Talk:Homeopathy/Archive 13: Difference between revisions

Revision as of 20:30, 17 July 2009

Further categories added

I just added Chemistry and Health Sciences as categories most close to this topic, and I hope this stimulates some of the necessary rewriting. --Daniel Mietchen 18:22, 28 April 2009 (UTC)

I suggest, as a starter, that since there seem to be a number of people who feel that the Overview is buried far too far from the top, that it be either moved or the lede be rewritten. Let's start taking to heart the posted CZ Neutrality policy:

"Expert knowledge and opinion receives top billing and the most extensive exposition."
"The task is to represent the majority (scientific) view as the majority view and the minority (sometimes pseudoscientific) view as the minority view." Hayford Peirce 18:30, 28 April 2009 (UTC)

Think that's right, and I've moved the Overview up and tightened the wording a bit.Gareth Leng 12:03, 8 May 2009 (UTC)

Lately I have been reading about water memory, its scientific evidence is even less than I expected. I see clearly now that much of the discussion in the section "Scientific basis of homeopathy" is neither here nor there. Ortho/para water, isotopomers, glass chips, it is all true but what is the connection to homeopathy? We could extend the list of true, but meaningless, facts ad infinitum. So I propose to shorten this section, beginning with taking out the reference to solitons, clathrates, and nanobubbles. --Paul Wormer 12:29, 8 May 2009 (UTC)

A proposal that will, no doubt, cause consternation

I propose that we take the bull by the horns and rewrite the lede sentence to read:

Homeopathy or homoeopathy is a system of alternative medicine whose principles, however, are not accepted by most medical doctors and scientists, particularly those in the West.

Is that anything about that simple statement that is false, misleading, or unprofessional? If not, then I *strongly* urge that we begin the article with it, and then do the necessary rewriting in the rest of the article. Hayford Peirce 17:57, 8 May 2009 (UTC)

No, it's accurate. Still, I might be tempted to add "It is an alternative system that uses a fundamentally different model of health, and whose proponents say is difficult if not impossible to judge by standards of evidence-based medicine; it has to evaluated in its own frame of reference." That's wordy and can be improved, but I think it states a fair point. Howard C. Berkowitz 18:04, 8 May 2009 (UTC)

I could certainly live with that, and I think that any other fair-minded person (which, of course, defines ALL Citizens!) could too. So why don't you do the rewrite and I'll do the copyedit if needed? Hayford Peirce 18:07, 8 May 2009 (UTC)

What is the basis for the qualifier "particularly those in the West"? I'm aware that homeopathy is more accepted in the region of the Indian subcontinent than in the West, but I've not seen evidence that it is accepted by non-Western doctors and scientists more generally. Note that homeopaths have expressed regret that "nobody knows anything about homeopathy" in China, for example. Raymond Arritt 20:30, 9 May 2009 (UTC)

Further: I don't agree with the general proposal. In my view the first paragraph (and certainly the first sentence) should state what homeopathy is. We have the rest of the lead to comment on its acceptance and so on. I've done a bit of rearranging of the lead in an attempt to make it read more smoothly, but please feel free to revert my changes if you disagree. Raymond Arritt 21:02, 9 May 2009 (UTC)

It's certainly more accepted in India, I gather. Otherwise, I agree with you on the "non-Western" part -- I wish it could be rewritten. As to the rest, you have simply restored the old version with which we were concerned about its lack of skepticism. If, to stretch the point, we have an article about Flat Earth, we don't wait until paragraph umpty-ump to say that all mainstream scientists consider this idea to be nonsense. Everyone except you, for the last couple of weeks, has agreed that the homeopathy article waited *way* to long to point out, and then to point out strongly, that mainstream science does *not* consider it to be useful. We are, therefore, in this draft article, consciously trying to change the balance of the article. We don't "own" the article -- you're certainly welcome to make suggestions and changes, but I think that if you try to restore the old framework, you are going to run into considerable opposition. Hayford Peirce 21:20, 9 May 2009 (UTC)

I emphatically agree that the approved version waits far too long to state the prevailing scientific and medical view (and does an embarrassingly poor job when it finally gets there). I don't agree that it needs to be right up front in the first sentence, but if everyone else believes it should be in the first sentence I won't argue the point further. I must note that in its present form the lead paragraph is very poorly written in terms of clarity and style; it will have to be cleaned up if we expect the new draft to be taken seriously. Raymond Arritt 21:34, 9 May 2009 (UTC)

I think the lede para. is a perfect model of clarity and concision, saying exactly what we want it to. You obviously disagree, but how about giving us a "for instance"? Or how about rewriting it so that its "clarity and style" are improved. Not changing what it says, as you did before, but improving the existing text. I think that all of us would welcome that.... Hayford Peirce 04:04, 10 May 2009 (UTC)

You really don't see the style problems? I suppose everyone read things differently. For a start the use of "however" is strange, because it does not make a contrast. The paragraph also is made up entirely of loose sentences. How about something like:

Homeopathy or homoeopathy is a system of alternative medicine. Its principles are not accepted by most medical doctors and scientists, particularly those in the West. As an alternative system it uses a fundamentally different model of health that, its proponents say, cannot be judged by standards of evidence-based medicine and must instead be evaluated in its own frame of reference.

Another possibility is that the long second sentence could be tweaked to say:

Homeopathy or homoeopathy is a system of alternative medicine. Its principles are not accepted by most medical doctors and scientists, particularly those in the West. Its proponents say that as an alternative system it cannot be judged by standards of evidence-based medicine and must instead be evaluated in its own frame of reference.

No change in meaning, but (I think) either of these versions, or something similar, would read more smoothly. The main points are: (1) lead with a simple declarative sentence; (2) remove the "however"; (3) tighten to eliminate redundancy or other unnecesary words. Raymond Arritt 17:21, 10 May 2009 (UTC)

Removal of para

Daniel commented out the irrelevant paragraph on "scientists may have it wrong". I agree completely.--Paul Wormer 13:44, 9 May 2009 (UTC)

To lede?

IMHO the following sentence should go from the section Scientific basis of homeopathy. As far as I'm concerned it could go to the lede, or to clinical trials, or may be deleted (because I suspect that something similar has been stated already in the present article):

Further, homeopaths assert that the overall evidence for homeopathy, including clinical research, animal research, basic sciences research, historical usage of homeopathic medicines in the successful treatment of people in various infectious disease epidemics, and widespread and international usage of homeopathic medicines today, indeed provide the required extraordinary evidence for the benefits of this system.^[1]

--Paul Wormer 13:44, 9 May 2009 (UTC)

First, the paragraph now in the lede,

"Classical homeopathy" or "Hahnemannian homeopathy" refers to the original principles of this medical system in which a single remedy is chosen according to the physical, emotional, and mental symptoms that the sick individual is experiencing rather than only the diagnosis of a disease. "Commercial" or "user-friendly" homeopathy refers to the use of a mixture of remedies in a single formula containing individual ingredients that are generally chosen by the manufacturer for treating specific ailments. Such homeopathic remedies are used by consumers all over the world for self-treatment of common self-limiting ailments and injuries.

fits better at the end of the section "preparation of homeopathic remedies", perhaps with a little flow editing.

Second, if the paragraph you suggest moving to the lede were to go there, it needs to be introduced with something including the sentence "These stringent demands are often summarised by the maxim "Extraordinary claims require extraordinary proof".", and editing the paragraph so there is a transition to the "extraordinary proof" in the "homeopaths assert..." I'm not sure if the material between "extraordinary claims" and "Further" needs to be there so it's coherent. The "Further" sentence doesn't quite make sense on its own in the lede.

On a different subject, some material either needs to be deleted or move to history of homeopathy. Given a century of progress in immunology, is there any point to quoting Von Behring here? The only point seems to be to explain 19th century thinking, which does have the justification that 19th century medical drugs tended to be toxic and ineffective. In like manner, can we really leave "Homeopaths consider that two conventional concepts, vaccination, and hormesis, can be considered as analagous to homeopathy's law of similars and the use of small doses. " unchallenged, vaccination being a completely different and understood mechanism, and hormesis still being explored?

I'd also get rid of mithridization, or move it to history. There's no modern belief in that concept. Howard C. Berkowitz 17:57, 9 May 2009 (UTC)

The sentence that Paul mentions is very badly written in any case -- it needs to be simplified and redone so that it makes sense. Hayford Peirce 18:10, 9 May 2009 (UTC)

I don't want to get into a revert war here, but I think fairness does call for mentioning the basic vital force and similars principles in the first paragraph. Don't get me wrong; I don't think there's substance to homeopathy, but the current first paragraph just deprecates their model without any text about what it includes. Howard C. Berkowitz 17:30, 11 May 2009 (UTC)

I agree with Howard on this. In fact I was going to ask the same question myself: Daniel, why did you cut this bit out? I think that it is, in fact, important that it be restored. Hayford Peirce 18:07, 11 May 2009 (UTC)

Odd sentence

The lede contains the sentence:

A number of homeopaths also are strongly opposed to vaccines, which public health officials, including ones with homeopathic training, consider a danger to the community.

What is the danger? The fact that unvaccinated people are in the community? Or the opposition of homeopaths? I don't see it.--Paul Wormer 07:46, 10 May 2009 (UTC)

I think what it's *trying* to say is: A number of homeopaths also are strongly opposed to vaccines, which they consider a danger to the community; some public health officials, especially those with homeopathic training, agree with them. But it's unwieldy and should be further revised, or shortened (eliminate second phrase), or just deleted. Hayford Peirce 16:34, 10 May 2009 (UTC)

No. Vaccination is an accepted technique, in public health, for preventing infectious diseases. A number of homeopaths consider vaccines to be actively dangerous and recommend they not be used, which presents a danger to the community. Some homeopaths advise against the use of drugs to prevent malaria, to which even the director of the Royal Homeopathic Hospital objects.. Howard C. Berkowitz 17:40, 10 May 2009 (UTC)

Is that your proposed rewrite as opposed to mine? If so, stick it in. Whadda *I* know about this stuff? Hayford Peirce 18:20, 10 May 2009 (UTC)

Weasel wording in the last section, "Safety"

I have done some editing here to get rid of either contradictory words and/or weasel-wording. If it's really true, and can be *shown* to be true, that only "many public health professionals" disagree about the safety of vaccines, instead of "nearly all", then change it back, slap me on the wrist, and I will depart from Citizendium forever. How can we possibly permit such weaselry in our major articles? Hayford Peirce 02:15, 13 May 2009 (UTC)

Moves to History of Homeopathy

I moved the comment of von Behring to history of homeopathy, linking it. Tomorrow, I'll put in some of Osler's comments about both the toxicity of conventional drugs at that time, and also Osler's view that both allopathy and homeopathy were "medical cults" to be superceded.

Why do we have the material on mithridization? It seems to be random, not especially tied to homeopathic concepts, other than perhaps indirectly through hormesis. While hormesis probably should be there, I'd get rid of mithridization completely. Howard C. Berkowitz 04:30, 13 May 2009 (UTC)

On further reflection, I moved up hormesis, but then took out the material below, which I simply can't relate to the discussion.

Mithridatization (which is not a term used in contemporary science or medicine) may be a better metaphor than vaccination for homeopathic treatment. Mithridatization is the chronic administration of subtoxic doses of a toxin, in an attempt to develop resistance (or "tolerance") to large doses of the toxin. It is said that Mithridates VI Eupator, King of Pontus (132-63 BC), used this technique to protect himself from his enemies^[2]. ^[3]

There are many different mechanisms by which tolerance can develop - and exposure to repeated small doses does not always result in tolerance. A herpetologist who receives many small doses of snake venom may indeed become tolerant to them. A beekeeper, however, may become hypersensitive to the venom and, after receiving a sting, go into anaphylaxis. This type of response to small, not necessarily precisely measured, doses is not predictable on an individual basis. "Allergic desensitization" is a technique used in conventional medicine to treat individuals who have a specific allergy to something that they cannot easily avoid. This involves exposing the patient repeatedly to tightly controlled doses, increasing the doses gradually over time. This treatment can be dangerous (exposure of sensitive individuals to an allergen can produce anaphylaxis), and it has very inconsistent efficacy, so is normally only attempted when the allergy poses serious restrictions on the patient's normal life.

Both mithridatization and homeopathy might be considered as instances of [hormesis] Howard C. Berkowitz 21:02, 13 May 2009 (UTC)

I can see where the first paragraph is starting to head, but then the second paragraph wanders off... somewhere. Raymond Arritt 00:21, 14 May 2009 (UTC)

Still, I'm not sure homeopaths routinely refer to mithridization; I vaguely recall a non-homeopath brought it into the article.

Immunization is a tricky area when talking about homeopathy; yes, it involves small doses of something that could cause symptoms, but the similarity stops there, unless one wants to make the rather sweeping statement that the vital force is equivalent to the immune system. Immune response doesn't really explain homeopathic cures for non-infectious disease or symptoms. Howard C. Berkowitz 02:51, 14 May 2009 (UTC)

I'm the guy who kept trying to put in, "I tell the tale that I hear told, Mitridates, he died old." But, of course, as the article title says, It Never Got Me Anywhere.... John Brock, le nom de secret agent de Hayford Peirce 03:40, 14 May 2009 (UTC)

Seriously, does this tale come from homeopathic literature? Howard C. Berkowitz 04:00, 14 May 2009 (UTC)

I think it was Pierre-Alain Gouanvic who was keen to insert this. I inserted some of the second para as an explanation of tolerance in that context, I think there was discussion of desensitisation which I think Dana argued on the Talk page as an example of use of like cures like, and the insertaion on desensitisation was a summary of the outcome of that discussion.Gareth Leng 16:07, 23 May 2009 (UTC)

Without some serious referencing, rather than some original hypotheses, it should go, not even in history. Howard C. Berkowitz 16:15, 23 May 2009 (UTC)

Repetitiveness

It seems to me that there still are many Wikipedia-like repetitions in this article. For instance, the lede says twice: [homeopaths] use a fundamentally different model. I noticed more of these kinds of repetitions. Before re-approval we should get rid of most that because they look silly and non-professional.--Paul Wormer 07:15, 13 May 2009 (UTC)

I agree -- please do as much editing on this stuff as you can! Hayford Peirce 16:04, 13 May 2009 (UTC)

Retitled section

I changed the section title "Attempts to provide a scientific foundation for homeopathy" to "Proposed scientific foundations for homeopathy." To my ears "attempts to..." sounds a little more judgmental than we probably want, while simply saying "proposed" doesn't imply anything either favorable or unfavorable. Is this OK? Raymond Arritt 00:28, 14 May 2009 (UTC)

It's fine by me, and I agree with your reasoning. Hayford Peirce 01:32, 14 May 2009 (UTC)

Ortho-para water

The difference between ortho-para water is due to the Pauli principle: protons are fermions and have a totally (spin + space) antisymmetric wave function. Ortho stands for spin triplet (is symmetric in spin and antisymmetric in space); para stands for spin singlet (antisymmetric spin, symmetric space). The ratio 3:1 is the triplet(3) : singlet(1) ratio. I removed nuclear because these spins can be flipped by paramagnetic interactions on a molecular level. If a homeopathic tincture contains an open-shell, paramagnetic, transition-metal center, then it is conceivable that it can change the 3:1 ratio. Also some catalysts (e.g. active charcoal) may change the ratio. That is why I added the proviso that even if such a change happens its healing power is still unclear.

Personally I see isotopologues as something completely different from ortho/para, which is why I put them into two different paragraphs. I realize that this view is academic and that seen from a distance the two concepts belong in the same remote corner of molecular physics.

--Paul Wormer 06:11, 14 May 2009 (UTC)

First paragraph

I'm still dissatisfied with the first paragraph. Currently it reads:

Homeopathy or homoeopathy is a system of alternative medicine whose principles are not accepted by most medical doctors and scientists, particularly in the West. As an alternative system, it uses a fundamentally different model of health that, its proponents say, cannot be judged by standards of evidence-based medicine and must instead be evaluated within its own frame of reference.

My proposed revision is:

Homeopathy or homoeopathy is a system of alternative medicine. As an alternative system, it uses a fundamentally different model of health whose principles are not accepted by most medical doctors and scientists, particularly in the West. Its proponents say that cannot be judged by standards of evidence-based medicine and must instead be evaluated within its own frame of reference.

The main points of my revision are: (1) it starts with a simple declarative "what it is" sentence; (2) the next two sentences state the scientific and medical view in its own sentence, contrasted with the homeopaths' response in its own sentence. Comments? Raymond Arritt 17:43, 14 May 2009 (UTC)

Assume this is the first paragraph. I think it's essential, then that it transition to a second paragraph that, as succinctly as possible, defines the fundamentally different model. Howard C. Berkowitz 18:31, 14 May 2009 (UTC)

It looks as if the Bug is back! I put in a comment here about half an hour ago, it shows up on my Contributions log, but it's gone! It's that rat Howard, deletin' my stuff! Anyway, here's what I said, if I can recall: "Your suggestion looks fine to me if you think that's an improvement. But there should be an it after Its proponents say that".... Hayford Peirce 18:42, 14 May 2009 (UTC)

On this note I'm 99.9% certain that I signed my comment below under "Reapproval" in the usual way, but apparently it didn't show up. Has anyone noticed signatures getting dropped off? Raymond Arritt 16:48, 15 May 2009 (UTC)

I *think* that what you did was maybe just type three tildes instead of four -- the date was there, but not your name.... Hayford Peirce 17:04, 15 May 2009 (UTC)

...particularly in the West

I have deleted the qualifier "particularly in the West." The qualifier was added by Martin Cohen in this edit.[1] In looking at the Talk page around that time I see no specific argument favoring this statement (here[2] is a snapshot of the Talk page around that time). Homeopathy has no general non-Western prevalence; for example, homeopaths themselves have lamented that "nobody knows anything about homeopathy" in China.[3] From what I've been able to find out it appears the correct form of the qualifier would be "outside the Indian subcontinent" but do we want to be that specific? Raymond Arritt 00:56, 15 May 2009 (UTC)

No. I'm glad to see that it's gone. Your next project, should you accept it: check the verifications of the weird (to me) statements about the percentage of French and German doctors who believe in it, or don't disbelieve in it. I lived in Tahiti for 25 years, a French territory, and knew about half the non-hospital doctors there and was close friends with a number of them. There was *never* a homeopath in Tahiti, none of the doctors ever mentioned them, and I find it hard to believe that 30 or 40 percent of French doctors believe in this. Hayford Peirce 01:31, 15 May 2009 (UTC)

I haven't been able to find these figures. There's an interesting article in BMJ that estimates one-year prevalence of CAM use in various countries as of 2000,[4] but homeopathy is only one part of CAM.

I wish Homeopathy stated where those numbers came from. While Wikipedia uses far too many references, I often think Citizendium uses too few. But that's another conversation for another day.

In any event I'm going to stop editing the article for a while so it will be stable enough for the approvals manager to have a look at it. Raymond Arritt 04:01, 18 May 2009 (UTC)

I found in Ref. [36] of the draft (BMJ 1994;309:107-111 Education and debate. Medicine in Europe: Complementary medicine in Europe by Peter Fisher and Adam Ward):

Over a third of France's 54500 general practitioners use complementary methods: 5% exclusively, 21% often, and 73% occasionally.

and:

In the Netherlands 47% of general practitioners use complementary therapeutic methods, most commonly homoeopathy (40%); 9% use manipulation and 4% acupuncture. Manipulation and acupuncture are more commonly used by health professionals other than doctors and by non-medically qualified practitioners. In Germany 77% of pain clinics use acupuncture,11 and up to 37% of British general practitioners use homoeopathy

The draft refers to [36] with the sentence

In some countries, all (or virtually all) professionals that use homeopathic treatments are MDs (such as France, Spain, Argentina, Colombia)[36].

I read and searched Ref. [36], Argentina and Colombia are not mentioned at all. About France and Spain the following is stated:

In most member states of the European Union, including Belgium, France, Spain, Italy, and Greece, the practice of medicine, except by statutorily recognised health professionals, is illegal.

Further Ref. [36] states:

It [an EU proposal] also demanded an end to prosecutions of non-medically qualified practitioners in countries such as France and Spain, and for a pan-European system of regulation of non-medically qualified practitioners along the lines of the British Osteopaths Bill.

To conclude from these sentences that "all professionals in France, Spain, Argentina, Colombia using homeopathy are MDs" is stretching Ref. [36] further than I believe is honest. This makes me wonder: how relevant/pertinent/accurate are the other references in the draft?

--Paul Wormer 09:40, 18 May 2009 (UTC)

Thanks for tracking all of that stuff down! I remember, months ago, that Dana kept putting this stuff in and other people kept trying to modify it. Could you now make some sort of decision about what to do with it all? Thanks! Hayford Peirce 17:24, 18 May 2009 (UTC)

It's probably worth asking for the purpose of the material. I have no objection to saying that some people and cultures, more than others, like homeopathy. There seemed an effort, at times, to push homeopathy both by endorsements and numbers, or by citing work by physicians who had done both homeopathic and non-homeopathic things, but only citing the former.

One claim was made that homeopathy was the third most common form of alternative medicine, and I did a little calculation given the numbers of homeopaths and the claimed number of patients. Poor fellows would have needed to see around 1000 patients a day to keep up the encounter lengths.

It's one thing to say a physician uses homeopathy at all, and another thing to say a physician endorses homeopathy. Just as physicians, in the U.S., inappropriately use antibiotics due to patient pressure, I wonder how many European physicians use homeopathic preparations due to patient pressure. Oscillococcinum seems widely used. Actually, I saw it in a U.S. drugstore, prominently advertised, and could not help but think of the sound made by its principal ingredient (when alive). Howard C. Berkowitz 17:51, 18 May 2009 (UTC)

Reapproval?

Does anyone think the current draft is essentially ready for reapproval? There have been significant changes that have (in my view) gone a long way toward fixing the most glaring problems with the original approved version. I think there's something to be said for reapproving the article at incremental points (say every few months or so) rather than springing a wholesale rewrite on people, especially with a controversial topic like this. Raymond Arritt16:07, 15 May 2009 (UTC)

Yes, you're probably right. Also, we don't want to keep the improved version away from the general public for too long. I'll ask Joe Quick, the Approvals Manager, to take a look and tell us what he thinks needs to be done. Hayford Peirce 16:40, 15 May 2009 (UTC)

Text in footnotes

Given that this is a hyperdocument, not a professional journal, I don't like the practice of putting any substantial amount of text (e.g., measles or gangrene) into footnotes. An online reader is not necessarily going to get to endnotes, and there's no way the reader can know that a given footnote is more than bibliographic.

My rule is that any substantive text either belongs in the article, or in a linked subarticle. Howard C. Berkowitz 20:30, 15 May 2009 (UTC)

I don't quite know what Howard is referring to here, but I certainly agree with him -- text should be in the article or a related subarticle except for the minor sort of footnote material that we all learned about in school. Hayford Peirce 20:53, 15 May 2009 (UTC)

I never liked these footnoted comments but thought "maybe that's the way it's done around here." I'm glad to see others agree. Most of these footnoted remarks have little or nothing to do with the topic at hand and can simply be deleted. The few that are on point are best merged into the text, per Howard. Raymond Arritt 21:05, 15 May 2009 (UTC)

Allez-y, mon pote! Hayford Peirce 21:06, 15 May 2009 (UTC)

Confused on source

In the section "a typical homeopathic visit", we have:

At other times, a professional homeopath will often treat these patients with a constitutional remedy based on the patient’s genetic history, health history, and present overall physical and psychological state, with the intent to strengthen the person’s general health, thereby reducing the frequency or intensity of the symptoms of hay fever.[44]

with the source information: ↑ Dennis Chernin (2006) The Complete Homeopathic Resource for Common Illnesses. Berkeley: North Atlantic. Stephen Cummings and Dana Ullman (2004). Everybody's Guide to Homeopathic Medicines. New York: Jeremy Tarcher/Putnam.

I'm confused -- we have three sources, none easily checked, with no page references. Look at the quote: is it plausible that homeopaths are really using genetic history? Howard C. Berkowitz 02:45, 16 May 2009 (UTC)

No, that's not plausible. I suspect "genetic history" should be "family history" (see e.g., here[5]).Raymond Arritt 03:45, 16 May 2009 (UTC)

Causes of disease

While I agree the rewrite involving vital force improved the text, we can't ignore that homeopathy really does reject the theory of a disease etiology, such as disease being caused by a pathogenic organism, and appropriate treatment to kill that pathogen. Their main model is to strengthen vital force so that the body, perhaps through immune response, kills the pathogen. An antibiotic, however, is outside their model unless, perhaps, it produces the disease effect in provings. Howard C. Berkowitz 21:01, 16 May 2009 (UTC)

Support among medical doctors

Wearing a homeopath's cap I tried to find some numbers in the literature for support of homeopathy among MD's. So far I came up with the following:

In the USA there is some support for homeopathic medicine among physicians. One survey¹ found that 39% of the faculty of a medical school for primary care physicians considered use of homeopathic medicine legitimate, although only 8% had personal experience with such medicine. A survey of physicians representing a broad variety of specialties in a mid-sized southeastern US city found² that 17% of the respondents considered homeopathy legitimate medical practice, but only 1.4% of the respondents had actually prescribed such medicine.

References
1. S. M. Levine, M. L. Weber-Levine, and R. M. Mayberry, Complementary and Alternative Medical Practices: Training, Experience, and Attitudes of a Primary Care Medical School Faculty, J. Am. Board Fam. Pract. vol. 16, pp. 318–26 (2003)

2. J. Jump, L. Yarbrough, S. Kilpatrick, and T. Cable Physicians’ attitudes toward complementary and alternative medicine, Integrative Medicine, Vol. 1, pp. 149–153, (1998)

Apart from the low percentages of MD's that actually used homeopathic medicine, our homeopath friends won't object against including these numbers in the article, I guess. For the sake of objectivity I will look further.

--Paul Wormer 12:13, 19 May 2009 (UTC)

I checked the literature somewhat further and could not find any other numbers than the ones I quoted above. A long time ago I added a number to the article that has been removed in the meantime. This is Knipschild et al. who found that about 45% of the Dutch GP's thinks that homoeopathic remedies are efficacious in the treatment of upper respiratory tract infections or hay fever. For chronic joint problems this is 30%. The article by Knipschild et al. is famous, I see it referenced over and over again.

I hope that our homeopathic colleagues will come up with one or more references to back up their claims, if not --and let's wait a while-- we will have to do some rewriting without them on basis of Fisher & Ward, the two references about the US situation, and Knipschild et al. about Dutch GPs.

--Paul Wormer 14:17, 19 May 2009 (UTC)

Use of homeopathy by MDs

Looking for recent objective assessment of the attitudes of practising physicians to homeopathy I found This survey in Germany which reported responses indicating that about 50% of respondents (GP physicians in Germany) judged homeopathy to be “rather credible”, 6% used it “very often” and another 32% “at times”. This seems consistent with the high rate of use of homeopathy by MDs in Germany reported elsewhere. Thus for example this study reported that Paediatric homoeopathy is quite popular in Germany, particularly among children from families with a higher socioeconomic status, and found that “Almost half of homoeopathic preparations were obtained by prescriptions either from medical doctors (25.7%) or from Heilpraktiker (nonmedical practitioners) (23.1%), while one-third of them were bought as OTC drugs (Paediatric homoeopathy in Germany: results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS).Du Y, Knopf H (2009) Pharmacoepidemiol Drug Saf 18:370-9. PMID 19235777

A 2009 study by Münstedt K et al. in Forsch Komplementmed PMID 19420957 aimed to assess the use of complementary and alternative medicine (CAM) methods in German departments of obstetrics. ..” The most commonly used CAM therapy was acupuncture (available in 97.3% (366/376) of departments) followed by homeopathy (offered in 93.4%)”

On use in India, its been the subject of a special report in the Lancet (Prasad R (2007) Homoeopathy booming in India. LancetNov 17;370(9600):1679-80. PMID 18035598 ("In India, where homoeopathy is a national medical system, the market is growing at 25% a year, and more than 100 million people depend solely on this form of therapy for their health care")

[6]

The Faculty of Homeopathy in the UK was incorporated by an Act of Parliament in 1950. which gave the Faculty a role in regulating the education, training and practice of homeopathy by the medical profession, and gives details of GPs who provide homeopathy

In Europe, homeopathy is probably strongest in France, where two of the major manufacturers of homeopathic pharmaceuticals, Boiron and Dolisos, are located; homeopathic remedies prescribed by MDs are (partially) reimbursed by the State Medical system, and seem to be[ http://www.boiron.com/en/htm/01_homeo_aujourdhui/realite_eco_homeo.htmquite commonly prescribed there]. The second largest market is Germany.

There've been older surveys by the AMA of CAM use by family practitioners in the USA, must be somewhere in the history of the article. When I fisrt looked into it I recall I was very surprised by how many GPs were willing to refer patients to homeopaths or prescribe homeopathic remedies themselves. The impression I got was that most family doctors were quite relaxed about it.Gareth Leng 09:35, 22 May 2009 (UTC)

We didn't hear from Dana and Ramanand during this revision discussion, but it seems to me that we have now enough material to write honestly and well-documented about the use of homeopathy by physicians, even without them. What do you think?--Paul Wormer 10:28, 22 May 2009 (UTC)

Well I trawled through PubMed and don't think I've missed anything recent at least. I think there's enough here to provide an objective documentation, so I suggest you just go aheadGareth Leng 13:14, 22 May 2009 (UTC)

I edited in your references and a few others I found. I tried to reproduce the numbers that I found in the references as factually as possible (with the risk of being accused of "fringeness") --Paul Wormer 09:46, 26 May 2009 (UTC)

Essential point

Dilution often continues to the point where none of the original substance remains in the remedy. is essential but incomplete. I believe it is correct to say that homeopaths believe the "remedy" need not have any of the original "substance"; the usable remedy is modified water (or other vehicle).

Perhaps analogies help. In mechanical engineering/manufacturing, a template or jig is essential to making the desired part, but it no longer is present in the part. In various chemical syntheses, precursors are essential but no longer present. The analogies get more strained when thinking of things like primers in polymerase chain reaction, or antigens in medical remedies that work by passive immunization -- providing antibodies.

The key difference, of course, is that in each one of the analogies, we can reasonably well trace the relationship from the substance to the final product, and how the product works. In homeopathy, we get to the classic line "and here a miracle happens", whether it be memory of water, etc. Howard C. Berkowitz 15:55, 22 May 2009 (UTC)

The essential unbelievable point is that water is a liquid. For solids memory is well documented and usually called hysteresis in science. There is magnetic hysteresis and form hysteresis. Use of plaster models in art goes back to antiquity.--Paul Wormer 16:14, 22 May 2009 (UTC)

Perhaps it may not be the best example, but there's an old electronic engineering lab practical joke -- throw a charged electrolytic capacitor to someone and say "CATCH"! On a more routine basis, if one wishes to be an old engineer, one takes great precautions with high-voltage systems that are not "on".

How do we, succinctly and vividly, make this point about liquid in the context of homeopathy? Howard C. Berkowitz 16:28, 22 May 2009 (UTC)

Because I'm not a physicist I have no reason to know that it's not credible that water may have something analagous to hysteresis in aspects of its structure (of course I'm happy to accept this is so). What I find not credible is that we have could have evolved a mechanism to recognise and respond adaptively to differences in water structure. So for me, it's by the way whether water has a memory or not. Gareth Leng 14:04, 23 May 2009 (UTC)

If water wants to forget, does it hurl itself into the canteens of the French Foreign Legion? Howard C. Berkowitz 15:13, 10 June 2009 (UTC)

size of atoms

I don't know who entered the statement about Loschmidt and the size of atoms, but I liked the sentence because after the size of atoms (or, as we say now, molecules) was determined, it became clear that matter is not continuous, not infinitely divisible, and not infinitely dilutable. Loschmidt was the first to give an estimate of Avogadro's number and Avogadro's number is crucial, of course, in the discussion. Maybe we should write something like: "after it was established by Loschmidt in 1865 that a given volume of matter consists of a finite, albeit large, number of molecules, it became clear that a finite volume of solvent cannot be diluted infinitely." What do you think Raymond? --Paul Wormer 14:38, 23 May 2009 (UTC)

That's fine. It captures the important point, which is that matter is not infinitely divisible. Whether the size of the indivisible chunks is 10^-11 m or 10^-10 m or whatever doesn't seem relevant here. Raymond Arritt 14:54, 23 May 2009 (UTC)

Re section on conflict with conventional medicine

I read that section as delivering largely a point of view, and somewhat selective in its negative implications of conventional medicine. Anthony.Sebastian 01:20, 25 May 2009 (UTC)

Anthony, what keeps you? You can adapt the text of the draft, as long as you are fair to homeopathy (and to conventional medicine as well, of course).--Paul Wormer 16:16, 25 May 2009 (UTC)

I think Paul meant to type "you can EDIT the text", but I won't edit his own text, hehe. Hayford Peirce 16:21, 25 May 2009 (UTC)

I know nothing, I'm a foreigner, I don't even know what is wrong with "adapt".--Paul Wormer 16:39, 25 May 2009 (UTC)

I sure wish that my French was one-tenth as good as your English! But in this case, "adapt" would mean that he is copying, and then possibly changing, the text in question for some private use of his own, not just changing the text that everyone else can see. Hayford Peirce 16:46, 25 May 2009 (UTC)

Reapproval

To me it is important that Dana Ullman is willing to approve the revised version. We tried hard to be unbiased and I hope that Dana indeed reads it that way, which would mean that we have succeeded in writing a balanced article.

Somebody put the chemistry category to this article, which implies that formally I could be an approving editor, but I would prefer that editors from health science (or whatever it is called) approve it, as the article contains little chemistry. --Paul Wormer 14:29, 27 May 2009 (UTC)

I do not agree that it is important for Dana Ullman or any other particular individual to approve the article. We should adhere to the stated approval process without deferring to any specific person. Raymond Arritt 15:40, 27 May 2009 (UTC)

Seconded. John Stephenson 10:14, 28 May 2009 (UTC)

Seems to me you've done a fine job here, conscientiously neutral, and the re-ordering works for me. I don't see anything lost that I'd worry about, the simplifying is good as is avoiding redundant adjectives. You've removed some text that was intended to emphasise the non-dogmatic and open nature of science, and that's fine, I don't think it was really needed because the article doesn't read like a lecture, which was something I was overanxious to avoid. I'm happy to support reapproval. I think Dana should be alerted and like Paul, I hope he will also find it an improvement. Dana has been a conscientious supporter of honest efforts at balance and neutrality here.Gareth Leng 13:03, 28 May 2009 (UTC)

First, I agree that the Approval process should not depend on a single person. Even if Dana were not available, it's not unprecedented to get external reviews from a non-citizen expert, which can guide one or more Editors with some expertise.

Gareth, have you considered writing an essay on that non-dogmatic position of science, especially vis-a-vis what may be considered fringe assertions, and creating it as a Signed Article to which multiple articles can link? It's not quite a policy statement, but neither is it specific content to articles where I've seen variants on it. Howard C. Berkowitz 15:35, 28 May 2009 (UTC)

[unindent] I don't want Dana to approve the draft as a person, but as a homeopath. It is easy enough to write about homeopathy in a manner that all non-believers will nod and agree that it is a good piece of work. It is much more difficult to have both parties agree that the work is honest and balanced. How do we know that the point of view of homeopaths is represented fairly and squarely other than by approval of a representative of the homeopathic community? --Paul Wormer 16:13, 28 May 2009 (UTC)

We should of course give due consideration to whatever points Dana might raise with respect to the draft. In any event I hope that a new draft can be approved in some form. As a physical scientist I cannot help but wince when reading the "Scientific basis of homeopathy" section in the approved article. Citizendium's aspirations toward being recognized as "reliable and of world class quality" are not furthered by having such material in one of its articles, much less an approved article. Raymond Arritt 01:49, 30 May 2009 (UTC)

I left a short note for him asking him to stop by if he has a chance. --Joe (Approvals Manager) 02:20, 30 May 2009 (UTC)

(undent) I haven't been able to look over all the changes, but from what I've seen so far, it looks good to me. I'm not comfortable with the lead yet, though. Comparing the lead from the approved version to the draft, I'm not sure it is an improvment from a copyedit perspective. I think we can probably clean it up some. For example, we use the word 'akin' twice. Our first sentence seems to put the skeptical view before the horse. We appear to be discounting the practice before we even define it. Anyone have an issue with me ~~removing it to the end of the fourth paragraph~~ moving it? This is what we have now:

Homeopathy or homoeopathy is a system of alternative medicine. As an alternative system, it uses a fundamentally different model of health whose principles are not accepted by most medical doctors and scientists. Its proponents, however, say that it cannot be judged by the standards of evidence-based medicine but must instead be evaluated within its own frame of reference.

This is what I changed. Feel free to revert).

D. Matt Innis 04:08, 30 May 2009 (UTC)

Looks OK to me. Maybe Hayford can do some final touch-ups on the writing style, if we ask him nicely. Raymond Arritt 04:10, 30 May 2009 (UTC)

(edit conflict)"Use" is fine with me, English is my other language - southern is my first :)

I, too, would like to see that we have a homeopath review our (mostly your) work. Dana would be great. I also feel good that Paul is satisfied with the chemistry portion and Gareth has looked over the science stuff. Why am I here? :-) D. Matt Innis 04:21, 30 May 2009 (UTC)

Y'all, suh, are heah because while you are not a homeopath, you also have a somewhat different perspective than a pure medical clinician on things that may be good, but not EBM, medicine. I'm a tangent on the biomedical side, but you might be surprised how open I can be to some complementary methods -- and no, I haven't been convinced homeopathy is one of them. After seeing some TCM and shamanic techniques, I'll accept we don't know all -- and I'm still going to insist on an emergency medical protocol for a life-threatening emergent condition. I might even ask a clinician or two, not citizens and not likely to become ones, to review. Howard C. Berkowitz 04:37, 30 May 2009 (UTC)

Dear fellow Citizendium friends…I haven’t check CZ for many months, and I am generally pleased when people want to improve upon previous work. While I do not think that articles should rely upon just one person, CZ is known to respect and utilize the expertise of certain people. This makes sense. I was personally asked by Larry Sanger to be an editor on the homeopathy article many months ago, and I hope that my expertise can be helpful.

I see more biased info here than I’d like to see. Please note that I have purposefully not gone through each correction to determine who made what changes, so it is not my intention to point fingers at anybody. I only want to see a fact-filled, well-referenced encyclopedic article.

I am concerned that the 1st paragraph is inappropriate for an encyclopedia. To actually say that homeopathy is a different model of medicine which most conventional physicians and scientists do not accept even BEFORE discussing what homeopathy is…creates a palpable evidence of bias in action. Please compare the 1st paragraph in the Main Article and see how encyclopedic it is, and then, see how the draft version isn’t.

Further biased and inaccurate info is in the next sentence in the 1st paragraph! “Its proponents, however, say that it cannot be judged by the standards of evidence-based medicine but must instead be evaluated within its own frame of reference.” There is NO consensus from homeopaths on this statement. Homeopaths generally believe that one must evaluate an entire “body of evidence,” which is the totality of basic science studies, controlled clinical trials (double-blind studies as well as outcome studies and cost-effectiveness data), epidemiological evidence, historical evidence, and case studies. Homeopaths do recognize that double-blind studies are helpful, but only when they are conducted in a way that is sensitive to the method of homeopathy itself. Just as double-blind studies are used in a great number of surgical procedures, no one asserts that surgery is therefore “quackery” or “unproven.”

What is written here is non-encyclopedic-like and is simply a half-truth.

The next paragraph has the statement, “it is a homeopathic principle that the more dilute the preparation, the more potent it is.[2] Sorry, this is wrong! “Dilution” is just one part of this process, and anyone who suggests that this is all that there is to homeopathic pharmacy is over-simplifying and trying to set up a straw man.

It is more accurate to say: “It is a clinical observation over the past 200 years from homeopaths and their patients that the more a medicinal substance undergoes a specific pharmacological practice called “potentization” (the medicinal substance is diluted with double-distilled water in a glass vial which is vigorous shaken and then undergoes sequential dilution with vigorous shaking in-between dilutions), the more powerful the medicine acts, the lower it acts, and the fewer doses are necessary.” (Hopefully later we can discuss the silica hypothesis, amongst other theories that provide potential explanation for what is going on).

At present, it is then written, “Dilution often continues to the point where none of the original substance remains in the remedy.” First, Avogadro’s number is a probability issue, not a definitive one. At the most, one can say that “in all probability none of the original substance remains.” Therefore, at the most, it can only be said, “In all probability, the homeopathic potentization process may leave none of the original molecules of the medicinal substance.” But this is not even the point. Homeopaths assert that although in all probability none of the original molecules of the substance remains, homeopathic medicines change the nature or structure of the water to which certain people whose disease syndrome matches the medicine’s toxicology are hypersensitive.

Further bias: The paragraph that begins with (“Physicians are concerned that some patients seek homeopathic treatment as a first resort, even for conditions where there are effective conventional treatments.”) has no place at the top of the article. Once again, I believe that this paragraph is evidence of people re-writing this article in a way that have an anti-homeopathy bias and who seek to set up a straw man. The fact that some good clinical studies on the homeopathic treatment of people with asthma is oddly missing from this paragraph…and in any case, it should not be at the top. References: -- Matusiewicz, R, “The Effect of a Homeopathic Preparation on the Clinical Condition of Patients with Corticosteroid-dependent Bronchial Asthma,” International Journal of Biological Therapy and Integrated Medicine, 1997,15:70-4. -- Reilly, D, Taylor, M, Beattie, N, et al., "Is Evidence for Homoeopathy Reproducible?" Lancet, December 10, 1994, 344:1601-6.

OVERVIEW: It is non-encyclopedic (again) to begin this section as it begins about someone’s assertion that “extraordinary” evidence is required for homeopathy even before one provides an overview of the subject itself.

In fact, if a human being claimed that he could fly, he would simply have to demonstrate that he could do so under controlled conditions ONCE or maybe TWICE or maybe a certain handful of times, as long as the conditions were previously determined and met. He would not have to prove “how a biological mechanism could have evolved” this state (as is asserted in a somewhat silly fashion below in the section on Scientific Foundations).

Ironically, I wonder if some people might condemn the evidence that this man could fly by simply admitting that he can fly but he cannot fly as fast as a jet or as high…thereby, this man is a “fraud.”

It is further ironic that some people claim that there is only “one” medicine…there is “proven medicine” and “unproven medicine.” And yet, is it fair to say that homeopathy requires extraordinary evidence? When one considers that the excessive costs of conventional medicine and the truly low costs of homeopathic medicines, one might assume that there should be “extraordinary evidence” for modern technological medicine.

I therefore recommend that the statement about extraordinary evidence has no place here.

The statement that homeopathy has “no scientific plausibility” is also simply wrong. While I certainly agree that we do not yet known with certainty how homeopathic medicines work, there are “plausible” explanations for how it may work (i.e. the silica hypothesis…plus many others). References: -- Bellavite and A. Signorini, The Emerging Science of Homeopathy: Biodynamics, Complexity, and Nanopharmacology. Berkeley: North Atlantic, 2002. --Roy, R, Tiller, W, Bell, I, Hoover, MR. The Structure of Liquid Water: Novel Insights from Materials Research; Potential Relevance to Homeopathy, Materials Research Innovations Online. 9,4, December 2005. -- In this special issue of the journal Homeopathy (http://www.elsevier.com/wps/find/journaldescription.cws_home/623042/description#description) -- The website of professor Martin Chaplin: http://www.lsbu.ac.uk/water/homeop.html http://www.lsbu.ac.uk/water/memory.html

We have to remember the definition of the word “plausible” (Definition: Seemingly or apparently valid, likely, or acceptable). It does not mean “proven.” It simply has to mean that it is theoretically possible and/or explainable, and there are plenty of scientists who insist that it is plausible.

HISTORICAL ORIGINS: In the last words of the first paragraph, it asserts that Hahnemann conducted provings in “high dosages.” First, bad grammar (perhaps someone meant “from” high dosages). However, it is totally unclear what is meant by “high dosages.” For the record, Hahnemann’s provings were primarily with the CRUDE dose of the substance. Only after 2 decades (!) of such experimentation did he and others begin conducting provings with potentized doses beyond Avogadro’s number (this info is a part of both the original article on CZ and the draft). The proving information from 100-200 years ago confirms what is known about the toxicology of hundreds of substances.

Proposed scientific foundations for homeopathy This seems to be an inaccurate sub-heading. “Scientific foundations” could have many meanings, but what this section seems to focus on is the “proposed mechanism of action of homeopathic medicines.” I believe that THIS should be its sub-heading.

It was written, “For instance, homeopaths point out that water is not simply a collection of molecules of H2O, but contain isotopologues.” Where do homeopaths point this out?

It is asked: · why the principle of similars might apply in the case of homeopathic remedies Does anyone know why resonance has hypersensitivity, why the C note of a piano is hypersensitive to when other C notes are played?

It is asked: · how a biological mechanism could have evolved to recognize the specific nature of homeopathic remedies Is it asked how a biological mechanism could have evolved to benefit from large concentrated doses of conventional pharmaceutical? While the above question is an intriguing one to consider, it is not necessary for the scientific acceptance of homeopathy.

The astronomer Kepler once asserted, “Nature uses as little as possible of anything.”

It is asserted: “There also needs to be · clear and irrefutable evidence for the efficacy of homeopathic remedies, evidence that cannot be explained by placebo effects.” I suggest that we consider saying: “The body of evidence drawn from controlled trials in the basic sciences and clinical trials, epidemiological studies, cost-effectiveness studies, and historical evidence must show benefits from homeopathic medicines as distinct from placebo effects.” CLINICAL TRIALS:

It is written: “Homeopaths strongly value the evidence of their own experience in treating patients, supported by the satisfaction reported by their patients in surveys;” I suggest that this be changed to: “Homeopaths strongly value the evidence of the 200 years of usage by hundreds of millions of patients plus their own experience in treating patients, supported by the satisfaction reported by their patients in surveys;

The newest Cochrane Report on the use of homeopathic medicines to help reduce the adverse effects of chemotherapy and radiation in cancer patients should be added [7].

Also, a new important study on cell cultures seems important due to dramatic effects of some high potency homeopathic medicines, with increasing effects from the higher potencies: http://ecam.oxfordjournals.org/cgi/content/abstract/6/2/257?etoc (For those of you who do not know the journal in which it is published, eCAM, it is published by Oxford University Press, and it has a 2.55 impact factor---that is reasonably good impact factor).

At present, the draft says: “NCCAM's acting deputy director, Jack Killen, said, in a Newsweek article, "There is, to my knowledge, no condition for which homeopathy has been proven to be an effective treatment." I personally talked with Dr. Josephine Briggs, the Director of NCCAM, about this statement, and she told me that both she and he regretted this statement that was made when Killen was new to the field and was serving as acting deputy director. The CZ article itself shows several studies (the Oscillococcinum studies, for instance) which provides evidence that Killen’s statement is wrong. In this light, I propose the deletion of this confusing and ill-informed statement, unless our desire is to provide an anti-homeopathy assertion, whether it is accurate or not, just because it is from an individual who should be informed (but isn’t or wasn’t).

Later in this section, there is a statement: “Homeopaths respond that the vast majority of the larger high-quality trials simply tested a single homeopathic medicine, without the requisite individualization of treatment common to homeopathic treatment. But this does not explain why small trials should have more strongly positive outcomes than large trials.” Actually, this second sentence is not correct. If small and medium-sized studies used an individualized application of homeopathic medicines, while ALL of the larger studies simply use ONE medicine, the larger studies do not have external validity and are of little consequence in terms of the negative result because homeopathy is rarely practiced like that in typical clinical care. It is akin to conducting numerous studies on penicillin in the treatment of people with allergies, arthritis, and heart disease and then asserting that based on the overall “body of evidence” penicillin has no therapeutic benefits.

If one evaluated ONLY the “high quality” studies from the Shang article in the Lancet (2005), homeopathic medicines were found to be effective: -- Lüdtke R, Rutten ALB. The conclusions on the effectiveness of homeopathy highly depend on the set of analysed trials. Journal of Clinical Epidemiology. October 2008. doi: 10.1016/j.jclinepi.2008.06/015. -- Rutten ALB, Stolper CF, The 2005 meta-analysis of homeopathy: the improtane of post-publication data. Homeopathy. October 2008, doi:10.1016/j.homp.2008.09/008

I realize that the above two articles are references in the CZ draft, but I repeat them here because they verify my assertion that we should delete the statement: “But this does not explain why small trials should have more strongly positive outcomes than large trials.”

SAFETY: The CZ draft says: “The U.S. Food and Drug Administration's (FDA) view of homeopathy is that there is no real concern about the safety of most homeopathic products because they contain little or no active ingredients.” Unless we have a formal reference to this statement, we should change it back to what was originally said: “The U.S. Food and Drug Administration's (FDA) view of homeopathy is that there is no real concern about the safety of most homeopathic products because of the extremely small dosages.” OR I suggest a new version: “The U.S. Food and Drug Administration's (FDA) view of homeopathy is that there is no real concern about the safety of most homeopathic products because of the extremely small dosages and because of the 200+ history of safe usage of homeopathic medicines.”

I realize that I’ve covered a lot of ground here. Let’s talk about it…Dana Ullman 04:58, 1 June 2009 (UTC)

On the FDA statement: The wording in the article closely follows that in a statement by the FDA's Edward Miracco:

"Overall, the disparate treatment has been primarily based on the uniqueness of homeopathic products, the lack of any real concern over their safety because they have little or no pharmacologically active ingredients, and because of agency resources and priorities," explains Miracco.

Unfortunately the link presently is broken, though it's available in a cached form at Google. We can wait and see if the link reactivates itself. Raymond Arritt 23:53, 1 June 2009 (UTC)

Answer to Dana

To make the previous section not unduly long I started a new section.

I'm disappointed that Dana still sees so much to criticize and he revived my fears that an article, acceptable by homeopaths and not seen as "fringe" by the rest of the world, is not possible. Dana, are all your objections equally important to you, do they all have to be answered before you can approve the article, or could you be satisfied with a few alterations?

After a quick scan of Dana's text I saw that I'm responsible for two of his objections:

Dana asks: It was written, “For instance, homeopaths point out that water is not simply a collection of molecules of H₂O, but contain isotopologues.” Where do homeopaths point this out?

The answer is easy: in the version approved by Dana. I only added the technical term "isotopologue" to the sentence in the approved version, reading: Water is not simply a collection of molecules of H₂O, it contains several molecular species including ortho and para water molecules, and water molecules with different isotopic compositions such as HDO and H₂¹⁸O. The technical term for molecules with different isotopic composition is "isotopologue".

With regard to Dana's objection: OVERVIEW: It is non-encyclopedic (again) to begin this section as it begins about someone’s assertion that “extraordinary” evidence is required for homeopathy even before one provides an overview of the subject itself.

I moved up the sentence ending with: "... provide the required extraordinary evidence for the benefits of this system" from somewhere further down in the article, and thought that for coherence and style reasons the "extraordinary evidence" had to be introduced by a short introductory sentence. So, nothing deep here, this is fixable.

Further I must add that I cannot take the work of R. Roy seriously, Roy sees water burn (really, he does literally [8], see also National Geographic News June 1, 2009). One or more references to Roy's work in an approved article would let me say goodbye to CZ and join the ranks of those who see CZ as an undertaking where the crackpots rule. --Paul Wormer 07:48, 1 June 2009 (UTC)

Thanx for creating a new section, Paul. It does help.

I'm a bit confused how or why you've refer to Rustum Roy as a crackpot. Besides being professor emeritus at Penn State (!) and besides being the head of a material sciences lab that is world renown (the ISI once ranked it as the best material sciences lab in the world), Roy has had at least 15 contributions published in NATURE...and you have just pointed to a reference in National Geographic to his work. Are you suggesting that NATURE and National Geographic are crackpot too? Please note that my reference to Roy was just one of many (!) where I showed that there IS plausibility to homeopathic potencies. (THIS is what I mean when I say that there is strong bias against homeopathy in this new draft.)

As for isotropologue, I do not think that it helps our article by adding technical terms, and personally, the sentence was already fairly (and seemingly, unnecessarily) technical. Dana Ullman 14:12, 1 June 2009 (UTC)

Dana has some good points; I'd agree that we should perhaps avoid technical terms where possible. On the lead, this section "it is a homeopathic principle that the more dilute the preparation, the more potent it is.[2] Dilution often continues to the point where none of the original substance remains in the remedy. This lack of even one molecule of substance leads scientists to doubt its plausibility and generally reject the possibility that the remedy itself is responsible for any of the effects that may occur." is, as Dana says, wrong; this is not a principle of homeopathy, and remedies are potentised by vigorous shaking, not by dilution in their theory. As homeopaths do not themselves believe that potency is imparted by the presence of any molecules, it is perhaps important not to phrase this criticism in terms that may seem to suggest that homeopaths don't realise that there are no molecules present.

However, to cite Chaplin's websites as cases for the scientific plausibility of homeopathy as explained by homeopaths would I think be wrong. Chaplin states that "Although there is much support for water showing properties that depend on its prior processing (that is, water having a memory effect), the experimental evidence indicates that such changes are due primarily to solute and surface changes occurring during this processing. The experimentally corroborated memory phenomena cannot be taken as supporting the basic tenets of homeopathy although they can explain some effects" He suggessts that the vigorous shaking "may produce significantly increased concentrations of silicate, sodium and bicarbonate ions by dissolution of the glass tubes and increases in nanobubbles and redox molecules from the atmosphere, respectively" In short, I think Chaplin argues that the water that homeopaths prepare may include some unanticipated contaminants which may mean that it has some effects different to those of solutions diluted without shaking, but he does not say anything that I have seen that indicates that this is a mechanism by which any properties of the original substance that was diluted can be retained.

As for Rustum Roy - looking from the outside he seems to be a very distinguished materials scientist, but he is 86; his reputation was not built on his ideas about water structure, and I take Paul's comments as meaning that his current ideas in this area are not given mainstream credibility. I think it would be a mistake to cite him, basically because I don't see how he could be cited without immediately following with an attack on what we're citing him for, to put the mainstream view from materials science.Gareth Leng 14:33, 1 June 2009 (UTC)

There's lots of ground to cover here. May I suggest that we proceed step by step? In my view the three sections of the Approved article with the most serious problems are (in order of decreasing severity) "Scientific basis of homeopathy," the lede, and "Overview." Would it be helpful to cover those three sections (or other specific sections) in turn, not moving on to the next section until we reached agreement on a particular section? Raymond Arritt 15:17, 1 June 2009 (UTC)

I introduced isotopologue not to show off my knowledge of difficult words, but, as always with technical terms, to condense the explanation why a mixture of isotopic forms of water cannot explain memory. It was not me who thought of isotopes as a possible explanation and I didn't create it as a straw man either. As far as I'm concerned, the suggestion that the presence of isotopologues can explain the memory of water can go.--Paul Wormer 15:31, 1 June 2009 (UTC)

A simple Google search shows that water isotopes are commonly invoked as a proposed mechanism for homeopathy. Accordingly I disagree that we should delete all mention of it, though the material could perhaps be reworded for a general audience. Raymond Arritt 15:39, 1 June 2009 (UTC)

I sympathise with Paul over isotopologues; this is the type of thing that cropped up again and again as the original article evolved - sometimes it's necessary to explain an argument in detail to show at the end of the day that it should all disappear - that's why in the end we proposed moving all such technical arguments to the article on memory of water. I didn't see any errors in the original version of "Scientific basis" and don't see any in the present version either. I don't see this section as really being an issue. Paul has added explanations of why some hypotheses are untenable the original version tackled that in a different way with this para, now excluded - "These are not mechanisms of memory in any cognitive sense; the term memory here is used as a metaphor, implying only that the past history has a discernible influence on the present properties, but homeopaths believe that, through these or other mechanisms, water can form and retain some useable "memory" of the original medicinal substance[65]. Many homeopathic remedies are however available as solid preparations -"pillules" of lactose and/or sucrose, intended as inert cores which are transformed into homeopathic drugs by impregnating them with a dilution of homeopathic stock." In other words the original version said (1) that just because processing might affect the properties of water it doesn't amount to memory in the sense that homeopaths posit - i.e. an information rich (cognitive) memory of the structure of the diluent and (2) the discussion is by the way because most remedies aren't in liquid form anyway. The lede has problems but I think they should be reconcilable. The position of the overview is probably the crux - originally it was at the end and I worried about it "having the last word", which is why I was careful to try to end it on an open note. I see Dana's point about it setting an editorial tomne for what follows. I am and have always been relaxed about letting homeopaths describe homeopathy in their own terms (with the ground rules that should apply to all articles, about verifiability, sourcing, claims etc.) My understanding was that leaving the scientific perspective until late, and then wording it gently, led some into thinking that the article was unbalanced. I always thought it's not over till the fat lady sings, and that readers can make up their own minds pretty well given the facts without rhetoric, but this is a collaboration and I'm OK with a reordering.Gareth Leng 16:04, 1 June 2009 (UTC)

(undent)Glad to see Dana's response above, but I haven't followed up on all of the issues (that was a long discussion!). I still have only worked my way through the lede. I am a little confused, though. I'm not sure whether Dana had a chance to see the changes that I made late last week because it seems that some of the issues relate to things I tried to handle. (For example, the statement from Dana above: ... biased and inaccurate info is in the next sentence in the 1st paragraph! “Its proponents, however, say that it cannot be judged by the standards of evidence-based medicine but must instead be evaluated within its own frame of reference.” - I removed that sentence already). I would like Dana to comment on the newer version of the first paragraph before I think about changing more.

If we've gotten something wrong from a homepath's perspective, let's fix it. Obviously, Dana is an expert there, so jump in. This update is meant more to correct any shortcomings from the chemist's perspective, which Paul can handle. The rest of us can cleanup and work on juxtapositioning of ideas - which if we are not careful can taint the neutrality that we aspire to. D. Matt Innis 23:01, 1 June 2009 (UTC)

As a general comment, I'm uncomfortable relying on anything that depends on "long history" or, in the case of Roy, an older body of work -- just as I was uncomfortable citing immunology from 1905 outside the history article. Now, I'm willing enough to go along with the history of homeopathy demonstrating a lack of direct adverse effects, but I simply can't say the history justifies claims of efficacy. A huge number of medical procedures and techniques were believed efficacious for many years, but often turned out to be useless or worse.

From a presentation standpoint, I just don't think we can get away with being perceived as neutral without a statement, in the lede, that the principles of homeopathy are not medically accepted. That doesn't preclude being more precise about the principles of homeopathy, although I make a distinction between a "principle" such as vital force and similars, and a "technique" such as potentiation. Howard C. Berkowitz 23:19, 1 June 2009 (UTC)

I see it as a statement in the lead that states something to the effect of "not being medically accepted" (though this probably even needs some attribution - medically who) would be absolutely necessary in order to make it neutral. Otherwise we would be advocating for one side and not the other. There is no question that there is dissent, and in some cases quite passionate. To leave that out would be amiss. I am not sure which "principles of homeopathy" we're talking about, though. Medicine uses a lot of principles that are basic to homeopathy. So we probably need to be more specific when we make a statment like that. When I try to evaluate what it is that "medicine does not accept", the only thing I come up with is that "not a single molecule" is in the remedies. Isn't that what makes it "implausible". Everything else, including that there is little EBM, can be said about procedures in each field and, unless we want to debate with the scarce hard data that is available about each, we probably shouldn't bother.

I think that as long as we can show that homeopathy has a rich history and is still very much used today, that the science is shaky, its popularity is good, and you can't argue that it isn't safer than any medication, then we are in the ballpark. The risks are related to missed opportunities to diagnose and treat the treatable life threatening diseases and that's about it. I think we pretty much say all of that. D. Matt Innis 00:42, 2 June 2009 (UTC)

Gareth is correct. I evaluated the version of the Draft from last Friday, not the most recent version. I appreciate some of the corrections, though I have some additional hopefully helpful thoughts.

I strongly recommend that we move the 3rd paragraph and move it to become the 1st paragraph. First and foremost, homeopathy is the “principle of similars.” It is not a good idea to reference the “vital force” first (As I mentioned previously, 9 of my 10 books don’t even make reference to the “vital force,” so as a principle, it is NOT essential.

After that new 1st paragraph, I recommend that we add: Historians today recognize that conventional medicine of the 19th century was not only ineffective, but it was dangerous. Although homeopathy was and still is controversial, it is recognized that homeopathy helped question and ultimately stopped the use of bloodletting, leeching, and dangerous drugs of that time. In fact, Sir William Osler (the “father of modern medicine”) asserted that ““No individual has done more good to the medical profession than Samuel Hahnemann.” [Homeopathy, Time, May 27, 1940.]

The OVERVIEW is much better. Paul or someone made some changes in the paragraph about extraordinary evidence in a way that works. Good work.

However, I cannot accept the statement in this section about the “scientific implausibility” of homeopathy. I have already explained my rationale here. Because Gareth and others have noted that some theories exist for how homeopathic medicines may work (even if we ignore Rustum Roy’s work), there IS plausibility.

The Lancet’s article about homeopathy in India asserts that 100 million people in India today rely solely on homeopathic medicines as the method of treatment is of be of significance. I suggest that we insert this fact in the Overview right after the reference to homeopathy in the UK. The reference: http://lib.hukm.ukm.my/indeksjurnal/2007/lancet/370/lancet10.pdf

The section on THE LAW OF SIMILARS has a dangling fact that doesn’t seem to flow or fit. I suggest that we delete: “Vaccine doses are calculated from the TCID50 dose; the minimum dose required to infect 50% of tissue cultures tested in a laboratory assay. A single dose of measles vaccine will contain at least 1,000 x the TCID50 dose in 0.5 ml.[35] “

THE CLAIMS FOR HOMEOPATHY Because the vast majority of homeopaths see themselves as just one part of a health care team, the list of diseases which homeopaths sometimes treat need to include a statement that affirms that homeopaths do not see themselves as the sole source of treatment. I suggest that we add after the word “AIDS”: The vast majority of homeopaths see themselves as just one part of a health care team, and thus, although they may treat people with a wide variety of chronic illnesses, they do not seek to be the sole health care provider.

My previous statements about clinical studies and scientific foundations still stand and need further discussion. More later… Dana Ullman 05:52, 2 June 2009 (UTC)

Dana, you write: The OVERVIEW is much better. Paul or someone made some changes in the paragraph about extraordinary evidence in a way that works. Good work. I wrote that (commonplace etc.) on May 15, since then the paragraph hasn't changed. What version did you comment on above?--Paul Wormer 06:39, 2 June 2009 (UTC)

I agree that the principle of similars should probably take a higher priority than vital force and made some changes accordingly. It probably still needs some touching up, so go for it. D. Matt Innis 00:07, 6 June 2009 (UTC)

Matt's recent revision of the lede is much better. I agree the measles TCID50 isn't needed.

I am a bit confused about the statement that homeopaths see themselves as part of a health team. Ramanand was fairly adamant that he saw homeopathy as primary. NCCAM categorizes homeopathy as a whole, alternative system, not complementary.

If the current homeopathic view is that it is complementary, then I think we have to have some discussion on the complementary relationships. In past drafts, we've had, for example, attacks on corticosteroids in asthma. How do homeopaths work in an integrative medicine team? Howard C. Berkowitz 00:08, 6 June 2009 (UTC)

Howard, I understand your confusion, but let me try to help you understand. Homeopathy is BOTH an alternative to conventional treatment AND a complement to it, depending upon the situation. Sometimes, homeopathy can be used as the sole method of treatment, and sometimes, it is a part of a complex treatment program that includes conventional medical treatment and various other "alternative" modalities. Yes, there are certain risks in using homeopathy as the "sole" method of treatment, and there are other risks in using conventional medicine as the "sole" method of treatment. Dana Ullman 20:30, 7 June 2009 (UTC)

I understood that. Specific examples of the complementary use, however, are needed, if the assertion that it is complementary as well as alternative is made. Sorry, this "helping" is coming across as patronizing rather than informative. Please be specific, and do realize that I understand the complementary vs. alternative, and risk-benefit decisions. I'd note that Ramanand was insistent on alternative-only. Howard C. Berkowitz 20:57, 7 June 2009 (UTC)

Behring, and other things that are history at best

I simply cannot accept, in the main homeopathy article,

, Physicians of the 19th century though Emil Adolph von Behring, the scientist who discovered the tetanus and diptheria vaccines, acknowledged that vaccinations derived from the homeopathic principle.^[4]

He may have "acknowledged", but, bluntly, he was wrong.

History of homeopathy, yes. Think of it in this way: let us assume we are dealing with the article on vaccination. Would anyone take 1905 theory on immune response seriously there? Would a reference to homeopathy be appropriate in an article on vaccination? Jenner obviously didn't use the principle of homeopathy as it had not been named, and there's little to assume that he used the principle of similars -- he used the observation that cowpox caused immunity. Von Behring wouldn't be especially relevant to vaccination other than to say he developed certain vaccines; he simply did not understand the mechanisms. Nobel Prizes were being given then for clinical results, not necessarily for understanding -- indeed, there's a Nobel or so (e.g., pernicious anemia) that is based on erroneous explanations.

It is one thing to cite Hahnemann, as directly relevant to tbe development of homeopathy qua homeopathy. It is quite another thing to cite effectively ancient biomedical authorities as justification for homeopathic explanations in an article on modern homeopathy and the direct development of homeopathy. I see quoting Von Behring as a misleading appeal to authority to justify homeopathy's effectiveness. Howard C. Berkowitz 20:00, 6 June 2009 (UTC)

von Behring is considered the "father of immunology." When anyone today says that there is no comparison between homeopathy and immunology, it is appropriate to go to one of the sources of this assertion. Then, we can also make reference to modern writings, such as: http://ecam.oxfordjournals.org/cgi/content/full/nel117v1

This combination of original source material and modern references is just what CZ should be about. Dana Ullman 15:45, 7 June 2009 (UTC)

As the draft is presently written, it uses a blanket statement that is extreme and wrong. The material that I originally wrote should be re-inserted along with the above reference. Dana Ullman 15:48, 7 June 2009 (UTC)

I disagree that CZ should have such a combination in main articles. Historical background is entirely appropriate in subarticles. For example, I have a top-level article, Wars of Vietnam, with extensive subarticles. Some historical background is merely mentioned, or given a sentence, with a link to a more specific article. The French colonization in 1868 is relevant to modern wars, but not in detail, although it is relevant to the subarticles dealing with the war against the French. Even so, there are things relevant to the Vietnamese military view that are sufficiently far removed that they are not even formal subarticles, such as the Nguyen Dynasty and Dai Viet.

Someone may be a spiritual father of an idea, but that's their main significance today and it is not appropriate to go back, at least in basic understanding of the current situation, to a source whose specific ideas have long since been proven to be, at best, glimmerings. This is especially true in fields that go through constant self-criticism and improvement. I sincerely doubt any approvable article on immunology would cite von Behring as authoritative. Howard C. Berkowitz 18:27, 7 June 2009 (UTC)

I find it odd that Howard tell us that von Behring was "wrong" when he asserts the link from homeopathic principles to vaccinations. This is re-writing history. von Behring discovered two important vaccinations, and he attributes in part his discoveries to homeopathic principles...and yet, Howard is suggesting that he did not, while von Behring asserts that he did. Even if Howard doesn't believe in the potential benefits of homeopathy, he should not write homeopathy out of history based on HIS beliefs. And while I agree that we should not provide too much detail about history, I also believe that we should not ignore it. My efforts to add ONE sentence about the history is certainly not dwelling in the past but is providing some important context. THAT is why encyclopedias do. Dana Ullman 20:24, 7 June 2009 (UTC)

No, I did not say von Behring did not associate his discoveries to homeopathic principles. I said that he was wrong to do so, by the much better modern understanding of immunology. While one can say Copernicus, Ptolemy, and Galileo had details wrong in the heliocentric model of astronomy, one can also say that the earth-centric model was flatly wrong. Any implication that diptheria and tetanus vaccines are based on the principle of similars or other homeopathic models, as opposed to antigen-antibody reactions on a molecular basis, are flatly wrong. Any encyclopedic mention that his assumption is other than wrong is not to rewrite history, but to rewrite reality.

As long as there is an implication that Von Behring's idea means that vaccination works by homeopathic principles, yes, it should be ignored. Howard C. Berkowitz 20:57, 7 June 2009 (UTC)

Mutual respect

I think we need to maintain mutual respect for the different views of scientists and homeopaths; we should not imply that somehow they are compatible or that scientists have some similar beliefs when they don't. The principle of similars is not held in any form by scientists today, a principle is a universal truth and no scientist would consider this a universal truth. It is the case that in the 19th century the idea was part of the reason for experimenting with vaccination, but that's all that can be said. Darwin was never an advocate of homeopathy; he was a skeptic, he did try homeopathy for a while, though skeptical throughout, and when he concluded thatit didn't work he reaffirmed that skepticism strongly. I don't think it's right to list adcocates of homeopathy, that just invites the response of a longer list of more distinguished skeptics. Gareth Leng 11:28, 7 June 2009 (UTC)

Concerning lists of advocates, I agree. We can explain homeopathy without creating long lists of advocates and skeptics. Let's not go there. We wouldn't list all the people that advocate for conventional medicine and their skeptics, so why do it here. D. Matt Innis 14:01, 7 June 2009 (UTC)

History IS important, and highly respected "cultural heroes" who have gone public with their use of or advocacy of homeopathy is noteworthy. Likewise, those "cultural heroes" who have spoken against it might be similarly notable.

As for Darwin, he definitely was a skeptic of homeopathy, though the RESULTS that he received from Dr. James Manby Gully are notable. Just prior to his visit, Darwin was unable to work one out of every three days, and he said that he was "going the way of all flesh." Within one month of treatment, he was totally re-invigorated and became an "eating and walking machine." For details on this history, go to: http://www.homeopathic.com/articles/view,128

As for the "principle of similars," it may not be recognized as a "universal truth," but it is a principle that has been acknowledged since ancient times, and it is still used in modern medicine, though it is simply described in a different way. Dana Ullman 15:59, 7 June 2009 (UTC)

I have to agree that the principle of similars is not, in any meaningful way, part of biomedical thinking. Claiming that it is is either a failure to understand modern models or an attempt to justify support that is simply not there. That an antigen is "similar" to a receptor is an observation, with substantial theoretical and experimental support, which is completely different than the idea of similar effects in a proving. Howard C. Berkowitz 18:31, 7 June 2009 (UTC)

We need to be careful to avoid black/white statements. Here's a 2nd reference to link homeopathy with modern concepts of immunology: http://ecam.oxfordjournals.org/cgi/content/full/3/1/13?ijkey=2c71ff01e079f4832810794bbcd0f7ae8038282a Dana Ullman 20:13, 7 June 2009 (UTC)

Oh, I think this is very, very dark gray rather than black and white, but I do not see attempts to link homeopathy with modern concepts of immunology as any more than an attempt to strengthen the position of homeopathy. Immunology (simplifying) is about antigen-antibody reactions, not similars, not vital forces, not potentiation by dilution and succussion. The mechanism of immunization does not need to hypothesize about memory of water but is directly demonstrable at a molecular basis, in vitro and in vivo. Howard C. Berkowitz 20:57, 7 June 2009 (UTC)

Darwin's experience with Gully is fully covered in Charles Darwin's illness, it is clear that whether he experienced any benefits or not, he was severely skeptical throughout, he certainly was no advocate of homeopathy - quite the opposite. To argue that he benefited from it, even though he concluded it was ineffective is not something I feel we can include here.

The link Dana provided just discusses basophil degranulation - the benveniste studies - these are cells of the innate immune system responsible for inflammatory responses - the adaptive immune system that generates immunity is quite separate. Immunity depends on antibody production which requires recognition of an antigen, without an antigen you can't generate antibodies to recognise the antigen - so the presence of an antigen in a vaccine is essential; it's very much not an example of like cures like - the antibody recognises the particular molecule, and will not recognise a different molecule even if the different molecule produces identical symptoms. Which is why vaccinations against one flu strain are ineffective against another. Thus, vaccination is actually a counterexample to the principle of similars, and thus a disproof of it. Gareth Leng 08:31, 9 June 2009 (UTC)

Should this point, then, not be in the article? Howard C. Berkowitz 13:58, 10 June 2009 (UTC)

A seeming impasse

I'm afraid that I see no resolution to the idea that clearly disproven/obsolete statements by biomedical figures belong anywhere except the History of homeopathy area. The matter is even stronger for the issue of endorsements and lay advocates.

Realistically, there can be an Editor vote here. I'm trying to work with Chris to get the Editorial Council election moving, but it is inactive at present, and Larry is not often available. Howard C. Berkowitz 21:04, 7 June 2009 (UTC)

Gangrene

Gangrene has been in this article for some time, with a reference on its homeopathic treatment. Why remove it? Now, if you were asking my opinion, I'd regard homeopathic treatment of gangrene as insane, but no non-homeopath put that into the article.

Claims that severe diseases can be treated homeopathically, I believe, do belong in the article, to let the reader judge plausibility. Now, if as I had asked, there was an example of how homeopathy might complement other methods in the treatment of gangrene, I'd find that quite interesting and informative. The claim that was removed, however, did not consider debridement or the carefully considered use of optional therapies, including hyperbaric oxygen and anti-clostridial antibiotics. Howard C. Berkowitz 22:29, 7 June 2009 (UTC)

The gangrene discussion is a straw man. Unless Howard can show that it is somewhat common for homeopaths today to treat it solely with homeopathic medicines, it has no real or clear purpose. There is already enough info on this section on the prescription of homeopathic medicines to treat serious illness. Please cite some type of reference to your assertion or let it go... Dana Ullman 14:30, 8 June 2009 (UTC)

Why was it not a straw man when Ramanand brought it in, but no objection was raised by homeopathic experts? If there are to be claims for treating cancer, as vague a term as that is, multiple sclerosis, etc., please cite some sort of reference to your assertion or let it go...

Further, I am still waiting for concrete examples of how homeopathy is used in specific complementary treatment plans, not vaguenesses about balancing risks. I ask for nothing more than would be in a risk-benefit analysis of a medical procedure.

First, I would simply say that not all homeopathic "experts" are equal. Gangrene-out. We can also take out multiple sclerosis, simply because I am not familiar with the modern literature's reference to it in homeopathy, while there is a significant literature on homeopathy and cancer (I cited some...and as such, I'm wondering why you're asking for it here).

Howard, I am not certain if you are being obstinate without purpose or you are simply not reading our article or Talk sections, but I recently discussed and referenced a 2009 (!) Cochrane Report on the use of homeopathic medicines to reduce the side effects of chemotherapy and radiation. I would assume that THIS is quite strong evidence of the use of homeopathy as a complement.

Please also note that the use of homeopathy as an alternative or as a complement is also dependent upon the patients' desires. Some patients do not want any chemo or radiation...or they have had it already and don't want any more. Some patients, on the other hand, want to use conventional and homeopathic treatments together. Dana Ullman 23:52, 8 June 2009 (UTC)

Obstinate? I might prefer to say that I am following what I consider to be standards of encyclopedic writing, with which, here and there, I have just a bit of experience outside a single subject. Simply citing a study, without context, without explanation, is neither evidence nor encyclopedic writing.

Telling me some patients want to use conventional and homeopathic treatments together tells me absolutely nothing about the best homeopathic thinking about how the disciplines can be complementary. Howard C. Berkowitz 00:48, 9 June 2009 (UTC)

I inserted the section on gangrene. I think it's important to recognise that many physicians believe that it is often better not to treat mild self-limiting conditions, and in these circumstances are perfectly comfortable with homeopathic remedies as placebo treatments that reassure the patient while doing no harm. However, most are incensed by the claim that homeopathy can cure anything, and consider its use in serious conditions as irresponsible and potentially dangerous in deflecting patients from effective treatments. I'd be only too happy to remove mention of gangrene, AIDS etc if we can find an authoratative homeopathic source condemning this use. Otherwise I think we must tackle this important issue explicitly. Dana, can you point to statements from homeopathic organisations condemning the use of homeopathic remedies in such cases, and we can cite those?Gareth Leng 09:06, 9 June 2009 (UTC)

My recollection, Gareth, is that several people were involved in bringing in material on gangrene. It was Ramanand, I believe, that mentioned the homeopathic remedies. Again trusting to wetware memory, I believe you mentioned dry and wet gangrene, which surprised me a bit since that distinction is not used in the quick scan of trauma surgery texts I have at hand. If I may suggest avoiding the provenance of the gangrene material, I think that would be a good idea.

"Incensed" is, indeed, not at all hyperbole, especially when it suggests alternative treatment for emergent presentation of conditions where minutes may make the difference to survival. This did come up for several respiratory emergencies, where it was not at all clear to me that all were even referring to the same entitities with asthma, bronchitis, and anaphylaxis. I happened to spend yesterday at a tertiary care veterinary center, trying to assess what may be related bronchospastic, sinus, and skin disorders in a very dear cat. I should have a good many more test results today, although it's frustrating that many of the immunologic diagnostics from human practice aren't available. Nevertheless, while I am quite willing to work with elimination diets and careful observation for Mr. Clark's obviously uncomfortable skin lesions and mild respiratory disorders, incensed would be too mild a word for my reaction to someone that tried to suggest using other than bronchodilators and corticosteroids if he has another frightening respiratory exacerbation.

So, Gareth, I agree that explicit condemnations are needed here, or a much more detailed discussions than "some patients make choices." Indeed, I can think of the very soul-searching explorations I've made in choosing between aggressive and palliative cancer therapy for both two- and four-legged family members, where the responsibility was mine. I considered science and quality of life, but I do not regret that I physically intimidated people that tried to block the decision once made. Howard C. Berkowitz 10:48, 9 June 2009 (UTC)

I simply recommend that we delete the paragraph about gangrene unless or until someone finds modern references to its treatment. There are, however, good modern references to the treatment of many non-self-limited conditions, ranging from COPD, AIDS, and cancer. Dana Ullman 02:19, 10 June 2009 (UTC)

Modern references to the use of homeopathy for treating gangrene are abundant. Just beginning to scratch the surface, we find a mix of practicing homeopaths and academic sources:

Diabetic foot (gangrene) cured by homeopathy, Dr. Prabhakar Shetty (Licentiate Certification in Education of Homeopathy)
Arsenicum album recommended for treatment of gangrene in Homeopathy: An A to Z Home Handbook by Alan Schmukler, founder of the Homeopathic Study Group of Metropolitan Philadelphia and teacher of homeopathy for Temple University's adult education program.
Subramanyam., B, 1999:Gangrene of tail in a dog cured with homeopathy Indian Veterinary Journal 76, 241-242.
Sivaraman, P., 2003: Skin Troubles Cured By Homeopathy. Published by B. Jain, 404 pp. Materia Medica with numerous references to gangrene.

Additional sources available if you need more. Raymond Arritt 02:53, 10 June 2009 (UTC)

I don't understand something

The following just doesn't parse:

because the historic use of homeopathic medicines have not found a deterioration of effects over time and because finished product identification is not presently possible, though identification of the starting product using modern pharmacological processes is utilized by homeopathic drug manufacturers and is regulated by the FDA.

Now, if this means that it is impossible to detect any of the simillium in a remedy, I suppose I can understand that from an Avogadro standpoint. It also reinforces the idea that there is no practical means of using memory of water.

It's also a bit confusing to say that there has been no deterioration, if, using current methods of analytical chemistry, there is no difference between a just-made remedy and one that is years old. One might need to assume that water modifications are immune to entropy, or simply that pure water doesn't deteriorate. Howard C. Berkowitz 22:41, 7 June 2009 (UTC)

Howard, I am confused by your question. Perhaps you do not understand the meaning of the word "simillimum." "Simillimum" is the most similar medicine to a specific person. The only way to know if a medicine is the simillimum to a specific person is what their response to treatment is...and this has no meaning to drug regulation.

What I wrote is accurate. Please note that I did not say that there is "no deterioration" but that homeopaths "have not found a deterioriation of effects over time." There may be some deterioriation over time, but there is not yet evidence of it. By the way, the French require an expiration date of 5 years on each homeopathic medicine. Dana Ullman 14:27, 8 June 2009 (UTC)

Oh. Homeopaths have not found any deterioration. Homeopaths aren't routinely qualified in analytic chemistry at the nanochemical level.

I used "simillium" as the medicine, selected for the patient, that is introduced into double distilled water, succussed, and potentized. Since selection of the medicine is individual, it seemed the appropriate term, certainly better than "active ingredient" since there needs to be causality shown for a pharmacologically active ingredient.

Again, please watch the patronizing; "perhaps you do not understand" is quite different from "the definition of simillium is...". Now, if the only way to tell if a simillium is appropriate to a person is that it works, how would it be possible to distinguish a remedy with the wrong simillium from a deteriorated remedy with the right simillium?

As far as I can see it, the blunt truth is that homeopaths do not submit to drug regulation as applied to any other area of therapy, but hand-wave about "history of not doing harm" and "prove it doesn't hurt." Howard C. Berkowitz 14:47, 8 June 2009 (UTC)

Actually, I thought that my choice of words was not patronizing, but my apology if it seemed such. Now that you know what it is, you hopefully understand that there is no objective measure of a simillimum and that the only way to know if a simillimum was found was by the reactions to the medicine from the patient.

As for your reference to homeopaths not being analytic chemists is another strawman. My point is that homeopaths use their medicines for many many decades, and sometimes, they use medicines that have been handed down to them from old homeopaths, and these medicines still seem to work. My statement above still holds, but please don't assume that I said or implied that homeopaths did some type of chemical testing (I never said such nor implied such). Howard, you do have a strong tendency to make assumptions that try to make homeopathy and homeopaths much stranger than they are. I hope that you will become aware of this, just as I will try to not patronize you, so that we can work together more effectively. Dana Ullman 00:01, 9 June 2009 (UTC)

(EC) "Seem to work". Quad erat demonstratum.

The point is that for historical and political reasons, homeopathic remedies get a pass that no other therapeutic modality gets. I wouldn't say I make assumptions that make homeopathy stranger than they are. I would say I observe when homeopaths make claims that are acceptable in no other field of health care. If there's no chemical testing, and there's no way to detect the efficacy, I suggest that is part of the reason a majority view is that homeopathy, as opposed to many other alternative medicine, comes across as unconvincing fringe. Howard C. Berkowitz 00:48, 9 June 2009 (UTC)

There are all types of exceptions in every field of endeavor. Take surgery, for instance. We all realize that one cannot conduct double-blind placebo controlled studies, but no one (!) refers to surgery as quackery or unproven, even though there is a long history of mis-using surgerical procedures. Dana Ullman 02:08, 9 June 2009 (UTC)

I don't think it is a big leap for us to disconnect homeopathy as a profession from homeopathy as a treatment. In the case of a treatment option, it isn't hard to imagine an MD using homeopathy in a patient where "watch and wait" is considered a reasonable choice for a variety of reasons, i.e. childhood ear infections. Head colds, rhinitis, allergies, anxiety and things that may not necessarily require antibiotics or be the result of a chemical imbalance (or perhaps the risks outweigh the benefits), the onus sits on the physician to guide that patient through to health. We, as a community, tend to trust the MD when he/she uses homeopathy because we know that he/she could have used antibiotics, etc.. The fear is that the homeopath or alternative practitioner would continue to treat past the point of no return. The question is whether this fear is real or imagined. I think what Dana is saying is that his training may lend more to the complementary model than Ramanand's, who lives in a region where treatment protocols are totally different, in other words, the traditional medicine of the region is more apt to prevail - in his case, it's not considered alternative medicine at all, but just plain ole medicine. D. Matt Innis 03:59, 9 June 2009 (UTC)

I think, Matt, I agree with the spirit of what you just said...I think. :-)

If this disconnect could be made more clear in the article, it would help. An implicit acceptance of watchful waiting can make sense to someone with a reasonable amount of medical sophistication, but isn't necessarily obvious to the general reader. Further, when I think of complementary medicine, I think of experience with very closely collaborative integrative medicine, where, for example, an MD works with an OMD in acupuncture, or the MD may be dual-trained in medicine and TCM/acupuncture. I think of how my primary internist, a quite academic sort, routinely cross-referred to a dual-certified DC/PT; the latter would not have dreamed of treating chest pain until emergent medical causes had been ruled out. In like manner, the internist routinely referred for chronic pain.

Just to say there is complementary work, or to cite a study or two, just isn't enough for this article. Howard C. Berkowitz 04:17, 9 June 2009 (UTC)

Need help finding a source

I was looking for the FDA source for this statement, but the link does not seem to work for me.

FDA regulates homeopathic drugs in several significantly different ways from other drugs. The Manufacturers of homeopathic drugs are deferred from submitting new drug applications to FDA. Their products are exempt from good manufacturing practice requirements related to expiration dating and from finished product testing for identity and strength because the historic use of homeopathic medicines have not found a deterioration of effects over time and because finished product identification is not presently possible, though identification of the starting product using modern pharmacological processes is utilized by homeopathic drug manufacturers and is regulated by the FDA. Homeopathic drugs in solid oral dosage form must have an imprint that identifies the manufacturer and which indicates that the drug is homeopathic.^[5]

↑ Iris Bell I (2005) All evidence is equal, but some evidence is more equal than others: can logic prevail over emotion in the homeopathy debate? J Alt Comp Med 11:763–9.
↑ Appian, History of Rome, §111
↑ There is a famous, untitled poem about Mithridates by the English poet A.E. Housman. The last line is, "I tell the tale that I heard told, Mithridates, he died old."
↑ Behring, A. E. von. Moderne Phthisiogenetische und Phthisotherapeutische: Probleme in Historischer Beleuchtung. Margurg: Selbsteverlag des Verfassers, 1905.
↑ Homeopathy: Real Medicine or Empty Promises?, Food and Drug Administration

D. Matt Innis 00:04, 9 June 2009 (UTC)

Matt, this recently disappeared from the FDA website. Who knows why -- maybe they are reorganizing their site. Google has a cached copy but I don't know how long cached pages stick around. There are numerous verbatim copies posted around the web, such as here and here and here (among others). Raymond Arritt 00:45, 9 June 2009 (UTC)

Thanks Raymond. I see that we have quoted this work verbatim as well and therefore need to put it in quotes, but Dana's last edit made an addition that is not part of it. It makes it appear as if Dana's statement was the reason that they made the decision, which of course, would be misleading. We either need to put this in our own words, or take Dana's part out (italics)and quote the whole thing.

cited version

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 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.

our current version

FDA regulates homeopathic drugs in several significantly different ways from other drugs. The Manufacturers of homeopathic drugs are deferred from submitting new drug applications to FDA. Their products are exempt from good manufacturing practice requirements related to expiration dating and from finished product testing for identity and strength because the historic use of homeopathic medicines have not found a deterioration of effects over time and because finished product identification is not presently possible, though identification of the starting product using modern pharmacological processes is utilized by homeopathic drug manufacturers and is regulated by the FDA. Homeopathic drugs in solid oral dosage form must have an imprint that identifies the manufacturer and which indicates that the drug is homeopathic.^[1]

D. Matt Innis 01:10, 9 June 2009 (UTC)

My bad! Apologies. Please know that I had thought that I had corrected that error...but I guess I didn't. It was NOT my intention to change that quote. Dana Ullman 02:03, 9 June 2009 (UTC)

No problem. Until and unless we come up with a rewrite of that blockquote, I'll go ahead and change it back. You may feel free to make a comment below that if you like and we can all go to work on it from there. I'll leave the FDA sourcing for now but we probably should see if we can find it again or cite another source. D. Matt Innis 03:24, 9 June 2009 (UTC)

Changes

1) Dana replaced this sentence "Thus conventional treatments involve application of measurable doses of substances, at levels known to activate a cellular response. In contrast, homeopathic preparations above the $24X$ ( $12C$ ) potencies do not contain enough molecules to activate any known metabolic or signalling pathway." with a sentence suggesting that some remedies have been shown to induce an immune response. That is wrong; the paper describes the contested effects on basophil degranulation, while these are part of the innate immune system this is not "an immune response" - that phrasing specifically referes to induced immunization - i.e. antibody production, which is the key mechanism of action in immunity.

2) the lede change - I have to contest Dana's change, it is simply not right to state that homeopathy follows a principle unless it is clear that this is their own principle not accepted by anyone else.

3) Again, publication bias is not specific to "small studies with chance false positive outcomes", it's unrelated to either the size of the study or to whether the results are valid or not; publication bias simply is about the fact that studies without positive outcomes are less likely to be published. Gareth Leng 14:48, 9 June 2009 (UTC)

concerning 1); I agree. Feel free to make your adjustments.

concerning 2); unless it is clear that this is their own principle not accepted by anyone else. Then maybe principle is the wrong word?

concerning 3); I agree. Publication bias is just one of the factors we should all look at with any study. Just as I am sure that everyone considers the source when Johnson and Johnson releases their findings about Tylenol. D. Matt Innis 17:12, 9 June 2009 (UTC)

Gareth is over-simplifying the eCAM research that I referenced. Antibody production is not the only part of immune response. What he wrote is simply wrong...and this is why I chose to delete it There is evidence that various homeopathic doses have influences on immune response, though more research is certainly warranted.

I think my point is that in the context of immunity - i.e. vaccination, the relevant part of the immune system is antibody production. The inflammatory response system is not relevant. I've looked at the review and while it refers to some studies with some plant extract that may be used to prepare homeopathic remedies, these studies do not appear to be studies at homeopathic doses. I think we should note here that in this article it might easily be assumed that the term "immune response" means inducing immunity; it doesn't; there's no evidence that I know of for this.Gareth Leng 15:07, 10 June 2009 (UTC)

As for the lede, there are plenty of articles on CZ and on wiki in which the first paragraph or more provides an overview of the subject without reference to "conventional medical or scientific thinking." An encyclopedia describes a subject on its own term first. Only later, if appropriate, is it necessary to mention what conventional medical thinking assumes about it.

As for reference to publication bias, what is written afterwards in our Draft is a definition of "publication bias"...and what Gareth wrote above is just what I changed our Draft to say! Cool, we are on the same page on this issue. Dana Ullman 04:54, 10 June 2009 (UTC)

Indeed, there are plenty of articles that do not make such reference, but those articles do not also immediately claim that their topic is a system of treatment. Respectfully, I suggest that one that would explain to others about the purpose of an encyclopedia might do well to participate in regular Forum discussions searching to answer just such a question, which by no means is answered, rather than simply making assertions in a single article. Howard C. Berkowitz 09:07, 10 June 2009 (UTC)

Gareth, I'm about to go out the door to obtain remedies for the immune response of my cat, but I just reread your note above. If I'm thinking of the same study, it was a non-homeopathic dose of a phytochemical that mediated degranulation and direct histamine release; no immunoglobulins involved. If that's the same one, maybe we need some wikilinks from around the text to such things as immunoglobulins, mast cells, histamine, and inflammatory response to contextualize the material. It would also be fair, I believe, to review the trigger chemical concentrations. Howard C. Berkowitz 15:19, 10 June 2009 (UTC)

How close to re-approval

Do we have any issues that would keep this from being re-approved? D. Matt Innis 17:42, 9 June 2009 (UTC)

Enormous ones, such as the attempt to use vaccination as a means of explaining homeopathy or vice versa, a lack of specificity in the complementary medicine aspect, and the harping on "long history" as justification or suggesting that the lack of RCTs in surgery imply there's no more EBM there than in homeopathy. Personally, I'd be happier with a CZ with no homeopathy article at all than this constant back-and-forth. I'd rather see the existing version un-approved.Howard C. Berkowitz 17:51, 9 June 2009 (UTC)

We've also found a number of instances where reference citations don't support the text to which they're attached. Just now, I noticed that the sentence Hormesis has been hypothesized as an explanation for some homeopathic affects, [sic] although hormetic doses still are constrained by the Avogadro limit. refers to Calabrese and Baldwin (1998). But in that reference the sole mention of homeopathy is that they included it as a search keyword: Based on information obtained from the initial searches described above, additional search strategies were employed using the same three databases and the following key word descriptors: low dose plus stimulation, beta curve plus dose response, adaptation plus pollution, and homeopathy. Nothing about using hormesis to explain homeopathy.

The article should not be approved until someone has gone through all of the references with a fine-toothed comb. In fact I would argue that until such a check can be done for the current approved version, the approval should be revoked and the article placed in cold storage. Repeated misuse of references (whether accidental or otherwise) just isn't on. Raymond Arritt 18:35, 9 June 2009 (UTC)

All the more reason for re-approval I suppose! Let's get it right so we can replace the old version. Anyone here think Hormesis is an important enough concept to keep in this article? If so, I need to some sources to review. D. Matt Innis 18:47, 9 June 2009 (UTC)

In the approved version, the wording is "Both mithridatization and homeopathy might be considered as instances of hormesis, which describes the phenomenon that some chemicals at high concentrations have opposite biological effects to those at low concentrations. [34]" which is accurate; the citation refers to the definition of hormesis. Where are there any incorrect statements in the approved version? I don't think it's perfect by any means, but I'd be surprised if it was inaccurate; in fact I've not seen any example given here of anything factually incorrect in the approved version. I certainly checked all the references and didn't spot any instances where the ussage was incorrect. Again Howard, in the approved version there is not this problem with vaccination - there, it's handled properly, there's no distraction re surgery, the gangrene section is included. and I think the reference to historical precedent is there and appropriate - it's absolutely correct to say that homeopaths think that its use for centuries is an argument for its continued use, and I think it's important to see the arguments that homeopaths give. People can make up their own minds about the strength of that as an argument - I think we can all think of daft things that have been done for centuries, and all know that science is something that does not stay unchanged but continually evolves, rejecting old mistakes once held for centuries. It has reasonably been argued that the approved version leaves the scientific view too late, that it includes some material not specific to homeopathy, and doesn't cover some things in adequate detail, but where in the approved version are any statements that are wrong? Taking that article down seems a retrograde step. I agree that the present draft article has some more serious problems. Gareth Leng 20:36, 9 June 2009 (UTC)

(EC) Thinking about it, is not hormesis still a chemical phenomenon, so that it would be inapplicable beyond the Avogadro limit? Howard C. Berkowitz 21:10, 9 June 2009 (UTC)

I haven't specifically said the approved version is wrong in specifics; I do, however, believe, for reasons such as the positioning of the scientific view that you mention, that it is a detriment to CZ.

Whether in the current or old version, history has to be handled in perspective. For example, it is not reasonable to invoke medical history, such as von Behring, to assert vaccination is homeopathic. Von Behring may have said that, but his 1905 statement is flatly wrong by some very solid modern understanding.

That homeopaths believe their remedies are safe, based on history, is reasonable enough. Using history to claim efficacy, however, is not. There is an enormous difference among the active harm done by 19th century medical dosing, essentially inert substances, and molecular pharmacology. They can't be equated, yet there is now that implication. Howard C. Berkowitz 21:08, 9 June 2009 (UTC)

I agree - but the point is that homeopaths think that history provides evidence of efficacy, and it's important that we explain that they use this argument, an argument that you and I agree is erroneous, and an argument whose value can be judged by anyone for themselves. I agree that von Behring should not be cited as though his reasoning was today regarded as valid, when it's clearly not. Hormesis indeed cannot be an explanation of effects below Avogadro's limit, but Dana has been at pains to point out that some homeopathic remedies do have some active substance in them. More importantly perhaps, for substances that show hormesis there is some justification in regarding these as cases justifying the use of the 'principle of similars'.Gareth Leng 21:28, 9 June 2009 (UTC)

Apropos hormesis, how do you see the principles of similars? My understanding of hormesis is that it is a model that shows nonlinearity in dose-response and even effect of dose. Hypothetically, that could mean that a hormetic dose might be an agonist at one level and an antagonist from another. Those are molecular concepts. Where do the similars come in? Howard C. Berkowitz 21:37, 9 June 2009 (UTC)

The relevance is that hormesis provides a justification for expecting that a highly diluted substance will have biological effects opposite to those seen at high concentrations - hence providing some reason for thinking that symptoms that follow a high dose might be cured by administration of a very low dose - like cures like. Don't ask me to defend that reasoning closely, but I can see where it's coming from.Gareth Leng 21:40, 9 June 2009 (UTC)

[unindent] This section from Hormesis could perhaps be adapted for the Homeopathy article:

Whereas hormetic (chemical) responses are induced by small but measurable concentrations (above Avogardo’s number), homeopathic concentrations are often far below this. The use of a remedy with a "concentration" of 10-400 of the stem solution is common practice in classic homeopathy....Hormetic substances do not require any special preparation. Homeopathic remedies, in contrast, require a lengthy and exacting process before they are ready for administration.[29]

Important points are the Avogadro limit (as you have discussed) and the irrelevance of homeopathic methods of preparation (esp succussion) to hormesis. It is interesting that on the one hand homeopaths emphasize the importance of succussion in changing the properties of the solution, while on the other they propose a mechanism (hormesis) that has nothing to do with succussion. Raymond Arritt 21:43, 9 June 2009 (UTC)

This is true. I have also toned down the staetements about hormesis which I do not think are accurate; Calabrese is certainly a serious and powerful advocate, but it's not really attracted much interest - and nobody has shown its practical utility as far as I am aware. It's not in itself controversial, it's easy to say many ways in which hormesis can arise, and Calabrese has argued that the standard model of the monotonic dose response relationship has been overused mainly as a knee-jerk reaction to homeopathy. He may be right; that's not a defence of homeopathy, it is an eloquent attack on rather dogmatic scientific attitudes. In pharmacological terms it's pretty clear that hormesis will be common - many substances are partial agonists, and accordingly at low concentrations will act as antagonists (by displacing endogenous ligands that are more potent) while acting ass agonists at high concentrations. Accordingly effects are expected at the lower limits of binding - typically 10-12M. Gareth Leng 21:57, 9 June 2009 (UTC)

Gareth, your statement "Don't ask me to defend that reasoning closely, but I can see where it's coming from" is very much to the point. There are quite a number of topics in the current draft: hormesis, homeopathy as complementary medicine, vaccination, etc., where if it's going to be in the article as a basis of homeopathy, it needs a strong defense from homeopaths. I'm sorry, I don't go along with neutral writing being a homeopath throwing off a citation or general statement, at the same time when there is something as explicit as Avogadro. Neutrality is equal force; I don't go along with the idea that an expert-guided encyclopedia has specifics on one side, "might-bes" on the other, and the excuse the reader will see that only one side has a case. Howard C. Berkowitz 22:15, 9 June 2009 (UTC)

I think you're making a mistake here - we have to report what homeopaths say, how they justify their ideas. That's reporting what they say, it's not agreeing with it. If they use an argument we don't like or don't agree with is not the point, we report it as their argument. (The scientific view of these arguments may also need to be explained where its necessary to do so; sometimes I don't think its needed, as when arguments can be left to stand or fall on their own merits). Again, the vaccination issue was covered fine in the approved article. It's not our job to present a basis for homeopathy, but to describe what homeopaths regard as the basis. Gareth Leng 08:29, 10 June 2009 (UTC)

My point about hormesis is that this field embodies a large and multi-disciplined body of evidence for the power of small and very small doses. That said, I have carefully acknowledged that hormesis provides only a partial explanation for the effects of homeopathy. As with many fields of inquiry, there are many explanations for different stages of systems. We should avoid over-simplifying things. Because hormesis research does not test doses beyond Avogadro's number, the field of hormesis does not dis-prove homeopathic doses beyond Avogadro's number. However, hormesis does provide evidence for the power of doses of certain substances in the pre-Avogadro's number range on certain systems. Because these doses are similar to those doses of a large number of homeopathic medicines that are sold over-the-counter, the power and influence of these small doses are neither "implausible" or unproven. Dana Ullman 05:08, 10 June 2009 (UTC)

Howard asks what hormesis has to do with the homeopathic principle of similars above. We have clearly said in this article that homeopathy is a system that utilizes extremely small doses (many of which are in the hormesis range). Hormesis obviously has a place in this article as long as we don't oversimplify it or say that it explains everything (which we don't do).

By the way, I was OK with the previously approved version of this article. I only began to edit here again because some people here wanted to create a new and improved version, though I found this new version to be new but not improved. I have been working down on the article and am not finished providing my input, but if people have lots of reservations about this new version, I can stick with the old. Dana Ullman 05:20, 10 June 2009 (UTC)

First, if the new article were as explicit as some of this talk discussion, saying that hormesis not only doesn't explain everything, but has little practical impact, I'd be much less concerned. No, I do not agree that "hormesis does provide evidence." In medicine, we use the shorthand of speaking of a class of antidepressants as selective serotonin reuptake inhibitors, but, for example, the fact of the delay between serotonin change and clinical benefit is not a complete explanation, but the start of an explanation. Almost certainly, SSRIs reset some regulatory mechanisms that are not yet identified. We can, however, measure changes in intersynaptic neurotransmitter levels; we do not yet have nearly as clear a measurement of hormetic effect.

I'd go carefully here: hormetic effects are real, uncontroversial, and quite easily measurable effects of some particular substances. It's been argued that these should be taken into account in assessing toxicological assessment of risk, it's also been argued here for example and here that it is not yet an acceptable basis for policy, So it has potential practical impact, especially on public health policy, but as yet has had little impact.Does "this field embodies a large and multi-disciplined body of evidence for the power of small and very small doses" as Dana says? No, not really, it's a relatively small area, the evidence is there and uncontroversial - its a phenomenon of some substances, not a general phenomenon of low doses - the power of this is not generally accepted - probably the prevailing view is that these effects though common are mostly minor without practical significance except in the highly contested area of toxicological risk assessment - i.e. determining "safe" levels of exposure to toxins, where some argue that conventional toxicology sets acceptable levels of environmental contamination too low.Gareth Leng 10:41, 10 June 2009 (UTC)

I believe it fair to say that on reflection, several contributors here feel the old version of the article should not have been approved, and the new effort is trying to get to something that is more broadly acceptable. It is an open question if that is possible. Not all subjects can get to an approvable level, no matter how much some people might want them to do so. Howard C. Berkowitz 08:56, 10 June 2009 (UTC)

In retrospect, a key problem seems to be that there was no clear statement of what needed changing in the approved version before setting about changes. Actually I think the approved version is fine, and I've seen no examples given of any errors in it; it can get better of course. It's true that some think the approved version somehow reads as supportive of homeopathy; read as a whole, I don't think that's true, but that's my reading (as an extreme skeptic).Gareth Leng 10:47, 10 June 2009 (UTC)

What's wrong with the approved version? I tell you. The approved version gives the strong impression that homeopathy has a scientific basis. Further it claims without any proof that 30-40% of the French doctors and 20% of the German doctors practice homeopathy. The tenor of the lede of the approved article (as well as of the lede of the draft) is that homeopathy is a very respected form of medicine because of its long tradition (it implies that it is based on "ancient wisdom" by stating that it goes back thousands of years). Further the lede suggests to anyone believing in homeopathy that the technocratic, scientifically oriented, reductionist physicians in the materialistic west are too shortsighted to recognize this. Readers who don't believe in homeopathy have seen where the article is going before they finish the second paragraph and won't read as far as the sentences about the opinionated western doctors. --Paul Wormer 13:35, 10 June 2009 (UTC)

The French figure I didn't question because I knew that a) about half of the French population report having used homeopathic remedies b) these are available on the State medical scheme if prescribed by MDs, and c) homeopathy is taught quite widely in French medical curricula. The figure of 40% seems about right, if this WHO report is still true: "A 1987 survey found that 36% of allopathic doctors, mostly general practitioners, used at least one complementary/alternative technique in their medical practices" [9]. In Germany, according to WHO, three-fourths of allopathic physicians use complementary/alternative medicine [10], this is the second strongest market for homeopathy after France homeopathy, and homeopathy is the most popular alternative medicine in Germany (There were 20 million patient contacts with complementary/alternative medicine in 1992. The most frequently sought complementary/alternative therapies are, in order of popularity, homeopathy (accounting for 27.4% of patient contacts)....). On what people read into an article - as you say it rather depends on the reader. I didn't read anything into the article that suggested that homeopathy had any scientific basis, and would have found it hard to read into statements like "The theory underlying homeopathy is not considered plausible by most scientists working in academic institutions in Europe and the U.S.A." anything particularly supportive. As for the origins, well the Hippocratic (and indeed preHippocratic traditions) - look much more like homeopathy than modern medicine. I don't give any weight at all to historical precedents, but medicine does labour its Hippocratic ancestry so I guess it is appropriate at least to mention that those ancestors have given rise to diverse descendents. Why anyone would think that that is any reason to believe homeopathy today is beyond me (you wouldn't put a great weight today on Aristotelian notions of matter, would you?). I accept that some readers feel that the tenor is over favourable to homeopathy, but again, I don't see factual inaccuracy. My concern is that if the facts are right, the reader can make up their own mind, and we shouldn't try to make their mind up for them. Gareth Leng 16:01, 10 June 2009 (UTC)

Strict factual accuracy is a necessary but not sufficient condition for writing a neutral, credible article. It is quite possible to create distorted or misleading material that is devoid of factual errors -- ask any political speechwriter or advertising executive. (Or see examples at Conservapedia.) Raymond Arritt 16:31, 10 June 2009 (UTC)

Make up the reader's mind? No, but guiding is one of the things that, to me, differentiates an expert-guided resource from the Other Place. First, we know that some readers, especially those that may be somewhat hostile to CZ, are not going to read more than the lede. Second, not all readers are necessarily going to analyze the facts if not presented appropriately. Note that I reverted a change yesterday that restored the strong disclaimer sentence that had ended the first paragraph; the argument for removing it was that a more specific statement was further down — but the effect was to remove the implausibility statement from the critical first paragraph.

An old preacher's rule is to tell your audience what you are going to tell them, then tell them, then tell them what you told them. My dark past includes both political advertising and psychological warfare; it's sometimes a challenge to tease meaning out of facts. Where's my copy of How to lie with Statistics? Howard C. Berkowitz 18:56, 10 June 2009 (UTC)

Of course I agree with Ray. We must remember though that this is an article about homeopathy, - and not simply about its credibility, but also should describe its history, prevalence, practise and popularity, and report fully its belief systems. This is a matter of reporting, and the mere presence of these elements has no bearing on the issues of scientific credibility or efficacy. The case against homeopathy really comprises just 3 statements: 1) Most scientists have concluded from their analysis of the evidence that the effects of homeopathy are probably all placebo effects 2) Most scientists regard the proposed mechanisms of action of homeopathic treatments as either wrong or implausible and 3) many physicians are concerned at the risk of patients with serious treatable conditions being deflected from seeking effective treatment. These things are I think said robustly. I don't see the scientific view as being portrayed in any way as conservative or dognatic - quite the contrary, the original overview at length described the scientific attitusde as open minded and non dogmatic while still dismissing homeopathy. I don't think it will ever be possible to write an article that is seen as balanced both by those who a priori dismiss all evidence and arguments against homeopathy, or by those skeptics who discount evidence favouring homeopathy simply because it favours homeopathy and who believe that only trenchant denunciation is unbiased. Fortunately there is ample material on the internet to satisfy both of these constituencies. There is however little for the uncommitted and open minded reader. I am concerned that the article can be read as unbalanced - though I don't see that myself, that's by the way - if it can appear unbalanced to an uncommitted reader that's wrong and needs fixing. These are my opinions, and I have no intention of impeding improvements, and as a collaborative writer am happy to give way on most things except matters of fact. I do now think that on the French doctors point, it would have been better to say something like "In France, according to a 1987 WHO report, 36% of MDs occasionally prescrbe homeopathic remedies." That would have been a better way of stating it. It is perhaps misleading to call this pracising homeopathy - about 11,000 MDs in France do practise homeopathy mainly or exclusively, but this is a small minority, most seem to use these as convenient placebos (but that's an inference)Gareth Leng 19:05, 10 June 2009 (UTC)

Gareth, your statements about what "most scientists" think about homeopathy neglected to include: -- Most scientists know little or nothing about homeopathy. -- Most scientists know little or nothing about what research has taken place to date testing homeopathic medicines. -- Most scientists did not understand the mechanism of action for aspirin until the 1980s, and yet, not a single doctor (or scientist) refused to prescribe it just because s/he didn't understand its mechanism. -- Most scientists have no way to measure love (should we then assert that "love does not exist" or "love is unproven" or "love is quackery"?)

What is interesting here is that everyone here acknowledges the significant numbers of MDs who use homeopathic medicines, many of whom rely solely on prescribing homeopathic medicines to their patients. We also know that 100 million people in India rely solely on homeopathic medicines for their health care. And yet, I personally do not know a single physician who has ever spent a month or a year just prescribing sugar pills to his/her patients. Such physicians would not keep their patients, and they would be called at all hours of the day and night for a new treatment.

What is also interesting is that some people here have said that one of the reasons for writing a new article on CZ is to make corrections in the number of doctors in Europe that use homeopathic medicines, and yet, Gareth has made a strong statement above that suggests that our numbers are accurate or near accurate. Dana Ullman 03:44, 11 June 2009 (UTC)

" everyone here acknowledges the significant numbers of MDs who use homeopathic medicines, many of whom rely solely on prescribing homeopathic medicines to their patients."

Really? Howard C. Berkowitz 03:52, 11 June 2009 (UTC)

Dana, I was just stating the case against, which needs to be in the article; you've stated the response, which also needs saying.Gareth Leng 08:33, 11 June 2009 (UTC)

hyphens

the first sentence now needs some hyphens. as the Kop who may be approving this rewrite sometime, i suggest that you ask Heaux Noble Rheaux at User:Ro Thorpe to do the necessary.... Hayford Peirce 21:50, 9 June 2009 (UTC)

The writing style also is a bit rough in places, but I think it's best to wait until content settles down to do the final polishing. Raymond Arritt 01:47, 10 June 2009 (UTC)

And apropos of content settling, if you're not part of the solution, you must be part of the precipitate. Mind you, I have known a few gels and colloids.Howard C. Berkowitz 02:01, 10 June 2009 (UTC)

last paragraph in vaccination section

The homeopathic principle of similars has also been linked to vaccination. Although homeopathic remedies and vaccinations both use low doses of active ingedients, there are important differences. First, the doses used in homeopathic remedies are always very much lower than used in vaccines. Second, every vaccine produce a measurable immune response (e.g., immunoglobulin production). Thus conventional treatments involve application of measurable doses of substances, at levels known to activate a cellular response. In contrast, homeopathic preparations above the $24X$ ( $12C$ ) potencies do not contain enough molecules to activate any known metabolic or signalling pathway.

Is dose the thing that links the principle of similars to vaccination? I think the genreal idea is that vaccination uses the "like to cure like" - regardless of dose. D. Matt Innis 01:03, 11 June 2009 (UTC)

There are several problems with this idea. First, the literal inventor of vaccination, Jenner, didn't assume that principle; he simply observed people that had had cowpox didn't get smallpox. "Similars" doesn't appear in his writings.

Remember that many homeopaths reject Koch's Postulates and organisms as causal of infectious disease, so there's a flaw there in assuming "likeness"; there's no attempt to cause "like symptoms", which would seem a homeopathic requisite. An effective vaccine generates measurable immune factors.

Immunization is moving toward acellular preparations, where the antigen is a single molecule that stimulates specific immunoglobulin production, ideally without any symptoms. The holy grail in anthrax immunity, for example, is to generate not immunoglobulins to the bacterium, but something that will create an antibody to one of the three proteins necessary for B. anthracis to do its damage. That's getting farther and farther from like.

In other words, it might be a general idea, but when one gets into how vaccination works at a molecular level, the general idea no longer fits. Howard C. Berkowitz 01:33, 11 June 2009 (UTC)

The point being that vaccines use the cause of the disease to cure the disease is the "like". The rebuttal such as you describe is the reason it is not a reasonable assertion. It has nothing to do with doses, though. If I were a noncommitted reader, I wouldn't buy the what we are saying. D. Matt Innis 01:45, 11 June 2009 (UTC)

Howard has effectively proven Matt's point. Howard asserts that Jenner did not acknowledge the principle of similars, and thus, Howard sought to rely upon one of the original developers of vaccination to prove his point. Therefore, my previous reference to and quote from von Behring has bearing (I hope you like that illiteration).

The similiarity between homeopathy and vaccination is that they both use small doses of what might cause an ailment in order to prove a health benefit. Although conventional physicians may ascribe the mechanism of action to specific biochemic pathways, one way to understand why they have these effects is what the homeopaths refer to as the principle of similars. Dana Ullman 03:56, 11 June 2009 (UTC)

Do not, Sir, presume to tell me what point I have proven. Howard has not proven Matt's point, disagrees with Matt's points, and finds especially offensive your twisting of Howard's points. Howard's reference to Jenner was to point out that Jenner and vaccination cannot be used to support homeopathy or the principle of similars because he didn't use either. It would be more correct, however, to say he was the developer of vaccination.

Go ahead. Put that "one way to understand" into the article. Make my day.

Sorry, this discussion is turning into what Churchill called arrant nonsense up with which he shall not put. It is making a mockery of CZ; it's interesting but sad that almost nothing else is being done. Howard C. Berkowitz 04:06, 11 June 2009 (UTC)

I'm not sure what points ya'll are talking about, but mine is that there is no dose relationship between homeopathy and vaccines. Homeopathic remedies are extremely low doses. Vaccines are just doses. Take that sentence out and that paragraph will make more sense. D. Matt Innis 03:17, 13 June 2009 (UTC)

Howard, you are welcome to say what you want, as I am. I did interpret what you said as support for what Matt said. Whether we refer to Jenner as the developer or the discoverer of vaccination makes little difference. von Behring's quote is again an important link between the two...and from such a leading historical figure in medicine/science (von Behring was the FIRST to get the Nobel Prize in medicine!). Dana Ullman 16:03, 13 June 2009 (UTC)

Do homeopaths have this training and equipment?

An adequately trained homeopath is expected to recognize symptoms that indicate an acute and potentially fatal condition. The practitioner is expected to have emergency medical training and equipment appropriate to his or her level of training in the place of practice (e.g., dressings and basic airway management tools for an individual with training at the Emergency Medical Technician (EMT) of Basic or higher level, and preferably an automatic external defibrillator and advanced cardiac life support resources generally accepted as appropriate for an office. Potentially serious acute ailments may require medical supervision, but homeopaths sometimes prescribe remedies either for adjunctive use or as alternatives to conventional treatment.

This looks unusual for a homeopath, is it? D. Matt Innis 01:40, 11 June 2009 (UTC)

Remember this was written at a time when Ramanand was talking about homeopathy as the first line of treatment for potentially fatal emergencies. If anyone who presumes to offer primary care is not at least Basic Life Support qualified, I think that is very significant information. If anyone who administers any remedy isn't prepared for anaphylaxis, I think that also needs to be brought out. Howard C. Berkowitz 01:48, 11 June 2009 (UTC)

Are we saying that homeopaths do have defibrillators in their offices? Do they? It seems to infer that they do. D. Matt Innis 01:56, 11 June 2009 (UTC)

That sounds right. The other might be, too, but I doubt it. Do you know Dana? D. Matt Innis 01:59, 11 June 2009 (UTC)

Pull defibrillator, although that's now pretty standard for exercise centers -- mandatory at casinos and at least US airliners. Let's hear about BLS. At least in the US, there's usually a requirement for police, barbers, massage therapists, and a wide range of other people that conceivably might run into a situation to be CPR certified. I think it's very relevant if someone claiming to be a healthcare professional doesn't have that skill level -- and yes, I know the dismal rate of survival even with Advanced Cardiac Life Support. Howard C. Berkowitz 02:03, 11 June 2009 (UTC)

I think I saw CPR on one of the homeopathic college course lists. It probably does vary by jurisdiction, but I would think that most with regulations would require that as a prerequisite for sitting for a board. D. Matt Innis 02:17, 11 June 2009 (UTC)

It will be very challenging to find training standards for each country for each health/medical subject.

In a similar vein, I'm curious if the people who think that this line of information is so important that we determine what training medical doctors get in the use of safe treatments methods in the light of the Hippocratic dictum, "First, do no harm." Should we work to alarm people about the dangers of going to medical doctors due to inadequate training in safe treatment methods? Should we work to write this warning into every disease? Yeah, these are rheutorical questions. Dana Ullman 04:13, 11 June 2009 (UTC)

Alas, I do not regard that Hippocratic dictum as terribly realistic; I believe you yourself spoke of choices. Further, I doubt any modern medical school could or should require that dictum.

It's certainly not rhetorical to me. I would regard anyone who claims to be a healthcare practitioner, but does not qualify in emergency measures, as indulging in what the lawyers call reckless disregard for human life.

Go ahead. You are a U.S. practitioner. Answer for the U.S.

I am disgusted. Anybody who wants to erase that with {{nocomplaints}}, just go ahead and erase my account. Howard C. Berkowitz 04:19, 11 June 2009 (UTC)

Howard, it varies - in France homeopathic remedies can only be prescribed by fully qualified MDs, and the WHO report gives the number of homeopathic practitioners at about 11,000. In the UK, the Faculty of Homeopathy represents registered medical practitioners who practise homeopathy - when I looked it seemed there were just 400 GPs. These numbers even in France represent a very small number of GPs, but in France they account for all prescriptions of homeopathic remedies. So the context in which treatment is offered clearly varies. Gareth Leng 08:30, 11 June 2009 (UTC)

Your comment is more pertinent to my questioning about how we "all agree" to significant numbers of MDs using homeopathy. I believe that statement is cynical manipulation, just as is the rather confused claims about Jenner and von Behring, or how Hippocrates is the definitive guide to treatment. Howard C. Berkowitz 08:36, 11 June 2009 (UTC)

Suggestions

This discussion is deteriorating, there have been many good points made but are in danger of being lost. What are the ways forward? We can either

a)continue to improve the draft, which I think needs a statement of faults to be corrected, includeing (i) sourcing (or elimination) of statements about French and German use, and (ii) correction of tone to ensure that the article reads as neither pro nor anti, with the assumption that the approved version seems by its tone to be pro.Gareth Leng 08:43, 11 June 2009 (UTC).

Or b) adopt a different solution, and have two adjunct short articles putting the cases for and against homeopathy as they would be written by proponents and skeptics. i.e. Display the key arguments that are here in the main text space.Gareth Leng 08:43, 11 June 2009 (UTC)

As a first step, talk commentary needs to focus on the article, not rhetoric. I was not, in the slightest, being rhetorical about emergency capabilities; I think this is necessary disclosure. The equating of homeopathy and vaccination shows such a lack of understanding of immune mechanisms -- not "some doctors' explanations" -- as to be beyond utility.

I will not participate in a forum that adopts Solution B. It makes a mockery of expert guidance. Just as negative experimental data is significant, it is significant if a topic simply cannot be resolved within various interpretations of a goal of neutrality.

I don't think it is possible to have something that is absolutely neither pro nor con. In other words, I increasingly believe any attempt at this article is doomed, it is sucking up enormous amounts of resources, and belongs in Cold Storage at best. The Approved version, unless read completely by a careful person, does read as pro, or at least apologetic that science might question. Howard C. Berkowitz 08:55, 11 June 2009 (UTC)

Fine, I'm happy wth solution A. By neither pro nor con I mean neither promotional nor denigrating. Facts are facts, they're neither pro nor con. Improving the article, solution A, requires identifying specified problems, and resolving those without introducing others. I should say that for all the heat on this page, if we look at the draft article, as I have just done - I do not see any major impediments to reapproval. So in the present draft, exactly what needs fixing? Gareth Leng 09:25, 11 June 2009 (UTC)

First, I see CZ without homeopathy better than CZ with homeopathy. I'm not sure that I want to be part of a CZ with it, as it's a magnet for fringe and a repulsor for contributors. Had there been an influx of new authors, on any subject, due to the months of agony, I'd think differently.

Second, minimal points:

Hormesis: gone. A basic summary of memory of water, and all of the other mechanisms that "might" put a scientific face on homeopathy: a clear statement that homeopaths assert things, often in terms that are oversimplified in terms of immunology, materials science, etc., and cite things that the immunologists, materials scientists, etc., consider manipulative oversimplifications or outright wrong (i.e., active immunization is not based on similars. End of discussion).
Clear, nonhandwaving "people have choices" about when and where homeopathy is proposed as an alternate/whole system (as observed by UK and US government reports), and, if it is used in a complementary way, plausible and specific examples. Evidence that homeopaths will or will not refer for conditions outside their scope of practice, or, indeed, if they consider certain things outside the scope of their practice. If, say, US homeopaths are expected to have Basic Life Support (or more advanced) skills, but Indian ones are not, the worldwide differences need to be clear; no handwaving about how it can't be generalized.
No misleading statistics. As with recovered memory of diabolical tortures, if a small fraction of practitioners account for the great majority of usage, counts alone are insufficient without giving ratio of the count of MD homeopathic prescribers to all MDs in a country. An MD has to regularly use homeopathy for it to be a part of practice; as the article reads, an MD could prescribe it once in a career and be considered an MD (also DO in North America) user of homeopathy.
James Tyler Kent out of a text box, not presented romantically, and homeoprophylaxis in context.
"In brief, for homeopathy to receive serious scientific consideration, there needs to be plausible explanations for the following: " needs to be much earlier in the article.
Von Behring, Hippocrates, etc., can be cited as part of homeopathic belief, but in absolutely no way to suggest that their statements are representative of medical support for homeopathy.

That's a start. Again, I am opposed to having the article; I think an approved new version, even improved, will be a liability of CZ — if CZ isn't already terminal. Further, I believe the article/authors should have the same sort of financial interest disclosures that are common in scientific journals. Howard C. Berkowitz 12:02, 11 June 2009 (UTC)

I have to say I am bemused by some of these. Homeoprophylaxis is described as follows "The notion of homeoprophylaxis has not received support from systematic trials and has no place in conventional medicine. Suggestions that homeopathic treatments are an effective alternative to vaccination are regarded as irresponsible by many public health professionals, and also by some professional homeopathic organizations;..." What more context are you looking for? No idea what you mean by romantic; frankly I don't see how the quotes can be read without any modern reader both understanding what he said and seeing that from a modern perspective it's nonsense. Maybe specific suggestions would help clarify. Von Behring is not in the current draft unless I've missed it but the statement in the approved version seems fine as given there. Where is it suggested that statements about Hippocrates are representative of medical support for homeopathy? - I thought we'd conspicuously avoided any form of words that could be read in that way? I don't see any reason for excluding the present concise mention of hormesis, it is commonly cited by homeopaths and needs at least to be explained what it is and where it might be relevant (i.e. not to ultradilutions, possibly to low dilutions).Gareth Leng 12:54, 11 June 2009 (UTC)

"Maybe specific suggestions would help clarify": for background, I also quote " don't see how the quotes can be read without any modern reader both understanding what he said and seeing that from a modern perspective it's nonsense", watch American political rhetoric, and remind you of the power of ignorance and agendas, and quote Barnum's sign, "This way to the Egress".

I will reemphasize that homeoprophylaxis is featured visually, with the James Tyler Kent story; when I say "romantic", I speak of dramatic quotes from him, in a colored text box, preceding the contextualization. Get rid of the text box, move the definition and analysis first, put the Tyler story afterwards, and I'd be happier. Again, this is a matter that facts can be presented in a confusing context; that context can be visual and organizational as well as misleading words and statistics. There is no reason I can see that Tyler should be visually featured with his own headline. That he rejected the germ theory, as have other homeopaths, perhaps belongs earlier in the article.

It is true that some of the Hippocrates and von Behring material are not in the article. They have been, however, hammered on the talk page. You'll remember that the E-I-C, in the previous approval round, established some ground rules. Paracelsus was sent off to the history article. That these are still cluttering talk are the verbal equivalent of acid rain, or perhaps just an excess of pigeons.

Simplify. That homeopaths cite hormesis, memory of water, etc., can be reduced to citing things questioned or rejected by domain specialists, or, in the case of hormesis, without any clear causality.

The heat of all this would be reduced were some discipline reintroduced on the talk page. Von Behring, Hippocrates, etc.: stopped. Alto. Finis. Pushing up daisies and gone to join the choir eternal.

The waxing and waning of analogies between immunization and homeopathy also deserve a Pythonesque treatment. That Mr. Ullman is still questioning, even on talk, the mechanism of active immunity is, again, something that needs to be ended by the majority. In the article is Homeopaths consider that two conventional concepts, vaccination, and hormesis, can be considered as analagous to homeopathy's law of similars and the use of small doses. (that's analogous). There needs to be a proximate statement that immunologists consider, with hard experimental data, the vaccination analogy to be utter nonsense. Howard C. Berkowitz 15:34, 11 June 2009 (UTC)

I strongly assert that hormesis has a place in this article. Although it is not an explanation for all of homeopathy, it provides evidence for a large body of research to show that power of extremely small doses of substances on certain systems. As for the use of homeopathic medicines by physicians, I believe that we should use what reliable data exists. Data from the WHO and the BMJ provide such. Even if a doctor only occasionally prescribes homeopathic medicines, this data is still valid. If a person only flys once (but not every day), isn't that still of interest? Dana Ullman 15:53, 13 June 2009 (UTC)

With some people's proposals to change this draft, I will simply prefer to keep the old draft rather than approve this new inaccurate one. ...said Dana Ullman (talk)

I prefer to adopt the new draft than to keep the old inaccurate one. If we cannot reach agreement then the article should be reduced to a stub. Raymond Arritt 20:14, 13 June 2009 (UTC)

Thank you for reminding me I did need to update the entry on Binh Duong Province to identify Ben Cat as the village that had to be destroyed to be saved. Seriously, I think part of the expert-guided model as recognizing that an article cannot be saved, at least in the sense of being acceptable, under the Neutrality Policy, to a reasonable number of Citizens -- especially Citizens with experience in multiple articles on multiple subjects.

Doctors sometimes unwisely prescribe antibiotics simply to stop complaints; there seems a poetic justice that the parent who has demanded the antibiotic now has to put up with the child's complaints (I am not looking forward to the next 2 1/2 weeks of dosing a cat with a necesary antibiotic, although I think we've worked out a method that isn't too stressful for either of us). While the ethics might be questionable, I could rationalize giving a child a harmless homeopathic remedy rather than risk resistance with amoxicillin, although tincture of time is probably better than either.

As to the flying, if it is without benefit of aircraft and independently confirmed, that is indeed notable. If one thinks one flew, even once, when no one else can detect it, that is also significant. Personally, I am rather happy I am no longer eligible for a Gold Royal Medallion Frequent Flyer card. I would, however, be very interested in a homeopathic way to fly places without having to deal with airline security. Alas, however, articles need to deal with CZ intellectual security. Howard C. Berkowitz 20:34, 13 June 2009 (UTC)

Being direct

The immediately following sentence says "Scientists and medical doctors today do not think that the principle of similars is generally true or useful, and they explain the efficacy of vaccination without referrring to it." How more proximate were you wanting this? The point is not that the analogy isn't good - it's a perfectly reasonable analogy, but that for scientists, the principle itself has no value/ Gareth Leng

How about "Scientists believe that likening vaccination to the principle of similars is a vivid metaphor, but that vaccination is well explained by mechanisms directly demonstrable at a molecular and clinical level. The principle of similars, in modern immunologic thinking, has absolutely nothing to do with the way vaccination actually works." No "generallys". No talking around the point. Howard C. Berkowitz 20:36, 11 June 2009 (UTC)

"Without referring to it" could be interpreted as saying that vaccination is somehow related to the principal of similars but goes unmentioned (say, because it's too obvious to note explicitly, or because the concept now goes by another name). If vaccines don't work by the principle of similars then we should say that vaccines don't work by the principle of similars. How about "Scientists and medical doctors today do not think that the principle of similars is valid or useful. Vaccines are now known to work by mechanisms unrelated to the principle of similars." Raymond Arritt 04:57, 12 June 2009 (UTC)

That change works for me.Gareth Leng 08:28, 12 June 2009 (UTC)

There is still something wrong with it - the law of similars doesn't state a particular mechanism of action, it just hopes to create the right response in the host. Isn't that what a vaccine does, we just know what that response is. D. Matt Innis 03:54, 13 June 2009 (UTC)

The problem is, Matt, that this is turned around. It sounds as if you are saying "law of similars" is something tangible. It's not. It is a well-recognized anthropological principle of sympathetic magic.

Active immunization is very tangible and measurable. The way it's being phrased assumes not just that homeopaths believe in the law of similars, but the law of similars is something precise, and then vaccines are being mapped to it. There is no question that antigen-antibody reactions exist. There is considerable question that the law of similars is anything but an occasional observation or a hope, much like a cargo cult. Similars, contagion, synecdoche — all anthropological principles of ritual magick. Howard C. Berkowitz 04:36, 13 June 2009 (UTC)

I fully agree with Matt, and the differences of POV here make writing this challenging. Perhaps we could use that old quote from von Behring that talks about the connection of vaccination to the law of similars and homeopathy and then say that large numbers of medical doctors today assert that vaccinations do not work by the homeopathic principle of similars but by specific antigen-antibody reactions. Dana Ullman 15:39, 13 June 2009 (UTC)

If a homeopathic authority made such a claim, it could make some sense. I believe, however, that there is a consensus of contributors that century-old statements by physicians and researchers have absolutely no place in this article, when used as support for homeopathic theories. Von Behring is dead. Von Behring would be undead and a possible source had he identified as a homeopath, but he didn't. Using Von Behring to explain vaccination is like using Aristotle to explain orbital mechanics.

It's not "large numbers" of medical doctors that "assert that vaccinations do not work by the homeopathic principle of similars " (an excellent example of literally correct fact that is presented in a very misleading way). Very, very few medical doctors or immunologists ever refer to the principle of similars, so they aren't making such an assertion that seems to put the homeopathic position on a par with the general scientific position. Indeed, a medical doctor found not to consider antigen-antibody reactions might have his license in jeopardy. "Large numbers" of medical doctors never think about the principle of similars and vaccination, because they have an experimentally demonstrable and theoretically sound model — the trend toward acellular vaccines gets even farther from any resemblance to a homeopathic preparation. Howard C. Berkowitz 15:58, 13 June 2009 (UTC)

The fact that von Behring was not a homeopath gives his quote even greater significance. The fact that he is sometimes referred to as the "father of immunology" gives him and his quote particular significance. IF he was a homeopath, I'm sure that you would say that we could not accept this quote because of his "bias." Howard seems to want to ignore history, and yet, good encyclopedias use history as context. Historical info has value in certain subjects, like this one! Dana Ullman 14:23, 15 June 2009 (UTC)

Kent box

On the Kent prophylaxis box, I think I'd like to hear other views, though I've no objection to you or anyone else trying a rearrangement. For me, this was a stand-alone item, that isn't part of a narrative thread, hence the box. The material in it, and the way it's presented, prominently highlights an aspect of homeopathy that is attacked both by conventional medics and also by other homeopaths. It is not in any remote sense promotional or pro-homeopathy. As for the quotes - how better to say that Kent rejected the germ theory of disease than to use his words? On hormesis - what is there is accurate and germane - is there any other support for its removal? But I guess we should hear what others think, or see what the changes look like if anyone wants to try any. Gareth Leng 16:41, 11 June 2009 (UTC)

Again, things are talked around. Back in my psychological warfare training, one of our rules was that anything was more credible when the source's words came first.

Even more important than homeoprophylaxis is that Kent and others reject the germ theory, or, to use something where we have a link, Koch's postulates.

Some homeopaths reject the germ theory of disease, expressed in Koch's postulates. For example, James Tyler Kent (1849-1916), the author of one of the major homeopathic repertories, published in 1897. Kent denied the conventional germ theory of infectious disease, declaring that "The microbe is not the cause of disease. We should not be carried away by these idle allopathic dreams and vain imaginations but should correct the Élan vital". Instead, he believed that illness had spiritual causes.

Kent went further to argue for homeopathic prevention of a notion known as "'homeoprophylaxis", which has no relationship to any demonstrable principles of induced immunity pr endocrine regulatory mechanism.

Other homeopaths, such as Hahnemann, did consider pathogenic organisms, but in a different theoretical model of miasms: three fundamental 'miasms' underlie of all the chronic diseases of mankind: 'Syphilis', 'Sycosis' (suppressed gonorrhoea), and 'Psora'. Miasma, from the Greek for 'stain', was an old medical concept, used for "pestiferous exhalations". In Hahnemann's words: "...a child with small-pox or measles communicates to a near, untouched healthy child in an invisible manner (dynamically) the small-pox or measles, … in the same way as the magnet communicated to the near needle the magnetic property..." The relationship between Treponema pallidum and the miasm of syphilis, or between Neisseria gonorrheae and gonorrhea, is not addressed.

That's an idea of an objective rewrite, still using Kent's (and Hahnemann's) words. It just might, conceivably, be significant that these insights into infectious disease come from the 19th century, and, clearly, there has been no progress in understanding of infectious disease since then -- yet apparently the Long and Distinguished History of Homeopathy cannot be assailed, as, of course, can the Horribly Toxic Medical Treatments that haven't changed in a century or so.

The Cuban homeoprophylaxis can certainly follow. Howard C. Berkowitz 20:36, 11 June 2009 (UTC)

Actually I'm not so sure about the Cuban homeoprophylaxis material. On checking more deeply it turns out that the nosode was only one part of an overall public health initiative (Programa Nacional de Prevención y Control de la Leptospirosis, the National Leptospirosis Prevention and Control Program) that included conventional vaccination as well as mundane but essential measures like rodent control. How much of the reduction in leptospirosis was attributable to the nosode versus other measures is probably unknowable.

The Finlay Institute, maker of the homeopathic nosode, specifically says their conventional vaccine "made it possible to control this disease in Cuba." So I guess they win both ways. Raymond Arritt 02:04, 12 June 2009 (UTC)

Do mosquitoes "cause" or create swamps, or would it be more accurate to say that mosquitoes go to swamps because they are a good breeding grounds for them. Mosquitoes, like bacteria, are opportunistic. From an ecological and systems point of view, germs are results of disease, not the "cause." If germs were the cause, they would always "cause" disease. It is more accurate to say that germs are "co-factors" to disease. Dana Ullman 04:35, 12 June 2009 (UTC)

Swamps, to the best of my knowledge, are caused by lots of water. While swamps may be picturesque, the major sources of malarial mosquitoes often are manmade stagnant areas. Who, incidentally, brought up mosquitoes?

Life itself is a cofactor for disease. Very few corpses get infections. Did you actually want to address the points being made, and suggest specific text for the article, or do more handwaving?

Very few things in existence are invariably causative, but that's the way the smart money bets. Now, if one puts a pistol to one's temple and fires, every so often, the bullet deflects off the skull, runs under the scalp, and comes out the other side. As the saying goes, guns don't kill people; they are just a cofactor. Howard C. Berkowitz 04:49, 12 June 2009 (UTC)

The sentence "The relationship between Treponema pallidum and the miasm of syphilis, or between Neisseria gonorrheae and gonorrhea, is not addressed." is an ahistorical absurdity. And I am not sure if its true that any homeopaths today refect the germ theory. Dana's comment "If germs were the cause, they would always "cause" disease." I agree with Howard that that is not how we'd use the word cause generally. We'd say that a broken leg was caused by falling off a tree even if someone else fell off the tree and didn't break a leg.Gareth Leng 09:58, 12 June 2009 (UTC)

How is 'The sentence "The relationship between Treponema pallidum and the miasm of syphilis, or between Neisseria gonorrheae and gonorrhea, is not addressed." is an ahistorical absurdity.' an absurdity? Ullman is rejecting germ theory. The relationship I just brought up is straight from Hahnemann and in the history of homeopathy article; certainly, if Von Behring can be quoted as an authority on medicine, I can quote Hahnemann on homeopathy.

Not sure if any homeopaths "today" reject the germ theory? See the "cofactor" text above, and note how my specific questions about Koch's postulates have not been addressed. If the issue is "homeopaths today", simple fairness says to rule out the "physicians in 1905". "Rich history" also comes into a bit more perspective. Howard C. Berkowitz 15:58, 13 June 2009 (UTC)

I thought Nodosa (or whatever they are called) are for treating infections... where they use the discharge from an infection.. to treat infection. I'm not sure that you have to believe in the germ theory, but it does show that they recognize that the body is reacting to something.. and they seem to call it infection, so I suspect that today they understand and accept and teach their patients that their problem is the result of a "germ". What more do we need? I think the only thing that matters is that homeopaths consider the symptoms the body's reaction to the stressor rather than the result of the stressor. In other words, rhinitis would be the respiratory systems response to a foreign invasion rather than the result of something that the foreign invader was producing to cause the histamine reaction. That doesn't seem that radical. I would think there are conventional medical doctors and scientists that might agree that this is plausible for certain conditions. It would be rather dogmatic to believe that all disease was the result of germs. I don't think anyone believes that, do they? D. Matt Innis 16:58, 13 June 2009 (UTC)

(undent)Let's be a bit more specific than "germ theory" and say Koch's postulates. No physician suggests all disease is the result of germs, but I think all would say that all infectious disease is the result of pathogens. We can reasonably say that the disease cannot take place without the pathogen, but that a given transfer of pathogens will not invariably cause disease. A very basic reason that varies, for example, is the number of organisms in a specific transfer, versus the infectious dose (or at least ID₅₀). Tularemia has a very low infectious dose, where leprosy appears to be very high and need multiple transfers. I have yet to see a non-MD homeopath that flatly accepts even the modern evolution of Koch.

"Cofactors"? No one disagrees that cofactors affect the chance of a clinical infection, but that still doesn't mean the pathogenic organisms aren't causing the disease. Sickle-cell trait is protective against Plasmodium falciparum malaria, but doesn't confer immunity. There are both natural and induced immunity to other infections that are near-absolute, but that doesn't mean that an immune patient couldn't get blasted with immunosuppressants and get the infection. Howard C. Berkowitz 17:24, 13 June 2009 (UTC)

Koch's postulates are:

The microorganism must be found in abundance in all organisms suffering from the disease, but should not be found in healthy animals.
The microorganism must be isolated from a diseased organism and grown in pure culture.
The cultured microorganism should cause disease when introduced into a healthy organism.
The microorganism must be reisolated from the inoculated, diseased experimental host and identified as being identical to the original specific causative agent.

As homeopathy started before Koch was born, I am quite sure that when the postulates were first introduced, very few agreed with them, you referred to those that did begin to use them above - the new group of physicians that used scientific thinking to test even allopthic treatments (but that wasn't until the Flexnor report - the early 1900s - almost 100 years later), etc.. But, if you consider the Cuba Leptospirosis experiment, those that were working on it certainly saw the Leptospira bacteria as the cause. I don't see that the practice of homeopathy necessarily concerns itself with the identification of the pathogen as much as it does the treatment of its "symptoms" (which includes its signs). I think that today's homeopaths think they are just increasing the the number of hosts that will not suffer as a result of the disease, not that they won't get infected, but that they can effectively be treated regardless of whether the disease is a result of an infection. I think the difference is in the treatment, not the etiology.

I did find this that might be an intersting addition to explain in the article:

"They saw that Koch’s first and third postulates did not hold true – not all hosts of an organism would show illness and not all host receiving the inoculation of the culture would get sick. This made them realize that maybe Pasteur’s theory was not all there was to the story."

It came from this.D. Matt Innis 11:55, 14 June 2009 (UTC)

First, Matt, I fully agree homeopathy started before Koch. I suggest you look at my article on Koch's postulates, and see that they have involved over time; the four you cite are not the way a modern microbiologist uses them.

Quoting Pasteur is also a problem, as Pasteur was not the theoretician that was Koch, but, in any case, he's a 19th century immortal. Really, "germ theory" is not a term much beyond the high school biology level; infection is much more complex. So, that which you quote about the first and third postulates does not disagree with the evolved theories. One of my problems with many of the homeopathic claims in this article is they suggest that it was a largely correct discipline in the 19th century, cite far too medical sources from the 19th and early 20th centuries, and still, as with Mr. Ullman's talk of "cofactors" and avoiding causality, still do not appear to accept anything like a current model of infectious disease.

Incidentally, leptospirosis isn't that easy to diagnose, at least when you aren't looking hard for it -- I was out of the hospital for several weeks before the diagnosis was made. A teenage promise broken...I was holding my miniature dachshund for his immunizations, Peter jumped, and the needle went into my hand. The vet looked at me apologetically and said "well, you'll never get distemper, leptospirosis or rabies." There is dispute if I am ever distempered. Howard C. Berkowitz 15:26, 14 June 2009 (UTC)

Oh, no, I wouldn't use that quote, that was just a quote from that article that seemed to support your assertion that homeopaths don't believe in Koch's postulates, but as you said, I don't think even scientists use it that way. It seems that homeopaths would likely agree with the 'newer' version. That doesn't leave us with much to write about. D. Matt Innis 19:55, 14 June 2009 (UTC)

Ahistorical absurdity? The sentence says, in a paragraph describing Hahnemann's views, "The relationship between Treponema pallidum and the miasm of syphilis, or between Neisseria gonorrheae and gonorrhea, is not addressed". Hahnemann died in 1843. N goonorrheae was first described in 1879, T pallidum in 1905. Current homeopathic remedies for treating syphilis include Syphilinum, made from a dilution of killed T pallidum. Current homeopathy sites explain the bacterial origin of these diseases. Gareth Leng 11:38, 15 June 2009 (UTC)

Hehe, that's absurd! D. Matt Innis 17:16, 15 June 2009 (UTC)

As long as historical artifacts such as von Behring are being brought in, I see no reason not to mention Hahnemann's ideas of miasms. Von Behring didn't know about immunoglobulins; Hahnemann didn't know about those organisms.

One of the problems with the homeopathic presentation is it that it spends too much time in the 19th and early 20th century, especially when it tries to use medical authorities of those times, such as von Behring, or selective quotes from Osler. Let's face it -- modern medicine is really less than 60 years old. Still, we do have Mr. Ullman talking about cofactors and seemingly avoiding a direct comment on current concepts of infectious disease. We are learning more, not less, about individual variation, but that's often now demonstrably genetic, not spiritual or balancing. In many years of outdoor activities, I've never had a skin irritation suggestive of poison ivy (Rhus toxicendron , if it's called something else on the other side of the pond). I probably have some genetic immunity. I still tell newcomers to the woods, "leaflets three, let them be" because most people (two- and four-legged) have troubles with it. Howard C. Berkowitz 17:30, 15 June 2009 (UTC)

I had no problem with the miasm text, only the last sentence was problematical. I don't have any problem with it being stated that von Behring saw vaccination as suggested by the principle of similars (that's true, so where's the problem?) so long as it's clear that the modern view is quite different.15:05, 16 June 2009 (UTC)

We can work on the last sentence; my point was that if history can be invoked, it needs to be in context whether Hahnemann or von Behring, both of whom did good work for their time. The danger is in having any suggestion that von Behring's model of active immunity or Hahnemann's model of miasm has any present validity. Apropos of the latter, I honestly believe homeopathy would present itself much more strongly if it put less emphasis on fairly old history, and used a model, as does chiropractic, of how it evolves. Howard C. Berkowitz 15:11, 16 June 2009 (UTC)

Complementary medicine statistics

Something just caught my eye: "Over a third of France's 54500 general practitioners use complementary methods: 5% exclusively, 21% often, and 73% occasionally." Complementary (see integrative medicine) does not equate to homeopathic. Quite a few nonpharmacologic methods in pain management, for example, are arguably complementary -- manipulative therapies, relaxation and distraction techniques, etc. They aren't homeopathic. Howard C. Berkowitz 16:36, 11 June 2009 (UTC)

The WHO report says "36% of allopathic doctors, mostly general practitioners, used at least one complementary/alternative technique in their medical practices. Among allopathic physicians using complementary/alternative medicine, 5.4% used it exclusively; 20.7%, often; and 72.8%, occasionally. " So the 36% refers to all allopathic doctors, not just GPs, but it's mostly GPs who use homeopathy. So we can't work out from this what proportion of GPs use homeopathy. Where is the primary source? The WHO report is itself a secondary source. Gareth Leng 17:00, 11 June 2009 (UTC)

The singular of data not being anecdote, I happened to ask my primary care physician, a board-certified MD internist, about his opinion of homeopathy. Let me note that he cross-refers with chiropractors, acupuncturists, dietitians, and several other complementary disciplines. I cannot, alas, reproduce the snorting noise he made, although I can say he then reminded me of the sound made by the source of the simillium of Oscillococcinum. Howard C. Berkowitz 20:36, 11 June 2009 (UTC)

Indeed. And perhaps we might add with Steve Jones that "scientists generally despise physicians" but not sure that this is helpful.Gareth Leng 09:32, 12 June 2009 (UTC)

Howard says: "Complementary (see integrative medicine) does not equate to homeopathic." And indeed he is right, acupuncture is much more popular among regular physicians using CAM than homeopathy. I noticed this when I went through some literature trying to prove the homeopath's claim about 40% French doctors using it.--Paul Wormer 05:07, 12 June 2009 (UTC)

This site gives the source of the 40% as Compl Med Research, May 1990, 4(2)4-8.Gareth Leng 09:32, 12 June 2009 (UTC)

Should we be referencing 20 year outdated statistics? Raymond Arritt 20:09, 13 June 2009 (UTC)

Not without giving the date. We just have to be honest. What is the truth here?Gareth Leng 12:24, 15 June 2009 (UTC)

Hippocrates and similars

This needs sourcing before being included

Hippocrates taught that "Natural forces within us are the true healers of disease," but also because he recorded what some physicians of that day did to initiate healing: he noted that some physicians cured people by using the same medicinal substances that caused the symptoms that the sick people were experiencing-—arguably an early expression of the "principle of similars."

Howard C. Berkowitz 00:11, 12 June 2009 (UTC)

This is a commonly cited paraphrase of translations from the Hippocratic corpus; this passage perhaps sets out the relevant doctrine clearly : "His theory of medicine was further based on the physical philosophy of the ancients, more especially on the doctrines then held regarding the elements of things, and the belief in the existence of a spiritual essence diffused through the whole works of creation, which was regarded as the agent that presides over the acts of generation, and which constantly strives to preserve all things in their natural state, and to restore them when they arc preternaturally deranged. This is the principle which he called Nature, and which he held to be a vis medicatrix. " Nature," says he, or at least one of his immediate followers says, " is the physician of diseases." "

hippocrates is also widely cited as declaring that "Some diseases can be treated best by contraries and some by similars."(see here for the link to Homeopathy Gareth Leng 08:42, 12 June 2009 (UTC)

Fascinating how that last comment by Hippocrates hss ...um...similars to a quote from Osler, which is not the one introduced most often into this article. See Flexner Report for additional context.

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."(Flexner report, page 162)

Howard C. Berkowitz 13:58, 12 June 2009 (UTC)

Famous homeopathy patients

Daniel drew my attention to a website (in German) where three famous users of homeopathy are mentioned: Adolf Hitler, Heinrich Himmler, and Rudolf Hess. Should we mention them?--Paul Wormer 07:10, 12 June 2009 (UTC)

Indeed. But I thought we were firm against celebrity endorsements.Gareth Leng 09:16, 12 June 2009 (UTC)

We've still got the sentence "Homeopathy has a rich history; many famous people over the past 200 years have been users and advocates of it [12]; homeopathy has tended to attract people who are educated and wealthy.[13]" Note the last phrase references a study of 19th century physicians. Is it still true that homeopathy attracts the "educated and wealthy"? (In the U.S. it tends to attract New Age types, who probably have higher income than average, but I don't know about the situation in Europe.) If not then we should put it in the past tense. Raymond Arritt 12:56, 12 June 2009 (UTC)

I've seen that phrase in published surveys of usage. Not sure where. How about "many famous (and many infamous)"Gareth Leng 13:30, 12 June 2009 (UTC)

I would just say "Homeopathy has a rich history." The mentions of famous people, etc. don't really fit with the rest of the paragraph, which discusses homeopathy's influence on the development of (conventional) medicine. If sufficient demographic data are available (not just stories about Prince Charles and so on), it would be interesting to have a "Who uses homeopathy?" subsection complementary to the "Professional homeopaths: who are they?" section. Raymond Arritt 14:01, 12 June 2009 (UTC)

It would be most useful, if citing "famous people" with no specialized healthcare background, to have any information on why they made a (hopefully) informed choice to use homeopathy rather than other methods. There are, indeed, celebrities that have made thoughtful commentaries on why they made choices that range from very aggressive research-level treatment (e.g., Christopher Reeve), to alternative methods, to watchful waiting, to palliative care. Some celebrities have shared the details of their illness and treatment to bring attention to conditions that may not be well understood, or that are avoided in general education (e.g., Farah Fawcett wanting to use her experience to encourage early detection of anal cancer). Howard C. Berkowitz 15:05, 12 June 2009 (UTC)

Actually, my book and research provides strong evidence that Hitler did NOT use homeopathy. I put a section on him in my book because I uncovered a lot of evidence to disprove his use of homeopathy. It seems that some people only looked at my table of contents and did not read my book (the amount of sloppy research out there is a tad embarrassing). That said, there is some evidence that Himler and Hess appreciated homeopathy, and I actually have no problem mentioning them AS LONG AS we have specific quotes/statements about their views or experiences on homeopathy and AS LONG AS it is a part of a detailed section that highlights other cultural heroes for whom there is evidence of some type of strong statement about the subject. Dana Ullman 16:15, 13 June 2009 (UTC)

There's no need to mention "famous people" in an article like this, whether it be Prince Charles on the one hand or Rudolf Hess on the other. Let's just say "Homeopathy has a rich history" without veering off into matters of such tangents. Raymond Arritt 20:07, 13 June 2009 (UTC)

Agree. Gareth Leng 13:16, 15 June 2009 (UTC)

It's not so much the villains that used homeopathy, it's the list of those who never would that gets ugly. I agree we, thankfully, don't need to go there to explain homeopathy. D. Matt Innis 00:33, 16 June 2009 (UTC)

Concern about homeopathy being used for serious illnesses

May want to consider this of evidence for the existence of such concern.Gareth Leng 12:39, 15 June 2009 (UTC)

Gareth, do you really mean to take this seriously? Aren't you at all suspicious of a document that questions the homeopathic treatment of childhood diarrhea and influenza when there are multiple high quality clinical trials that show efficacy of treatment? You have to be very careful when drawing info from the Sense about Science site. It is full of fundamentalist information that is not balanced. 14:11, 15 June 2009 (UTC)

I think the concern is real enough among the health science and medical communities that inappropriate treatments will cause many deaths and missed opportunities. If the concern is unfounded, that is one thing, and if it isn't then we should be able to show that as well. Do the homoepathic colleges support the use of homeopathy in place of other treatments for HIV, TB, etc.. or are we looking at a fundamentalist homeopathy group thought that advocates this, and if so, how large is it. If homeopaths want to treat these patients alongside of conventional medical care, is there harm in that? Or do the homeopathy institutions advocate treating these patients in leui of conventional medicine. D. Matt Innis 17:12, 15 June 2009 (UTC)

Well said, Matt. For example, Ramanand's website points to a 3-month trial in which homeopathy was claimed to reduce HIV viral load, but brushed off a longer evaluation. Unfortunately, there have been repeated, first promising, trials of medical highly active retroviral therapy, which could make HIV disappear -- but it always came back after a year or so off drugs.

There are at least two levels here. One is the avoiding of treatments of known value and known imperfection. The other has to deal with the 800 pound gorilla of health care budgets: any complementary therapy adds cost -- is the benefit justified in terms of outcomes? In some cases, the answer is unequivocally yes; indeed, medical measures may be the complementary therapy to chiropractic in acute low back pain. I use essential oils because they subjectively make me feel better, but I know classic aromatherapy has not been demonstrated to improve surgical therapy -- there is, however, some evidence that using essential oils with massage therapy may do so. It's one thing if the patient pays out-of-pocket for complementary therapies (e.g., surgery for acute low back), but another matter if it has to come out of a limited budget. Howard C. Berkowitz 17:22, 15 June 2009 (UTC)

I explicitly added watchful waiting. Now, an ideal situation for a homeopathic treatment might be where medicine offers nothing, or nothing with reasonable risk-benefit for the severity of symptoms, and there is a careful integrative approach that stays alert to the possibility of exacerbation. It assumes that the homeopath is qualified to recognize exacerbation, or at least cooperate in it (hypothetically, draw blood for monitorig). The economics need to be considered. Howard C. Berkowitz 04:12, 16 June 2009 (UTC)

Sense about Science is a registered charity, established by a former Government minister, with a Board of Trustees and Advisory Board that is eminently distinguished and fully representative of the senior establishment in British Science. A fuller list of the "great and good" in the UK it's hard to envisage - it includes for example former Heads of the MRC and Wellcome Trust. As a statement of mainstream scientific and medical opinion in the UK I think it is pretty unimpeachable. You may think they are misguided; that's not the point, the point is that if these express concern then we have to acknowledge the existence of concern Gareth Leng 08:46, 16 June 2009 (UTC)

Associated Press article about the dangers from some homeopathic "natural" medicines

Check this out: http://www.google.com/hostednews/ap/article/ALeqM5gQ2bZ11tGtoiKx6BO5K70Lx1ETmgD98SK27G0 Hayford Peirce 21:57, 18 June 2009 (UTC)

I have been watching this as well. Besides the obvious (that there is some risk to some homeoapthic remedies), it shows that our article has not acknowledged that some homeopathic remedies, or maybe many, actually do have measurable amounts of substances and their effects (and side effects) may be real and a real concern. D. Matt Innis 23:07, 18 June 2009 (UTC)

It's a particularly complex example of nonlinear dose-response curves, since zinc deficiency also can cause anosmia, and zinc levels are part of the medical workup of olfactory disturbances. Howard C. Berkowitz 23:16, 18 June 2009 (UTC)

Exactly, zinc has been used in cold remedies for ages, we assume safely. It is touted as good for skin and mucous membranes, which I presume is why it is used in cold remedies. I am not sure about direct contact with the olfactory nerves, though, that might be where things go wrong. It will be interesting to follow. But, again, we might need to give a little more attention to the remedies that do have measureable product in them - because we can't claim that they are all without risk for certain populations. Did the Lancet study just look at products over (or under) 30C? What research do we have about the products that are less diluteD. Matt Innis 23:54, 18 June 2009 (UTC)

It's a bit ironic to look at the manufacturer's statement as a result of the FDA notice, [11]. "We were surprised that the FDA decided to take this action without notifying us first, given our cooperative relationship with the FDA since we launched our first product in 1999. Had we had the opportunity to sit down with the FDA beforehand, we are confident that the FDA would have agreed that the scientific data clearly demonstrated the safety of our products.”

This reminds me of some of the self-serving statements from the Dark Side of Big Pharma. Where's the "above all, do no harm?" While most FDA urgent recalls have involved a threat to life, I can think of some that involved loss of limb or sensation. In the risk-benefit analysis that applies to any kind of health care, it seems prudent not to dither about something that can cause loss of taste or smell, for a self-limiting condition such as the common cold. Note that the manufacturer's other zinc products have not been recalled and remain available for cold treatment; it's only the intranasal ones being questioned. Howard C. Berkowitz 00:12, 19 June 2009 (UTC)

I do agree something smells fishy (pun intended :). I'm just not sure we have enough information to draw any conclusions. I wonder what the scientific research does show, and if there has been any. I think that is what the FDA is saying - that if they want to market this product then they need to do the research to show it is safe. Of course that would cost millions, similar to medications, which would revolutionize the supplement industry. This would be a different line; rather than trying to prove a supplement is effective, prove it's not harmful.D. Matt Innis 00:53, 19 June 2009 (UTC)

I think that you're all missing the real point of the article -- please read it again: it is essentially saying what a crock of something or other homeopathy has been and still is.... Hayford Peirce 05:12, 19 June 2009 (UTC)

The FDA acknowledges that the vast majority of homeopathic medicines are OTC drugs, though they also recognize certain homeopathic medicines as Rx drugs. The latter are deemed such if their dose is not safe. As such, Zicam, which has Zinc gluconate 2X, is simply not safe at that dose. It should be an Rx at that dose. Plain and simple.

I, however, am shocked at the misinformation that AP and select other major media have spread. AP wrote that over 800 homeopathic medicines could be dangerous, but then they note that they are only dangerous in doses that are not homeopathic. And then, the reporter sought to scare people by saying that homeopathic medicines have 10% alcohol and that taking a homeopathic medicine is like drinking a martini (a Harvard pharmacologist actually said that!). Let's be careful out there. Truth is the victim here. Dana Ullman 07:01, 19 June 2009 (UTC)

In a New Drug Application for a non-homeopathic drug, the manufacturer usually initiates the request for prescription status to the FDA. If the proposal is for immediate over-the-counter licensing, safety data are required. When there is consideration of a formerly RX drug going off prescription, this usually triggers an advisory panel, which has stopped some bullets like Seldane. This was a prodrug of current H2-blockers, and had some rare but fatal cardiac side effects seen only in large populations, which genuinely seem to have shocked all involved. Everyone involved had thought Seldane and Hismanal were safe, and, indeed, their metabolite Claritin does seem to be safe.

Yet the attitude expressed here seems to be "acknowledging" the majority of homeopathic drugs are safe, without the formalities of safety testing, any more than there have been formalities for nutritional supplements. Nutrititional supplements can and are used in a controlled manner, by physicians, and (my own case with niacin) can have dramatic and serious side effects, luckily reversible.

Pharmaceutical companies have financial reason to avoid independent regulation. Tobacco, of course, has centuries of safe use. Some nutritional substances are safe and fine (I use some with knowledge of my physician). The nutrititonal industry, and the homeopathic industry, are not free of potential conflict of interest, and this isn't being mentioned at all. Homeopathic manufacturers might well go out of business were they subject to safety, much less efficacy testing. Efficacy testing, where the UK leads, is one way to approach the "me too" cost factor in national health budgets.

This article does not suggest homeopaths or homeopathic manufacturers might ever have crass commercial conflict of interest. Is that correct? Howard C. Berkowitz 13:31, 19 June 2009 (UTC)

While we've got Dana on the line, a couple of questions. My understanding is that Zicam is not a "true" homeopathic remedy in that it barely diluted, and I have not found any evidence that succussion is used between each dilution (though I have not found evidence that it isn't, either). Zicam's self-description as "homeopathic" seems more than anything to be an attempt to exploit the homeopathic exclusion from regulation. Does anyone know if Zicam is a real homeopathic preparation? Raymond Arritt 23:56, 19 June 2009 (UTC)

Although I'm leaving for Berlin tomorrow to lead a 2-day seminar, I've squeezed in a little time to review some things here briefly. Zicam IS a real homeopathic medicine, legally speaking, though the manufacturer did use some of the vagueries of regulation to create a medicine that did not undergo adequate safety testing. The fact of the matter is that the company knew about the problems with the loss of smell for many years, and they did not choose to make the medicine more safe by making it with a higher number of potentizations. They kept it at a 2X, instead of a 3X, 4X, or on and on. In Europe, a homeopathic medicine has to be at least 3X for it to be deemed a homeopathic drug. In the US, Calendula (marigolds) in tincture is both an herbal remedy and a homeopathic drug. The difference is only in what the manufacturer decides and what indications the manufacturer chooses to use (or not).

That said, please know that the AP article was full of distortions. They emphasized the alcohol in homeopathic medicines, even though less than 1% of homeopathic medicines sold have ANY alcohol in them. The 800+ ingredients that are "dangerous" are only dangerous in doses that are non-potentized. Heck, calcium is dangerous in a high concentration. The article mentioned that the NCCAM gaves $3.8 million in grants for homeopathic research between 2002 and 2008. I wish that this were true. I know of only 1 or 2 small studies that were funded during this time. I have no idea where the reporter dug up this statistic, and based on the many other distortions in the article, I would not trust that number. Dana Ullman 06:32, 23 June 2009 (UTC)

Forget the AP statement...

And look at the manufacturer's own statement, which I have cited once but have seen response only to the AP article:

[12]. We were surprised that the FDA decided to take this action without notifying us first, given our cooperative relationship with the FDA since we launched our first product in 1999. Had we had the opportunity to sit down with the FDA beforehand, we are confident that the FDA would have agreed that the scientific data clearly demonstrated the safety of our products.

Now, maybe it's just me, but this doesn't seem terribly different than some self-serving statements put out by "conventional" drug manufacturers, whose products, in some cases, were eventually pulled for safety reasons. Contrast that with the instantaneous and drastic response of Johnson & Johnson, done far beyond anything the FDA required, when there was an incident of after-market poisoning of Tylenol. I grew up hoping to work in pharmaceutical research, and have been saddened to see how the ethics declined from the 1960s. Back when I was a high school student getting some mentoring at Schering, regretting Merck was just too far away for visits, it would have been inconceivable to see test suppression such as seems to have happened with Vioxx.

I have no reason to believe Samuel Hahnemann was not one of the most ethical healers in history. The homeopathic side in this article, however, often makes innuendoes about the corruption of physicians and the medical pharmaceutical industry. Indeed, there has been increasingly good reason to regulare manufacturers run by marketeers and financial people rather than the pharmacologists that created them. It's been obvious for some time that supplement manufacturers drive through loopholes, as with multiple ephedra incidents and recently with Hydroxycut, but, in the U.S., there has been resistance to any kind of regulation, which does exist in some European countries. I'm afraid I'm hearing both "trust me, trust me", from homeopathic spokesmen, and very little mention of manufacturer roles. Could it possibly be that the exemptions from regulation are traditional and mercenary rather than best current practice? Remember, FDA had no authority over drugs until the Elixir Sulfanilamide tragedy.

The article has to reflect that not every homeopath, homeopathic manufacturer, and blurry "natural" or "supplement" manufacturer has an automatic moral superiority to the medical, increasingly regulated model. Howard C. Berkowitz 14:33, 23 June 2009 (UTC)

Long time no see (post)!

Hi guys, I've been really busy for some time now. I just wanna clarify some points: Only allopaths are allowed to practice allopathy in India - there's a Supreme Court (of India) ruling which says that anyone cross practising should be arrested (and that's really happening). Nobody takes homeopathy because it is 'good old medicine', but only because it helps them. If a patient dies after treatment by a doctor (including a homeopathic doctor), he/she will be imprisoned for life and the license/registration will be cancelled. In India, homeopathy is an alternative medicine and not a complementary system of medicine, because a homeopath isn't allowed to practise allopathy. If a reply is important here, please feel free to e-mail me (I've left everything to Dana here).—Ramanand Jhingade 13:57, 29 June 2009 (UTC)

Request to revoke approval

Text here was removed by the Constabulary on grounds of civility. (The author may replace this template with an edited version of the original remarks.)

Let's be precise. The article does not, from a CZ perspective, advocate homeopathy for anything, much less acute asthma attacks. I wrote respiratory emergencies, and would probably club anyone who was considering using homeopathy for acute asthma. Nevertheless, as much as I'd like to see this article go away, the distinction is valid that some homeopaths argue for some things, while we should be making it clear it's medical insanity. Howard C. Berkowitz 00:53, 18 July 2009 (UTC)

Responding to the deleted comment, which may be entered in more civil form, I would not be opposed to removing approval on the existing article. Nevertheless, there is a procedure, and there is a CZ style of discussion. Howard C. Berkowitz 01:14, 18 July 2009 (UTC)

It says in the article "For some disease conditions, such as asthma and acute bronchitis, homeopathic remedies are often prescribed not only to alleviate chronic symptoms, but also to treat acute attacks. Homeopathic remedies might also be used after an asthmatic episode with the intent to prevent recurrences. "

Later we get: "Some of the common ailments for which patients seek homeopathic care are eczema, chronic fatigue syndrome, asthma, migraine, irritable bowel syndrome, allergic disorders, arthritis, fibromyalgia, hypertension, Crohn's disease, premenstrual syndrome, rhinitis, anxiety and depression"

Then finally, right at the bottom of an excessively-long article, long after most people will have stopped reading, we have the ridiculously weak "For example, asthma and other respiratory disorders with a seemingly mild initial presentation can be a life-threatening condition, and acute attacks, if not treated effectively, can lead to sudden death. According to conventional opinion, prescribing homeopathic remedies in these cases may delay the delivery of conventional treatment with potentially serious consequences."

This is advocatng Homeopathy as a treatment for acute asthma attacks, with the most horribly de-toothed statement of the mainstream perspective ever. If we're going to present Homeopathy neutrally, we could do that. What we are doing is presenting the homeopathic view as superior to the mainstream one, carefully detoothing any mainstream criticisms, and shoving them to a ghetto at the bottom of the article, after the homeopathic promotion. We need to revoke this article's approval. Adam Cuerden 01:23, 18 July 2009 (UTC)

Secondly, by CZ's rules, any member of the healing arts group can block the approval of a genuinely neutral article. So, Dana Ullman - who has no medical degree, just an MPH (Isn't that like a one or two year program?), does not, as far as I can tell from public biographies, have any homeopathic licensure either, and who was arrested for practicing medicine without a licence - why is he even considered an expert here? Adam Cuerden 01:29, 18 July 2009 (UTC)

Are you referring to the Approved or the Draft version? Yes, I agree, the Approved version is too soft on the mainstream perspective. The appropriate action would be to replace it with a properly worded Draft, given the article won't disappear. De-approval isn't going to happen but replacement can.

I would be interested, seriously, in seeing a source on an arrest. An MPH is an advanced degree, but it's not clinical; the major emphasis is biostatistics and preventive medicine. Howard C. Berkowitz 02:00, 18 July 2009 (UTC)

I agree that we should be able to handle (and have already handled) most issues on the draft. I'm willing to keep moving forward with something that most everyone can agree is neutral. The problem with re-voking approval is that the draft becomes the front article and edit wars continue similar to wikipedia. I think that is the idea of having an approved version so that we have some stability while we work behind the scenes to improve the draft. I am grateful to have homeopathic input on this article, as I am grateful to have a health science perspective as well. Unfortunately, I've never had the honor of being arrested, but I do have a few traffic violations and they still let me drive ;-)

If we have any problems here, it is that we have tried to change too much too fast. Maybe we chould take one issue at a time and re-approve as we go. D. Matt Innis 02:30, 18 July 2009 (UTC)

↑ Homeopathy: Real Medicine or Empty Promises?, Food and Drug Administration

[1] Iris Bell I (2005) All evidence is equal, but some evidence is more equal than others: can logic prevail over emotion in the homeopathy debate? J Alt Comp Med 11:763–9.

[2] Appian, History of Rome, §111

[3] There is a famous, untitled poem about Mithridates by the English poet A.E. Housman. The last line is, "I tell the tale that I heard told, Mithridates, he died old."

[4] Behring, A. E. von. Moderne Phthisiogenetische und Phthisotherapeutische: Probleme in Historischer Beleuchtung. Margurg: Selbsteverlag des Verfassers, 1905.

[FDA-HP-5] Homeopathy: Real Medicine or Empty Promises?, Food and Drug Administration

[FDA-HP-6] Homeopathy: Real Medicine or Empty Promises?, Food and Drug Administration

[1]

[2]

[3]

[4]

[5]

[1]

@@ Line 1,123: / Line 1,123: @@
 :::I would be interested, seriously, in seeing a source on an arrest. An MPH is an advanced degree, but it's not clinical; the major emphasis is biostatistics and preventive medicine. [[User:Howard C. Berkowitz|Howard C. Berkowitz]] 02:00, 18 July 2009 (UTC)
+::::I agree that we should be able to handle (and have already handled) most issues on the draft.  I'm willing to keep moving forward with something that most everyone can agree is neutral.  The problem with re-voking approval is that the draft becomes the front article and edit wars continue similar to wikipedia.  I think that is the idea of having an approved version so that we have some stability while we work behind the scenes to improve the draft.  I am grateful to have homeopathic input on this article, as I am grateful to have a health science perspective as well.  Unfortunately, I've never had the honor of being arrested, but I do have a few traffic violations and they still let me drive ;-)
+::::If we have any problems here, it is that we have tried to change too much too fast.  Maybe we chould take one issue at a time and re-approve as we go. [[User:D. Matt Innis|D. Matt Innis]] 02:30, 18 July 2009 (UTC)