ~~~~.)

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

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

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

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

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

(response by Pierre-Alain to Gareth:)

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

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

Pierre-Alain and Gareth - I think the 'simple' point is that money-wise, the great majority (I think you will know the figures much better than me) is spent on 'treatment' rather than prevention. Correct me please if I'm misinformed!! Can I suggst a health editor/author improves the text though expanding (perhaps as a box) to reflect the finer points rehearsed here? ...said Martin Cohen (talk) (Please sign your talk page posts by simply adding four tildes, ~~~~.)

Also see the demarcation section, below.

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

Public health initiatives

(response by Pierre-Alain to Gareth:)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Public campaigns have indeed influenced policy occasionally - as with DDT - in that case, according to the World Health Organisation and others, at the cost of a massive death toll for babies in Africa; the WHO is now campaigning to reverse the ban on DDT (see[3]). I don't know the truth there, all I do know is to doubt anything that anyone says without seeing the evidence. As far as I'm concerned naturopathy is a massive fraud, because they can sell their products with claims that require no evidence whatsoever - and that's just not good for anyone. Gareth Leng 18:25, 20 December 2008 (UTC)

Can we reflect the 'debate' please in the page, without going into too much detail? This is, after all, an overview. We can always create new pages for specific debates 'if needed'... Martin Cohen 23:36, 22 December 2008 (UTC)

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

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

Gareth, I presume? The quote is illustrating the irrationality of 'fear' of the use of 'alternative' methods, as opposed to conventional ones. In that sense, it is, rehearsing (I think reasonably) the statistical evidence in favour of the 'safety' of Alternative treatments. Now, we would have to be aware of a great deal more information to argue that conventional drugscausing large numbers of fatalites were AT THE SAME TIME saving so many that the fatalities dwindled into statistical insignificance. The cases described in some detail by the book being cited are very much of drugs causing large numbers of fatailites without saving many lives, and being withdrawn later from the market. But the debate is as I say, about the perception of risks. However, in Gareth's favour? one could, I suppose, construct a 'general' case for drugs where 'most drugs' are saving lives, and only a few are not. As I say, this would be a big claim and would seem to require a lot of evidence. Martin Cohen 23:36, 22 December 2008 (UTC)

Tamoxifen and breast cancer mortality

Take just one particular example. In 1992, tamoxifen was introduced as a treatment for breast cancer. Since then, in Europe, mortality rates from breast cancer in women have fallen from 40/100,000 per year in 1991 to under 30/100,000 per year by 2006 [4]. This means that, in Europe alone, every year there are 20,000 fewer deaths from breast cancer mainly attributable to just this single drug.

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

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

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

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

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

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

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

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

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

Well, first you don't respond, and second, your conclusions lack support.

Once again, i could spend time addressing your claims. But the list of claims you choose not to address becomes longer and heavier.

--Pierre-Alain Gouanvic 04:33, 23 December 2008 (UTC)

However, the mortality figures are also misstated; in the USA there were just 10,000 deaths attributed to prescription errors in 1998 [5] - and of course these mainly arise because a drug is not prescribed that could have been effective. The number 100,000 is deaths from all medically associated interventions - and includes deaths during surgery and following post surgical complications, deaths from hospital-acquired infections, and deaths that were avoidable but because the condition was misdiagnosed, effective treatment was not given.

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

Could we incorporate this into the page proper? Wheere is Tom Meade's statement from, please?Martin Cohen 23:36, 22 December 2008 (UTC)

Sheldrake and his critics

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

(response)

I will try to avoid this phrasing.

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

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

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

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

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

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

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

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

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

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

PA - I think we need to modify the text, as you say, there is a link to be brought out with the 'ancients' and their search for significance. But this can be done gently, without making too bold a claim (as I agree with Gareth this one at present is) to start with. Martin Cohen 23:36, 22 December 2008 (UTC)

Yes, it's becoming more obvious the more I work on Sheldrake and the ancients. I'll keep this bold claim for later... or not!--Pierre-Alain Gouanvic 08:08, 24 December 2008 (UTC)

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

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

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

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

Actually (see Kuhn above!) it's often best to avoid the term paradigm as no one agrees on what it means or entails... Martin Cohen

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

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

Thansk Gareth and Pierre, sorry for the delay in commenting! Martin Cohen 23:36, 22 December 2008 (UTC)

Scientific content

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

Take for instance the following quotation:

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

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

The claim is most likley drawn from this book Goldfrank's Toxicologic Emergencies, By Lewis R. Goldfrank, Neal Flomenbaum, Robert S. Hoffman, Mary Ann Howland, Neal A. Lewin, Lewis S. Nelson

Published by McGraw-Hill Professional, 2006 ISBN 0071437630, 9780071437639 Page 665. Martin Cohen 23:58, 22 December 2008 (UTC)

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

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

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

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

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

Onions are also represented in scholarly books. Do some more googling! Martin Cohen 23:58, 22 December 2008 (UTC)

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

Paul, most of the comments you disparage as 'urban legend' are not worth treating as Journal paper statistics. What is worth doing is checking they are not erratic claims not shared by others. In fact, they are widley claimed,a nd this article is attempting to describe the ways people understand both human health and wider issues of humanity's place in 'creation' and the universe. Not so much science as cosmology. One does not need to google claims from Ancient Egypt about the univers being an onion to see that the claim has only a significance in the comparison of a humble plant with a conceptual, philosophical absolute. I've noted them, and here and there we could expand the footnotes (not that it would help much) but it honestly seems to me that your objections are really not germane to this kind of debate. But please do 'improve' the examples if you think you can! That's the other side of the coin with this sort of style, the examples are not so precise that they cannot be embellished.Martin Cohen 23:47, 22 December 2008 (UTC)

Paul, onion comes from the latin unus.

Googling is wise; etymologyzing can be even better.

--Pierre-Alain Gouanvic 04:22, 23 December 2008 (UTC)

Demarcation

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

Ethical problems arising in evidence based complementary and alternative medicine, J Med Ethics. 2004 April; 30(2): 156�159. [6]

RESEARCH FUNDS ARE SCARCE

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

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

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

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

Modus operandi

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

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

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

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

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

Good advice; I have, indeed, put some additional material in John Snow (physician) and Phytotherapy. Nevertheless, if one chooses to write "controversial articles", one should not be surprised if there are strong dissents. A declared controversial article, if it is in main article space before it is well-developed, cannot reasonably expect questionable assertions not to be challenged when they appear. No one "owns" an article.

If some section is developing, I believe that many potential critics are far more willing to wait if there is a Talk Page note that briefly outlines the direction that a controversial section intends to take. When I see that a key point seems to be missing from the article page text, but is at least a bullet in an outline, I am far more willing to be patient, since I am aware that my concern has been recognized and will be addressed. When I see a position on the main page, which I believe ignores key data, I am much more likely to deal with it boldly than if I have some reassurance, from talk page comments on the authors' plans, that the apparently contrarian position will, in the reasonably short term, be balanced and presented in a neutral context. Howard C. Berkowitz 20:43, 25 December 2008 (UTC)

Conversations moved

In order to keep this articles discussion focused, I have moved some of the conversations that threaten to get us sidetracked to pages that are appropriate for their discussion and collaboration by the community as a whole. D. Matt Innis 20:35, 23 December 2008 (UTC)

Moved Talk Page Conventions conversation

I moved the Talk page conventions conversation, though important, to the CZ talk:How to use talk pages. Please do continue to work out these conventions so that it will likely be a value to every article. D. Matt Innis 20:20, 23 December 2008 (UTC)

Moved Citations discussion

I moved the Citations discussion, again important, to the CZ talk:Original Research Policy where it can get a proper hearing and vetting while this page can concentrate on Alternative medicine (theories) D. Matt Innis 20:35, 23 December 2008 (UTC)

Just a note on article improvement

Clearly, it is not productive to conduct a debate on the talk page, although an encyclopedia has never, historically, been based on debate. Some directly sourced contrasts are provided for assertions in the article.

Lewis Thomas' book The Youngest Science: Notes of a Medicine-Watcher is extremely insightful, yet many alternative medicine advocates persist in making comparisons to times where, as Sir William Osler put it, there were medical cults, not science-based medicine. Howard C. Berkowitz 04:27, 24 December 2008 (UTC)

Additional information added to article

Since there was no response to my question about identifying original sources paraphrased by Goldberg, Bivins, etc., I inserted, without deleting the paraphrase but adding context, fully accessible material from at least the CDC, WHO, and NEJM. These, I believe, are needed within the neutrality policy of presenting opposing views.

I have tried not to be argumentative, although I have removed some subjective language. Howard C. Berkowitz 18:24, 24 December 2008 (UTC)

Snow

"Revisionism" is, bluntly, a buzzword. Snow's own work is extensively published. Find one example of Snow using "miasma" in his own works. He correlated a problem with a specific pump, using statistical methods. When the water officials refused to correct it, he broke the handle off the pump, a pump which he found using statistical methods; many of my epidemiology texts credit Snow as the father of statistical epidemiology.

Breaking the Broad Street pump stopped the epidemic. No miasmas. Cause and effect. Western rationality. Annoying, innit? Howard C. Berkowitz 02:25, 25 December 2008 (UTC)

Totally off the point. You're ignoring the quote i provided. This is unprofessional. Should i call the constables again?--Pierre-Alain Gouanvic 04:02, 25 December 2008 (UTC)

And of course not worthy of any conversation between reasonable adults: "Cause and effect. Western rationality. Annoying, innit?". Insulting. --Pierre-Alain Gouanvic 04:17, 25 December 2008 (UTC)

You did not question the substantive additions about Snow on the talk page, as might have been something a reasonable adult might do. Instead, you threw a fundamentallly irrelevant quote into the article, ironically from the very same site that had Snow's specific ideas. It was irrelevant because it was a secondary or tertiary source focusing on miasmas, a concept that Snow explicitly rejected. Instead, you chose to add, in the body of the article, that it was "revisionist", which, in my experience, tends to mean "I don't agree with something".

As more cases appeared, Snow began examining sick patients. All of them reported that their first symptoms had been digestive problems. Snow reasoned that this proved that the disease must be ingested with polluted food or water. If the victims had absorbed cholera poison from polluted air, as the "miasma" theorists believed, then their first symptoms should have appeared in their noses or lungs -- not in their digestive tracts.[7]

It was hardly professional to attack the Snow material with what is demonstrably a theory to which he did not subscribe, and himself attacked. In fact, had you read farther on the very site from which you drew your counterargument, you might have found that you were describing a common opinion of the time, but one that Snow argued against.

Mr. Gouanvic, you have made a point of wanting to have "controversial" articles. Do not be surprised, then, if you generate controversy, and people that vehemently disagree with you and expect to see authoritative sourcing.

Insulting? No, not particularly more insulting that much of Burton Goldberg. Howard C. Berkowitz 04:48, 25 December 2008 (UTC)

I told the constables i wouldn't continue to argue until you properly adress the citation provided. --Pierre-Alain Gouanvic 05:56, 25 December 2008 (UTC)

But I have addressed it. You brought it up to counter Snow. Lo and behold, on the very webpage that you took it from, is text that specifically describes Snow's counterargument against miasma, two paragraphs above the paragraph that you took to support your position. In other words, I don't even need the separate Snow quote from 1831 as well as the 1850-ish Broad Street pump episode; his observational evidence, and argument for, the germ, instead of the miasma theory is on the very same webpage from which you took a quote that seemed to support your position. Did you just search for quotes that supported your argument and not read the rest of the page?

Please do call whomever you like, although I suspect a Healing Arts Editor is a bit more qualified to comment on whether one of us is misinterpreting or misquoting major events in the history of epidemiology. I have, in fact, made such an editor aware of the disagreement.

In fact, I have thoroughly addressed your out-of-context quote. It appears you don't like the way I addressed it. Snow's actual papers, I believe, are available from the Snow Society. Want to get an independent confirmation that Snow used statistics, evidence and causality, and thought miasmas were absurd? Howard C. Berkowitz 06:36, 25 December 2008 (UTC)

Howard, if you dislike my use of "revisionism", this is one thing. Let's see how and why I used it and discuss.

Here is the context (before you insert your text and broke the logic):

It would be, however, an instance of scientific revisionism to attribute to statistical analysis and evidence-based decisionmaking, the tools of modern clinical epidemiology and evidence-based medicine, the major improvements in population health that were observed in the XIXth century. The public health reforms that were initiated during this period were designed and enforced because thinkers of the time adhered to the view that decomposing matter and excreta were vectors of spirit-like entities that accounted for the epidemic nature of diseases like cholera. In the minds of clinicians and public health reformers, the miasmatic theory of disease allowed to design concerted efforts against major sources of disease. Only later was it possible to demonstrate that the miasms they were containing by promoting purity and eradicating unnatural accumulations of waste, were, in actuality, bacteria, amoebas and viruses.

The germ theory for cholera was finally established, although earlier changes in the sanitary environment, called for by the erroneous miasma theory, had actually done much to reduce the transmission of disease. London provides an example of how useful a wrong theory (miasma) can be for addressing an epidemic (improvement of air, solid waste and water supplies), in this example cholera.[11]

Now, let's see how you address that:

"Revisionism" is, bluntly, a buzzword. Snow's own work is extensively published. Find one example of Snow using "miasma" in his own works. (..., ..., ...)

So? You still don't get why I responded that you were off the point? --Pierre-Alain Gouanvic 17:15, 25 December 2008 (UTC

Your original first paragraph is not clear on the period you are discussing; it is unclear the first sentence that mentions a date implies that you are talking about the 19th century in general. Sourcing would have helped, and preferably, in the interest of neutrality, sources readily available online and from general historians, not partisans like Burton Goldberg.

You make general statements about miasmas driving 19th Century medicine, to which there are counterexamples. I began by pointing out two of them (Snow and Nightingale), and you didn't go to the talk page and discuss the issue. Instead, you went into a further essay complaining of revisionism. In partial support of that argument, you offered a source from UCLA's Department of Epidemiology, which ignored, two paragraphs before, on the same page, a specific statement of how Snow had rejected miasmas.

It may well be that what you want to say is that 19th century practitioners didn't have antibiotics. The reality is that antibiotics are not the only treatment for infectious disease. Other treatments exist, such as surgical debridement and passive immunization. There is also prevention on an individual basis.

Counterexamples? Snow's observations, as early as 1831. While Snow is often considered the father of epidemiology, a reexamine of Nightingale's work shows that she was using recognizable statistical methodology; the pie chart, for example, appears to be her invention. The pleasant compromise is to say that epidemiology had a mother and a father, although I don't know if they ever ment.

Just from memory, here are several 19th century counterexamples that there were no individual treatments, agreeing there were no systemic antibiotics:

• Lister's revision of surgery to use antiseptic technique, so debridement and surgical treatment of infections were possible. Lister also made extensive use of phenol dressings, which often caused toxicity, but also certainly prevented a number of surgical wound infections or reinfections.
• Passive immunization from von Behring, Pasteur and Roux.
• Tragically rejected at the time, but Semmelweis' attempt to stop nosocomial transmission of what was called puerperal fever.
• Ehrlich's dissertation on the differential effects of dyes on infection, and continue through to his work, still in the 19th century, that eventually led to systemic antimicrobials, some in the earliest century — but the work began in the 19th.

You may not want to hear it, but this article would be significantly improved if it concentrated more on the actual theories of alternative medicine, and less on attacking conventional medicine. I am the first to admit that there were things terribly wrong with medicine well into the 20th century, but write about alternative medicine, with less emphasis about how much more clever were the alternative theorists. There is reason to mention integrative approaches, such as the Chinese Three Roads restructuring of TCM.

Later in the section, it's hard to respond to allegations of the superiority of alternative medicine and the evils of conventional medicine, when there is either no sourcing, or indirect sourcing from people like Burton and Bivins, who have a clear ax to grind. In Burton's case, his website to have just as much economic interest, on a smaller scale, than those of major pharmaceutical companies.

The later paragraph,

And today, advocates of enlightenment thinking cite examples of treatment by Alternative Health practitioners as dire evidence of the spread of 'irrationality". Yet how rational is say, modern medicine, and how irrational are alternative remedies? It has been said that unidentified World Health Organisation (WHO) figures, in the 30 years from 1967 to 1998, just under 6000 adverse drug reactions world-wide can be traced back to the prescription of herbal and other alternative medicines.

The first two sentences are argumentative, condescending, and not representative of neutral encyclopedic writing. In the third sentence, I inserted "unidentified", as I will continue to do when there is an appeal to authority that cannot be independently verified. I also inserted some comments on the questionable use of statistics there.

The World Health Organization, in the specific, available report I cited, is not quite so generally supportive of herbalism as the article suggests. Do I reject herbal medicine? Absolutely not in the sense that there are phytochemicals that are effective in disease. The idea that the whole plant must be used for therapeutic effect, however, can be challeged on grounds including evolutionary botany.

In summary, I don't believe I was off point. I was, instead, showing that there are factual errors in an article that has a clear non-neutral agenda. When I raised concerns earlier, I was told to have patience while the article developed. The problem with having patience is that random new users may come to CZ and find this article, and have serious questions about CZ's claim about accuracy. They will not go to the talk page to find the assertions that it is developmental.

If the article page said. at the top, that this was a developing article, on controversial topics, and is not yet ready to be assumed as authoritative, I would have far less problem. If this were in userspace and an essay style article were being worked out there, I'd also be far more patient. None of these conditions, however, exist here. Howard C. Berkowitz 18:34, 25 December 2008 (UTC)

Suggestions on vocabulary

In the lead, I have variously either substituted the term used by the National Library of Medicine's Medical Subject Headings (MeSH) controlled vocabulary (e.g., spiritual healing vs. faith healing), or piped the definition, in order to be more compatible with other articles. Several contributors are putting the MeSH definitions into CZ, at least as stubs, to make it easier to search the general literature. MeSH is preferable to general dictionaries.

If there is a strong desire to use a non-MeSH term, than I strongly recommend a stub be created explaining the usage.Howard C. Berkowitz 21:06, 25 December 2008 (UTC)

John Snow

Howard, you've very solidly sourced John Snow's thinking; can you simply put the article straight on this without conducting an argument on the article page. This is clearly important to include; it's a key step in the divergence of thinking in modern medicine from precursor theories, but the quotes are overlong. Can you partly paraphrase?

Martin - you deleted a section of Howard's text - in general don't delecte text where it is possible to move it (into a stub article or footnote pending discussion. In this case I agree that the text you deleted in this case is not directly relevant - this article is about theories, not about the practice of alt med. Gareth Leng 23:41, 25 December 2008 (UTC)

Gareth, I have been moving the material into John Snow (physician). The problem was that the original reference to the history of medicine in the 19th century were factually wrong; miasmas seemed to be there to support...I'm not exactly sure what point. Perhaps a more direct statement of the point to be made, rather than trying for elegance in prose or to cast hard science into discussion of ideas.

I shall take a guess at what could be the essence of a valid point: "It may not be necessary to understand the mechanism of disease, or of prevention, or of treatment, as long as there is significant evidence of cause and effect. Those that do not understand the mechanism, however, may need to be willing to let go of approaches that are shown to be irrelevant when mechanisms are understood." Yes, I am quite aware "mechanistic" shows a certain philosophical view; it is one that needs to be accepted and not attacked; other views can be described as parallel to it.

I literally don't know what are being expounded as theories here; perhaps they need to be presented on the talk page if necessary, in more basic bullet/outline form. Elegance of prose is a secondary concern. As Churchill put it in a not completely irrelevant way, "Not end a sentence with a preposition? This is arrant nonsense up with which I shall not put!" Make the theories clear without flourishes. Howard C. Berkowitz 00:06, 26 December 2008 (UTC)