Talk:Homeopathy/Archive 13

Some ground rules (please do not delete from top of the page)

Here are some brief comments that I hope will help reinforce our ground rules. I'm sorry I don't have time for more detailed engagement right now. Some Citizens have complained to me that homeopathy's advocates on this page are tending to purge criticisms. On this I will absolutely put my foot down. You may not do so. You may maintain that (and say in the article how) homeopaths reject the criticisms, but you may not simply delete points, and source material, simply because you disagree with them or you think they are misinformed. If you have a strong disagreement about a published criticism, you should voice it in the article, rather than removing the criticism. There may be exceptions to this rule, but (I understand) not in several recent cases in the present article. Of course, the "reply, don't delete" rule assumes that a source and criticism are important enough from the point of view of homeopathy's critics to be included. While they can have input of course, this is not ultimately a matter that homeopathy's defenders are best placed to decide. The word "skeptic" should not be used, pejoratively, to identify those who reject homeopathy in the article. If there is a need repeatedly to identify the skeptics of homeopathy, you may not use a term that the skeptics themselves reject. You must find a mutually agreeable term. I suggest "mainstream physicians." "Allopaths" won't do, either, although it certainly can be introduced, and it should be. It should not be necessary for me to point out that the article can neither endorse nor roundly condemn homeopathy. The article does not take a stand; it presents both (or all) sides on all controversial issues it presents, and leaves it up to the reader to decide for himself. The article does not endorse a position. Precisely because homeopathy happens to be a minority viewpoint when it comes to the health issues it discusses, criticism of homeopathy does not belong in a separate "criticisms" section of the article. I have my doubts whether there is any need for a "criticisms" section at all, but I can't say so until I've read the current version, which I haven't done. Selective and uncritical reporting of references is contrary to CZ's neutrality policy: this makes it appear that we officially think the literature says such-and-such, when there is legitimate disagreement about whether it does say that. When, therefore, a "skeptic" raises a question about a statistic such as 18% of Americans, we must absolutely deal with this question. I am very uncomfortable publishing information about the percentage of Americans who accept homeopathy, when it has not been made clear what "acceptance" amounts to in the survey that was performed. Therefore, either this essential interpretive information must be included in the article, or the information about the statistic must be excluded. Anything else would be, quite simply, misleading and unscientific. More generally, on a topic with this much disagreement, we simply cannot add heaps of studies and statistics to the article without adequate explanation and without critical responses where such may exist or be possible. Uncritical reportage of the results of disputed studies has an inherently biasing effect. Finally, I want to underscore that if anyone repeatedly reverts significant parts of the text without explaining and defending his actions here on the talk page, I will consider banning that person. I would ask those who are following the article more closely to make a list of such unexplained reversions, and provide it to me privately. On the basis of such information I will either issue a warning or, if the problem is very serious, a temporary ban. Let me finish on a positive note. Despite the amount of struggle over this article, or perhaps because of it, this article has grown and in many ways improved, and other articles have spun off. This is a good thing. As I like to say, if everybody is equally frustrated, that means that work is getting done and the article isn't too biased one way or the other. Still, if we can all follow the above ground rules, I think we'll get along quite a bit better. --Larry Sanger 16:22, 20 October 2008 (UTC) I want to add another point. While I do not endorse Wikipedia's inane and abusable rule "assume good faith," I do want to suggest that we need something a little like that. I might say, instead, "Assume your opponent is reasonable enough to be open to compromise." If you make that assumption, you will yourself be much more likely to propose a compromise, and to be open to one. Then, if the other person shows himself to be completely closed to any compromise, whether yours or any that he might propose, the matter suddenly becomes much clearer. Then you can contact me, saying, "Look, I proposed a compromise, so-and-so did not accept it or propose any compromise in response. What do we do?" --Larry Sanger 15:17, 24 October 2008 (UTC)

How about a break?

I believe we all need a longish cool-down period on this article. I think that a break of two weeks would give all of the participants enough time to get some much-needed perspective. Moreover, you can use your wonderful energy on an article other than this one--how great would that be? So, unless there are any objections, I would like to ask, not require, that the participants here just drop things as they are now and return on November 16. --Larry Sanger 03:50, 3 November 2008 (UTC)

Sounds good to me. I certainly have a few other articles, here and there, to which I might contribute.Howard C. Berkowitz 03:52, 3 November 2008 (UTC)

Ramanand, I'm hoping you read this--did you see the above? Do you not agree to a time out/cooling off period? --Larry Sanger 02:48, 7 November 2008 (UTC)

Larry, I agree completely. I was making some minor edits, but if that is not O.K. with you, I'll lay off till the 17th. I'm sorry if I offended you.—Ramanand Jhingade 02:53, 7 November 2008 (UTC)

How about a compliment? This article looks great. It's very readable! When will it get finished & approved?

I can't understand the Homeopathy article at Wikipedia. WP's article starts by confusing me with a lengthy parenthesis about Greek stuffs (sounds Greek to me) & then it completely stops the reader & pierces him/her in the eyes with "A central thesis of homeopathy is that an ill person can be treated using a substance that can produce, in a healthy person, symptoms similar to those of the illness." I'm trying real hard to understand what that sentence means. Can anyone else, honestly?

(Chunbum Park 02:59, 7 November 2008 (UTC))

Absolutely no offense whatsoever. Let's do take a break. I agree with Chunbum that one positive outcome of all the wrangling is a much longer and better article than it would have been if everyone had been nodding their heads in unison! --Larry Sanger 03:12, 7 November 2008 (UTC)

Article balance and strategy

The Encyclopedia Brittanica is exhaustive and accurate. Wikipedia has been taken over by the theorizing, skeptical, critics of Homeopathy who ban anyone who has anything positive to say about Homeopathy (99% of the people on Wikipedia are anti-alternative medicine, but due to the efforts of Eubulides, Naturstud and Bryan Hopping, the articles on Chiropractic, Naturopathy and Osteopathy, respectively, are readable). There are lots of other articles (like the ones on Climate Change & Intelligent Design) which have gone hay wire because people want only their views in the article. Citizendium may be going the Wikipedia way with the negative statements and allegations (like the ones by Dr.Sagar, Jack Kilenn etc.) being incorporated here. I think we need to tone down the negative statements and allegations, as well as the no. of them.—Ramanand Jhingade 03:04, 12 November 2008 (UTC)

Is anything from the following section from Wikipedia factually untrue, yes or no?

Regulation and prevalence: Homeopathy is fairly common in some countries while being uncommon in others; is highly regulated in some countries and mostly unregulated in others. Regulations vary in Europe depending on the country. In some countries, there are no specific legal regulations concerning the use of homeopathy, while in others, licenses or degrees in conventional medicine from accredited universities are required. In Germany, no specific regulations exist, while France, Austria and Denmark mandate licenses to diagnose any illness or dispense of any product whose purpose is to treat any illness. Some homeopathic treatment is covered by the public health service of several European countries, including France, the United Kingdom, Denmark, and Luxembourg. In other countries, such as Belgium, homeopathy is not covered. In Austria, the public health service requires scientific proof of effectiveness in order to reimburse medical treatments, but exceptions are made for homeopathy. Two countries which formerly offered homeopathy under their public health services have withdrawn this privilege. At the start of 2004, homeopathic medications, with some exceptions, were no longer covered by the German public health service, and in June 2005, the Swiss Government, after a 5-year trial, withdrew homeopathy and four other complementary treatments, stating that they did not meet efficacy and cost-effectiveness criteria, though insurance can be bought to cover such treatments provided by a medical doctor.

Hayford Peirce 04:08, 12 November 2008 (UTC)

OK, it appears that Ramanand and Hayford couldn't resist. (Ramanand, please don't answer Hayford--he's just being clever and making a point, but I don't think that answering him will help to come to a resolution.) I think we are due for a straight-forward discussion of the general, not specific, question Ramanand raises. Is this article not balanced? Why do you think it is unbalanced, Ramanand? I don't want many specific examples now, because that's endless (but see below). I want some more general discussion.

I've seen some of your edits, in which you make the article, and thus CZ, endorse a homeopathic position. That's simply not permitted here. We can report what homeopaths say, but we must make it absolutely clear that we aren't endorsing it. Also, when a homeopath position is taken, with which there are some important disagreements from the side of mainstream medicine, balance requires that we report, without asserting, the point of disagreement. As far as I can tell, Howard and Chris have been trying to move the article back in the direction of balance. As it stands, the parts I've been able to read are remarkably charitable and sympathetic to homeopathy.

Are there large sections that you disagree with? Which? Can you more generally or helpfully characterize why you think the article is unbalanced? If you simply say there's too much negative stuff about homeopathy, that doesn't help me because I don't know how much too much is. I'm sure you don't have time, but I'd love to see a version of the page marked up with everything you object to in red. Actually, I'd love to see a version marked up by "the other side" with everything they object to. --Larry Sanger 05:37, 12 November 2008 (UTC)

Friends, I hope that we all realized how blessed we are to have Larry's input here...and I hope that we all understand what he has written.

Hayford's insertion above has way too many factual errors. Most of all, it is confusing because it is mixing up regulations about the practice of homeopathy with regulations on what is and isn't covered by government health plans. Also, virtually every country in the world recognizes and regulates the sale of homeopathic medicines. Because homeopathic medicines are legally recognized as "drugs," doctors are allowed to prescribe them, and in all countries that recognize homeopathic medicines, the general public is allowed to purchase them, except for a small number of low-potency homeopathics that can be dangerous in their crude form. Dana Ullman 20:34, 12 November 2008 (UTC)

There are lots of anti-Homeopathy statements on the internet. I'm only against insertion of negative statements and allegations (like the ones by Dr.Sagar, Jack Killen etc.) being incorporated here.—Ramanand Jhingade 03:32, 13 November 2008 (UTC)

Doesn't Killen represent an opinion of some weight? Chris Day 03:51, 13 November 2008 (UTC)

Killen's opinion is of significant weight specifically because he said it while a government official specifically concerned with complementary and alternative medicine. When the senior British general in 1914, said "the machine gun is a much overrated weapon", it was a significant statement.

In any event, it is specifically against the ground rules to object to factual statements merely because they are negative, and it is factual that Killen made the statement. The United States just went through a political process where, surprising as it may be, candidates made negative statements about one another. Should they not be reported?

A cooling-off period was requested, but the article was not locked. It can be. It is no more likely that there will be agreement on homeopathy than any of a wide range of subjects where the different viewpoints have different standards of evidence and proof. Howard C. Berkowitz 07:33, 13 November 2008 (UTC)

OK, I'm going to try to understand. Sagar simply mocks homeopathy, and homepaths don't want to be mocked, of course. And the Killen quote undercuts the credibility of homeopathy because he is an official with an organization that does careful scientific studies of homeopathy, and he simply says it has no basis.

Like it or not, alternative medicine is in fact mocked, and such mockery is a common reaction to alternative medicine among health professionals, just as it is a common reaction to "pseudoscience" among scientists generally. Right now the article says that homeopaths don't find the joke funny. What more do you want? To remove the mockery; I don't know but I don't see that as being justified. But it could be part of a reasonable compromise.

As to Killen, I'm not sure what the objection is. Is the quotation taken out of context? (Is it?) Or is the problem, perhaps, that Killen is just expressing his own idiosyncratic opinion and does not speak for the National Center for Complementary and Alternative Medicine? Is it that that organization is not the best organization to represent mainstream medical opinion of homeopathy?

Why are you, as you say, "against insertion of negative statements and allegations (like the ones by Dr.Sagar, Jack Killen etc.)"? Is it merely because such statements are, in fact, negative? Is it because you disagree with them, because you think they are false? Is it because you think they somehow misrepresent what non-homeopathic physicians believe? Or do you have some more specific reason? Please do clarify the latter confusion for me.

If the problem is not about any specific negative statements, after all--although that is what you just said--but instead about the sheer quantity of negative statements, then let's talk about that. Can you characterize in any useful way why the current proportion of negative statement strikes you as excessive? Also, can you motivate or argue for the reasonableness of any particular cuts or consolidations? I do notice that there are several sections that might be a little redundant, at least... --Larry Sanger 14:58, 13 November 2008 (UTC)

Larry makes several important and good points. I am not against "negative" statements as long as they are notable and have some degree of legitamacy and accuracy. I do, however, have some problems with Jack Killen's statement where he says, "There is, to my knowledge, no condition for which homeopathy has been proven to be an effective treatment." My problem is that this statement is simply wrong...and because this article makes references to numerous positive studies showing beneficial results from homeopathic treatment, this statement creates confusion. In the 1997 meta-analysis by Linde et al, they assert that although there is evidence that the results from homeopathic medicine are different from that of placebo, there is no one condition for which homeopathy has been proven to be effective. The difference HERE is that this study defined "proven to be effective" if there are at least THREE trials showing efficacy. As it turns out, the next year (1998), the third trial showing efficacy of homeopathic Oscillococcinum was published. The problems, however, with Killen's quote is that it gives no specific definitions of "proven efficacy" and as such, it is vague and inaccurate in its vagueness. Dana Ullman 16:43, 15 November 2008 (UTC)

You, sir, are changing the subject. I have repeatedly written that Killen's statement is significant because it was said by a U.S. official in the context of a widely distributed news magazine (Newsweek), and the statement was not rejected by any higher official of the U.S. government. Whether or not it is vague or not, it gives insight into U.S. government thinking on homeopathy. Are you saying that statements by government officials, which might be confusing, do not belong in Citizendium? If so, that would have a chilling effect on political articles.

Were I not respecting the moratorium, sir, I would restore the legislative history of Senator Copeland, a homeopathic physician, successfully inserting an amendment into the FDA establishing legislation, which banned the FDA from requiring safety and efficacy testing of homeopathic remedies. You also removed that saying it was irrelevant, but I believe, and I would submit to the Editor-in-Chief, that political aspects of regulation are quite relevant. Politicians of many countries frequently do controversial things with respect to health policy; they are noteworthy because they did them although they can be criticized for conflict of interest or for vague inaccuracy.

A general news magazine is simply not going to get into definitions. We have no way of knowing whether, in fact, Killen gave specific definitions or not to the interviewer, but that's not really relevant to the fact that the acting deputy director of the National Center for Complementary and Alternative Medicine said it. Killen could have said "homeopathy is ineffective because it involves dancing deasil around the cauldron, which any person well-versed in neodruidic ritual would know should be danced widdershins." That such a statement would be completely wrong is irrelevant to the context in which the quote is being used. For the article, the significant point is that a U.S. government official said it.

If, at the time, a homeopath had countered it in public with the reference to Lunde, that would be noteworthy. If it can be demonstrated that a letter to the editor of Newsweek had been sent at that time, and not published, that would be noteworthy. Arguing with the specifics of a news quote simply is irrelevant to the point, and, in my opinion, again an attempt to attack any criticism of homeopathy rather than report that the criticism was made and move on.

Larry, this is an example why I see hope for this article. Howard C. Berkowitz 20:21, 15 November 2008 (UTC)

All that confusion is why you see hope for the article? I don't understand.  :-)

After this exchange, it seems obvious to me what a compromise solution would look like, and I'm surprised that neither you, Howard, nor Dana proposed it. If the point of the quotation is to express what a government official said about homeopathy (and I think we still need to investigate if that was the view of the agency or just one person in the agency), then say that. In other words, make it absolutely clear that the point of our using the quotation is to establish...well, whatever the point is. Moreover, I personally would like to know if the "National Center for Complementary and Alternative Medicine" is the leading serious research organization about alternative medicine in the U.S. Without any context, the article suggests it is. If it isn't one of the top organizations in the field, then why are the first two paragraphs about it in a section titled "Medical organizations' attitudes towards homeopathy"?

Moreover, if homeopaths very strongly reject what Killen says, even if the point of our quoting it is to show how the medical establishment feels about homeopathy (is that it?), then why not let them say it? Something like: "Homeopaths, for their part, reject Killen's view, claiming--as is explained in other parts of the present article--that there is significant clinical evidence for the effectiveness of some homeopathic remedies."

Come on--is this really that hard? --Larry Sanger 21:27, 15 November 2008 (UTC)

Sorry, that should have been no hope for the article. I would have been happy to observe the moratorium on the talk page as well as the article, but I have not made changes on the talk page. Let's be specific: National Center for Complementary and Alternative Medicine is the part of the National Institutes of Health concerned with complementary and alternative health, including homeopathy. In other words, it is the central U.S. government organization that funds research into CAM, again including homeopathy, and does synthesis in the field. Killen, at the time of the statement, and as far as I know, still is, acting deputy director. What additional information did you need to have that it is influential?

Larry, I spent 40 years or so in Washington. When someone at a deputy director level or above says something in a national newsmagazine, and there is no repudiation, one has to assume that either the upper echelons don't disagree or may support it. If homeopaths, as a group, felt so strongly about it, surely there must be authoritative sources about immediate responses to Killen's statement. I'd be delighted to see such material. Your example of "Homeopaths, for their part, reject Killen's view, claiming--as is explained in other parts of the present article--that there is significant clinical evidence for the effectiveness of some homeopathic remedies" is something that should be sourced by more than individual opinion. Believe me, when someone at Killen's level in NIH said something that was offensive to any of a number of activist groups (e.g., AIDS, breast cancer), there was huge response. Forget activists and deal with professional groups, on something like the controversy over Robert Gallo's work (originally at NIH) on AIDS, and this year's Nobel going to Luc Montagnier.

I do not believe it is unreasonable to ask for sourced responses to Killen. Call it changing the subject, but I'd like to bring in, again, the homeopathic exception in the FDA enabling legislation, which was sponsored by a Senator who was a homeopathic physician. There's just been a bit of controversy over blocking of tobacco oversight by Senators from good Suth'rn tobaccy states. Dana removed that factual legislative history, and, if one reads the article, one might assume the FDA approves of homeopathy. If they are still there, I cited current FDA web publications that the law differs with the current professional opinion of the FDA. I'd like to put the Copeland amendment his

Do you really mean that a rational compromise is to have a generic "homeopaths disagree" with every sourced criticism? If so, yes, I do consider that very hard.Howard C. Berkowitz 22:00, 15 November 2008 (UTC)

The Killen quote appears to be aimed, through the use of exactly one quotation by one scientist, at proving that the whole U.S. medical establishment blanket-rejects the effectiveness homeopathy. I know something about the NIH and I'm sure any deputy director that might be interviewed by Newsweek is highly-placed. None of this establishes that Killen actually does speak for the NIH as a whole. Besides, in the previous paragraph our article says "in others, more benefits were seen than expected from a placebo"; either Killen doesn't know about those above-placebo "benefits" or he denies that they really prove that the "benefits" constitute "effective treatment."

Look, I don't care about the details here. What I am trying to establish is that it is reasonable to edit the text in a way that will be more acceptable to the people you are (or were) trying to collaborate with. Look at it this way, Howard. You aren't trying to be neutral here if you simply deny that the other side has a legitimate complaint. I think their complaint can be given a very reasonable interpretation: Killen's view seems to contradict what we said the NCCAM says, and he is, after all, only one government scientist. For CZ to publish an article that does not properly contextualize this quotation is essentially for CZ to endorse the sentiment in the quotation as the mainstream medical attitude toward homeopathy. From a homeopath's point of view, Howard, you ought to be able to see that that is an important piece of information, and that it is very important that we get it right. So, again--why is it so hard? Why not just edit it? Something like this (I've added the parts in red:

On the effectiveness of homeopathic remedies, the attitudes of mainstream medical organizations within the U.S. are ambivalent at best. One major research institution, the National Center for Complementary and Alternative Medicine (NCCAM), which is part of the National Institutes of Health, funds research into homeopathy. It states that controlled clinical trials of homeopathy have produced mixed results; in some, homeopathy appeared to be no more helpful than a placebo, but in others, more benefits were seen than expected from a placebo.

While that statement might appear rather noncommittal, one of the NCCAM's scientists, acting deputy director Jack Killen, has been more forthright. Killen said in a Newsweek article that homeopathy "goes beyond current understanding of chemistry and physics." He added, "There is, to my knowledge, no condition for which homeopathy has been proven to be an effective treatment." Perhaps needless to say, homeopathic researchers believe they have demonstrated positive effects in clinical trials.

More indication of mainstream U.S. medical opinion about homeopathy's effectiveness can be found in the stance taken by the American Medical Association. ...

I might try to illustrate my point with the rest of the section, but I hope that won't be necessary. Such relatively minor edits are harmless. You ask for a "sourced reply" to the Killen quote--I'm sorry, but I don't see why. The point is that, when in an encyclopedia article on an evidently controversial subject, we cite a statement that is that definite, we want to make it very clear to our readers that we, CZ, do not endorse this view ourselves. Not all criticisms of homeopathy are this definite, Howard. The very fact that Dana and Ramanand are objecting so strenuously ought to be enough of a clue that the text at present looks biased, at least to them, to give you serious pause. That is, if your purpose, Howard, is not merely to give voice to your own views about the subject, or the mainstream attitudes toward it, but instead to sympathetically portray the range of views that exist, then the fact that Dana and Ramanand are objecting should indicate that they don't find homeopathy sympathetically portrayed. The reaction I would hope you would have, in that case, is: "Aha, they are really objecting to this hard. There could be something wrong here. Perhaps I can recast it in a way that still does full justice to the underlying criticism, but does not have any unnecessary implications that I did not intend, or that the evidence does not support." That, I think, is what the red additions I made above do.

Again, I don't see why this has to be so hard. Once you are committed not to defending The Truth as you see it, but instead to fairly laying out the dialectical landscape, it becomes a fairly straightforward matter of problem-solving.

Still, after all this, I am still inclined to agree with Hayford--that both sides here are so set against such reasonable and obvious compromises that it is best if we just mothball the article until we can find some people who can treat the subject in the way I've described, and will then roll up their sleeves get to work. I would do this myself but I'm very busy these days...maybe in a few months. --Larry Sanger 04:14, 16 November 2008 (UTC)

I agree it should be mothballed. Why do I ask for a sourced response? I'd like to know that more than two homeopaths have been upset by Killen's quote. With something of the circulation of Newsweek, it strikes me as unlikely that if it is so broadly objectionable, there aren't more than two individuals on Citizendium that have said so in a public forum. Actually, I'm rather surprised, given U.S. politics, that Killen's comment seems not to have generated any protests, at the time.

The Bush Administration has not exactly been tolerant of public statements by "one scientist". I invite you to look at former Surgeon General Carmona's sworn testimony, to Congress, of the pressure put on him to have his statements meet with their approval -- he found he couldn't stay in the job. Vint Cerf, who has been one of my mentors, cataloged quite a few examples of comments by "one scientist" getting slammed if it wasn't supported.

Further, there is a difference between accurate and "sympathetic" writing, which perhaps could use some discussion in a broader forum. Interest has been expressed in improving the Holocaust article. I'm sure that some things might be proper contributions to that article, reporting positions that were grounds for death sentences at Nuremberg. Are you saying that CZ needs to report "sympathetically" on what Julius Streicher said, from his perspective? Sorry, sometimes the truth hurts, not "my vision of the Truth", but accurate representation of expert, mainstream positions. I really don't care to put everything in a Seinfeld-style "but that's all right."

I have, Dr. Sanger, examined my objectivity about what you have put in red, and, if I start having "The reaction I would hope you would have", I don't belong here. I believe that, in fact, quite a number of Citizens would not have that reaction; perhaps you might examine whether you are attempting to enforce your view of The Truth. Howard C. Berkowitz 05:42, 16 November 2008 (UTC)

I'm puzzled about how I might try to answer this--while actually contributing something useful. I don't think I can respond without "escalating the situation," not because I'll say something rude toward you (quite the contrary), but because I suspect that more detailed replies would only muddy essential points more. So I think that you and I, Howard, should take a break from further conversation on this page, and step back and reflect a little bit to ourselves. But I do want to say just that I'm very disappointed that there has been such profound miscommunication between us. --Larry Sanger 03:33, 17 November 2008 (UTC)

Conditions of compromise?

What are the necessary and sufficient aspects of a compromise that can meet the integrity requirements of CZ, as opposed to both proponents and opponents of a given discipline?

While I recognize that some homeopaths disagree, I find an overemphasis on history centuries and millenia old, even given the existence of history of homeopathy. Looking at virtual any health sciences article, there may be basic history, there may be subarticles on particularly significant historical events, but the emphasis is on current synthesis. I believe that the article has an overemphasis on history, and, in the talk page, insistence that homeopathy has passed the test of time, so it is appropriate to speak of 18th, 19th, and 20th century homeopathic criticism of then-contemporary medicine. This presentation comes across as aggressive and angry; the political history by which some countries avoid homeopathic remedy regulation has been removed by advocates of homeopathy.

There is so much insistence on the uniqueness of every encounter that basic approaches are still not clear. Note that articles on other complementary and alternative techniques, such as acupuncture, as well as mainstream history and physical examination, seem to have little difficulty in articulating these concepts -- and some, such as acupuncture or pain medicine -- are highly individualized.

I regret that I believe there remains a pattern of editing out material unfavorable to homeopathy, which does not seem to be corrected by the existing process. Howard C. Berkowitz 17:11, 13 November 2008 (UTC)

Howard, you're asking one question and making three points, and it is all at best loosely connected. Why not tell us which of these is most important so we can focus on it? We can't discuss and adjudicate all of these at once. --Larry Sanger 18:49, 13 November 2008 (UTC)

None of the points are especially relevant without an active, neutral editor being involved. There is a point to what I see as continuing editing to "improve", with specific violations of ground rules. Larry, you as EIC have said there is no right to remove statements merely because they are negative, if they are factual. Ramanand had repeatedly said there should not be negativity. Those are fundamentally incompatible assumptions, and since one set is basic CZ policy, I do not see a satisfactory outcome. Subjectively, I believe there are issues of conflict of interest that will not resolve. The main reason I involve myself in this article is to be able to represent, to potential and new contributors, that partisan positions are not acceptable.

If there is one specific point, it is a firm ruling that a reasonably sourced statement, perceived as negative, cannot be removed. A three-sentence, carefully worded quote from a meta-analysis cannot be "simplified" such that all that remains seems at least a limited endorsement of homeopathy. Other points are not appropriate for a public talk page. Howard C. Berkowitz 19:20, 13 November 2008 (UTC)

I don't think we need such rules, frankly; I don't think they will help anything. I agree that it is never an adequate justification to remove a quote just because it is negative. Also, I can't believe that Ramanand wanted all negative statements about homeopathy removed. I really think it comes down not to debates over specific quotes but to a perception of unfairness or imbalance in larger parts of the text like paragraphs and sections. You don't always seem to explain homeopathy's attitudes sympathetically, and I suspect that is what the homeopaths are ultimately upset about here. They, on the other hand, are indeed removing your perfectly legitimate critical text, which also seems unfair and unjustified. What we need is someone who will attempt at the same time to express the homeopathic positions sympathetically, while casting the criticisms of homeopathy in a straightforward way, that is makes us come across as respectful and not dismissive of homeopathy. Probably, Howard, you need to point out the sections and a few choice more specific items that bother you, and then see if someone else can even things out, so to speak. --Larry Sanger 19:38, 13 November 2008 (UTC)

A diagnosis of the ongoing controversy?

As I look over the article this afternoon, I have to say that I think that most of the complaints that people have can be explained in a simple, if not obviously helpful way: they think their positions are unfairly treated. Yes, so what does that tell us? Well, the sense of injustice is not usually so much due to any particular line in the article as it is patterns or narratives that appear largely on the level of paragraphs and sections. That is, a paragraph or section seems to be "aiming at" a certain conclusion with which somebody disagrees. When we complain here on the talk page about particular criticisms, or deletions of criticisms, those are merely the epiphenomena, the side-effects of the underlying lack of fairness of larger groupings of text.

If that's the case, then we might be going about this all wrong. If perceived semi-broad patterns of bias are the problem, then talking more about specific texts on the talk page will not solve anything. Instead, judicious editing of the article by a good, fair-minded editor or two will do the trick. Such an editor must not only understand what neutrality requires and be committed to it, he must know enough about the subject not to introduce factual errors in adjusting various positions. Moreover, he must be creative and sensitive enough to foresee objections than different combatants will likely have--so they don't have to object in the first place.

Basically, then, if we skillfully edit the text in way that tries to make the various complainants happy, their complaints will evaporate.

This is in line with what Gareth Leng has said in the past. I think he was onto something. --Larry Sanger 19:05, 13 November 2008 (UTC)

A diagnosis and way forward

As I look over the article this afternoon, I have to say that I think that most of the complaints that people have can be explained in a simple, if not obviously helpful way: they think their positions are unfairly treated. Yes, so what does that tell us? Well, the sense of injustice is not usually so much due to any particular line in the article as it is patterns or narratives that appear largely on the level of paragraphs and sections. That is, a paragraph or section seems to be "aiming at" a certain conclusion with which somebody disagrees. When we complain here on the talk page about particular criticisms, or deletions of criticisms, those are merely the epiphenomena, the side-effects of the underlying lack of fairness of larger groupings of text.

If that's the case, then we might be going about this all wrong. If perceived semi-broad patterns of bias are the problem, then talking more about specific texts on the talk page will not solve anything. Instead, judicious editing of the article by a good, fair-minded editor or two will do the trick. Such an editor must not only understand what neutrality requires and be committed to it, he must know enough about the subject not to introduce factual errors in adjusting various positions. Moreover, he must be creative and sensitive enough to foresee objections than different combatants will likely have--so they don't have to object in the first place.

Basically, then, if we skillfully edit the text in way that tries to make the various complainants happy, their complaints will evaporate.

This is in line with what Gareth Leng has said in the past. I think he was onto something. --Larry Sanger 19:05, 13 November 2008 (UTC)

Here, I have an idea for how to proceed after the moritorium is lifted: why doesn't everybody list the five sections or subsections that bother you most? Also, if there are particular texts that really bother you, then yes--quote them here on this page and we'll look at them. Please do this!

Just for example, I'll bet the "Questions about homeopathic theory" bothers the homeopaths considerably because they come off looking like fools, and the other side comes off looking too clever by half--they're a little sly, aren't they? That's unnecessary. It can be fixed, in a way that is more respectful but gets across the same skeptical points, and that encapsulates the homeopath's attitude more sympathetically--even if they don't have any answers to the skeptical questions.

Once we have these lists of complaints, the lists of offensive sections and paragraphs and quotations, then, Howard, Ramanand, and everyone else who is inclined to defend their own view, just lay off--do nothing. Let others, like me or Gareth or some others, weigh in and make a few additions and cuts and rearrange things so that they are more likely to be to everyone's liking. Basically, I think you'll stop fighting and we'll be able to make progress if more fair-minded people just roll up their sleeves and do what has to be done. --Larry Sanger 19:38, 13 November 2008 (UTC)

How to deal with negative comments

Respectfully, Larry, I don't think that is going to work. It's not a "list", but basic structure: what is it that homeopaths actually do? The area that I find most frustrating is not how homeopathic remedies do or do not work, or whether there are vital energies, but that I constantly get the answer that the basics of an interaction are so individualized that they cannot be described to a non-homeopath. I cannot think of a general or specialized area of medicine, for example, where it is impossible to describe the basics of patient-clinician encounter and preliminary planning. While it started out as a joke, I did get a start on rocket science; I'm stuck because I don't know how to format some of the equations. Brain surgery? Sure; I'm not Harvey Cushing but I can explain the basics of central or peripheral neurosurgery.

Now, believe it or not, I happen to think that there are aspects of shamanic healing that can be complementary. One of Michael Harner's contribution was the cross-cultural comparison of shamanic journeys in cultures that could not have had contact. As long as I can't seem to get basic answers in homeopathy that I can get in any other field that isn't experiential and faith-based, I see no way to progress. Sometimes, all that can be done has been done; sometimes, it's a question of whether the resources are better spent elsewhere. Howard C. Berkowitz 20:14, 13 November 2008 (UTC)

Howard, you're changing the subject. The subject you're now speaking about is well worth discussing, I'm sure, but what I was talking about was how to get everyone to stop complaining about why this article is so biased, how to stop me getting mail from people complaining about how their stuff was deleted, or how the article is so biased against homeopathy. So, after looking over the article again, especially with Ramanand's complaints about those very critical quotations in mind (and your defense of them), it occurred to me that what ultimately seems offensive about those quotations is not the quotations themselves but the fact that they are part of allegedly biased narratives, with which Ramanand disagrees. And the narratives are more or less on the section or paragraph level. Then I looked over the whole article and it occurred to me that the article is often biased one way or the other in different sections. The best way forward is for both you and Ramanand, and probably Dana too, to just lay off, list the problem sections of the article and what you find biased about them, and then let somebody else go to work fixing them. --Larry Sanger 20:26, 13 November 2008 (UTC)

Sorry, Larry. I hear you trying to defend a complaint against what seemed a very basic violation of ground rules: you don't get to delete things simply because they are negative, if they are verifiable. No, I'm not going to list sections. I am concerned now about the process, not the article. If one political candidate calls another a terrorist sympathizer, the fact that the candidate said it, biased or not, is significant. Howard C. Berkowitz 20:50, 13 November 2008 (UTC)

If you don't want to list sections or paragraphs that give you problems, that's fine. Maybe the other side will; they can reply in the above section if they are game. I don't know what you mean by "trying to defend a complaint." I'm not defending Ramanand's complaint about negative quotations, if that's what you mean; I just have trouble believing that he is objecting to all negative quotations just because they're negative. So I'm giving him the benefit of the doubt. If he replies clearly to me that he simply doesn't want to see any negative quotations in the article, then matters will be much clearer. But I do doubt that he will say that. As to your proposed rule, it seems too broad. It's easy to imagine situations in which a perfectly authoritative but negative quotation turns out to be inappropriate for reasons other than that it is negative. Your rule would require that we retain any "reasonably sourced statement, perceived as negative." I would rather say that we cannot remove any reasonably sourced statements merely on grounds of its being negative. --Larry Sanger 02:39, 14 November 2008 (UTC)

I can live with your wording about a rule for negativity, but I do not have your trouble believing that objection is being made to any negativism about homeopathy. Certainly, in writing about virtually any recent U.S. political campaign, one has to accept a great many acknowledged but generic attack ads as "a tale of sound and fury, told by an idiot, signifying nothing." When, however, one of the quotes cited for negativity is from Dr. Killen, a senior official in the U.S. government organization with current responsibility for complementary and alternative medicine, that isn't mere negativity, but the opinion of a policy-level official. To the best of my knowledge, his statement was not disavowed by any higher-level U.S. government official or mainstream organization.

My material about the legislative history of how homeopathy gained a unique exemption from Food and Drug Administration regulation, in 1938, was earlier removed as negative, and claimed to be irrelevant. In how many other discussions of regulatory law would it be considered irrelevant that the author of an exemption benefited from the exemption?Howard C. Berkowitz 03:04, 14 November 2008 (UTC)

Howard, your previous statement about the FDA's exemption of homeopathic medicine was deleted because it was not accurate, not because it wasn't relevant. First, the FDA has strict regulations on homeopathic doses that they define as either OTC dosage or Rx dosage. The difference here is completely around SAFETY issues. Although Belladonna is a homeopathic medicine, it is only available in OTC dosage at a dose in which the FDA recognizes it as "safe." Belladonna tincture is an Rx drug, while a dose of Belladonna 6X is an accepted OTC homeopathic dosage. As for "efficacy," homeopathy is not simply a different system of drugs, it is a different paradigm of medicine. According to the system of homeopathy, medicines are individually selected to people based on their overall syndrome of disease, not just a localized pathology. Although there are a small number of controlled clinical trials using a "this for that" conventional medical paradigm (one drug for one specific disease), homeopathy (like acupuncture) represents a different and more complex model of treatment that is more systemic in nature and practice and less reductionistic. You will be an even better editor of this article once you understand and respect the different paradigm that homeopathy represents. Dana Ullman 17:35, 16 November 2008 (UTC)

First, you will be a better editor when you stop patronizing me about what will make me a better editor.

Second, you have yet to explain the different paradigm of homeopathy in understandable terms. Now, perhaps it helped my attention level in discussing Traditional Chinese Medicine that I happened to date the TCM student (and later doctor), but she was able to give me a quite good idea of the model of treatment, not just acupuncture but the various diagnostic techniques. How am I supposed to respect a paradigm of which I cannot get a specific explanation? Indeed, I've had acupuncture treatment from two MDs that were absolutely delighted to find interest in their paradigm -- although both looked at it as complementary medicine. One, born in Vietnam and having gotten MD and OMD degrees in Asia, was also the dean of gynecological ultrasonography in the Washington DC area; I mourned him as an incredibly wise man who did not insist you must understand the different paradigm. Luckily, he was so respected in the community that we could spend hours taking up restaurant tables, with meridian and neuroanatomy charts spread out before us, and some of the latest complementary studies from China. Paradigm understanding, I have found, was enhanced both by hormones in Tina's case and Vietnamese food with Dr. Tran. We explored knowledge together; I cannot imagine them telling me "once I understand and respect the different paradigm." Instead, they talked about the paradigm, made connections when there were some, and did not expect obeisance based on authority. Perhaps the most difficult paradigm acceptance was on the part of the restaurant, but Dr. Tran eventually convinced them that there were Westerners that thought nuoc mam was a perfectly reasonable condiment, and could appreciate properly cooked shrimp shells and heads. Yum.Howard C. Berkowitz 20:57, 16 November 2008 (UTC)

A proposed solution -- and I'm serious

Delete the entire article AND the talk pages for one entire year. Make it impossible for anyone to start another article about the subject.

A year passes quickly: I've been here for a year and a half now and it seems to me as if I only started yesterday....

In a year's time, we will hopefully have a quiver of expert doctors or medical historians or some such or a combination of all of them who are working here as active and expert editors. Then, if such people are on board, restore the article, and let them get out their scalpels and suggestions.

But until there is a cadre of competent editors to take this in hand, vanish it! Hayford Peirce 21:13, 13 November 2008 (UTC)

It's worth thinking about really. In the last couple of weeks, while the moratorium has gone on, I think the project has actually benefitted from our not having Recent Changes filled up with endless back-and-forth between partisans writing on Talk:Homeopathy, who chronically refuse to compromise or to hear the other side sympathetically. With the lack of anything like a neutral moderator who might try to rewrite the article in a way that will keep both sides happy, and none seems forthcoming (I can't make the commitment myself), it does look like we're stuck with endless debate or taking your advice, Hayford.

Here is what I would like us to think about, if we want to go down this path: what is the principle involved? How about this: "If (1) there is a dispute about whether an article is biased or not, (2) the dispute concerns the article from top to bottom (cannot be solved by tackling just one or two sections), (3) there is no neutral moderator who is willing and able to go through the whole article and essentially mediate the dispute, (4) no one side is at fault for being unreasonable, ignorant of rules, etc., and (5) the dispute seems intractable, i.e., after weeks (or months) of back-and-forth, no agreement seems reachable, then we move the article to a talk page for one year (or some similar lengthy period of time), protect it, and protect the talk page, where an ending date for the moratorium is announced. A Constable is contacted to unprotect the page after the prescribed moratorium.

Here's another question: what exactly is the primary purpose of moratoria? Is it to save the community from the wrenching process of an intractable and frustrating debate? Or is it to prevent one side from wearing the other side out, "winning" by default? The latter would be a very bad situation--it is de facto the way many Wikipedia disputes are handled, I think. If I were to support the rule, it would be primarily for the latter reason, rather than the former, but they are connected. This is not obvious, and is very interesting, I think, so I'll try to explain. I think the reason that Ramanand and Howard are going at it for so long is that our rules require debate about significant changes to articles--and therefore, if they stop debating, they in fact relinquish the authority to impose their edits on the other side. What small authority we have to make edits, in our more or less egalitarian system, is secured by the outcome of a rational debate rather than by expertise (although expertise can be used to make an end run around debate, in the right circumstances--and that's a CZ advantage, I think). If edit wars are to be decided by exhausting one side, then evidently, like it or not, we have the same "rule of the most persistent" that Wikipedia has. Now notice that if there were not the threat of losing through exhaustion, then there would not be intractable edit wars. Since matters in dispute are more or less informally decided by who wrote on the talk page last, to stop debating is to lose authority just by keeping silent--which is not only a little humiliating perhaps, it actually feels like you're being unjust to your own cause. That's why these debates are wrenching and heated; they are really power plays.

Hayford's notion of extending moritoria for a long time basically cuts the Gordian knot. Does it look like a dispute is intractable? Then (given the other conditions are met) we just take the article down. This would have the effect of making the disputants think twice about their (to me) very frustrating failure to compromise or think in terms of neutrality. They and their work will be penalized by not being displayed, if they fail to cooperate with each other. Moreover, I note that right now there is no such incentive to cooperate; our incentives are, rather, to disagree persistently with anyone who it seems cannot be expected to arrive at an agreement with us. A game theoretical analysis is probably in the offing here.

Well, that's my first reaction anyway. I'm not instantly in favor of the proposal, I'm just intrigued. Probably, we should carry on in the forums!

What, I idly wonder, would be the homeopathic cure of the current problem? Perhaps just a very tepid debate... ;-) --Larry Sanger 03:22, 14 November 2008 (UTC)

I would support Hayward's proposal. Here and there, over the years, I've had a bit of exposure to game theory and strategic thought, and I submit that this is not the place to have the discussion about whether, in a specific context with real people involved, if it is always possible to have neutral compromise. You have your opinions on that, and I really don't disagree with neutral presentation being an ideal. It may be worth assessing the larger community experience on what is, and is not, possible with regard to neutrality.

That larger experience has to look, as well, at the not completely related question of whether every controversial topic must be covered, especially when there may not be a broad consensus of notability, and the best use of the precious resource of neutral editing. You can believe it or not as you will, but I have done my level best to phrase things here neutrally, including substantial effort to provide sources that support theories with which I personally disagree. Respectfully, there is an issue of the integrity of the entire process, when the appearance can exist that the main thrust for the very existence of an article is to advocate a partisan view. There is often a very narrow line between the appearance of conflict of interest and the certainty of conflict of interests. I would far rather fight other battles than this one, but I spend time at this because I believe it is a matter of integrity. Howard C. Berkowitz 03:51, 14 November 2008 (UTC)

What Dr. Sanger said about the "winning" in Wikipedia is accurate. I was thinking of taking the initiative of reviewing all the edits & giving a "3rd opinion," but probably I shouldn't. What I didn't like about that option in Wikipedia was that a bunch of people (or sock puppets) who didn't know anything about the dispute would take sides with terribly light understanding of the problem & with too much apparent bias & without the effort to really try to learn the subject first. (Chunbum Park 20:34, 14 November 2008 (UTC))

As someone who has previously edited on wikipedia, I think that talking and editing on CZ is so much sophisticated and diplomatic. The frequency of UNDOing edits is so much less common here. Yes, I have done some deletes and some UNDOs, but these have been quite infrequent...and I have not seen much serious edit fights (as are common on wikipedia). Despite our differences of opinion here, I think that we listen to each other. I do not consider the situation "broken." I do not see the same degree of problems here that some others do, though that said, I too have some concerns. But I do not think that the problems warrant a year-long moratorium, and I certainly do not believe that we should delete the entire article. I think that we can and should follow Larry's ideas for balance.

To clarify, although I feel that Killen's remarks are incorrect and confusing, I would support their inclusion if some people here feel strongly enough about it (and it seems that they do). I would simply recommend that we also then acknowledge that some homeopaths have responded to it. For example, see: http://theintegratorblog.com/site/index.php?option=com_content&task=view&id=441&Itemid=1. Dana Ullman 17:05, 16 November 2008 (UTC)

I also want to add that I suggest that Hayford and Howard (and anyone else) who has some disagreement with this article provide specific suggestions on the Talk page for their recommended changes. Even though we may have different ideas, I think that we can be all reasonable people and collaborate on this. Dana Ullman 17:45, 16 November 2008 (UTC)

And to respond to the blog response, while I'm not certain if there is an actual rule, blogs tend not to be the best of sources. I did find it interesting, however, that "some homeopaths" on that blog included:

"The ill-informed media and selected ill-informed representatives of the CAM community (including Dr. Jack Killen, in this case) have echoed the 'junk science' reports and turned this information into 'junk journalism.'" (signed Dana Ullman, MPH)

When I cite even peer-reviewed work that contains my own contributions, I am quite careful to make clear my name appears in the citation, and I frequently, although I agree not universally, add a disclaimer on the talk page. I do consider that my books, from major publishers, with a review process, do deserve a disclaimer as well as a proper citation. In other words, I do work very hard to avoid the appearance of conflict of interest; I have done a couple of signed articles, which were meant to be both illustrative examples but also funny; humor has a place in making seemingly inaccessible subjects accessible. Accessibility to the ideas, incidentally, remain one of my major concerns with this article. Trust me -- one never really understands what it's like to be in a military maximum security vault, until the door gets jammed and you are stuck, for two hours, next to a man with a cigar.

Subarticles, as for many subjects, may be a way of resolving some of the conflict. Dana, will you please believe that I am being sincere that while Hahnemann's work certainly is main-article relevant, bringing up 1905 immunologists, analogies to Jenner, etc., does not add to the credibility of the artice — it raises suspicion on the part of someone with a more current biomedical orientation? Osler's observations about the drugs of his time were quite correct at the time he wrote them, although Osler's comment that he wanted to replace both allopathy and homeopathy (his terminology), which he called medical sects) with a synthesis do not seem to have stayed in the article. He considered allopathy quite different than scientifically-based medicine.

For anyone who has not read it, I highly recommend The Youngest Science: Notes of a Medicine Watcher by Lewis Thomas. I am the first to say that until well into the twentieth century, medicine had no particular idea why drugs worked. The ideas of Hahnemann's medical contemporaries indeed have not stood the test of time, but I do not agree with your statement that homeopathic ideas have met the test of time. 1905-1910 medical quotes don't do it.

I need to know more about the cognitive process of a routine homeopathic encounter. Believe me, I have, 20 minutes or so into a first meeting with a new physician, concluded that said board-certified physician was an arrogant fool and not just walked out, but formally denied that person access to my records. I will not have a physician that is unwilling, in a nonemergent situation, not to explain why they want to do something -- and I don't insist on a lay explanation. If I could get a basic understanding of how homeopathic practice takes place from this article, I would feel much better about it.

There is much presentation of arguments for and against homeopathy, there are various trials, but a clear understanding of how modern homeopaths approach patients remains, to me, a fundamental lack that seems unique to homeopathy. I can't write that section because I freely admit it baffles me, but I also reject the concept that there can be no reasonable tutorial. Without that, I believe the article is not encyclopedic.

I continue to endorse Hayford's proposal, as I have seen no evidence, as yet, that meaningful collaboration is possible, certainly on the talk page. To me, the comment "Hayford and Howard (and anyone else) who has some disagreement with this article provide specific suggestions on the Talk page for their recommended changes" demonstrates that. There are 6 or so archive pages that contain a great many phrase pre-deleted because it would have violated the family-friendliness policy recommended changes. Very few were accepted by you or Ramanand. Unfortunately, CZ does not yet have in placed the desired dispute resolution and judicial mechanisms that might be needed here. Howard C. Berkowitz 20:36, 16 November 2008 (UTC)

I have a simple proposal. Those people who suggest that there should be a one-year moratorium on editing this article should take that one-year moratorium. Those people who do not want to do this should not.

Howard, you may not give a fig about what Sir William Osler (the "father of modern medicine") may have to say about homeopathy, but others do. A good encyclopedia should cover a range of subjects. And because you have an interest in knowing about the "cognitive" functions of a homeopath, I suggest that you do that research and submit it to the talk page. Please do not expect others to write about your idiosyncratic desires. The great thing about CZ is its democracy, but as a part of a good democracy is personal paricipation. Go for it. Dana Ullman 03:06, 17 November 2008 (UTC)

I don't understand why Osler's opinion is so important in 2008? Chris Day 04:40, 17 November 2008 (UTC)

Chris, I agree. While Osler is one of my heroes, and his advice in the clinical encounter in medicine does remain a textboodk standard, if he is mentioned here, I want all his relevant comments given, not just the one favorable to homeopathy. He also said

"A new school of practitioners has arisen which cares nothing for homeopathy and still less for so-called allopathy. It seeks to study, rationally and scientifically, the action of drugs, old and new."(page 162 of the Flexner Report;).

Reformatting only of above statement, and clarifying Flexner mentioned only as bibliographic sourceHoward C. Berkowitz 12:47, 22 November 2008 (UTC)

I would like to ask those of you who have exchanged "advice" and epithets above to edit your remarks, please, rather than having me or a constable do so. Please also review CZ:Professionalism. I'd also suggest that, other than that, Howard and Dana, please both of you take a break of a day or two. --Larry Sanger 03:19, 17 November 2008 (UTC)

I would like this matter considered by an appropriate CZ body, as I believe there are matters of policy involved, as well as specifics that are relevant more to a judicial process but indeed would violate professionalism if presented here. Howard C. Berkowitz 04:50, 17 November 2008 (UTC)

The Constabulary determines when CZ:Professionalism has been violated. If no Constable is available, it falls to me. --Larry Sanger 13:40, 17 November 2008 (UTC)

I'm a bit confused by Chris Day's statement about Osler. Chris suggests that he doesn't understand why the words of "father of modern medicine" has any value or pertinence to the subject of homeopathic medicine. I have no problem if Larry wishes to add the other quote, though if anyone chooses to add that quote, it would also be appropriate to mention that Osler was one of the leading critics of the Flexner Report (his antagonism to this report is particularly notable because Flexner asserted that the Johns Hopkins School of Medicine was the "ideal" medical school, and Osler was the head of clinical medicine there. Dana Ullman 02:50, 22 November 2008 (UTC)

Let me address only the issue of the Osler quotes, and asking not to bring in anything else regarding Flexner. I agree and disagree with parts, so maybe that's some compromise. Osler, for his time, was quite balanced about the needed transitions in health care. The context of his praise of homeopathic dosages was an attack on the more extreme allopathic methods, but that statement needs to be taken in context with Osler's second statement saying that both allopathy and homeopathy should be replaced with a more scientific approach. Osler never used "allopathy" as a synonym for what he considered the proper direction of medicine, only for what, at the turn of the twentieth century, was more dangerous than homeopathy.

I mentioned Flexner only as a bibliographic source. The Flexner Report, published by the Carnegie Foundation, is the most readily available pnline source of Osler's second quote. Whenever possible, I prefer to use online sources simply for accessibility to the reader; that was the only reason for using that citation rather than printed biographies of Osler.

It is not appropriate to put in Osler's criticism of the Flexner report, because it was simply being used as a bibliographic source. Bringing in the Flexner report proper, and what it said about homeopathy, is another major subject that I don't think belongs here. My position is that either both Osler quotes stay or both Osler quotes go. If they go, they can go, with Flexner's criticisms of homeopathy, into History of Homeopathy. Howard C. Berkowitz 05:04, 22 November 2008 (UTC)

I have no idea why you are confused Dana. We have been through this before in Archive four:

Isaac Newton is often rolled out as one of the famous scientists who endorsed creationism. While factual the relevance often escapes me. The case with Osler is similar although clearly not as extreme. Chris Day 01:09, 10 October 2008 (CDT)

I am concerned that Howard's anti-homeopathy biases are too strongly influencing his writing and thinking. His statement in reference to Osler was, "It is a great leap to say that because an individual in one field admires aspects of another, he is endorsing it in lieu of his own." Osler was not endorsing homeopathy "in lieu of his own." He was acknowledging that homeopaths DO maintain a scientific attitude and that they have something important to offer to medical treatment. Further, Osler insists that allopaths should not have quibbled with homeopathy on its doses. The majority of doctors during Osler's time had the SAME degree of insistence their treatments were "scientific" as doctors today do. And yet, decade to decade, we find that medical treatments change, and we acknowledge our errors.

The bottomline to this article is that Osler's comments are notable.

Chris, lovely comment, but not too relevant for this article. Dana Ullman 16:44, 11 October 2008 (UTC)

You wrote: "Sir William Osler greatly admired Hahnemann". Without clarification I suggest that such an endorssment is quite similar to Newton's one of creationism. In the context of its time its meaning is quite different than if given today by someone of similar standing in the medical field. Chris Day 03:30, 14 October 2008 (UTC)

If you don't see my comment as relevant then you are blinkered to the problem that I, as a scientist, have with this article. Chris Day 07:19, 22 November 2008 (UTC)

Blinking at the indentation; staying focused

Reflecting on some feedback I've gotten privately, I am going to try to take this in a very specific manner. As much as possible, let us try to leave Flexner, Hahnemann, and other historical figures out of the meat of the discussion, with the caveat that publications of some individuals simply may be a bibliographic reference. There are several basic issues here:

• Osler made more than one verifiable statement regarding homeopathy, as well as what he termed allopathy as a practice of his time, as well as what he saw as a future direction. To me, they only make sense if they are given together, with minimum explanatory and contextual material; Osler wrote fairly clearly.
• Osler's basic textbook, The Principles and Practices of Medicine, is still in print after many editions, with a mostly Johns Hopkins authorship. It is still often considered the best introductory textbook for mainstream medical students, followed by more detailed works such as Harrison's or Cecil's internal medicine, because many of Osler's approaches to asking questions remain useful.
• There is a rather fundamental gap between some contributors here. I hope no one seriously suggests that most mainstream drug treatments through the early twentieth century, besides a fairly well-defined list that can be counted on the fingers of two hands, were safe and efficacious. Osler properly criticized the thinking of his time. He explicitly proposed a synthesis. The underlying science was not up to that science for several decades, and, even there, probably had two eras, one beginning in the late 1930s, and the other well into the late twentieth century.

• The gap, as I see it, between accepting some historical statements as unchanging truths relevant to the modern practice of medicine, and accepting them as accurate for their time, but need to be used in a context where fundamental assumptions in medicine have been challenged and more consistent — not complete — understanding reached.
• The gap, as I see it, is an overemphasis on historical statements. Newton and creation were mentioned. Newton, however, said "If I have seen farther than other men, it is because I have stood on the shoulders of giants." With sincere respect, I would like to know if homeopathy has gone through the same self-examination and re-invention as medicine. Chris, I hope I represent your position as well. Is it also fair to say that your comment on Newton and creation is general, to say that admiration of any field, at a time of little general understanding, may be historically insightful but not relevant as a core argument?

• I do find, unfortunately, that some of the fourth archive material on Osler is selectively quoted to argue homeopathy was right all along, and medicine was and is mere allopathy. Osler absolutely, positively did not say that, if all his quotes are taken together.

So, as I have suggested

• • either full Osler or no Osler
  • working on non-homeopath perceived blinkers that there is an overemphasis on positions passed by history
  • not introducing more historical fights such as Osler and Flexner.

Too many sincere questions about homeopathy today remain asked by non-homeopaths but unanswered by homeopaths for this to be other than a distraction. Speaking "sympathetically", if homeopathy is treated as what NCCAM terms a "whole system" and there is only a demand to accept a homeopathic paradigm and discuss within it, I see no way to get an encyclopedic-quality article done. If — dare I say an evolutionary? — approach to paradigms and present thinking is taken, we may be able to get somewhere.

I will be starting, first offline, and then perhaps in a sandbox, an article on the issues of evolution in multiple areas of healing and health sciences. It may be a better place for this discussion. Just as there have been some enormous efforts to make some military history topics by extensive and coherent use of subarticles, a problem may be that this main article is trying to do too much. Howard C. Berkowitz 12:47, 22 November 2008 (UTC)

There were previously some quotes in the article from Osler, but it seems that they have been removed. Whoever removed this quote didn't note this in any "summary." Such important deletions deserve more specificity in the summary.

To remind people what may have been written, here's some info:

In Sir William Osler’s farewell address to the American medical profession just prior to him leaving Johns Hopkins and going to Oxford University, he said: "It is not as if our homeopathic brothers are asleep: far from it, they are awake—many of them at any rate—to the importance of the scientific study of disease. … It is distressing to think that so many good men live isolated, in a measure, from the great body of the profession. The original grievous mistake was ours—to quarrel with our brothers over infinitesimals was a most unwise and stupid thing to do." (see page 116-117, http://books.google.com/books?id=7RUJAAAAIAAJ&q=william+Osler+hahnemann&dq=william+Osler+hahnemann&ei=u4XURvCbFYjm6wK8iI2PCA&pgis=1)

This statement from Osler also goes on to say: "Homeopathy is as inconsistent with the new medicine as is the old-fashion polypharmacy to the destruction of which it contributed so much." (Some people may want to include this sentence, though it is tad ironic that polypharmacy is as rampant today as it was then.

Further, this reference below from Time magazine is notable (and available online). Time reported that before Osler’s death in 1919, he expressed even greater support for homeopathy and its founder, asserting that “No individual has done more good to the medical profession than Samuel Hahnemann.” (http://www.time.com/time/magazine/article/0,9171,884121,00.html). Needless to say, this is a strong statement from someone who is as notable as Osler. While some people may want such information in the "history" article, the same criticisms that homeopathy received in 1900, it receives today...and Osler's words are as wide today as they were then. Dana Ullman 21:05, 23 November 2008 (UTC)

Are Osler's views held by his modern counterparts 90 years later? Likewise, did Newton's opinion's of creationism stand the test of time? While these are great scientists their opinions should be treated in a historical context rather than equivalent to current viewpoints. It is impossible to know if either would have thought the same thing given all we know now. Chris Day 20:39, 29 November 2008 (UTC)

Responding, hopefully in order

It is not clear who removed what, but Osler made several statements relating to homeopathy. Not all are unreservedly supportive, although some compared it very favorably to what he considered the allopathic medicine of 1905-1910. I cannot stress this enough: Osler was looking at an utterly pre-scientific "mainstream" medicine, which unquestionably used high doses of unsafe and ineffective drugs. Against that context, homeopathy did little harm.

While Osler could have been a bit more grammatical in (my emphasis), " "Homeopathy is as inconsistent with the new medicine as is the old-fashion polypharmacy to the destruction of which it contributed so much," he was clearly deprecating polypharmacy as practiced in the late 19th and the beginning of 20th century. Whether it is intended or not, remarking that it is ironic that polypharmacy is "rampant" today comes across as attacking. Osler referred to "old-fashion polypharmacy", not current best-practice polypharmacy based on molecular pharmacology. Not all polypharmacy today is solidly based, but it is a sweeping generalization to take swipes at it. I can give examples of synergistic combinations, but that seems outside scope.

Propose some text, Dana, on what you want from Osler. I can't respond to argumentative comments about what he thought about practices nearly a century after his death. Further, I consider it quite out of scope to start a homeopathic argument here against mainstream polypharmacy involving molecular pharmacology, unless homeopathy can be held to a comparable standard.

It would be much more straightforward to describe homeopathy as a whole system, explain it fully, and avoid the constant sniping at medicine. If homeopathy is such a different paradigm, than thoroughly present that paradigm in a meaningful way, and stop trying to attack other whole systems. Howard C. Berkowitz 22:37, 23 November 2008 (UTC)

First order of business

Constables consider that editors determine content. There needs to be some clarification of who the editors are on this page. Either way, professionalism needs to be practiced by everyone, including watching how we characterise other's and their work. Who are the editors on this page? D. Matt Innis 18:20, 18 November 2008 (UTC)

This is an objective matter; as far as I know, Dana is the only person here listed as a Healing Arts Editor.

I'm an editor as well in virtue of being Editor-in-Chief, but as usual I will step aside when it comes to content questions--modulo my own questions about what's going on. It's a rare occurrence indeed in which I will actually overrule a subject editor speaking about his area of expertise. My concerns are more about basic processes and fundamental policies. --Larry Sanger 19:55, 18 November 2008 (UTC)

Procedurally, given the amount of content added and changed, can Dana be considered an Editor in the sense of being able to give subject matter rulings? Howard C. Berkowitz 20:59, 18 November 2008 (UTC)

Procedurally, an issue concerning whether an editor who acts as an author can make content decisions, that would have to continue to work its way through to the Editorial Council, which would likely affect other articles as well. Historically, editors have been playing both author and editor roles since the inception of Citizendium. If you feel that you have a strong case for the contrary, then the proper thing to do would be to address the council, I suppose. I have opinions on the matter, but this is not the proper place for them. However, an issue concerning whether a particular editor is qualified, that should be brought up at personnel and should be a private matter and not show up on talk pages, lest we "impugn the moral character, or personal or professional credibility, of a project member", which would be a bannable offense according to our professionalism policy.

Since this looks as if a constable is going to be necessary on this page, and unless there is an objection, I think it best that I step back into a constable role. I won't be editing the article (except perhaps copyedits). I am quite sure that an article on Homeopathy can be written and approved that is neutrally written. D. Matt Innis 00:09, 19 November 2008 (UTC)

Would this be appropriate: User:Chunbum_Park/Sub/Homeopathy_research? (Chunbum Park 02:28, 19 November 2008 (UTC))

As suggested by Dr.Sanger, Hayford etc., it may be good to delete this article.—Ramanand Jhingade 11:43, 20 November 2008 (UTC)

Sorry to have been absent for a while here. I am an editor in the Healing Arts workgroup, and have been since its inceptionGareth Leng 12:43, 20 November 2008 (UTC)

I've been "off wiki" for a while now, so apologise if I've missing some key threads. I think it's worth making a couple of points here for everyone.

First, - this is not an approved article, not yet . It has some things in it that are unacceptable for varying reasons, and while that's true it won't be approved. OK, so we know that, we can relax a bit knowing that. Of course we still don't want junk on the page at all, but if its not quite right yet well we know that.

Second, this article is never going to get approved unless the editors concerned endorse it. At present I'd say it's not going to get approved (at the very least) unless both I and Dana are content that it is fair and accurate. We have to work together, and we have to work within the boundaries that each of us will find acceptable - in the area of overlap, if you like.

I've said often what my bounds are: 1) as far as "the editorial tone" is concerned, the article must neither endorse homeopathy nor denigrate it - the tone must be objective and detached

2) the factual content (citations) must be verifiable and verified, from reputable sources, and cited accurately for context as well as literal accuracy. They should be kept to a minimum partly because of the strain on verification and because notability should not be diluted.

3) the article must not make claims about efficacy; it may report such claims, but these must not be isolated from medical opinion. It should not appear that Citizendium either endorses or denies such claims, our job is to report what homeopaths claim and what medical opinion thinks about the claims

4) the article must not make claims about mechanism; it may describe theories about mechanism. but these must not be isolated from scientific opinion. Again our job is to report what homeopaths think, fairly and clearly, and what scientific opinion thinks about their explanations.

There are things in the article that for me cross these boundaries and must be changed. I concur wholeheartedly with Larry's style for approaching these issues.

On the Killen quote, I'll have to look at that again. I introduced that reference just by way of making it clear that while NCCAM funds studies into homeopathy, this should not be taken as implying that NCCAM believes that homeopathy is effective, which was the appearance of the text before I gave that reference. We must get such things right; NCCAM is neutral - it's an open question for them. They say that for them, there isn't enough evidence at present to say it works; but they're looking. I don't see why we can't get that said simply and objectively.

So, both Dana and I are editors in the workgroup, and we have both contributed as authors. Can we work this through together? I think so. Gareth Leng 13:18, 20 November 2008 (UTC)

While I want more coffee, I think I like what you said about Killen and NCCAM. I believe it is appropriate to identify government agencies that have responsibilities toward homeopathy. If they mix regulation and politics and questions of efficacy and issues of reimbursement, that's the sort of thing government agencies do, and my thought is that it is appropriate to note any possible conflicts, as with Switzerland, and move on without arguing the position in the main argument.

In like manner, the U.S. Food and Drug Administration is required to permit certain homeopathic preparations, as a result of 1938 legislation. There are several issues of coverage here. The 1938 legislation is complex, and, even though the Senator that insisted on the Homeopathic Pharmacopeia of the United States be grandfathered, I don't believe Senator Copeland was wildly pushing a personal agenda, although his personal opinions counted. It is, I believe, resposible to report that FDA has some quite explicit papers on its website that are not terribly pro-homeopathy, and I see no reason not to document, unemotionally and not argue about it, that FDA professional staff have said things that are not pro-homeopathy, but also accept they are legally required to work within their legal structure.

It might be appropriate to expand the existing Food and Drug Administration article to have more coverage of its authority and position on homeopathy, and be sure that links here, just as the National Center for Complementary and Alternative Medicine article needs to link. Looking at the FDA article, the 1938 context was complex for several reasons, including the Elixir Sulfanilamide disaster (nothing to do with homeopathy), but also the concern that while the FDA moved toward requiring efficacy testing & approval for medical drugs and devices, it was not allowed to do this for homeopathy. If there are equivalent situations with Swiss, British, etc., government agencies, it may be appropriate to be sure those issues are covered thoroughly in the appropriate articles, and that this article both links to them and calmly says that some of the agency positions are not pro-homeopathy. To me, those are simple matters of fact. There are political factors, unrelated to homeopathy, that I don't believe are good medicine but the FDA has had to accept.

In the interest of full disclosure, I have worked on inactive applications for FDA 510(k) approvals of information systems supporting some medical devices, but that was a couple of years ago and I'd be surprised if the process restarts -- purely a matter of patents and investors that has nothing to do with the FDA approval. If the funding restarts, I might be dealing with the FDA medical devices/information systems people.

Gareth, I think a ground rule has to be that if a government agency (or an individual who has made a statement that was not disavowed) has taken some position of which homeopaths don't approve, it's fair both to say the position is not agreed by homeopathy, but it can't be excluded from the article even if homeopaths find it vague and inaccurate. If we excluded government statements from CZ whenever they were vague and inaccurate, or offensive to some group, we wouldn't be able to write about very many activities of governments. I will ask for constabulary intervention, even on the talk page, if there starts to be an extended argument about the validity of the agency position, because it's simply a diversion from the article. If homeopaths actually took formal actions to protest or change policy, that would be entirely appropriate to document, but blog posts saying they are unhappy doesn't change what is appropriate and inappropriate for the article. It's a matter of staying on track. Howard C. Berkowitz 14:56, 20 November 2008 (UTC)

Hi Howard. I'm not disagreeing with you. I think we must be clear (for ourselves and our readers) exactly what information that we need to convey, and then find the clearest way of doing that accurately and verifiably. So it's not so much what we exclude, as what we choose to include and why. In the above case, the earlier article text appeared to imply that NCCAM, a major national research agency, implicitly accepted the efficacy of homeopathy; this is not true, as shown by a quote from a senior authority. Had the text read differently (and accurately) in the first case, it would have been unnecessary to include the rebuttal. The purpose of the quote was to demonstrate that while NCCAM funds studies into homeopathy, this does not mean that NCCAM presumes that homeopathy is effective or that it is plausible in the context of current scientific understanding. We could have just said that, or we could have simply used a different phrasing that avoided the suggestion that NCCAM funding implied endorsement.Gareth Leng 16:28, 20 November 2008 (UTC)

Gareth, thanks for coming back here. What you said earlier (not just above, but the earlier longer comment) put an important new perspective on the exchange here. I really appreciate it. --Larry Sanger 16:59, 20 November 2008 (UTC)

Gareth, I'm a little confused; maybe there's a typo somewhere. The only individual statement from an authority at NCCAM, Jack Killen, decidedly was opposed to homeopathy. There were complaints about his statement and demands it be deleted. I'm simply not clear to which text you refer -- the general comment that NCCAM, in a position statement, neither endorsed nor condemned? There were some edits that seemed to go into the other direction of endorsement. You may not want to deal with this level of detail; I'm just trying synchronized. My own thought is that the article should say the agency has no position on efficacy, is funding research, and one individual disapproves. Howard C. Berkowitz 17:09, 20 November 2008 (UTC)

Just one quick note to clarify a point from an offline question. I never have worked for the FDA. I have been a "client" as part of an approval process, which conceivably might restart. It is my belief that anyone that might have financial or legal dealings with a subject should disclose it, and I am disclosing that I may have an inactive application come before the FDA, which should present no conflict of interest.

I'll wait for a response on the FDA/Killen; I'm just confused on which text or version you are discussing. We may well be in violent agreement. Howard C. Berkowitz 17:32, 20 November 2008 (UTC)

I agree with everything that Gareth wrote above, and I look forward to collaborating to improve this article. Dana Ullman 02:57, 22 November 2008 (UTC)

Treatment of influenza

The following quote is from one meta-analysis which is prominently discussed in this article where it seems homeopaths would regard this as a "positive result from this [oscillococcinum] homeopathic medicine".

<start quote from New Zealand Guidelines Group>

Evidence on the use of homoeopathically-derived oscillococcinum or similar products for the treatment of influenza is available from four trials (with a total of 1,194 patients)7, 8, 10, 13. The trials ranged in size from 100 to 487 patients. Although the scientific quality of the trials was generally poor, two trials were considered to be of better quality than the others8, 13. Results from these trials indicated that, compared to a placebo:

• Oscillococcinum reduced the duration of influenza by about a quarter of a day (0.26 days).
• Oscillococcinum enabled a return to work about half a day earlier after the flu.
• The chance of still experiencing fever and two or more other flu-like symptoms after 48 hours was reduced by almost 6% in people taking homoeopathic oscillococcinum.
• The chance of experiencing no improvement in symptoms after 48 hours was reduced by almost 13% in people taking homoeopathic oscillococcinum.
• Back ache and side pain was reduced by almost 10% in people taking homoeopathic oscillococcinum.
• The use of medication for pain or fever was reduced by just over 9% in people taking homoeopathic oscillococcinum.

The above trials reported no significant difference between homoeopathy and placebo for sore throat, headache, spinal pain, cough, use of medication for cough or sore throat8, use of antibiotics, or use of any other medication during the trial period.

Combined results from all trials with relevant data showed no significant differences between homoeopathy and placebo for fever, runny nose (rhinitis), or aches. Compared to a placebo, homoeopathic oscillococcinum had a significant effect on the following outcomes:

• The occurrence of chills was reduced by just over 18%
• The average temperature was reduced by 0.39 degrees
• The occurrence of coughing during the day was reduced by just over 20%
• Patient assessment of treatment being a success was increased by just over 10%.

<end quote from New Zealand Guidelines Group>

Yet, when I look through above, there seems to be either small effects or none at all. Is this really one of the the best studies out there with regard to positive results for homeopathy? Chris Day 05:00, 25 November 2008 (UTC)

Outspoken skeptic

"Another study, conducted by an outspoken skeptic of homeopathy (Ernst) identified 17 useful articles."

Dana, this does not sound justified. Is he a homeopath or former homeopath? I don't know who wrote the original but your interpretation is extreme compared to what was there before. Chris Day 05:00, 25 November 2008 (UTC)

Please note the admonition against the use of "skeptic" in the Ground Rules at the top. It's one thing if the word is used in a direct quote, but, otherwise, it tends to be needlessly inflammatory.

Again, without going on at length, I still want to see more unifying principles of homeopathy's paradigms, rather than detailed arguing about individual trials. Remember, reading the report of a clinical trial often needs statistical background that many readers may not have. I can understand the clinical trial statistics, and it has been said I need to better understand the paradigm, yet I see little specific detail about the paradigm. A paradigm, to me, is more comprehensive than short phrases of "like cures like'. Again, I urge less arguing with medicine, less really old history, and more explanation of current homeopathy. Howard C. Berkowitz 05:22, 25 November 2008 (UTC)

I'll try to get back to this at the end of the week. Overall I don't think there are problems that can't be handled reasonably - there is argumentation in the present text (from both sides of the argument) that I think obscures rather than enlightens (reading this afresh after a break), but I think we can deal with that.Gareth Leng 13:49, 25 November 2008 (UTC)

I agree with Gareth--I see argumentation/assertion without attribution in the text from both sides. But I'm now more optimistic than I was about the future of this article. --Larry Sanger 15:46, 25 November 2008 (UTC)

That's what I like to hear! Nothing a little co-labor-ation can't handle. Keep going.. P.S. - there's some assertion in the lead and the lead is too long (I'd transfer some to the next paragraph if I were writing it), but what's a constable know? D. Matt Innis 18:26, 25 November 2008 (UTC)

Oh, I dunno. Sorta think of "constable" as like Suth'rn "sherf" sayin' "whut we got here, boy, is a failure to com-MU-ni-cate." You then explain with your club. Cool Hand Luke, meet Citizendium. Howard C. Berkowitz 18:57, 25 November 2008 (UTC)

That would be a golf club of course :-) D. Matt Innis 23:54, 25 November 2008 (UTC)

My apologies if some people think that the term "skeptic" is derogatory (I do not see it as such). I see the word "skeptic" as descriptive. I chose to do a relatively minor change in this section because I knew that it would be inaccurate to call him a "homeopath" or a "former homeopath" because there is no record of him being certified or licensed as a homeopath. I have seen him describe himself as a skeptic, so I am a bit unclear on what the problem is, except for some still unclear reasons, some people here think that the word "skeptic" is bad. Should we refer to Ernst as an "antagonist" to homeopathy, for that is another descriptive way to describe him and his actions. For the record, there is an entire magazine called "The Skeptical Inquirer." I personally do not know any skeptic of homeopathy who takes offense by that term (except for some people on THIS list). That said, if there is considerable support to avoid the term "skeptic" at all costs, I will honor that, even though I consider this quite silly. Dana Ullman 02:21, 26 November 2008 (UTC)

Frankly, I don't see any need for characterizations. If someone is a practicing homeopath with local licensure or recognition, that is descriptive. A practicing MD, or a research scientist, certainly can be identified as such, as can someone with an official position. Otherwise, I suggest it would much reduce the heat of the article if "advocate", "antagonist", "supporter", "skeptic", and similar inherently subjective terms were not used. Let the individuals' words and acts speak for themselves. While there is indeed a magazine, and, I believe, a cable television show, called the Skeptical Inquirer, they use it in a publicity-centric way that I see having no place in an encyclopedia.

Please do not make observations about what you do and do not consider silly. That, too, is judgmental and not conducive to collaboration. I do my best to avoid subjective terms in a tense situation. In many articles I have written at CZ, I have used humor, but almost always in a noncontroversial context. When I lecture, if my audience has people from other cultures, my usual humor is the first thing to go. May we assume there are different cultures here, and not try to do things that are easy to miscommunicate? I do manage to bite my figurative tongue. Howard C. Berkowitz 02:40, 26 November 2008 (UTC)

I started this section due to the completely different, almost opposite, interpretation of his expertise. Outspoken skeptic tells me nothing other than he is "anti-homeopathy" and possibly ignorant of homeopathy, I can not tell. A skeptic who has homeopathic training is of more interest. What is the reader supposed to learn from the juxtaposition of outspoken and skeptic? Chris Day 15:39, 26 November 2008 (UTC)

Chris, based on your above statement, it would seem that "skeptic" is a good word because it is neither positive or negative. As I believe, it is simply descriptive. I previously deleted reference to Ernst being a "homeopath" because there is no evidence that he was formally trained in it. I have found only one reference to him having "worked" in a homeopathic hospital as a young medical doctor. However, just as many editors here wanted us to delete the info I had posted on the percentage of doctors in Europe who "used" homeopathic medicine because the usage was vague, simply "working" in a hospital is similarly vague. If many of us don't want to use the term "skeptic," I suggest that we refer to Ernst as an "outspoken antagonist" to homeopath (he IS antagonistic to homeopathy, and this word is descriptive of his actions). I personally think that the word skeptic is less charged and equally descriptive. Dana Ullman 01:19, 27 November 2008 (UTC)

Wow, there's been a lot of activity here! Dana, I'll reiterate what I and others have said before about "skeptic": it isn't a wholly neutral term, as you claim. Why not? Because "skeptic" implies that the thing criticized has some presumption in its favor, as when, for example, we speak of global warming skeptics. It's similar to the word "nay-sayer." You don't usually call someone a "nay-sayer" unless you mean to imply that "yea" is the normal position. And..."antagonist" has similar implications, I suspect... Non-homeopaths are unwilling to let the labels that are put on critics imply that there is indeed a presumption in favor of homeopathy, and that is why the non-homeopaths keep bringing up the issue. "Critic" would be rather better; as far as I can tell, it really is neutral. An example of bias on the other side? "Debunker." Let's not use that one either. :-) --Larry Sanger 02:21, 27 November 2008 (UTC)

"Critic"! That is a good and accurate word. Let's use that. Dana Ullman 16:23, 27 November 2008 (UTC)

I agree. Howard C. Berkowitz 16:34, 27 November 2008 (UTC)

Mostly pure flow/text edit on lead

Matt's comment made me look at the lead, as a pure lower-case editing process. There is some redundancy, especially with regard to similars. Some terms are used before being defined. How about this?

--

Homeopathy or homoeopathy is a system of alternative medicine The term derives from the Greek hómoios (similar) and páthos (suffering), and homeopathy is based on what is called "the principle of similars," that is, the belief that a substance given in very low doses will initiate the healing of the syndrome of symptoms it causes in overdose.

• To appear as footnote: in homeopathic terminology, "symptom" refers to all of the external manifestations of a disease, and do not make the medical distinction between symptom and sign (medical).

In homeopathic theory, every person has a vital force--which today is commonly described as a person's overall defense system, has the power for intrinsic healing and/or maintaining homeostasis (biology); and which has inherent tendencies towards self-healing (the term vital force is akin to "chi" in traditional Chinese medicine). Symptoms of disease are thought to be efforts, sometimes successful and sometimes not, of this healing force to infection, to environmental exposure, and/or to various stresses. Homeopathic treatment attempts to strengthen this vital force by administering of strengthening with remedies, which are extremely small doses of drugs diluted in water or ethanol and dispensed in pills or liquid form. The remedy is designed to stimulte symptoms and thus promote healing.

• To appear as footnote. I have put remedy into bold, perhaps slightly violating CZ conventions, but preferring it to quotes. Quotes sometimes come across as deprecating, rather like saying "so-called remedy". start footnote: "Remedy" is a term of art in homeopathy, which refers to the preparations described. Use of the term "remedy" does not imply that their effectiveness has been established. [NCCAM cite]

What mainstream physicians call disease is, to a homeopath, a disturbance in the body's intrinsic defenses. Even today, most homeopaths believe that the fundamental causes of disease are internal and constitutional and that infectious disease is not just the result of infection but also of susceptibility. Given that they consider symptoms as defenses. advocates of homeopathy avoid, or use in a limited fashion, conventional drug treatments that suppress symptoms.

Separate content comments

I'd really prefer to avoid homeostasis, which, to me, is a quite deterministic term for often measurable process. For me, traditional Chinese medicine practitioners usually manage to use "chi" in a quite coherent way. If one needs a synonym for "vital force", I prefer "chi". Personally, I'd rather that "vital force" be stated as a homeostatic axiom and treated as any other axiom: a necessary assumption for the development of the theory, with no requirement for proof.

I have not, however, made that change above this subsection, so I am purely flow editing.

"Symptoms of disease are thought to be efforts, sometimes successful and sometimes not, of this healing force to infection, to environmental exposure, and/or to various stresses." This just doesn't parse. What is the implication of "sometimes successful and sometimes not"?

Traditional Chinese medicine

We didn't actually have an entry, just a redlink from acupuncture. I lifted the rather stubby definition there.

Since we have several Citizens that are knowledgeable in Chinese language and culture, I'd like to get them involved in filling out the TCM article. "Qi", I understand, may be a more accurate transliteration than "Chi". Howard C. Berkowitz 19:27, 25 November 2008 (UTC)

"Qi" is the correct spelling in pinyin, which is the Romanization scheme approved by the Chinese government and used by (probably) most western scholars today. "Ch'i" (note the apostrophe!) is the correct spelling in the Wade-Giles system, which was widely used before pinyin, and is still used by some western scholars today and in any case survives in many older texts. There are words spelled "chi" in both systems, but none of them is the one we're talking about here. Still, there should probably be a link to Qi or Ch'i at "chi (disambiguation)", since many English-speakers may look for "chi" thinking they're going to find an article on "Chinese traditional medicine's life-force." By the way, the "Chi" in the name of the martial art "T'ai Chi Ch'uan" (W-G; in pinyin, Taijiquan) has nothing to do with "Ch'i"/"Qi", and is pronounced differently. Bruce M.Tindall 01:55, 26 November 2008 (UTC)

Howard, in your example above:

• To appear as footnote: in homeopathic terminology, "symptom" refers to all of the external manifestations of a disease, and do not make the medical distinction between symptom and sign (medical).

In the interest of neutrality and being non-divisive, I would suggest:

• To appear as footnote: in homeopathic terminology, "symptom" refers to all of the external manifestations of a disease, and does not make the distinction between symptom and sign.

See what I mean? D. Matt Innis 23:58, 25 November 2008 (UTC)

OK, sorry; I didn't intend to have the "medical" as anything but disambiguating from "mathematical", "advertising", etc. Perfectly reasonable change.

I did leave out any reference to medical laboratory testing or imaging, which have been mentioned in this context. As I think we discussed with respect to the repertory you found, which was an excellent resource for which I've unfortunately lost the link (do you still have it? worth citing in the article), that homeopathic text listed anemia as a symptom. To me, that's very puzzling; at least in the mainstream medical sense, anemia can be present without signs or symptoms; sometimes the first warning of internal bleeding comes from laboratory screening that matches the pathologic definition of anemia. Howard C. Berkowitz 00:19, 26 November 2008 (UTC)

No problem, totally understandable. Here is the repertory link. Anemia does get confusing. It can be a condition itself or a sign of some other underlying disease and then of course there are the signs of anemia, such as palor, and symptoms such as fatique, etc. You can drive yourself crazy, but that doesn't change the concept that a homeopath is going to look for the compound that will cause the same signs and symptoms in a normal person. D. Matt Innis 00:38, 26 November 2008 (UTC)

I'll put the repertory link into the article, which doesn't have a citation on the term. Unfortunately, not all anemia is symptomatic. I ran across a case study today in which a patient hadn't had any healthcare in years — personality, not economics. An old friend, who happened to be a physician, got her to have a checkup, and did a routine CBC as part of the screening. Strikingly low RBC indices triggered a search for a cause, which turned out to be end-stage colon cancer, still asymptomatic, but breaking loose. The case study dealt with home hospice management for the patient, who rather suddenly had a massive hemorrhage and complete intestinal obstruction. Could the patient have been helped with earlier diagnosis? Who knows?

My point is that relying on visible signs and symptoms may not turn up any number of potentially critical conditions, only showing up on screening tests. As I understand it, these are not part of regular homeopathic practice — I might be wrong, but I just don't know and I wish the article helped me understand.

Does the pure edit of the introduction help? I'm not wedded to it, but I think it flows a bit better without anything I see as a substantive change. Howard C. Berkowitz 01:14, 26 November 2008 (UTC)

I don't know that a homeopath, after doing one of their workups, wouldn't have run perhaps a stool sample in an effort to "individualize" the treatment as they look for more details. I would think the repertory has something for blood in the stools?.. The question then becomes - do they treat with a compound that causes colon bleeding in normal people.. Then, of course, does anyone know if they have a better outcome than conventional treatment? Or do they refer to conventional medicine at that point? Anybody care to comment? D. Matt Innis 01:40, 26 November 2008 (UTC)

Again, can we reduce the judgments?

I personally would like us to simplify this article. There is a lot here that, as far as I know, have never been a part of any other article or book on homeopathy. Issues such as whether a homeopath will or won't do a stool sample is a good example of this. Should we discuss every possible objective finding to evaluate whether a homeopath would or wouldn't include this in his/her examination of the patient? The bottomline is that there are certain things that a homeopath does when doing a DIAGNOSIS but other things that a homeopath does to determine which homeopathic medicine to give.

I also suggest that we delete the following very silly statement: "'Remedy' is a term of art in homeopathy, which refers to the preparations described. Use of the term "remedy" does not imply that their effectiveness has been established." I have never seen this type of statement referenced to "herbal remedies," and for those people who want to keep it, should we then also call into question whether we should refer to homeopathic medicines as "medicines" or as "drugs."

Just dropped in to address this, haven't more time just now. The problem, (in so far as it is a problem, and I'm not sure that it is much of a problem) is that the dictionary definition of remedy implies effectiveness. Here, we are using that term in a technical sense without that presumption, so my understanding of the footnote is simply to explain that. I've tried a clearer wording. Gareth Leng 09:52, 27 November 2008 (UTC)

At least in the U.S., "drug", plant extract, and, without checking the exact phrase (relevant law [1] uses both homeopathic remedy and drug, but must be something explicitly listed in the Homeopathic Pharmacopeia of the United States) have very specific and different legal meanings. Drugs are subject tor regulation and testing that food supplements and homeopathic remedies are not. Additional categories exist, such as medical device..

A drug must go through formal testing of safety, bioavailability and efficacy through the New Drug Application (NDA) process. The organization submitting the drug specifies the indications for which the drug will be. It determines, with the FDA, if the drug should be prescription-only, as described in the Durham-Humphrey Amendment [2]. An independent determination may be made by the Drug Enforcement administration that it is a controlled substance.

So, in U.S. health-related law, which I have just skimmed, remedy" , indeed, a term of art with specific legal meaning. Drug is used but can be ambiguous. I believe other countries, such as Germany, also distinguish among conventional drugs, food supplements or nutraceuticals, herbals, and homeopathic preparations.

This isn't a silly distinction, but one that has to do with very critical standards of care, law, reimbursement and safety oversight at national levels. Howard C. Berkowitz 12:47, 27 November 2008 (UTC)

Homeopathic preparations, hmm, perhaps that is satisfactory to everyone? D. Matt Innis 15:19, 27 November 2008 (UTC)

Works for me, and I think it is also authoritative with much legal and regulatory language, although it may not be the traditional term of art. I might note that while there is a homeopathic usage of symptom, I might suggest, and I will create an article with further definition, that greater use of syndrome might be helpful as a more unifying term between homeopathic and medical terminology. Howard C. Berkowitz 15:28, 27 November 2008 (UTC)

To clarify, many repertories list disease names and various objective findings, though classical homeopathy is based on putting more emphasis on whatever unique symptoms that the sick person is experiencing.

Additional comments on the new intro include: -- homeopaths do not use "very low doses" but they do use "specially prepared very low doses." The words "specially prepared" are important. One certainly would not refer to the atomic bomb as a bomb created by very small atoms (there is a specific process by which the atoms are forced to react). -- before seeing all of this discussion, I deleted what I thought was a redundant and non-grammatical statement about homeostatis (if others feel strongly about including it, I can accept it). -- Thanx Bruce for your comments on chi and ki and the like... Dana Ullman 02:45, 26 November 2008 (UTC)

Dana, it was I who described the vital force that way, because of the description in the 6th edition of the Organon, especially with reference to Aphorisms 9, 26, 75, 76 etc.—Ramanand Jhingade 10:51, 26 November 2008 (UTC)

I will ask you again, Dana, to stop characterizing things in judgmental terms such as "silly". This is a matter of CZ:Professionalism.

That certain issues are not in books on homeopathy, not otherwise described, does not mean that the issues should not be here. Honestly, I don't know what you mean by "simplify", but that suggests to me, with the comment about things not being in books, that a simple article is essentially a condensed version of a book on homeopathy alone.

Personally, I find "special" to be a greatly misused term in general medical reporting. Many MDs speaking to the general public will describe a "special" instrument to do some procedure. Logically, what does that mean? Not-special is, perhaps, kitchenware? Is it "not special" when a medical drug, in a quite low concentration but still well within the Avogadro limit, is sterilized by radiation or ultrafiltration, its effective concentration checked by methods routine only to analytical biochemists, and perhaps put under vacuum or inert gas? Oh -- having written the article on nuclear weapons, it would never occur to me to describe the atoms as being large or small, unless talking about mass in fission versus fusion. Now, the term "special weapon" is a military term of art, or more precisely euphemism, for nuclear weapon.

The discussion about stool samples is not in the article. It is on the talk page, where there is a wider spectrum of what can appear, often so that Citizens can gain context.

While the specifics of whether a stool sample should be taken as part of a general evaluation is even an open issue in general medicine, you, I believe, have mentioned that homeopaths may use imaging and laboratory testing. Those are clearly not part of the classical homeopathic tradition. What is so unreasonable about someone knowledgeable in biomedical techniques trying to understand what a non-classical homeopath does, and where the line is drawn between homeopathic and non-homeopathic methods for someone trained in both? These seem perfectly reasonable things for a general encyclopedia article to ask; it is certainly a common sort of thing in medical articles, especially dealing with interdisciplinary techniques such as interventional neuroradiology.

It is a reality that many Citizens are struggling to understand what homeopaths mean by symptoms, as it is clearly not the same usage as in medicine. That is not an attack, but is an attempt to understand. Nonspecific responses that keep coming back to "homeopaths do what homeopaths do" are not enlightening.Howard C. Berkowitz 03:15, 26 November 2008 (UTC)

I definitely agree that we don't want to discuss stool samples in the article. As far as behavior, lets keep it clean (no pun intended) and cordial. Please do avoid unnecessary adjectives to make a point. Generally, you are more likely to win friends and influence people with detached reasoning. That goes both ways of course. D. Matt Innis 04:42, 26 November 2008 (UTC)

There is, of course, the nuanced distinction of detached reasoning and being detached from reasoning. Sorry; couldn't resist. Howard C. Berkowitz 05:04, 26 November 2008 (UTC)

Ok...I will try to avoid using "judgment" words. That said, because neither you or anyone else have chosen to not defend keeping that sentence about "remedy" in the article, I will remove it. As for the word "special," I didn't use that word. I used "specially prepared" very low doses. I am not wedded to THESE words, but I do feel strongly that the lone words "very low doses" is inaccurate and confusing. Because these words were used in the first paragraph, I simply wanted to provide SUMMARY info about homeopathy, without getting into details (which we provide later on in the article). Other possible words are: "doses of medicines that undergo a specific process of serial dilution and succussion (vigorous shaking in-between doses)" OR "very small and specially prepared doses of medicine" (the specific pharmacological process used in the making of these medicines are described below)." As you can see, it is challenging to describe briefly the "doses" that are used in homeopathy.

Howard has insisted upon having detailed information about what tests that homeopaths use (or don't use) in their assessment of the patient. I tried responding to his many questions here, though I personally think that most of the information provided here about conventional medical tests are not important for THIS article (perhaps they are OK for a sub-article). The bottomline is that homeopaths are a highly diverse group of licensed and unlicensed health and medical professionals, and as such, most wear two hats (one devoted to their license and conventional training and one devoted to their homeopathic training). Dana Ullman 01:10, 27 November 2008 (UTC)

Are we speaking the same language here, ie, English? How can anyone be an "unlicensed health and medical professional"? There are Indians who still burn eagle feathers for various treatments: are they to be considered "professionals" also? Hayford Peirce 01:38, 27 November 2008 (UTC)

Hayford, can you avoid offensive statements such as the one above about the English language because you are now showing your ignorance on THIS subject. In California and Minnesota, unlicensed individuals are legally able to practice homeopathy, herbalism, nutrition, and other health practices. Both of these states have "freedom of choice" legislation. A large number of the homeopaths in these states, for instance, have completed 3-year training programs, have received certification from independent agencies, charge for services (sometimes, with insurance payments). Yes, the words I used above were accurate. Hayford, I don't mind respectful questions, but your questions above are not. Is it a tad ironic that you wrote your offensive remarks under the sub-heading requesting that we reduce "judgments." Dana Ullman 16:19, 27 November 2008 (UTC)

I have stricken parts of the comments above to illustrate how to properly ask and respond to perfectly good questions that enhances collaboration rather than squelches it. I will remove them as inflammatory once everyone has a chance to see them. D. Matt Innis 16:49, 27 November 2008 (UTC)

Thanx Matt...and can you consider striking Hayford's comments about eagle feathers? And you can strike THIS comment when you've done so. Dana Ullman 18:23, 28 November 2008 (UTC)

I honestly, sincerely, deeply, and 100% believe from the very bottom of my heart than a properly trained Indian burning eagle feathers in carefully defined circumstances will be just as successful a healer as any homeopathy using his or her treatments. I therefore think that it is a perfectly valid comment that ought to be allowed to stand. Hayford Peirce 18:38, 28 November 2008 (UTC)

I am glad that you've outed yourself with your above declared statement...ironically, with self-declared 100% certainty. This article on homeopathy makes many references to randomized double-blind placebo controlled studies as well as basic science trials. Please refer me to such studies on eagle feathers. For others, I believe that Hayford's statement presents problems in both attitude and arrogance and has no place on CZ. What can or should we do with him? Dana Ullman 18:58, 29 November 2008 (UTC)

Let me try again; I am not principally asking what tests are used

When I ask about the cognitive process in current homeopathic treatment, I am asking, in the simplest terms, how a modern homeopath responds to a patient requesting assistance. Presumably, that process begins by talking to the patient to find out the reason the patient is there.

Assuming a conscious, cooperative patient, the practitioner will use his or her experience and training to gain information that will assist in solving the patient's concern. Such a solution will involve what I shall call diagnosis and choice of treatment. I do not know other words to use for the mental efforts used by the homeopath.

I am not asking for "tests". I am asking for a description of the diagnostic process, which, as I understand the process, elicits a set of symptoms. The homeopathic use of the word "symptom" differs from the conventional medical usage; I suspect syndrome may be closer to what both homeopathic and conventional physicians mean.

A practitioner decides on certain actions to alleviate the "chief complaint", syndrome, imbalance, or whatever one chooses to call the thing that the patient wishes to be healed. I am asking for an understanding of the decisionmaking process.

I can think of no area of conventional medicine for which I cannot describe such a cognitive process of understanding the problem, and then taking actions to alleviate the problem. The crux of our noncommunication, Dana, is I have no idea how a classical homeopath goes about this process, or how a clinician with homeopathic and non-homeopathic training makes decisions. Continuing to say, in effect, "it depends" is not responsive to the needs of a reader who might, for example, be considering whether to consult a homeopath. If you can't describe how a homeopath is going to deal with real situations, all the memory of water, historical errors of prescientific medicine, quotes and endorsements, etc., get use absolutely no closer to a useful encyclopedic article.

I welcome help in defining what I don't seem to be communicating to the homeopaths. How, in terms more specific than broad references to considering the feelings of the patient and other terms, does the history-taking differ? I do note that emotional, social, and even spiritual history are elements of good medical history-taking.

I also ask for some guidelines, for people that are not practicing pure classical homeopathy, when a non-homeopathic treatment would be considered. These are not demands for specific test results and responses. Just as a rough medical parallel, many guidelines speak of initial therapy, and then things to add if a desired improvement is not seen. Pain management specialists, who certainly do not limit themselves to pharmacologic modalities, do have a "ladder" or "pyramid" of increasingly potent drugs, of which the mildest that will achieve the desired result is preferred. You don't start with fentanyl for a mild bruise, and you don't give aspirin for a kidney stone. Howard C. Berkowitz 15:53, 27 November 2008 (UTC)

Returning to the lead

Since Hayford is making some flow edits, could I again ask if some of my proposed flow editing is useful, without going off onto other issues? Howard C. Berkowitz 16:49, 26 November 2008 (UTC)

Personally, I think you or someone ought to take a great big ax and remove at least half the article, or put the excised parts in other articles and/or footnotes. I don't know quite what the correct analogy would be, but it would be the exact opposite of the famous quote about the great English humorist: "To criticize P.G. Wodehouse is like taking a spade to a soufflé." Hayford Peirce 16:58, 26 November 2008 (UTC)

I don't disagree; as you know, I usually make extensive use of subarticles. There is, for example, a history of homeopathy to which a substantial amount of material could go. There has, however, been intense resistance to moving material to subarticles, for reasons about which it would be inappropriate for me to speculate here.

So, I am approaching just the introduction, bearing in mind that the way to eat an elephant is one bite at a time. Let me stay with that sole idea in this subsection, and discuss other points in other subsections. Howard C. Berkowitz 17:15, 26 November 2008 (UTC)

Sounds like a plan, I guess. Sigh. Until some more medical editors show up.... Hayford Peirce 17:34, 26 November 2008 (UTC)

Large, unapproved, and controversial addition

Ramanand added over 78,000 characters of a table of trial to the main article. May I again remind all that simple lists of trials do not add information; it is the objective synthesis of them where CZ adds value. I really don't see how this could possibly add information to a large main article. It possibly could go into a subarticle, still reviewed, on specific trials.

Attempts to argue the merits of specific trials is one of the region this article is large and controversial; the trial reports still do not address what I consider fundamental and needed explanations of the current day-to-day, not research, practice of non-classical homeopathy. I make the assumption that pure classical homeopathy has a paradigm sufficiently different from a randomized controlled trial that it would be impossible to do a trial; Institutional Review Boards for human subject research simply do not approve trials that do not meet certain scientific experimental design. Whether it is right or wrong, the paradigm explained of classic homeopathy simply will not mesh with an RCT trial.

I recommend the Constabulary remove this addition, as a major change not at all discussed or explained. It certainly does not exemplify simplifying the article, as Dana has desired. Howard C. Berkowitz 12:01, 26 November 2008 (UTC)

I just placed it on a subpage at Homeopathy/Trials, it is too big for this page and the article. It's formating is not in wikimarkup and its inconsistent throughout the table. It needs a lot of work but might be useful as a catalog if it is a truly representative set of studies. However, for a catalog it needs more comparative analysis otherwise it is just a data dump. With respect to the main article, we all know there are a lot of studies. I'm more interested in being pointed to some of the best ones. Is the most convincing one to date the meta-analysis of oscillococcinum? Chris Day 15:33, 26 November 2008 (UTC)

Howard's request would be out of a constables realm as I see it, though collaborative editing would allow Chris' actions so long as the editors don't have any issues. D. Matt Innis 15:16, 27 November 2008 (UTC)

"Point to the studies"

There's no question that Killen's remarks are controversial. It does not reduce judgment or objectivity to respond with only "Homeopaths say that this is his personal opinion and point to the studies which show that Homeopathy is effective." Where are these pointers? Even if every homeopath in the world disagrees with the substance of the quote does not change political and relevant reality that an American official went on record with the statement.

So far, I have only seen blog cites and unsigned opinions here that homeopaths say this. I'm sure there are homeopaths that do say this, but the phrasing here is argumentative, and, frankly, unnecessary. If there are specific, authoritative homeopathic responses, not generic ones that he's wrong, cite them. It is obvious that Killen doesn't like homeopathy. Homeopaths aren't likely to like people who don't like homeopathy. Is there a point to belaboring this?

Policy clarifications needed, but my understanding is that generic blogs are not considered authoritative. When a blog format is used for signed, verifiable content, usually by the owner of the blog, that's another matter, when the owner is an acknowledged expert.

I literally don't understand the value added by saying "homeopaths point to the studies which show that homeopathy (lower case in American English) is effective." First, the statement in question is a journalistic quote; Killen may have been specific but not reported. To my knowledge, there has been no disavowal, by more senior officials of the U.S. government, that it's "only his opinion."

Can we note that Killen said this, and then move on? It really speaks for itself. Arguing with it adds no value to the article. Howard C. Berkowitz 13:49, 26 November 2008 (UTC)

Dr.Sanger says it's O.K. to add that.—Ramanand Jhingade 06:09, 27 November 2008 (UTC)

Prevalence, popularity, etc.

To respond to Chris' edit note, first, the "market research survey" is distinctly non-authoritative and should be deleted. Following the link, it's not a survey report, but essentially an advertising press release from a market research firm. Going to the website of said firm, that's exactly what they are -- market research, with no visible credentials in healthcare, public policy, or quantitative methods in social science.

(bites tongue about not characterizing) I am rather puzzled why celebrity usage is especially important.

Incidentally, should it not be "Prevalence of homeopathy" rather than "Prevalence of homeopathic remedies"? If homeopathy is indeed very holistic, does every encounter involve a remedy? Might not a homeopath recommend diet, exercise, and a purring cat? Howard C. Berkowitz 19:28, 26 November 2008 (UTC)

I tend to agree with Howard here and made the following edit after reading his comment above. Removing the "homeopathy is not popular in Britain" stat makes the flow easier since it contradicted the NHS use of homeopathy. We really do need an authorative source for such data.

The endorsement of the Royal family section and other celebrities is just odd. Endorsements are popular as a marketing strategy because they work, hence Tiger Woods endorses many many products. But this is an encyclopedia and it is not appropriate here. Chris Day 21:53, 26 November 2008 (UTC)

The "market research survey" and endorsements seem to be O.K. I think a neutral editor like Gareth or Dr.Sanger himself should do what is right, rather than arguing about it.—Ramanand Jhingade 06:23, 27 November 2008 (UTC)

But you'd agree that the market research contradicted the other comments in that section re: use of homeopathy in Britain? Surely there are other sources for this kind of data? By the way, here is a question I asked in Archive 5 that did not get answered. I 'm still interested in a response to this thought.

One problem is the ambiguous nature of the questions asked in any poll. As written it claims that 18% of Americans trust homeopathy. But what does that mean? Trust it is safe? Or trust it is effective? I just saw a CAM survey that indicates that homeopathy has been used by 3.7% of the US population (once only counts). Again ambiguous, of those approx 4% who have used it how many found it helpful? And if 18% of Americans trust homeopathy why have so few ever used it? As always it is very hard to understand what the findings of any given poll really mean. Chris Day 19:32, 18 October 2008 (UTC)

I don't have a problem with statistics if the survey is done well. I'm not convinced that the TGI survey fits the done well criterion, as Howard mentioned before it is more like a press release i.e. marketing. I can't believe there are not some very well done studies by professional polling companies out there. Chris Day 06:39, 27 November 2008 (UTC)

Homeopathy in trauma

I temporarily undid the text below, because I believe we are running into a terminology problem. The text may be able to go back in, but framed differently. In contemporary medical usage, trauma medicine means something different than "injuries". Indeed, the term "trauma and critical care" is frequently used; I participate in a very active mailing list on the topic ( http:www.//Trauma.org "is an independent, non-profit organisation providing global education, information and communication resources for professionals in trauma and critical care".

Trauma, in this usage, is a multisystem syndrome that involves injury, but goes far beyond it. A trauma patient does not need merely mechanical or surgical measures, but often rapid and extensive, multidisciplinary treatment to avoid death. This has been popularized as the "golden hour", but there indeed are distinct syndromes of irreversible shock.

In other words, using the term "first aid" with respect to the current medical usage of "trauma" seems very inconsistent. There is a paramedic and above certification in "Advanced Trauma Life Support". Trauma patients, as the term is widely used in medicine, will die if they merely receive first aid.

The citations below refer to things outside the core of trauma medicine, a core that cannot be ignored because emergency medical system response to trauma is a major matter in public policy.

"Homeopathy in injury" might work much better with the examples below. Let's not confuse things with an ambiguous use of trauma as including sprains and mild head injury.

Homeopaths view injuries in a different manner than they view diseases, because they believe that everybody needs the same type of healing response to injuries, whereas a single disease may produce very different symptoms in different people. Homeopathic treatment of trauma is adjunctive to conventional first aid measures. Some clinical research has shown efficacy of homeopathic medicines in the treatment of select traumas, including mild traumatic head injuries and sprains and strains

...said Dana Ullman (talk)

I am guessing that this change was from Howard. Please sign such contributions. It would have been easier to change the sub-heading than to delete my contributions and references...which I will now do. Dana Ullman 17:19, 28 November 2008 (UTC)

It might have been easier to change it, but I am trying very hard to avoid revert wars, by taking things to the talk page rather than make changes that are only visible by frequently viewing article history. In good faith, I am making changes to the article only to clarify text, or to insert links at least to abstracts of journals not easily accessible. Howard C. Berkowitz 00:19, 29 November 2008 (UTC)

"Some" homeopaths...a minority among them?

My first question, after seeing Dana's changes, is how representative is Neustadter among homeopaths? Is someone that cites "unknown factors" for things being bad, but then, at least on his website, appears to have no statistics to back up his dire warnings, the kind of authoritative source to cite?

On this talk page, there have been repeated requests, which I hope are being honored, to avoid judgmental adjectives. Yet, in the article, there is the quote from Neustadter, "All those ridiculous viral vaccines for flu, hepatitis, measles, and chicken pox deplete the immune system. Meningitis vaccines are downright dangerous." If that adjective is inappropriate on the talk page, surely it is inappropriate in the main article.

Following his webpage links to excerpts from his book, [3] has lots of statements about specific, medically defined measurements and syndromes — but no references. Is this really a good thing to source? Are there no homeopathic critics of vaccines that might, for example, get into well-understood measurements of immune factors? Howard C. Berkowitz 18:29, 27 November 2008 (UTC)

Hold back Howard; this is an attributed quote and if on Dana's authority it is representative of opinion among homeopaths, then let it be said. We have to display here what homeopaths believe and say, not what we might prefer them to believe and say. It seems like an excellent quote to me, in being vivid and unmistakeable in its tone and meaning.Gareth Leng 21:06, 27 November 2008 (UTC)

The word "some" is more accurate that just "homeopaths" believe because I have not seen a formal survey on this issue. As for Neustaedter's quote, I think that we should avoid quoting blogs, except when they are notable for some reason, and I agree with Howard here (hurray...and I look forward to more!). This type of quote doesn't deserve to be in an encyclopedia. Dana Ullman 18:03, 28 November 2008 (UTC)

a revert war apparently is going on

The last sentence of this paragraph has sneaked back in again:

The main concern about the safety of homeopathy arises not from the products themselves, but from the possible withholding of possibly more efficacious treatment or from misdiagnosis of dangerous conditions by a non-medically qualified homeopath. Qualified homeopaths can diagnose and/or heal people. Hayford Peirce 00:04, 29 November 2008 (UTC)

Further, the sourced quote that was there, which is indeed critical of homeopathy but also recognizes the freedom to choose it or not, is gone. Is it really necessary to have to be monitoring this article frequently to deal with deletes and reverts?

I have trouble understanding "Qualified homeopaths can diagnose and/or heal people". Is this merely argument with the preceding statement?

Incidentally, "heal" is used frequently, and I don't understand what it means. Is it a homeopathic term of art? If so, would someone please define it? Howard C. Berkowitz 00:10, 29 November 2008 (UTC)

Exactly. You've removed this item once or two already and it keeps popping back up. Are we going to have to get Larry, Gareth, or a Constable to intervene here? It seems to me that nothing could be a more egregious breach of the rules that Larry has laid down about inserting one's own opinion into this article. Hayford Peirce 00:19, 29 November 2008 (UTC)

I don't see a revert war, but I have removed the paragraph in question. I'm not sure, but I think the whole thing needs attention:

• The main concern about the safety of homeopathy arises not from the products themselves, but from the possible withholding of possibly more efficacious treatment or from misdiagnosis of dangerous conditions by a non-medically qualified homeopath. Qualified homeopaths can diagnose and/or heal people.

D. Matt Innis 01:59, 29 November 2008 (UTC)

The Sagar quote in particular was inserted and deleted multiple times, without any discussion at least on the present talk page.

I would like a clear and straightforward explanation from Ramanand or Dana why they have removed the Sagar quotation. I would also like a clear and straightforward explanation from Howard, or someone else, why this quotation is important to include--what point, exactly, it is making in the article. Dana wrote in the edit summary, "This quote does not have a place on CZ...see Talk page." Where on the talk page should we look for the explanation, Dana? If this is not clearly explained, folks, then please ask me to reinsert the quotation myself.

Moreover, this sentence,

Qualified homeopaths can diagnose and/or heal people.

appears unacceptable as it stands, because it states an opinion with which many people can and do take issue. First, it might be taken to imply that homeopathy itself is effective at diagnosis and healing, and that is the sort of unattributed blanket statement that is contrary to our neutrality policy. But perhaps we can say, on a second interpretation, that qualified homeopaths are trained to recognized conditions for which treatment by conventional medicine is preferable (and thereby see to it that they are diagnosed and healed). Is that actually true, though? Is it true in the general case, of people regarded as "qualified homeopaths" in general? To be regarded as a "qualified homeopath," must one actually have the same sort of qualifications that we expect of an M.D. general practitioner (the family doctor)? I didn't think so. And that was kind of the point, I think: someone regarded as fully qualified as a homeopath might not recognize a dangerous condition which is perfectly obvious to a GP, and the homeopath might actually endanger a patient's life by misdiagnosing and/or failing to refer. Or is it understood by everyone that "qualified homeopaths" are also, as part of their homeopathic qualifications, as well qualified as GPs for purposes of diagnosis and referral for conventional treatment? If this isn't understood or agreed by everyone, then (on the second interpretation) the above sentence is not a neutral, fact-stating claim. --Larry Sanger 02:37, 29 November 2008 (UTC)

Larry, homeopathy needs a license worldwide, to be practised. This license is granted only after a course of study. I'm sure that qualified homeopaths can diagnose problems.—Ramanand Jhingade 10:38, 29 November 2008 (UTC)

I believe Dana cited, for California at least, that licensure was not always required. For any area of health care that I know, where there is a license, the U.S. term of art is "scope of practice". There is an expectation, and often quite specific guidelines, about recognizing things outside one's scope of practice, with due regard for emergency situations when a less fully qualified clinician is the only one available. There is especially widespread difference among advanced practice nurses and physician assistants.

In any number of textbooks of emergency medicine intended for use in a fully staffed and equipped emergency room, there are bold warnings, on the recognition of certain potential syndromes, signs, or test results, "seek immediate consultation from a hand surgeon | opthalmologist | neurosurgeon | infectious disease physician."

Diagnose is a term of art, with several subcategories. Perhaps triage may be a better word here: when does the patient become a potential emergency for a different sort of practitioner?

So, no, I can't accept "I'm sure qualified homeopaths can diagnose problems" to be other than personal opinion. I've seen too many literal post-mortems, where a critical piece of information was missed, to say that any discipline will diagnose everything, or even recognize a need for consultation. Triage recognizes that screening may be the best that can be done. Anecdote not being the singular of data, I encountered a situation in the last couple of weeks where the patient had nothing seriously wrong, but reported two symptoms that, until additional tests rule it out, are prudent to take as potential warning of a life-threatening cerebral hemorrhage. A medical term of art is "index of suspicion", which calls for further evaluation when something critical may be lurking.

Any form of practice that does not have such a structure of "rule out" or "refer", I believe, has not demonstrated a reliable ability to diagnose. This is is at the heart of much medical concern about alternative systems. Let me also say that I know practitioners in complementary and alternative medicine that absolutely do have such a structure, and I also know ones — not homeopaths — that didn't recognize dire warnings, continued treating by their paradigm, and the patient died. Yes, I have known physicians who have made such errors, and, while usually closed, a good hospital has a formal procews, most commonly called a "morbidity and mortality" conference or review, where the question is constantly asked, "could we have done better?" That is a form of humility that should be institutionalized, while there are bad physicians that don't do it, it is part of best practices. So far, I have heard no equivalent structure from homeopaths, especially classical homeopaths. If they have such a structure, by all means put it into the article. Howard C. Berkowitz 16:45, 29 November 2008 (UTC)

Part of the problem, Larry, is that "fully qualified as a homeopath" is ambiguous. Dana correctly makes the point that, depending on the jurisdiction, one may be a board-certified medical doctor who is also homeopathically trained, or may be purely trained in classical homeopathy, in a program with no significant biomedical content. When I've raised the point about qualifications, the response sometimes is that the homeopath is medically qualified. On other occasions, the only background is classical homeopathic.

As far as the Sagar quote, no, it isn't essential, but neither are quotes from Osler or others non-homeopaths expressions of opinion homeopathy. Do note that there has been some revert wars about quotes from Osler, whom I immensely respect, and want to see all his relevant quotes, not just those most favorable to homeopathy. Sagar clearly is a physician critical of homeopathy, but the quote, I believe, gently and with humor, presents a contemporary medical view that it is a personal decision to use, or not use, homeopathy. In contrast, Kellen is not kind and gentle, but relevant due to his position.

May I again request that someone clarify if "heal" is a specific term of art in homeopathy? Otherwise, it seems very subjective. Howard C. Berkowitz 02:59, 29 November 2008 (UTC)

Hahnemann used the term, 'heilkunst' (cure/heal); Dana, being a German may be able to describe that term best.mdash;Ramanand Jhingade

It may, indeed, be, a word with significant history. There are many places on CZ, however, where a historical word is deprecated because a newer, less ambiguous term, has a more specific definition, especially when the newer word has a common meaning across several disciplines. In such cases, the more general word is preferred, perhaps with a qualifying adjective, so that the reader can see consistent usage across a set of articles.

So, I believe its continued use requires more than just tradition. We've made some limited but encouraging progress in avoiding words that may be traditional in homeopathy, which we indeed define as a homeopathic term, but then use a word or phrase that does have create confusion with other disciplines' use, such as "preparation" rather than "remedy". Homeopaths do not use "symptom" in the same way as do mainstream physicians. Again, I encourage its introduction as a term of art and history, but I suspect wider use of syndrome would lead to better communication. Howard C. Berkowitz 16:45, 29 November 2008 (UTC)

Howard properly declared that the Sagar quote is not essential, and I agree with him. However, Howard's comparison with Osler's quote is completely different when you consider WHO Osler was (the "father of modern medicine" and author of a leading medical textbook). Sagar's attempt at humor has no place on CZ (IMO). I suggest that quotes from people should be limited to those who are truly notable and/or who have engaged in research. Sagar fits neither. Also, there are already many statements in this article that say that many conventional physicians assume that homeopathic medicines are synonymous with placebos, and Sagar's quote adds nothing. As for Osler, it is notable WHO he is and what he specifically said, especially because he acknowledges that many doctors were wrong in attacking homeopathy and homeopaths, that homeopaths DO maintain a scientific attitudes (or as he says, many of them do), and then his other quote about Hahnemann was exceptional.

For the record, I agree with some other here and do not believe that the sentence "Qualified homeopaths can diagnose and/or heal people" has any real meaning. Also, I am not German, but in any case, heilkunst has no real place here, though others can make a separate article on it.

As for the word "remedy" or "preparation," let's use the LEGAL word "drug" because homeopathic medicines ARE drugs. That said, to me, the words medicine, remedy, or drug are fine. The word "preparation" is not OK. Dana Ullman 19:20, 29 November 2008 (UTC)

Cautiously, I'll agree to drug, but it is appropriate, at least with respect to the U.S. and a number of western countries, to that "homeopathic drugs" are defined quite diferently from the safety and efficacy approvals, and even the required for medical devices, drugs based on pharmacology, radiopharmaceuticals, and even plant extracts. "new drug application" describes the process of safety and efficacy testing; it isn't just a form. From a U.S. Food and Drug Administration summary (I'll be happy to provide the formal legal text, but I think this gives a sense of the different standards):

FDA regulates homeopathic drugs in several significantly different ways from other drugs. Manufacturers of homeopathic drugs are deferred from submitting new drug applications to FDA. Their products are exempt from good manufacturing practice [4] requirements related to expiration dating and from finished product testing for identity and strength. Homeopathic drugs in solid oral dosage form must have an imprint that identifies the manufacturer and indicates that the drug is homeopathic. The imprint on conventional products, unless specifically exempt, must identify the active ingredient and dosage strength as well as the manufacturer.

As far as quotes, I'm not going to argue about Osler, a man I greatly respect, other than to say that if he is quoted at all, then all (about 3) relevant quotes about homeopathy need to be given, not the most favorable one. In the one that keeps disappearing, he equates homeopathy and allopathy as two traditions that need to be superceded by a science-based synthesis. Further, if the von Behring quote is retained, I think it only balanced that to note homeopaths do not seem to be able to have a testimonial from a modern immunologist of Nobel level; Behring was, what, 1905?

There has been an argument raised periodically that "homeopathy has met the test of time", which, thankfully, is no longer in the article. Very few medical therapies have "met a test of time", for the deliberate medical process of constant review and improvement. While I'd have to dig up my Osler biography, he observed that approximately 5-10 drugs of his time actually had a demonstrable benefit. There were unquestionably a huge number of dangerous, ineffective drugs. Of Osler's selected drugs, offhand, only morphine remains as a first-line drug, quinine is a last-resort antimalarial with a few other niche uses, and natural digitalis has been replaced, for multiple reasons, by synthetics such as digoxin.

Controlling my language very carefully, I shall merely note that it is no longer 1910, and it is distinctly non-neutral to suggest modern pharmacology is stuck in 1910. It is distinctly non-neutral to suggest that Jenner and Pasteur's insights into immunology reflect modern understanding, and are a reasonable standard by which homeopathy should be judged. Do not, incidentally, assume that I believe that a great many pharmaceutical advertisements are appropriately regulated, ethical, or safe. Howard C. Berkowitz 20:20, 29 November 2008 (UTC)

The great simplification

Gareth, things look good. Might I suggest that some of the material might well be preserved in appropriately linked subarticles? There is an existing history of homeopathy article into which a good deal might merge.

Perhaps another might be created to cover homeopathic preparations, their classical definitions (link to existing homeopathic provings with appropriate merges), and, perhaps, a high-level description of theories about mechanisms of action. With respect to the latter, I do recommend carefully introducing and linking to more detailed articles that have relevance to other than homeopathy alone, such as structure of water, hormesis, etc. There are, indeed, articles on those subjects, so the first level subarticle should deal with "homeopathic applications of xxx".

Trials, efficacy, etc., are a challenge for which I don't have an immediate answer. There are unresolved questions that are not limited to the use of randomized controlled trials in homeopathy, such as their use in pharmacogenetics and low-responder groups. I do recommend abundant linking to interdisciplinary topics here. While some homeopaths regard homeopathy as what NCCAM calls a "whole system", or puts as an "alternative" in complementary and alternative medicine, the more interdiscipinary links, the better a set of articles we will hae.

Legal and regulatory matters need to go somewhere. The details can be in a subarticle, but there is enough confusion to need clarification/definition about qualified versus unqualified, licensed versus unlicensed, classical homeopathy (i.e., homepathy as a whole system), homeopathy with other alternative medicine, and homeopathic techniques used by or with conventionally trained medical practitioners. Some of that probably needs to go into the main article, where we really can't have extensive "it depends" or "everything is individualized". While the latter is an ideal, it doesn't make for substance at an encyclopedic level, and it also denies the individualization in best conventional treatment.

Great, so far. Gordian knot and all that. Gordian knot as cut not by Alexander's Sword, but by Occam's Razor?Howard C. Berkowitz 18:14, 29 November 2008 (UTC)

Pausing

Have to pause now - my internet connection is very sluggish for some reason; will try to resume tomorrow afternoon my time. For now I've just tried to simplify the lead - yes my instincts are to keep material, but not necessarily within the article and especially keep the lead light.Gareth Leng 18:49, 29 November 2008 (UTC)

I must be off myself for a time, as I have to take an even more sluggish connection, called my car, to a repository of archaic things called books. Really! Library, not server? If it would be constructive, I am willing to try to set up some subarticles, perhaps in sandboxes, simply to have a strawman; I would do minimal content change but just try to show organization.

Later, however, I do want to point some places where, for want of a better term, some text argues with itself and essentially cancels out. Howard C. Berkowitz 18:56, 29 November 2008 (UTC)