Talk:Homeopathy/Archive 13

Homeopathy

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Beyond placebos

Let's go beyond placebo effects. There exists research on animals and cell cultures. I proposed to Ramanand that we investigate this field. Chris (Day) manifested his curiosity. Please see Ramanand's talk page. Pierre-Alain Gouanvic 00:47, 1 September 2008 (CDT)

This is what I posted there last: "I'm sure Molecular Biologists are working on studies like that; as a Doctor, I should be healing the sick. The proof of the pudding is in the eating, so I feel people should try Homeopathy before commenting on it."—Ramanand Jhingade 21:55, 1 September 2008 (CDT)

People should try homeopathy before commenting on it? I trust, therefore, there should be no male obstetricians and no astronomers have the right to comment on the Moon unless they had been on an Apollo mission? I suppose I should have rejected the nitroglycerine and morphine I was offered, during an episode of unstable angina, by a vigorous young cardiology fellow?

It's interesting...I've asked you several times how you would approach a patient with a well-defined set of symptoms, without one molecule in the explanation, and you ignored it. You brought up giving an iron salt to "improve" a blood count, and when I followed up with a few questions about that which you would be improving, I didn't seem to get any response. You stated that homeopaths routinely used diagnostic studies, but you were silent when I asked which you might order, again with a specific set of symptoms.

If the pudding is butterscotch, I might be persuaded that it's good pudding. I have to interpret that your comment about as a doctor, you should be healing the sick, and molecular biologists should be doing whatever irrelevant things molecular biologists do. Aren't there some sick people that need your attention more than we unenlightened ones just don't seem to be accepting your world-view and bowing and saying "yes, our studies and experience are irrelevant."

Until you give any indication you have any understanding of immunology or endocrinology, I am less than inclined to pay attention to your statements on how the immune system should be "strengthened".Howard C. Berkowitz 22:29, 1 September 2008 (CDT)

When you can trust a young Cardiology fellow, why not a Homeopath? You skeptics are theorizing, while Homeopaths know the effects of their remedies.—Ramanand Jhingade 22:36, 1 September 2008 (CDT)

Oh, quite a few reasons I'd trust that cardiology fellow, perhaps because I've had a fair bit of training and experience in cardiovascular medicine. A factor might be that cardiologists are constantly asking the question if their approaches meet continuing review of safety and efficacy, and if their techniques of prevention and treatment are consistent with increasingly specific understanding of the underlying mechanisms.

I have an excellent relationship with my primary physician, a general internist with a special interest in endocrinology. Unfortunately, many patients don't have the advantage that we have a common framework, and things aren't on a "trust me" basis. Either one of us can come up with suggested diagnoses or treatments, and we cross-check one another. If I call and say "Can we schedule an echocardiogram before my next visit to we can make an informed judgment about choices in insulin receptor agonists?", there isn't a need for a lot of mysticism; we both know where we are going, and that our collaboration has objectively improved a number of problems.

I haven't, for example, noticed any large-scale meta-analyses by homeopaths showing that a previously accepted standard of care, such as angioplasty and stenting, are rarely more effective than intensive medical management. Medical management is not stuck in materia medica and external observations, but constantly tuned by evidence-based medicine. One of the frustrations of cardiologists is that improvements don't necessarily get into wide use among primary physicians.

In contrast, the message from homeopaths is not "this is how we have refined. This is getting more quality-adjusted years of life in the treated group." The message appears to be "Have faith. Trust us. Don't ask for any verifiable information. Might I offer you a great deal on a 1984 Jeep Cherokee, barely used?" Howard C. Berkowitz 22:59, 1 September 2008 (CDT)

I told Pierre that for me clinical effects are enough and I'm repeating that here. Laboratory investigations like Blood tests, X-rays, C.T./ultra-sound scans etc. show improvements before and after Homeopathic treatment, so Homeopathy is not something that works by faith (I've healed people who had no faith in Homeopathy; I've also healed animals and babies who can't be influenced in any way).—Ramanand Jhingade 21:37, 2 September 2008 (CDT)

Since you are not a Healing Arts or Health Sciences editor, it is not your decision what is, and is not, enough. While I am not an editor in either of those groups, I am an Engineering editor, and I will say that the general standard in reporting on technical matters has a statistical framework, and generic references to a wide range of tests such as "blood test, X-rays, C.T./ultrasound etc." is so vague as to be meaningless.

I request that a Health Sciences or Healing Arts Editor make a content ruling on the standards to be applied to assertions. Indeed, wearing my hat as a Computers editor, there are generally accepted standards of acceptably specific output from a health informatics system. The assertions above do not come close to them; I'd suggest that an appropriate editor bring this content-free repetition to a merciful end. Howard C. Berkowitz 21:59, 2 September 2008 (CDT)

There are clinical trials as well, some of which I mentioned before, which can buttress my claims.—Ramanand Jhingade 22:22, 2 September 2008 (CDT)

Ramamand, above you wrote: "Laboratory investigations like Blood tests, X-rays, C.T./ultra-sound scans etc. show improvements before and after Homeopathic treatment, so Homeopathy is not something that works by faith (I've healed people who had no faith in Homeopathy; I've also healed animals and babies who can't be influenced in any way)"

Unreferenced assertions such a this are not useful to any discussion with respect to this article. We have to consider the whole picture not just your experience. Chris Day 22:29, 2 September 2008 (CDT)

Sweeping statements and a citation are not adequate detail for articles

In dealing with as fundamental a topic as the concept of apparently nonexistent doses having effect, it is totally unreasonable to accept "Foo has the best understanding", and give a reference to Foo, without any details of Foo's model, or authoritative responses to it.

There seems a fundamental misunderstanding that a proponent of a given approach, and I do not in any way limit that to health, can write an acceptable CZ article by stating his or her preferred interpretation of a subjective matter, and then demand everyone else disprove it.

I happen to be writing on Internet Protocol version 6, which involves several articles. They are scratching the surface; my intention was to get some things started, and, indeed, a colleague is doing some good collaborative edits -- for that matter, we are also discussing some aspects by email.

There is very little substantive support for statements being made here. When the author involved makes references to such things as "improving blood counts" or "strengthening the immune system", yet apparently can give no specifics, such material certainly doesn't belong in the article -- and is questionable on the talk page. Howard C. Berkowitz 22:20, 2 September 2008 (CDT)

I wonder how you have so much time to keep posting here (I make time because I can't let this article be an 'attack piece' like the article on Homeopathy on Wikipedia). Howard, you must stop being so skeptical - I have posted about other clinical trials.—Ramanand Jhingade 22:31, 2 September 2008 (CDT)

Why should I stop being skeptical? You tell me trials are "good", but you have yet to demonstrate any knowledge of the statistical design and validation of clinical trials. I've given you examples that could be used for discussion, I think it's fair to note that Gareth observed that the statistical problems of low-responder individualized medicine -- not homeopathy, but pharmacogenetics -- are a statistical challenge. He and I exchanged some thoughts. You did not participate.

You have made references to things such as "improving blood counts", but, so far, I have no reason to believe that you have any familiarity or understanding of what is in one, how it is interpreted, or that it is essentially a screening test that calls for additional analysis -- testing, history, physical, and systematic thought.

You, not I, suggested "Ferr. Phos." for "improving a blood count", although you did not indicate which of the five or so measured parameters and three computed values in a CBC needed to be improved. I believe there are a fair number of people who could point out a hematologic profile where administering an iron compound is hazardous.

I have read in homeopathy -- and rejected it for reasons as basic as physical chemistry. I might stop being so skeptical if you demonstrated that you had an understanding of what you are rejecting. You speak blithely of strengthening the immune system, but apparently see no conflict between that bit of jargon and the spectrum of autoimmune diseases. The alternative practitioners I most respect are integrative -- perhaps the most knowledgeable person I know in traditional Chinese medicine is also an excellent nurse practitioner. I've had any number of thoughtful discussions about complementary techniques with physicians that also had full pain management fellowship training. People that are trying to find common principles in acupuncture and electrotherapy have my respect.

When you make a comment that you are too busy healing people to worry about what molecular biologists do. When I find a homeopath that can discuss different approaches and finding, and seem interested in a search for integrative results rather than insisting on "trust me", I might be less skeptical. As it is, I'm really hoping that an appropriate Editor gets involved and puts a stop to this.

Revert wars are against CZ rules, so I won't engage in one. I will, however, contiue to question content in your article, when I see a lack of authoritative sourcing, or a flat statement that is utterly contrary to a significant body of knowledge. I will, as is appropriate, explain my reasons for doing so on the talk page, but I have no further interest in pointing out inconsistencies and refusal to answer questions on the talk page. I am not skeptical on the number of times that you have referred to testing, and then been unwilling to discuss any aspect of the test, what specific results you are discussing, or what "improvement" would be.

Res ipsa loquitur. Howard C. Berkowitz 23:23, 2 September 2008 (CDT)

How come you respect acupuncture and electrotherapy? There is hardly any scientific evidence for those forms of treatment (although I believe they work - I've seen results and that's enough for me to accept something, just like Homeopathy).—Ramanand Jhingade 05:51, 3 September 2008 (CDT)

Beyond placebos (cont'd): in animals

I found a good one. We're dealing with mice, there is a variety of controls, and both principles of homeopathy are involved : 1) a toxin, arsenic, is used to mitigate the effects of arsenic; 2) the doses used are well below Avogadro's limit (no arsenic left). I'dd add that the study was "highly accessed" and published in a BMC journal; we can expect some level of fact-checking and authenticity. Several indices were studied, including GSH and ALT. Ameliorating effect of microdoses of a potentized homeopathic drug, Arsenicum Album, on arsenic-induced toxicity in mice, P Mallick, J Chakrabarti Mallick, B Guha and AR Khuda-Bukhsh BMC Complementary and Alternative Medicine 2003. I would also add that there are serious implications to this finding. I quote:

Mainly with such a background (nota: arsenic intoxication in many poor countries), our initial aim was to find out suitable antagonists of arsenic poisoning, which should be i) easy to administer, ii) effective in low doses, iii) inexpensive and iv) without any toxic effects of their own. In course of our search, a potentized homeopathic drug, Arsenicum Album-30, was indeed found that showed highly promising results in combating arsenic intoxication in mice, in regard to a series of accepted scientific protocols used, such as cytogenetical, histopathological and biochemical [10-16]. Encouraged by the positive results obtained in these studies, and also of others [17], changes in activities of certain toxicity marker enzymes like alanine amino transferase (ALT, EC.2.6.1.2, also known as glutamate pyruvate aminotransferase) and aspartate amino transferase (AST, EC 2.6.1.1, also known as glutamate oxaloacetate aminotransferase) and changes in the level of reduced glutathione (GSH) in liver and blood tissues of mice, if any, have now been determined at different periods after single injection of arsenic trioxide. The present investigation also aims at ascertaining if oral administration of either of two micro doses of the homeopathic drug, Arsenicum Album, namely, Arsenicum Album-30 (henceforth to be called Ars Alb-30) and Arsenicum Album-200 (henceforth to be called Ars Alb-200) can ameliorate arsenic toxicity by bringing about positive modulations of these toxicity denoting parameters.(...)

© 2003 Mallick et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

Long quote? Sorry. It's simply that I can't believe my eyes!

Pierre-Alain Gouanvic 00:44, 3 September 2008 (CDT)

With all due respect, my concern here is not the performance of homeopathy in a particular trial, but whether best practices in homeopathy are consistently based on trials, or on objective versus subjective diagnostic practices. I'm willing, without reading the article, to accept that it showed certain verifiable results.

My concern with Ramanand, however, is that he will make fairly general statements such as "strengthen the immune system", or, which I find the most telling, give a dose of "Ferr. Phos." to "improve" a blood count. I do not find "improve" a meaningful term with respect to what is actually a set of tests. Perhaps an iron salt is being administered, as a homeopathic dose, to address what might appear to be a situation of iron overload. The complete blood count would only be suggestive of such, with abnormalities in the RBC indices. From a conventional standpoint, further tests would be indicated before treatment for iron deficiency or for overload, minimally including ferritin, serum iron, and total iron binding capacity. If the problem were not iron overload but iron deficiency anemia, these still might be appropriate, but one would want to look for both hemorrhagic or hematologic causes for such an anemia.

I did not find it terribly hard to write the above description of an approach to a hematologic abnormality. If someone claims to be able to treat an undefined abnormality, based possibly on the result of the CBC, I am skeptical until I discover that person demonstrates an understanding of the measured parameters of the CBC, the calculated RBC indices, and a diagnosis (possibly supported by other testing or examination). In conventional medicine, there would be a very specific purpose, for example, if the clinician chose to administer non-homeopathic amounts of iron salts,

If an overload condition such as hemochromatosis (abnormal iron accumulation) was the diagnosis, then there could be a substantive discussion of the homeopathic approach of using a remedy containing iron, as opposed to the conventional approach directed at reducing iron, including therapeutic phlebotomy, chelation of iron with deferoxamine, and close monitoring of liver function and other indications of significant complications of iron overload. I would find such a discussion to be meaningful and, if the homeopathic approach had comparable evidence for its efficacy as the conventional approach, confidence-building. In this example, if a course of a homeopathic remedy lowered the indicators of iron overload, there would be reason to presume cause and effect.

Does that strike anyone else as an example of a reasonable expectation of dialogue that would not continue to increase skepticism, but to decrease it? Howard C. Berkowitz 11:31, 3 September 2008 (CDT)

Howard, I've Homeopathically healed people with both Hemochromatosis and anemia. The remedy used differs in each individual, so clinical trials are difficult.—Ramanand Jhingade 21:58, 3 September 2008 (CDT)

First, I have repeatedly described a method, on which Gareth commented, in which clinical trials could be conducted on a treatment that involved individualized therapy. Such trials are clearly going to be necessary for research in pharmacogenetics, so this isn't picking on homeopathy.

Second, a claim of "curing" someone needs more substance than a flat statement. In the case of hemochromatosis, there would be specific changes that would indicate it is stable; I'd hesitate to use the term "cure" with a disease such as this, where there is an identifiable genetic abnormality. "Control" would imply an absence of symptoms, but also objective measurements such as iron levels, and also continued normal levels, over an appreciable period of time, of the more common serious secondary effects of the disease. Certainly, liver function tests would have to be consistently normal.

Anemia, with no further qualification, is an abnormal hematological function. It must be further characterized to even begin to say "cure". Now, if a patient was anemic due to trauma, surgical correction of the source of hemorrhage could very well be curative. If a patient presented with aplastic anemia after chloramphenicol therapy, stating a cure would first give the marrow and peripheral analysis that made a diagnosis; to speak of cure, there would be changes in marrow that persisted over years. Were the anemia genetic, as in sickle-cell disease, again, "cure" is a bit strong, although "reduction of exacerbations", along with before- and after- studies, might be something that could help me be a bit less skeptical.

Note that I am not describing generic things such as "anemia". I am being succinct but specific; were I building the evaluation into an expert system -- I do that more in cardiology and infectious disease than in hematology -- I'd be much more specific about signs, symptoms, inferences, etc. It is that level of precision that causes me to be less skeptical. It is also a statement of the probability of error, of adverse effects, of no benefit that also makes me less skeptical. Aside from any work I've done in medical decision support, I've had to make decisions for myself, or as a surrogate, where it was a matter of picking the least bad choice. Overconfident clinicians make me nervous. Howard C. Berkowitz 22:18, 3 September 2008 (CDT)

Beyond placebos (cont'd): in cell cultures

Dynamized Preparations in Cell Culture, (2007) Evidence-based Complementary and Alternative Medicine, Ellanzhiyil Surendran Sunila, Ramadasan Kuttan, Korengath Chandran Preethi and Girija Kuttan

Although reports on the efficacy of homeopathic medicines in animal models are limited, there are even fewer reports on the in vitro action of these dynamized preparations.

(...)

These results indicate that dynamized medicines possess cytotoxic as well as apoptosis-inducing properties.

Pierre-Alain Gouanvic 01:06, 3 September 2008 (CDT)

Pierre, thank God there is someone like you around. Why don't you incorporate these references in the article, since you are a 'constable'?—Ramanand Jhingade 05:36, 3 September 2008 (CDT)

Ramanand, please review the differences between a Constable and an Editor. A Constable has the necessary role of mediating where possible, but also enforcing professional behavior. Constables have full authority about behavior, but no particular authority about content.

Content decisions are made by Editors. They may rule that a certain line of discussion should be removed from an article, as not authoritative, or request authoritative support for a claim. They may make decision about article content being right or wrong, subject to review by other Editors of the same workgroup, or the Editorial Council or Editor-in-Chief. If an Author continues to post material after an Editor has ruled against it, a Constable can enforce that ruling, anywhere from deletion of the material to banning the user.

Very roughly, a CZ Constable has some functions similar to that of a WP Administrator. There is no WP equivalent to a CZ Editor.

So, if Pierre-Alain is acting as a Constable, he has no more authority on the topic content than any other contributor. If you, Ramanand, want rulings in your favor about content, you need support from an Editor. Howard C. Berkowitz 11:13, 3 September 2008 (CDT)

O.K., thanks for the advice Howard. I did not know about this. I will apply for a Status upgrade.—Ramanand Jhingade 21:58, 3 September 2008 (CDT)

Neutrality; Subpage?

Hey all--

I kept seeing this page come up on the recent changes page, and I just wanted to drop in and remind everyone that Citizendium is explicitly supposed to be neutral. As this has been elaborated in the context of anthropogenic global warming, in writing articles we are not trying to formulate the official Citizendium position on Global Warming or Homeopathy or whatever-- Citizendium does not and should not take a stand on a given issue, even if it's a stand that 95% of credible scientists endorse.

This does not mean that we mention every crackpot theory on every subject. In the case of homeopathy, however, there are fairly clearly defined positions on either side of the debate, and the purpose is not to advocate or denounce, but to articulate the positions.

Instead of arguing over what studies are and are not appropriate for inclusion on the main article, let me make a suggestion: make a new article on 'Clinical Studies of Homeopathy' (or something to that effect), and put your energies towards articulating your positions in the context of an article.

I don't have a dog in this fight, but I also wanted to note that, as written, I find the current 'Introduction' section (the one in the article body, not the intro) decidedly non-neutral.

Thanks, Brian P. Long 20:26, 3 September 2008 (CDT)

Thank you. I would be much happier if there were fewer "it is obvious", or citing a reference with absolutely no comment about it other than it was good.

Unfortunately, and I would truly appreciate suggestions on how to resolve this, perhaps the most neutral way to phrase things is that some of us are model/causality oriented and some are not. There is also an apparent lack of shared vocabulary, or, alternatively, very different perceptions of what terms mean, and what background knowledge might be inferred from the use of a term.

Any ideas? Howard C. Berkowitz 20:32, 3 September 2008 (CDT)

Removed from lede

I removed this from the lede. I would like to know what Khuda-Buksh says, though.

• The molecular mechanism of action of the potentized homeopathic drugs has been explained best by Khuda-Buksh<-- this is a constables contribution: WHAT CONSTABLE?, PLEASE? NOT IN REVISION HISTORY-->

D. Matt Innis 21:32, 3 September 2008 (CDT)

Again, thank you. I don't know how to respond to statements that give a conclusion but no explanation; I hope that when I cite articles, I give a minimal summary of what seemed relevant. Otherwise, it's a bibliography, not an encyclopedia. Howard C. Berkowitz 21:46, 3 September 2008 (CDT)

Why sure, Howard. I made a couple of edits in the first two paragraphs that I hope clarify it a little. I don't think I have changed the meaning much, but hopefully made it a little more succinct and readable by the lay person. If I am heading in the wrong direction, doo feel free to "adjust" as necessary. D. Matt Innis 22:10, 3 September 2008 (CDT)

Improvement

Matt, your rephrasing,

The underlying premise of homeopathy is that the signs and symptoms that accompany a particular illness are not simply the result of the breakdown of the organism, but instead part of the organism's defenses in an effort to fight infection, adapt to stress, and/or respond to toxic insult. The homeopath does not attempt to inhibit symptoms or suppress disease, but rather considers the remedies that they feel will best "...mimick the body's wisdom and therefore augment immune response."

is a definite improvement; it is a good deal less demanding of proof than a claim of an answer to cancer and schizophrenia -- neither of which are single entities.

My concern, however, is that "immune response", "immune system", etc., are being used very differently by some homeopaths and some people with a more molecular approach. I think it can be stated, with a high degree of solid data, that immune response involves multiple mechanisms, any of which can get out of homeostasis. There is a wide range of autoimmune diseases where different mechanisms in the immune system are hyperactive, directly attacking body cells or indirectly releasing inflammatory substances. In other immune-related diseases, there are specific mechanisms that could be "strengthened", such as the T4 lymphocyte count in AIDS. Strengthening T8 or NK cells would not be good.

A start might be a general agreement that immunity is not one monolithic system. From there, an integrative approach might say that this patient's basophil degradation is triggered too easily, with inflammation from histamine release. A conventional approach to such might be the administration of cromolyn sodium. A homeopath might do something completely different. The point is that I believe there is enough well-proven definition of mechanisms that it is possible to have objectivity about diagnosis (regardless of the theory of the cause) and the observable benefits of some therapy. Howard C. Berkowitz 22:30, 3 September 2008 (CDT)

Thanks, Howard. I have read this entire page and understand your issue and quite agree that the use of the words "immune system" are meant in a more metaphoric manner rather than biochemistry's more immunologically accurate description. I therefore left the quotes around any use of the term "immune", especially if it seemed to come from a quotation that we can reference. I would entertain the idea of removing the use of the word immune altogether if we can find an alternative way to describe it, otherwise, I see no reason why the paragraph that you wrote describing the difference in jargon should not be integrated instead. I am also open to any information that supports the use of the word without quotes. It is possible that there are references out there. I personally trust others with the science and prefer to concentrate on the art. By the way, sorry about your friend. D. Matt Innis 22:53, 3 September 2008 (CDT)

Reversions

We have a "no unexplained reversion" policy. This is why I reverted Ramanand Jhingade's own reversion of Matt Innis a few minutes ago. Please review what CZ:Professionalism says about reversion. The point is that when we have basic disagreements, rather than attempting to "force" our way, we negotiate on the talk page. This must be obvious to everyone involved, but I find it sometimes helps to repeat the obvious. --Larry Sanger 22:39, 3 September 2008 (CDT)

Thanks, Larry. Ramanand, I would be glad to consider your opinions on my edits, please feel free to let me know and I'll do my best to explain myself. D. Matt Innis 22:53, 3 September 2008 (CDT)

Summary, please

I would like to request, in my capacity as Editor-in-Chief, a summary of your complaints, disagreements, and requests or proposals for resolution--not longer than 200 words apiece, from anyone who would like to explain them. I simply refuse to read this entire page, which appears to get into many side-issues. Remember, please that other people have limited time to participate, and so it is a courtesy to them to keep your discussion relatively brief and, especially, to the point.

I ask that you limit yourself to 200 words so that you can give me (and yourselves!) the most pointed, highest-relevance explanation of what is going on here.

Thanks in advance. --Larry Sanger 22:39, 3 September 2008 (CDT)

192 words

Obviously, there are differences between homeopathy and conventional medicine. My impression is that a modest start would be more productive: establish what can be agreed. Ramanand has said that he uses laboratory medicine, so there are presumably is agreement that they may show abnormalities.

Identify where there are significant differences in terminology, and try to agree on definitions, such as: immune response, symptom, and sign.

All methods of treatment have risks and benefit. No system can keep insisting on its superiority, at least without evidence presented in recognized statistical terms. I urge a fresh start in a complementary articles, focusing on agreed principles.

Statistically valid clinical trials for individualized therapies are complex, but not unprecedented. Prospective trials are preferable, then statistically based meta-analysis is next $DEITY knows there are enough arguments over the efficacy and cost-benefit of "orthodox" medical treatments. A policy may need to say that claims that "everything is individual so I cannot offer any generalizations" simply are not encyclopedic.

Let us try to put aside the areas where there are fundamentally different models, such as the effect of chemicals on the structure of water, and focus instead on objectivity in diagnosis and evidence-based improvement. Howard C. Berkowitz 23:12, 3 September 2008 (CDT)

202 words : Pierre-Alain (not a constable BTW)

I quote Proof versus plausibility: rules of engagement for the struggle to evaluate alternative cancer therapies, J Hoffer, Can. Med. Assoc. J.

... the "rules of engagement" ... need to be clearly defined and the goals must be explicit and common to both parties. To do otherwise leads to the risk of unintended confusion and heightening of the barrier of mistrust that already stands between many individuals involved in this debate. Proponents of alternative therapy have an obligation to provide grounds for (1) biological plausibility, such as sound (a) theoretical or (b) preclinical data, or for (2) clinical plausibility, in the form of authentic, well-prepared case reports ... But plausibility, not proof, should be sufficient to initiate the process... (evaluating CAMs)

Let's

1.a.) Continue to explore the various theoretical models and physicochemical explanations

1.b) Cover the data on animals and cell cultures (see Beyond placebos, above).

2. Provide ample space to describe the healing art of homeopathy, its use of words, symptoms and intuition. Case reports. Ramanand told me he could provide his own reports, or others published in a specialized journal. This will help enormously in the present context.

Pierre-Alain Gouanvic 00:04, 4 September 2008 (CDT)

Pierre, if I may call you that, I think you have outlined a valid path. I would appreciate your efforts. Howard, I'm not sure that I've seen any reason to expect that the policies that Citizendium has in place won't result in a tenable outcome. Working with real names and gentle expert guidance has some benefits. Input from all sorts of positions is important to produce a well rounded article. I'm not sure what an encyclopedia article is supposed to say, or if that is what we are looking for here, but I do agree that the article needs to be a neutral look into homeopathy (and perhaps homeopaths). I'd say keep it coming and weed through it all. D. Matt Innis 09:04, 4 September 2008 (CDT)

Matt and Pierre-Alain, the thing I hear from both of you is that the article needs to make it clear when something is a matter of plausibility rather than certainty. I look for quantitative and statistical presentation; do consider that. I welcome your frank observations on what my comment may or may not bring. I'll comment that I think I've improved some articles with anecdotes, but always as signed article subpages or citations of my own published and reviewed work. It must be clear when something is an illustrative anecdote, rather than revelation. Howard C. Berkowitz 09:45, 4 September 2008 (CDT)

I have two specific-but-illustrative comments, which I will keep brief. I am not "taking sides."

Howard, you say that we should "establish what can be agreed," that we focus on "agreed principles" and "put aside the areas where there are fundamentally different models," and that "the article needs to make it clear when something is a matter of plausibility rather than certainty." This represents a misunderstanding of our Neutrality Policy, which requires that we attribute differing positions to their adherents, so that the article states only who believes what. The article should not state whether something is "a matter of plausibility rather than certainty," simply because people often disagree about all that. Rather, judgments of plausibility and certainty, together with the grounds of such epistemic evaluations, should be reported and attributed to their owners.

Second, I saw an excellent example where the latter policy can be applied. Howard, you removed this sentence: "The molecular mechanism of action of the potentized homeopathic drugs has been explained best by Khuda-Buksh." You explained: "It is not acceptable to make a sweeping statement, with a value judgment, about a model, but give no details." The latter is correct, as far as it goes. But if the sentence represents the common view of homeopaths, you should have simply attributed it to them and thereby avoided controversy: "According to many [?] homeopaths, the molecular mechanism of action of the potentized homeopathic drugs has been explained best by [first name needed] Khuda-Buksh." The latter is neutral and fact-stating, and you and I need not have any problem with it. If you feel it is important to say that modern medicine does not agree, you should add that, rather than removing the sentence entirely. In short, more information about the debate, rather than removing all debated points, is the way forward. (But note: if after requests, and some time, nobody elaborates an unclear claim, we should remove it, on grounds not of bias but of comprehensibility.)

I hope this is helpful, and let me say again that I am not "taking sides" against Howard or endorsing the cause of homeopathy. I merely saw these two points rather clearly and thought that stating them might help both sides understand better how wiki collaboration works. --Larry Sanger 10:21, 4 September 2008 (CDT)

Thank you, Larry. Is there a way to rephrase the first point not to say "plausibility versus certainty", but to suggest "X is an axiom of group Y. Their reasoning derives from it." It's one thing to say that the Y's have a structure based on X, but a very different thing to say "the Z's are wrong and the Y's are right". From what has been, I have been reading "homeopathy is right and should be used in preference to medicine." Is it fair to say that Z's are of the opinion that Y's have not proved their case; there is no immediate evidence the views will reconcile.

I see your point about "modern medicine does not agree". My interpretation is that the person bringing up Khuda-Buksh should describe enough of K-B's explanation so that, if it appears to conflict with a medical explantion, that an equally short response stating the disagreement can be made? A practical issue here is that people of either view are more apt to have access to the journals in their own field, and it is a courtesy to give just enough information so the other side need not go on a journal hunt to see if they agree or not.

Alternatively, and I am not being at all sarcastic, I don't think it's useful to say "Khuda-Buksh offers an explanation acceptable to homeopaths. The Avogadro Number argument, for people of a molecular orientation, rules out, in their opinion, the idea of potentiation when molecules are unlikely to be present?" (that latter could be a citation, although I'd rather see an equally succinct summary of Khuda-Buksh").

I would ask that anecdotal case reports of "I have cured", or "I have personally observed", be either external citations in a reputable source, or signed articles. Howard C. Berkowitz 10:35, 4 September 2008 (CDT)

Howard--just a few short comments. I'm not sure about the other sentences you say are not "useful" (I didn't notice or comment on them), and I generally agree about properly wording statements about purported "cures" and "observations" (both are loaded terms), but it depends on the case of course.

As to the Khuda-Buksh sentence, simply attributing the judgment, no matter how unclear, to its owners will remove the need for arguing and disagreement about what it says. Then you can work on getting the sentence's author to expand the thought and provide a reference. Can you propose a wording?

Another, more basic issue. I've noticed that we spend our talk page time disagreeing, arguing, and instructing, often at great length. I think our time could be more gainfully spent by working creatively toward a mutually agreeable solutions. The more that our well-intended efforts are aimed at exposing the subtle mistakes of others, the more work we unwittingly create for each other: others of course feel impelled to prove us wrong, and on it goes. This back-and-forth is not really aimed at solving the underlying sentence wording and article titling problems. If we all were focused not on proving each other wrong, but instead proposing new, creative, and kind ways to resolve conflicts, we'd have far fewer conflicts and far higher productivity.

In short, let's reconceive of talk pages: they are venues for discovering the best compromise solutions to problems of sentence wording and article titling, which problems we are all concerned to solve as quickly, creatively, and kindly as possible. Then we wouldn't fill up talk pages with 100K of argumentative text nearly as quickly. I don't think we'll ever entirely eliminate debate, but we can sure cut down on a lot of useless debate.

I could be full of it :-) but I don't think so. --Larry Sanger 13:49, 4 September 2008 (CDT)

A try at wording

See notes; I'm looking for acceptable vocabulary rather than trying to argue right vs. wrong.

Homeopaths find the work of Khuda-Busch to be a compelling argument that their remedies [note 1] have a sound therapeutic base. The basic homeopathic argument, however, does not agree with current concepts of molecular pharmacology. Since there is unlikely to be a resolution of these quite different models, a more effective means of finding common value may be evidence-based medicine (EBM). EBM is routinely used to compare the efficacy of medical methods, and also explicitly incorporates complementary and alternative medicine [Note 2]

• Note 1: Is remedy the right word? Drug? Someone suggest a word for the stuff that the patient ingests. "Remedy" feels non-neutral; I don't assume a "drug" will work.
• Note 2: I may be incorrect, but I believe it has been suggested that homeopathy is so individualized that that it becomes impossible to create a group of patients, with common presentations, so that outcomes can be compared. If so, I'm stuck, although I have suggested one statistical method, with which Gareth had some agreement (hope I'm quoting correctly) that could be used for highly individualized therapies, be they pharmacogenomic or homeopathic.

I hope I am wrong in the Note 2 suggestion, because if there are no ways to compare, I find myself stuck. Howard C. Berkowitz 14:13, 4 September 2008 (CDT)

Physicochemical plausibility

Howard, all,

I want to assure that I tried to suggest rewordings to your proposed text, but the following

The basic homeopathic argument, however, does not agree with current concepts of molecular pharmacology.

cannot be taken for granted.

I went on to summarize the review by Khudar-Bukhsh, emphacizing that it was published in a journal read and reviewed by biochemists. I inserted my contribution in the section Scientific Research Testing Homeopathic Medicines. This is where it belongs, for sure, but I question the validity of putting this fundamental section after The popularity of homeopathy and The skeptical view of homeopathy. It belongs in the introduction.

Pierre-Alain Gouanvic 16:47, 5 September 2008 (CDT)

First, let me congratulate you; what is there is nicely phrased. I will be interested in how the clathrate theory is elaborated. That clathrate formation does affect the "structure" of water is not in dispute, but consider two things (open to question from people more current in physical chemistry):

• Clathrates, as far as I know, form a "cage" of water molecules around an atom or molecule of low-molecular-gas. Now, I'll hypothesize that the shaking and such, perhaps with the homeopathic substance acting as a catalyst, encourages clathrate formation. Assuming my understanding of clathrates are correct, then the action of the remedy would be a result of the physicochemical changes by the clathrates, or by release of the gas in the clathrate. Mass spectrometry of the preparation, if clathrates are present, should show the released gas molecules.
• Where are the gases (if that's the case) coming from? The atmosphere during shaking? If the water at the start was gas free, and the shaking done under anaerobic conditions, could clathrates form?

This is not an attempt to dispute, just some points that you might want to cover.

As far as the placement, I completely agree that any fundamental scientific data should precede subjective popularity or skepticism. I'd probably put under a section heading just after the short introduction, for ease in linking to it.

Howard C. Berkowitz 17:34, 5 September 2008 (CDT)

First, it is much improved. Thank you.

Regarding the wording above,

The basic homeopathic argument, however, does not agree with current concepts of molecular pharmacology.

Might I suggest an alternative?

Work by Khudar-Bukhsh suggests a means, consistent with some work in general physical chemistry, by which the process of homeopathic preparation might indeed have an effect on water. Assuming, for example, that clathrates form, there is no current understanding, in molecular pharmacology, of mechanisms by which clathrates would have a metabolic effect.

I think this gives credibility to a breakthrough on the pure chemical questions of water, but that does not go directly to physiologic effects. Howard C. Berkowitz 02:55, 6 September 2008 (CDT)

First and foremost, I want to express my gratitude. Your appreciative remarks helped me to do this work which was, at times, quite heavy. Now that the science section is moved to the top and the intro is more readable, let's take care of those clathrates!

I'm moving your suggested text unedited in the Clathrate section; then, we could try to address the questions you were formulating above.

Cheers,

Pierre-Alain Gouanvic 11:12, 6 September 2008 (CDT)

References

I will put references that I find useful in the bibliography subpage, starting with this one:

Journal of Molecular Liquids, Volume 135, Issues 1-3, 31 July 2007, Pages 158-165 Conductometric studies of the serially diluted and agitated solutions on an anomalous effect that depends on the dilution process V. Eliaa et al.

I'm not assuming that it will accepted as a useful reference, but I think that it would be counterproductive to burden the talk page with that. Pierre-Alain Gouanvic 12:32, 6 September 2008 (CDT)

One of the nice things about the Bibliography subpage is that you should feel free to annotate the references; it's not like an inline citation. If you were to have a sentence or paragraph describing the significance or criticism of the reference, that's exactly the purpose of that subpage. Howard C. Berkowitz 13:16, 6 September 2008 (CDT)

A good model is the Trends in ..... review journals. They actually star the significant references at the end of the review with a little blurb on why it is a significant paper. It is very useful. Chris Day 22:21, 6 September 2008 (CDT)

Howard, Chris, Pierre, When we post about articles on Homeopathy or its' effects, it's important to see if they have considered the individualization process, if not it will not be accurate.—Ramanand Jhingade 23:56, 6 September 2008 (CDT)

I have repeatedly used an example in pharmacogenetics that, by definition, would be individualized. Gareth understood my point, and that an individualized treatment can still be tested on a group. Will I consider that an individualization process, without some fairly specific molecular bypothesis, can be judged purely on individual results? No, because I don't accept statistical trials are impossible for individualized treatments. They cannot be done meaningfully on samples of one, and I would not, under any circumstances including those of my probable death (but with palliation), consider participating in them or recommending them. I repeat: randomized controlled trials of individualized methodologies -- not results in a given case -- are possible, if difficult.

Howard C. Berkowitz 04:55, 7 September 2008 (CDT)

Reply to Larry Sanger

Dear Larry, I'm sorry for the delayed response, I was busy. The article on Homeopathy on Wikipedia has been taken over by the theorizing, skeptical, critics who have never tried Homeopathy. They tried to do the same with the other Alternative Medical Systems like Osteopathy, Naturopathy and Chiropractic, but could not succeed because those people 'control' those pages by banning the skeptics, although it is by an illegal method. When I saw that Citizendium gives preference to the views of the experts over the ideas of the theorizing, skeptical, critics who have never tried Homeopathy or whatever else, I was really happy. One needs to understand that the trials in Alternative Medical Systems are not upto the mark of the trials for Allopathy (the ordinary medicine available in the Medical stores). Please allow the expert Editors to over-rule the ideas of the theorizing, skeptical, critics who have never tried Homeopathy/Naturopathy. Thanking you, Yours faithfully,Ramanand Jhingade 23:34, 6 September 2008 (CDT)

This is a wonderful quote by Larry, "If we all were focused not on proving each other wrong, but instead proposing new, creative, and kind ways to resolve conflicts, we'd have far fewer conflicts and far higher productivity". We should all follow it in letter and spirit.—Ramanand Jhingade 23:40, 6 September 2008 (CDT)

Howard, Pierre, Can we mention the clathrate evidence in the Lead, before the 'Introduction' section? Can we come to an understanding about the mechanism of action of Homeopathic remedies, which most likely, is by active transcription?—Ramanand Jhingade 00:05, 7 September 2008 (CDT)

Nice to have you back, Ramanand! I relate to your experience with theorizing skeptics; they only accept the science that is popular, and minimize the results of their "own" science when it doesn't follow the mainstream.

I think that I see what you're referring to ("active transcription"). The water or ethanol clathrate crystals would activate the transcription of various genes. The subtlety of homeopathic actions would be best explained by subtle modifications in gene expression. Whether this clathrate theory proves right or wrong, I agree that it must clear that the processes taking place in cells are not entirely explainable with conventional pharmacologic approaches. I read (in another text by Khudar-Bukhsh... do you know him? Let's invite him....) that there is already evidence that some crystals can act upon receptors.

In any case, moving modern enigmas in the intro of an old "prescientific" healing art might be difficult, but necessary. When I tried to update the science on acupuncture, showing that NMR imaging proved the existence of (at least) some acupoints, I had to refrain from talking about the modern theory of acupuncture (organizing centers rich in gap junctions). I knew that these notions would be taken as random hypotheses by some sophisticated snake oil vendors.

I would suggest that we tackle together those difficult issues that the theories of homeopathy bring. I brought the notion of mithridatization to show that "information" might be relevant in biological systems, and that homeopathy is not an an orphan therapeutic. We need to focus on the oddities (compelling anomalies, as Kuhn or Popper said), if we want to let some room for an healing art as original as homeopathy.

NB: Please add as many references as you deem useful in the bibliography section of the article, here. Thanks in advance!

Pierre-Alain Gouanvic 01:18, 7 September 2008 (CDT)

Larry, I have a one paragraph request for clarification of my understanding of CZ policy below this, which is the shortest honest answer I can give to Ramanand's questions, which I do not completely understand. Howard C. Berkowitz 05:06, 7 September 2008 (CDT)

Ramanand, Let me answer indirectly: there times where I have gone into "conventional" medical treatments where I did not know if I would die during the procedure, and was quite aware of that going into the situation. I made my choices, and did it because the potential benefit, to be, justified the risks. In some cases, I was conscious, and, my own request, not sedated -- and by every subjective and physiologic mechanism available, I stayed calm.

One of the people that holds durable medical power of attorney for me happens to have a strong trust in certain aspects of herbalism. The question arose of whether or not, if I was diagnosed with a cancer for which medicine could offer nothing but a fairly quick death, I would want the herbal remedies tried. I have much more detailed criteria in writing, but my basic directions would be: no, do not try the herbal remedy, assuming that a competent palliative care specialist can ease my dying. There are some specifically defined cases where I delegate the authority to put me into a high-risk clinical trial, but I definitely rejected the herbal treatment. The herbal treatment has only anecdotal evidence, and I believe there are times when the correct choice is to die comfortably rather than go onto a search with nothing but hope. There have been time when I was the surrogate, and supported the decision of a patient, lucid at the time, that I would not have chosen for myself.

I have tried both experiemental complementary medicine in cases where I felt there were competent people involved -- usually a trusted physician who had a well-defined relationship with an researcher or alternative practitioner -- and also have that others consider it. I have seen, in a clinical setting, alternative therapies (moxabustion, for example) do measurable things that seemed worth continuing.

I literally do not understand what you are asking me. If you are asking me, hypothetically, if I would personally try homeopathic treatment, based on anecdotal reports and that I hadn't tried it for a life-threatening condition, my answer is unequivocally no. In that case, I would focus on comfort care, and have seen enough work by experts in palliative medicine to say that no one should have to die in agony.

If you are asking me if there should be controlled research into whether, for example, the clathrate hypothesis should be further examined, under scientifically controlled conditions, the answer is yes. If I was asked to participate in a randomized controlled trial of an individualized technique, such as pharmacogenetics, I would give it careful consideration. If I was asked to particate in individualized therapy that the investigator claimed was not subject to any formal testing, no, I would not.

So, if you are asking me if I will agree to support trials experimental treatments that do not meet the standards of allopathic trials of individualized therapies, the answer is no. If you are asking me to accept the hypotheses for the action of either an individualized genetic treatment using a customized monoclonal antibody, or accept the hypotheses of potentiation of water, I will not accept them for more than testing, unless I see much more solid theoretical evidence. No molecular biologist has a really solid explanation for gene activation and expression; why should I assume a less formalized discipline does?

If you are asking me if I would consider randomized controlled trials, with various safeguards, of an individualized treatment, I can't tell you in advance -- that would be a case-by-case decision. The answer might be yes. If you are asking me to accept that homeopathy can be a viable treatment based purely on your being "... expert Editors (presumably with credentials accepted only by Homeopaths/Naturopaths) to over-rule the ideas of the theorizing, skeptical, critics who have never tried Homeopathy/Naturopathy" the answer is no, because I am not yet convinced that there are experts in homeopathy as appropriate treatment. Will I accept that an expert in homeopathic preparations can prepare a treatment for evaluation by essentially molecular means? Yes. Howard C. Berkowitz 04:49, 7 September 2008 (CDT)

To Larry specifically -- I am perfectly willing for a homeopath to state what homeopaths believe, and have an alternative view represented. Perhaps I am misunderstanding Ramanand, but what I hear him asking is for me to accept, as generally true, homeopathic beliefs are true simply because "expert homeopaths" believe they are. With that I cannot agree; any more than I can say that the positions of one political party are true because their adherents say they haven't been tried and disproved. Please clarify if this seems an appropriate distinction for CZ. Howard C. Berkowitz 05:06, 7 September 2008 (CDT)

Pierre (ou Monsieur Gouanvic), merci pour tous les infos.—Ramanand Jhingade 23:02, 7 September 2008 (CDT)

Howard, God forbid you get an 'incurable' disease, but between Euthanasia and Homeopathy, you should choose Homeopathy - there's a good chance of being healed. I'll make you an offer - I'll treat you or someone you love, for free (if you think Homeopathy is placebo, you shouldn't have a problem trying it for a day or two). This article should state what Homeopaths believe, but can have a section for criticism much lower down (not in the Lead), because it should not look like an 'attack piece'.—Ramanand Jhingade 23:17, 7 September 2008 (CDT)

I really don't want to argue the issue of what I will and will not do, but I felt I had to respond to what seemed to be your suggestion that it was acceptable to have something more than an accurate statement of a consensus among homeopaths. I do not believe any text along the lines of "until it has been tried, it can't be ruled out" belongs in the article. I would welcome discussions of non-anecdotal plans for statistically sound trials of individualized therapies, pharmacogenetic, homeopathic, individualized monoclonal antibodies, etc.

This is a general question -- are homeopaths rejecting participation in trials that are designed to look at the sort of thing Gareth and I discussed for pharmacogenetics? Pharmacogenetics, rather by definition, is individualized. Assuming that the proposed treatment is for a disease that has no known treatment, a placebo-controlled trial is ethical. The geneticist/clinicians would analyze the patient, and design what they believe to be a specification for an appropriate treatment, and send that specification to the preparation specialists. The preparation people would open the next sealed envelope, determine whether to send back an IV of saline or genetically active substance, marked only as to which patient would receive it. The clinicians administer it and observe the results, with independent monitoring by a non-blinded safety panel.

It would be reasonable for the homeopathic section of the article to make a definitive, preferably sourced, statement, that this type of trial is or is not something in which they will participate. If yes, then a pointer to the ongoing work would be valuable. If not, I think it's fair to ask the reason, since I am asking no more and no less than I would be asking of a molecular pharmacologist proposing individualized therapy, which would be tested. Howard C. Berkowitz 23:50, 7 September 2008 (CDT)

I found this article titled, 'Series of studies confirm action of homeopathy on childhood diarrhea', at http://findarticles.com/p/articles/mi_m0ISW/is_243/ai_109946495

I also found this article, an abstract of which is on my web-site, by Rastogi, D.P., Singh, V.P., Singh, V., Dey, S.K., and Rao, K., titled, “Homeopathy in HIV Infection: A Trial Report of Double-Blind Placebo Controlled Study.” British Homeopathic Journal. 1999. 88(2):49–57.

There are lots of other articles which I'll keep posting about from now. Can we mention the clathrate evidence in the Lead, before the 'Introduction' section? Can we come to an understanding about the mechanism of action of Homeopathic remedies, which most likely, is by active transcription?—Ramanand Jhingade 00:38, 8 September 2008 (CDT)

Healing Arts Workgroup

I see that this article is under the Healing Arts Workgroup. Here are your Healing Arts Editors. Perhaps you might ask for some guidance there. D. Matt Innis 12:25, 8 September 2008 (CDT)

There are so many Editors, I'm scared of being banned for spamming all those Editors. Can you please do the needful or at least tell me how to do the same?—Ramanand Jhingade 00:17, 9 September 2008 (CDT)

You just go through the list, pick a few who seem that they might be interested, and contact them. If they've been inactive as determinable from their contributions, try to email them, but try to contact actives. Don't worry about what you've worried about! Besides, editors may appreciate prodding about a concrete case where they might help. Stephen Ewen 00:37, 9 September 2008 (CDT)

Thanks.—Ramanand Jhingade 01:22, 9 September 2008 (CDT)

Comments

Adding to what Matt said:

Gosh, it seems that a very great deal of energy has been used unproductively here. I think this was Larry's core-most point, above, and if I'm right about that, I obviously heartily agree. While not venturing to become an author here, I just want to make a few comments that might prod things to get "unstuck".

I see folks actually debating homeopathy, as if somehow this will convince diverse authors to come over to one side and write the article to represent a particular point of view. It'll never happen, folks. I know that my own personal belief about homeopathy, based upon my worldview and private study since about 1989, is that it is a false system; no amount of arguments here or anywhere is likely to convince me otherwise.

But my point is that that should be assumed from the get-go, and throughout; that there will ever be stark disagreement over homeopathy; so, there ought be a shift in focus about how to neutrally describe the system, to set it strongly in its own light in its own terms, and to then set the opposite view from materialistic science in kind.

So how will specific sections and paragraphs be worded in this regard?

Stephen Ewen 23:50, 8 September 2008 (CDT)

Stephen, Billions of Homeopaths have had results with Homeopathy through the ages (including me). Citizendium gives preference to the views of the experts over the ideas of the theorizing, skeptical, critics who have never tried Homeopathy, so, while there can be some criticism in the article, it should not look like an 'attack piece'. Thanks in advance for your co-operation.—Ramanand Jhingade 00:24, 9 September 2008 (CDT)

Billions? Howard C. Berkowitz 00:18, 10 September 2008 (CDT)

There's the phenomenon, which I was recently describing, perfectly encapsulated. Somebody makes a claim that seems unlikely on the talk page, but which has absolutely nothing whatsoever to do with how the article reads. Somebody else calls him on it and thereby starts a pointless debate. What's the point? Is this fun? I'm not sure; not for me. Enlightening? Rarely. Helpful to the article? Not in any obvious way. --Larry Sanger 08:51, 11 September 2008 (CDT)

Like I let on about above, no amount of testimonials of people who've had results with homeopathy will convince me. I have an alternative explanation for those results that disagrees with yours. I have a fundamentally different view of how we "know" as regards these things.

But that's not not my main point, except to say that you cannot and will not convince people who disagree to come to one side or the other; their own views are mature, just as are yours, and neither are likely to give up their views; nor should we even try to get people to do so here.

Obviously, the article should not favor one or the other set of experts but fully educate readers neutrally about the views of experts on both sides, believers and non-believers. If you are trying to maximize positive views of the system and minimize critical views of it, that's not neutrality and just won't work here, and besides its not particularly valuable anyway since people so well learn by contrasts. While you might wish to present it in a very positive light only, others will want to present it in a very negative light only, each in accordance with the major contrastive worldviews about it.

But no one get's their full plate in an article like this. No one, except insofar as the interest may be a neutral presentation as I've described above. And that's the goal here!

Stephen Ewen 00:39, 9 September 2008 (CDT)

I completely agree that the article should be neutral - that can be done by having the point of view of the Homeopaths in the Lead, with criticism from the skeptics lower down in the article.—Ramanand Jhingade 01:22, 9 September 2008 (CDT)

I think the lede should basically summarize the whole article, including that there is contention about the validity of homeopathy from the perspective of materialistic science, mainstream medicine. From there, the possible formats seem either block/counter block, or the making of contrasts throughout. Stephen Ewen 01:27, 9 September 2008 (CDT)

Block/counter block isn't a good idea, but the making of contrasts throughout should be O.K.—Ramanand Jhingade 01:53, 9 September 2008 (CDT)

Let me underscore that Steve has it right here. The opening especially paragraph should not take a stand on the validity of homeopathy, because many people will read just that paragraph. --Larry Sanger 08:47, 11 September 2008 (CDT)

Stephen, I agree with your approach. Clearly, a lede for anything has to define the subject, and, when the subject is a human definition, it has to start with a definition from the people who created it.

As a start, I'd like to concentrate on the lede, and see if we can get some consensus just on that, before the first heading. Arguing about the entire article means that a foundation is not ever established. There's a saying that the only successful way to eat an elephant is one bit at a time, and that proverb certainly applies here.

The first three sentences aren't bad, with the minor nit that the first citation of Boyd needs more specific sourcing, since it is a direct quote. I do have problems with the fourth sentence, as it has a flavor of not stating what homeopaths believe, or how they arrived at that believe, but feels as if it is starting a conflict. Replace it with the last sentence of the lede, which properly brings in the founder of the field; I would suggest adding a citation of Hahnemann, perhaps even his reputation at the time, and even that his name lives on in a major mainstream teaching hospital.

Starting with the second sentence of the second paragraph, and possibly even with the first sentence of that paragraph, one of the fundamental problems is that homeopathic and non-homeopathic medicine are not using basic words in the same way. signs and symptoms have a specific meaning in current medicine. I don't know if homeopaths make this distinction, but, at a very basic level, I start becoming confused when "symptom" seems to be used as a synonym for every aspect of a patient's condition. Since it seems to be agreed that homeopaths do use physical examination and diagnostic tests — the results of which are signs — it seems useful to be able to have a way to differentiate between the subjective concern of one who wants to be healed, and the objective observations of the healer.

So, perhaps some discussion here about that distinction being of concern, or if there is an agreement that it is a useful distinction that should be used throughout the article, is a first step.The fourth sentence, as I have said, seems antagonistic and doesn't add anything this early.

Going into the third paragraph, does anyone dispute there are conceptual problems between homeopaths and non-homeopaths, and this is central to the entire issue? If the entire lede only uses homeopathic definitions of basic concepts, the article will go nowhere, as people not already accepting homeopathic assumptions will very quickly stop reading. So, my immediate proposals:

• Try to reach agreement that the distinction between signs and symptoms is useful and will be followed throughout the article. Note that a sign is an observation. Neither a sign nor a symptom is a diagnosis, or an explanation of causation. Perhaps that needs to be said explicitly.
• Remove the fourth sentence and replace it with the last about Hahnemann.
• The rest of the lede is reasonable, with perhaps some fine-tuning of the statement that there is controversy -- not saying what it is beyond that there are different models of how the body works.
• I'd like to leave the lede at the level of saying that there have been trials that may have shown results, but the interpretation of the trials, and possibly their methodologies, remains open. As an aside here, just giving citations of trials is not enough; the article then, at best, is an annotated bibliography rather than an explanatory encyclopedia article.

Could we see if we can reach consensus on a lede? Right now, the major changes I see are deleting one sentence, and replacing it with the last sentence about the recognized founder of the discipline, and trying to agree about the sign-symptom terminology and agreeing that there are disagreeing models.

Howard C. Berkowitz 08:08, 9 September 2008 (CDT)

Howard, I find it more efficient in these controversial situations to work with the body of the article first and then the lede will become self evident. Keep in mind that neutrality requires us to explain all sides thoroughly without taking sides either way. For instance, once we clear up the sign/symptom issue in the article, we can state it succinctly in the lede. Having said that, let's start there. It seems that homeopaths are using signs and symptoms to decide what drugs to prescribe while medicine uses signs and symptoms to "reach a diagnosis" and then decide on what drugs to prescribe. The signs and symptoms are the same, the difference is in how each uses them. Ramanand, is that reasonable? [1] D. Matt Innis 09:26, 9 September 2008 (CDT)

I would agree that both sides should be explained, but I have a very basic concern here. There has to be either an agreed vocabulary, or there need to be separate terms. In your example, I do not understand why one would prescribe a "drug" without a diagnosis, unless one is using "drug" in the sense of generic symptom relief. If I have a mild headache, I'll try some acetaminophen, or some mint tea for a queasy stomach, without worrying about getting a head or abdominal CT.

I am not at all sure that, in your description, the signs and symptoms are the same. The symptoms may be, but I am very confused on the homeopathic usage of "sign", and especially how decisions are made to use laboratory and imaging studies. Ramanand has said he uses "blood counts" and "CT", but I have been completely unable to understand how he decides to use them and how he interprets the results. CT is not a completely benign procedure, and anyone ordering it has to do a risk-benefit analysis of the increased cancer risk from the radiation, versus the information to be gained. For the record, I will myself be agreeing to some studies that expose me to radiation, but I'm in discussion about the most appropriate method.

If I have a painful, hot, swollen, and red lower leg a week after a knee injury, in the absence of risk factors for deep vein thrombosis, I can accept a working assumption that there is a soft tissue infection. Three of those four are visible signs; reported pain is a symptom. The value of symptoms were, to me, in diagnosis. I believe an appropriate and moderate response would be an appropriate antibiotic and pain control. I'm willing to say that pain control is symptom relief, but I cannot conceive of simply regarding signs, on physical examination, that strongly suggest infection. Indeed, when in such a situation, I suggested to the physician that wanted me hospitalized and on prophylactic IV heparin out of his mind, and strongly questioned his wanting a Doppler ultrasound rather than starting with a CBC and D-dimer.

If I understand the homeopathic model, and its approach is to give a substance that reproduces "symptoms" &mdash which I put in quotes because I am not at all sure we mean the same things by that word &mdash that is so alien to what I understand as the medical meaning of "drug" that I am completely baffled. Here's a suggested first revision, with italics for terms that I'm not sure are being used in comparable ways. Please feel free to use something shorter for homeopathic remedy, but not drug:

Homeopaths are using signs and symptoms to decide what homeopathic remedies to prescribe that mimic, at a very low level, symptoms. Medicine uses sign and symptom to "reach a diagnosis" and then decide on what treaments to prescribe for metabolic support, symptom relief (i.e., if a patient doesn't report pain and is not showing evidence of unspoken pain, there's no symptom to relieve), and to correct an underlying pathology.

Howard C. Berkowitz 11:28, 9 September 2008 (CDT)

Homeopaths also use signs and symptoms to arrive at a medical diagnosis. They then consider the 'uncommon' symptoms and use a method called repertorization (most of the time) to select a Homeopathic remedy. Hahnemann defined symptoms as, "outward manifestations of internal disturbances". Matt, may be you can make the differentiation and put it in the article. I see that the clathrate evidence has been accepted, so I hope you can mention the clathrate evidence in the Lead/Lede.—Ramanand Jhingade 23:50, 9 September 2008 (CDT)

Ramandand, I repeat the point that as basic a word as "symptom" does not yet have an agreed definition. "Outward manifestations of internal differences" is certainly not the same as a patient's subjective report of distress.

What makes you think that clathrate evidence has been accepted, or belongs in the lede? It has been agreed that physical chemistry shows clathrates exist. There is a homeopathic argument that the remedy preparation may create clathrates. That's all that's been presented here in any useful level of detail. There has been nothing presented here that indicate whether clathrates do or do not have an effect on the body. Since the known clathrates are water structures around low molecular weight substances, such as methane or inert gases, and those gases are released by heat or disturbance, mass spectrometry of a vaporized remedy would at least be a reasonable way to demonstrate the presence of clathrates. Physical chemistry demonstrated the existence and structure of clathrates, so why should it not be called upon to test whether they are present in a remedy? Before anyone says they are accepted, let's find some simple, outside the body, evidence that they are present in a remedy. Perhaps a Chemistry editor is needed.

While I suggested alternate wording for the lede, Matt, a Healing Arts Editor, asked that the body be addressed. I am complying with the Editor's guidance; may I ask you do so as well?

Again dealing with language, I am puzzled that you say homeopaths arrive, at all, at a "medical diagnosis". Further, I have absolutely no idea what "They then consider the 'uncommon' symptoms and use a method called repertorization (most of the time) to select a Homeopathic remedy." means. What is reportization? What is done in the part of the time it is not used? Agreement on basic definitions are needed; I suggest focusing on that. I will merely note that you have spoken generically of a number of laboratory and imaging tests, but you have yet to respond to any specific questions of the results and how homeopaths interpret them. If I speak of a test, I am prepared to discuss its range of applications, its results, and how a biological scientist would interpret the results. I don't ask any more than I expect of my own writing. Howard C. Berkowitz 00:14, 10 September 2008 (CDT)

Pierre-Alain did mention the tests didn't he? I'll look for more to post here.—Ramanand Jhingade 00:58, 10 September 2008 (CDT)

Ramanand, I really hope there is someone who can help reconcile not our views on homeopathic vs. non-homeopathic theory, but that we seem to have a different idea how to write an article on a health-related subject. Matt, anyone, help!' I am not always trying to say "homeopathy does not work." What I personally want to feel, to see that the different views, which probably will not be reconciled, are at least clearly stated. I think I can express biologically oriented ideas fairly precisely, and I don't rely on citing a study or definition with no detail. My responsibility as an author, I believe, is to write a succinct statement of what various techniques and models are, and then support my writing with citations. Just giving a citation, with no context and no tie-in to the text around it, simply doesn't seem a good way to write about anything in an encyclopedia. If I mention a test, and am questioned about it, I am more than willing to explain, with support. I don't just say "blood count". I make it specific to "complete blood count", with or without differential, and cite white blood cell count, red blood cell count, hemoglobin, hematocrit, and platelets, and the computed mean corpuscular hemoglobin (MCH), mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC). See red blood cell size for a starting point on the significance of MCV; a proper assessment of anemia uses all of these metrics, as well as reticulocyte count. I'll try to work on the anemia article soon and expand this.

Literally, I don't know how one can talk about blood cell counts without being willing to get into these details -- and I have only stayed on the side with disorders of red cells. Really, if I am missing something, tell me what it is. Red blood cell disease doesn't just involve anemia, but can involve overproduction, or irregularities of iron metabolism. The latter typically need at least three tests of iron chemistry, and a number of those disorders now can be confirmed with specific genetic abnormalities.

What is it that I am missing, assuming that homeopaths may interpret these results in a different way, but that if they are going to do a blood count, these values are what blood counts produce. Why do a blood count if there are no explanations on how it will be evaluated? Howard C. Berkowitz 02:04, 10 September 2008 (CDT)

I've already explained that Homeopathic Doctors make a medical diagnosis (using tests where required), just like other Doctors and this is followed by a process of remedy selection - only one out of so many remedies will help heal a person of that problem/condition/disease.—Ramanand Jhingade 01:53, 11 September 2008 (CDT)

Respectfully, you have said homeopathic doctors use tests, but you have not explained how you use any medically defined tests. A few paragraphs above, i speak of the various numbers produced by a minimal complete blood count, and start linking to definitions. I am quite prepared to detail what I would expect to see from those measurements for a specific conditions, and, in the case of a fairly general result such as the erythrocyte-related values showing, say, a microcytic anemia, what that might suggest and what the next round of more detailed tests would be. that is an explanation. If I merely said I would recommend TIBC, ferritin, and serum iron, I have not yet explained anything. As I said above, and in other phrasings, Why do a blood count if there are no explanations on how it will be evaluated?Howard C. Berkowitz 02:17, 11 September 2008 (CDT)

This is not the forum for a discussion about anemia, but since you keep insisting on it, here is some information I copied:-

Microcytic anaemia is a generic term for any type of anemia characterized by small red blood cells. The normal mean corpuscular volume (abbreviated to MCV on full blood count results) is 76-100 fl, with smaller cells (<76 fl) described as microcytic and larger cells (>100 fl) as macrocytic.

In microcytic anemia, the red blood cells (erythrocytes) are usually also hypochromic, meaning that the red blood cells are paler than usual. This can be quantified as the mean corpuscular hemoglobin or mean cell hemoglobin (MCH), the amount of hemoglobin per cell; the normal value is 27-32 picograms (pg). Similar is the mean corpuscular hemoglobin concentration or mean cell hemoglobin concentration (MCHC), giving the amount of hemoglobin per volume of erythrocytes (normally about 320-360 g/l or 32-36 g/dl). Typically, therefore, anemia of this category is described as "microcytic, hypochromic anemia".—Ramanand Jhingade 03:34, 11 September 2008 (CDT)

I don't wish to discuss about anemia again, so please create that article on anemia and discuss things with people who want to discuss about it on the Talk page of that article.—Ramanand Jhingade 03:40, 11 September 2008 (CDT)

Thank you for admitting you copied the material, and that you don't want to discuss it. I find this interesting, given that you have claimed to have cured such an issue, you having brought up "improved blood count." You have repeatedly said that homeopaths use laboratory tests. I can explain such a test result in my own words.

Can anyone provide some information on homeopaths are trained in the interpretation of laboratory tests, and, if so, what model they use? Seriously, I find it very odd that if the "disease model" is being rejected, then measurements, which to me describe a disease process, is useful. It seems contradictory, which is the point I've been trying to make. A conventional physician can be criticized, by third-party payors if no one else, for subjecting patients to risks and costs of tests that do not influence treatment decisions. Howard C. Berkowitz 23:46, 13 September 2008 (CDT)

Let's be careful with the lead until the body is most complete. The Science section is certainly not complete and the lede should just summmarize the net results of that section. If that includes the work on clathrates then it will be obvious that it needs to be there.

I haven't seen much in the way of homeopaths using signs and symptoms to make a medical diagnosis, but am willing to look at any sources. I also think homeopathy uses the word symptoms interchangeably with what Howard (and perhaps mainstream) would consider "signs and symptoms". I think if we use the phrase "signs and symptoms" where they say "symptoms", we are essentially talking about the same thing. I can't think of enough reasons to let this be a stumbling block.

Homeopathic education: I understand there are some schools, but am also aware that this can be used by lay persons in self medication... is there a difference? Can we find some course syllabi for a homeopathic school? Does it include medical diagnosis? D. Matt Innis 04:26, 11 September 2008 (CDT)

American Medical College of Homeopathy curriculum D. Matt Innis 07:10, 11 September 2008 (CDT)

Baylight homeopathy curriculum D. Matt Innis 07:13, 11 September 2008 (CDT)

The point of all this discussion of how homeopaths use "signs and symptoms" escapes me. I hate to say it again, but it would help tremendously if, whenever you want to say something here on this talk page, everyone make it clear which precise wording you are favoring. It might turn out--when you creatively examine the relevant question of how the text should read--that there is an obvious formulation of the text that would remove all need of further debate (however interesting it might be). And if the discussion does not bear on how any particular text is formulated, then gee...wouldn't it help the project out more to add more content on article pages instead of talk pages?  ;-) --Larry Sanger 08:43, 11 September 2008 (CDT)

Thanks, Larry, good advice... :-) D. Matt Innis 09:01, 11 September 2008 (CDT)

Introduction needs work

I removed the introduction to this talk page. My concern is that, first, it is not an introduction, and second it is both argumentative and apologetic and not well written or neutral. I also think an introduction should include some history for context so I moved the history summary to the top for now. No words were lost during this exchange. Meanwhile, I think we might be able to use some of this intro somewhere if we must, but I think we can discuss this more neutrally. D. Matt Innis 09:56, 11 September 2008 (CDT)

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Introduction

Homeopathy is usually intended to treat a person with an illness, rather than an illness. Some homeopaths call this a "patient-centered approach" s, as a superiority of the homeopathic method over the so-called allopathic methods (allo : other; alienated from the patient) and from the other side, as a proof that homeopathy is not falsifiable, because it is immune to any form of generalization.

In actuality, any number of "allopathic" approaches address the specifics of a patient, for a variety of reasons. Individualization can be as different as the needs of a patient, with muscle soreness, just before an Olympic track event, and a poorly conditioned sedentary worker. In some cases, the specifics are based on genetic differences (i.e., pharmacogenetics). In others, a patient and her treatment may be individualized because she has more than one illness (i.e., a comorbidity); the choice of an initial drug to lower blood pressure (i.e., hypertension) can be quite different if the patient also has asthma or diabetes or is pregnant. It is not, however, a typical "allopathic" assumption that such individualized treatment plans are not subject to statistical testing of their effectiveness.

The specifics of a patient are handled differently by homeopaths. Taking as an example attention hyperactivity disorder, a careful conventional doctor may try to address issues such as malnutrition, an inadequate learning environment, personal psychological issues and lifestyle (does the person exercise well or enough?), in addition to prescribing (or before prescribing) methyphenydate (Ritalin). The individualization that takes place in the course of an homeopathic treatment, however, is entirely different (but not antagonistic). In a trial comparing methyphenidate with homeopathy, 24 different homeopathic preparations were used in 115 children. These numerous medications were not chosen subjectively by physicians, but were determined with the help of a software. This software helped physicians to determine the symptoms that differentiated each single child with ADHD from others. In this observational study practising a typical individualized prescribing, "homeopathy" was judged as efficient as methyphenidate, according to various known indexes. Needless to say, homeopaths do not imply that the regulation of monoamines in the brain, with methylphenidate for instance, is superfluous. They consider, however, that each person has his or her own way to address this and other related cerebral problems.

Still, homeopaths do not use a new substance for each new patient, and will use the same substances very consistently when confronted with intoxications or poisonings, with preparations that contain, after numerous succusions (or "shakings") and dilutions of a given substance, infinitesimally small doses of the substance (or none of it). The substance that is used is chosen in accordance with its ability to cause, at larger doses, symptoms that are similar to those of the person with the illness (treating "like with like"). This "law of similars" (Similia similibus curantur), as it is called, is an ancient principle that has been adopted by different cultures (the Oracle at Delphi was known to say "That which makes sick shall heal"). The Golden Bough by Sir James George Frazier is a treatise on the history of religion and magic, and one of its early chapters (pages 12-42) is entitled "Sympathetic or Homeopathic Magic").

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Request for a new method to edit this talk page

We have several issues to address: the structure of water (in terms of materials science: coexisting phases (also see my comments in the bibliography section), nanobubbles, epitaxis, van der waals bonds, etc.); in vivo studies; in vitro studies; the philosophical approach behind homeopathy vs conventional science; publication bias against homeopathy; the Benveniste affair and the studies by Belon et al.; others.

I'd really love to collaborate on these topics, but I find it hard to do so with the linear structure imposed by the rule that we must edit the talk page after the last sentence written.

I would prefer to continue the discussion "Beyond placebos", the other one on the physics of water clusters (clathrates AND other phenomena), and to throw other thoughts on the topics I mentioned above.

I suggest that we write at the bottom of the talk page a short summary of, or links to, the sections of this talk page that we edited. It will be possible to keep track of the edits, and it will allow rapid progress.

I'm simply suggesting a way to advance cautiously and collaboratively on the numerous sections of the body of the article that should be enhanced.

Another method that we could use, in order to respect the talk page editing rule: let's create as many subpages as necessary, that we could later delete and integrate in the article, or link, or summarize.

I'd be willing to work on Structure of water (materials science), Benveniste controversy, Lancet metaanalysis of homeopathy trials (homeopathy=placebo), in vitro studies of homeopathy, etc.

Pierre-Alain Gouanvic 17:01, 11 September 2008 (CDT)

Pierre, I am not entirely sure what your concern about the talk page is, but anything that helps us all keep informed without having to read through the history is okay with me. Going forward with subpages is a great idea, go for it! Keep us informed if you have any issues. D. Matt Innis 07:13, 12 September 2008 (CDT)

Being Encyclopedic

Friends and fellow authors, I previously put a lot of time and energy into this article, though I have not done so in several months. Larry Sanger has specifically asked me to become an editor here and to bring the varying points of view together. I will do my best, and despite my own advocacy for homeopathy, I will strive to maintain a NPOV. If and when you think that I have strayed for this ideal, help move towards that ideal. This article needs help in being "encyclopedic," that is, being written in a way that describes the broad field and that emphasizes NOTABLE and RELIABLE information. We can and should also avoid using adjectives such as the "best" description or "most notable author" unless we are referencing a specific article whose description provides that emphasis.

I also note that some authors here are being very verbose on the Talk page. This creates a big challenge for people who want to participate here.

I also notice that despite some difference of opinion here, this environment is so much more collaborative than wikipedia...and this is a real blessing. That said, I cannot help but notice that many of you have a lot more time to edit than I do. Dana Ullman 18:58, 11 September 2008 (CDT)

Hello again Dana! Thanks for taking Larry up on his request. While I have a passing knowledge of homeopathy, I'll bow to you on issues of how and what homeopaths do and think. Time is an issue for me as well, so I am dependent on authors as well. Please don't take any offense if I show up and make some grammer or clarifying edits, that is probably where I can help out the most. We do have a wealth of knowledge here that should provide us with a well balanced and interesting article. I won't be acting as a constable on this page, but rather an editor, so feel free to keep me in check as well if I stray from neutral. D. Matt Innis 07:21, 12 September 2008 (CDT)

Our definition of homeopathy

The lead included a quote by Boyd that was in quotation marks, but was not an exact quote. I replaced it with his exact quote: "Homeopathy is a therapeutic method which assumes that a deviation from the fundamental mean within reversible limits can be restored to normal by means of a stimuli, usually applied inthe form of drugs, only sub-physiological doses of which are necessary because of hypersensitivity in disease and whose action is always directed toward normal by virtue of altered receptivity to stimuli in disease" [1].

I have no issue with adapting this quote for our needs, but if we put it in quotes, it needs to be exact. D. Matt Innis 08:29, 12 September 2008 (CDT)

Ouch. Definitely so, Matt. --Larry Sanger 21:43, 12 September 2008 (CDT)

Yeah...quotes require precision. However, this quote is not a great one, and I hope that we find a better one. Dana Ullman 13:01, 13 September 2008 (CDT)

The definition itself is a strawman argument against homeopathy, as I showed, later in the article.

Homeopathy or Homoeopathy, is a system of alternative medicine that uses extremely small doses of the drugs that cause a similar syndrome of symptoms as the person's illness, to treat that person.

should be instead something like:

... that uses preparations which, after serial dilutions and succussions, little or no trace of the diluted substance, but which retain a putative trace or imprint of the substance ...

Pierre-Alain Gouanvic 01:01, 14 September 2008 (CDT)

Question about spirit-like issue

Dana, I notice that Hahnemann postulated that healing came from the spirit-like force within the body. Is this still an essential part of the homeopathy belief system? If so, maybe we should expand on that. If not, maybe we should expand on that, too. D. Matt Innis 09:58, 12 September 2008 (CDT)

Hey Matt, most of the 10 books that I've written on homeopathy do not include reference to or even mention of "spirit-like forces." Attempted efforts to explain how homeopathic medicines may work are not necessary to understand homeopathy or how to make the medicines work effectively. Personally, I prefer to say that homeopathic medicines influence the immune and defense system of the person. Ultimately, the concept of "vital force" is synonymous with these defense/healing responses. Dana Ullman 12:59, 13 September 2008 (CDT)

So, if I understand you correctly, then homeopaths no longer claim that the effects are the result of spiritual intervention such that Hahnemann once postulated, but rather that modern homeopaths feel that the responses can be totally explained by physical means, whether we are aware of the mechanism or not, correct? If this is the case, the introduction contains a line concerning Hahnemann's conclusion that the responses were the result of "spirit-like" forces, which I think was true at the time. I think it would behoove us to mention the current beliefs after that sentence. I did remove this sentence: "By 'spirit like force', Hahnemann meant, 'the natural healing processes' of the body.", mostly because I think Hahnemann truly felt that "the natural healing processes of the body" were the result of a "vital force" that was "spirit-like" much like other bright scientists at the time. D. Matt Innis 13:59, 14 September 2008 (CDT)

Dana, I accept that one doesn't need to know how something works to use it. Many physicians feel that orthopedists are just plasterers and carpenters that managed to get into a higher-paying slot; orthopedist jokes are legendary in medical circles. I understand the general principles of the engine of my car, but if there's anything wrong beyond an obvious broken belt or the like, I'm not going to be able to fix it.

Literally, when I was a boy, I pestered my mother for a Merck Index of Chemicals and Drugs for my 10th birthday, so I've been interesting in pharmacology and other medical scientists for a long time. My original research was in bacterial resistance to penicillins. While I'm hard-pressed to come up with an exact date, it was probably somewhere in the seventies when physicians, outside the laboratory, started to think in terms of molecular pharmacology (some still don't). Nevertheless, it was a personal revelation to start to be able to predict and understand the interactions of drugs and cellular mechanisms. As that approach became more common, progress accelerated exponentially. It's not that medical scientists know everything; they are acutely aware both of things they know they don't know, and are confident there are things they don't know that they don't know. I can cite several ongoing trials, which affect me as a patient as well as professionally, where there are conflicting results in some important issues regarding diabetes and coronary artery disease. People are working very hard to reconcile this.

So, I remember when conventional medicine was largely materia medica -- this was good for that, but we couldn't generalize. I also am aware how many things have come from evolved theory; I have the same genetics that killed my father at 42, while aggressive treatment has my heart pumping at near-athletic levels at age 60. So, no, one doesn't need to explain how homeopathy works to use it.

To get away from not speaking, or speaking in confrontational terms, to medical scientists, the reality is that they are going to apply the same rules to homeopaths that they use for themselves: why and how does this treatment work? There are some that are in use, clearly work, but don't have a good explanation why, although that's becoming less frequent. I urge the editors working with this article to make a conscious decision if it's going to be about homeopaths talking to a lay public, because they simply won't be taken seriously without more theory.

I will say, however, that when a homeopath says that he uses a common medical laboratory test, I expect him to be able to tell me what he learns from it and how it will affect his treatment decisions -- or, if he can't, to explain why he ordered it. When a homeopath here says he cures a specific disease, a disease that is largely defined by laboratory results down to the genetic level, I expect him to be able to discuss the test he claims to have used. If he understands it, that's a positive basis for cross-disciplinary communications. If he says he doesn't want to discuss it, and doesn't understand why copying textbook material on the subject is not responsive, there is a serious problem of credibility.

Dana and Matt, please think about this in a constructive light. Howard C. Berkowitz 15:15, 14 September 2008 (CDT)

Howard, I am not clear what you're trying to get at in light of the article, but to clarify, a homeopath may be an MD, DO, FNP, PA, RN, ND, DC, LAc, or completely without any degree. As such, some homeopaths conduct a conventional diagnosis (and some don't). The prescription of the homeopathic medicine is NOT dependent upon a conventional diagnosis. Your discussion of lab tests is not pertinent here (I think).

To clarify another subject, there are different "styles" of homeopathy practice, some of which are consider "classical homeopathy" and some that may be considered "clinical homeopathy" or "complex homeopathy." Like in acupuncture, there are different schools of thought in the field and different styles of prescribing, though this information may be pertinent to the article at some time in the future.

Above you wrote, "When a homeopath here says he cures a specific disease, a disease that is largely defined by laboratory results down to the genetic level, I expect him to be able to discuss the test he claims to have used." In the future, please be specific (!) on what is said and where. I do not see what you are seeing, and I would rather not spend my limited time on hypothetical issues. Dana Ullman 17:10, 15 September 2008 (CDT)

Dana, you have put me in a difficult position by CZ rules; by answering you specifically, I may violate CZ civility rules by criticizing an individual. Constables, please note that I am trying very hard to stay with direct quotes, inferences from them, and not directly attacking an individual. I hope my doing this meets both the civility test and Dana's request. I hope that I can phrase this to stay just within those rules. I would also ask you to reduce the lecturing about your limited and valuable time; I have limited time but I feel it worthwhile to spend time on an issue that involves basic credibility of CZ. I am also an editor and have responsibilities elsewhere in CZ, as well as contributing an article now and again.

An individual said "I've Homeopathically healed people with ... Hemochromatosis..." Unfortunately, the most common form of hemochromatosis is specifically associated with genetic defects (http://www.emedicine.com/med/topic975.htm). We now have several conflicts, depending on how precisely words are being used. I have repeatedly made the point that there are some seemingly basic words that are either imprecisely defined (e.g., "heal") or used differently by homeopaths and medical scientists (e.g., symptom and sign).

If "heal" is synonymous with "cure", defined as making all evidence and manifestations of the disease disppear, "curing" hemochromatosis would not merely stop discomfort, but would make the genetic malformation, most likely the HFE gene, disappear in all cells. No one has yet succeeded in changing the genome of a human being, which such a "cure" would involve.

If "heal", in homeopathic terms, means "cause a remission of all symptoms", then the statement makes more sense. The same individual has elsewhere stated homeopaths have "healed" HIV/AIDS (http://www.cure4incurables.com/homeo.htm#aids). That webpage has a headline "Homeopaths claim A.I.D.S. curable", and ends with "three hundred HIV-Positive patients were administered medicines for three months during the experiment. Thereafter, their blood samples were sent for tests at different laboratories, which showed that 15 samples were HIV-negative, said Rastogi. Note:The time factor of 3 months was too short; if the trial had continued for some more time, more would have been HIV-negative." I note this is a little imprecise: what is the criterion for HIV negativity? Western Blot or PCR, which have different latencies to becoming positive?

I'm sorry, but there have been numerous trials, with more than 300 patients, using Highly Active Antiretroviral Therapy (HAART). With the most sensitive viral amplification tests available, some of those people apparently had no Human Immunodeficiency Virus in their bodies. The HAART drugs, which all agree are toxic, were stopped, and many people hoped a cure had been found. Alas, from some unknown source in those patients' bodies, within a year, they again showed circulating HIV, more of a gold standard than circulating antibody.

If homeopathy has cured one genetic disease, and has definitively eliminated PCR-confirmed HIV after an adequate observation time, then, I suppose, molecular medicine should be thrown away and some homeopaths should be taking a trip to Stockholm for their Nobel Prizes. If, however, "heal" does not have a precise meaning, I suggest, Dana, that this is the reason that I seem to be taking too much of your time — language is being used imprecisely enough not to meet CZ quality standards. If there is any hope of making this into a neutral and high-quality article, language must be precise. Howard C. Berkowitz 17:47, 15 September 2008 (CDT)

Howard, please (1) write less if you can at all manage it :-) and (2) state what part of the article you're discussing. As to (1), the sheer quantity of your comments makes it impossible for any but the most stalwart/least busy to debate you, and will hence put off excellent new people at which you direct your verbiage. As to (2), Matt and Dana began with a reasonably specific question about whether a certain topic should be mentioned in the article, but you've gotten off track, it seems to me. I hate to be blunt, but if you're spending more than a few paragraphs on a regular basis discussing anything other than the article, you're probably wasting other people's time. I think this is something we have all learned by now. Also... (3) please bear in mind that calling the constables and even referring to rules about personal attacks in your comment summary is apt to put others on the defensive. If you've really got a problem or question about your consistency with the rules, then e-mail the constables and ask. (And if they don't respond in anything like a timely fashion, e-mail me.) --Larry Sanger 18:03, 15 September 2008 (CDT)

Apparently, I failed to make clear that I was concerned that to give an adequate answer, I was concerned with my violating the civility rules. Further, you certainly can think I am writing too much, but I believe that a great deal of hand-waving is being permitted. Let me propose to you that I will agree to stop commenting on this article in any way, if some neutral and qualified people will, definitely on the article and preferably on the talk page, control the more grandiose statemente (e.g., "billions" of homeopaths) having done things.

I shall move over to what seems a very relevant forum discusssion: I have to agree that the separation between health sciences and healing arts is dysfunctional. Howard C. Berkowitz 18:17, 15 September 2008 (CDT)

But Howard, you can be that person (who "controls" the "more grandiose statements"). By attributing, rewriting, qualifying, and in some rare cases removing "grandiose statements"--you know, working directly on the article--you will do us a great service. As a definitely second-ranked alternative, if you don't want to edit them yourself, then you could list them on the talk page. In order of helpfulness, very general philosophical complaints on the talk page ranks third.

I realized that you were referring to yourself. Shall I paraphrase? "Hey, I'm trying to be civil, but you're making me soooo crazy that somebody might have to call the cops!" :-) --Larry Sanger 18:54, 15 September 2008 (CDT)

Dana, you said, "..a homeopath may be an MD, DO, FNP, PA, RN, ND, DC, LAc, or completely without any degree. As such, some homeopaths conduct a conventional diagnosis (and some don't). The prescription of the homeopathic medicine is NOT dependent upon a conventional diagnosis. " I think this is vital information that needs to be stated early in the article. My question would then be, "Is anyone who uses homeopathy considered a homeopath?" Or should we state it as "..homeopathy may be used by an MD, DO, FNP,..." I think you have a better understanding of the best way to state it, so go for it. D. Matt Innis 19:39, 15 September 2008 (CDT)

Howard, I'm not sure, but I doubt that there is much left in the article concerning "curing" anything like hemochromatosis or HIV. Sometimes things are said on talk pages that no-one expects to end up on the article page, even the one that wrote it. Trust your editors. Is there a reason you wouldn't want to add Health Sciences to this article? D. Matt Innis 19:39, 15 September 2008 (CDT)

Howard, you didn't do any personal attack, but I do agree with Larry and Matt in everything they have said. That said, please bring up the issue about evidence if and when someone writes into the article that homeopathy "cures" or "heals" any specific disease. All specifics like this require verification of some sort.

Matt, you are right. That info should be a part of the article. You are welcome to insert it where you think it belongs, and we all will add to it as time goes on. On this subject, the name, "homeopath," should be left to those people who practice it professionally, not just anyone who uses homeopathic medicines. Please also note that every country has its own laws of who can and can't practice homeopathy. There are certain countries in which all (or virtually all) homeopaths are MDs (such as France, Spain, Argentina, Columbia), some countries have homeopathic medical schools (India, Pakistan, Mexico), some countries have natural medicine colleges in which students are taught some or a lot of homeopathy (Germany has its "heilpraktica"/health practitioners; U.S., Canada, and Australia have naturopathic medical schools), and some countries have "professional homeopaths" who have attended homeopathic schools and who then pass independent examinations that grant them "certification" as a homeopath...such as U.S. and U.K.). I hope this helps... Dana Ullman 23:51, 15 September 2008 (CDT)

Yours certainly sounds like a good start. Make any changes you think necessary:

Homeopathy is practiced in a variety of different ways and by a variety of different professionals and lay practitioners depending on the country and laws regarding the practice. There are certain countries in which all (or virtually all) homeopaths are MDs (such as France, Spain, Argentina, Columbia), some countries have homeopathic medical schools (India, Pakistan, Mexico), some countries have natural medicine colleges in which students are taught some or a lot of homeopathy (Germany has its "heilpraktica"/health practitioners; U.S., Canada, and Australia have naturopathic medical schools), and some countries have "professional homeopaths" who have attended homeopathic schools and who then pass independent examinations that grant them "certification" as a homeopath...such as U.S. and U.K.

D. Matt Innis 14:38, 16 September 2008 (CDT)

The structure of water

I renamed "The debate": "The structure of water". It seems reasonable because 1) "A false debate" was renamed "A common misunderstanding (Hayford is right); 2) The broader question of the structure of water is often considered non-sensical, and we ought to make some clarifications. The random network model of liquid water is not plausible anymore, although most chemists and biochemists consider it as a non-issue.

I began my summary of Structure Of Liquid Water; Novel Insights From Materials Research; Potential Relevance To Homeopathy (2005) R Roy, WA Tiller, I Bell, MR Hoover - Materials Research Innovations. This is a dense and informative article, that I recommend (32 pages). I would also recommend the speech given by Rustum Roy, the first author, in a conference on homeopathy at the University of Connecticut. I shared the video in Watchknow's youtube group.

I will add as much as I can reasonably can to this state-of-the-art in the field of materials science, help will be appreciated.

Pierre-Alain Gouanvic 19:43, 12 September 2008 (CDT)

A good beginning. I have just added more, including reference to what I consider to be the most comprehensive body of information and research on the structure of water...by Martin Chaplin. Feel free to tweak and expand. In particular, I need some help in formatting. Dana Ullman 13:38, 13 September 2008 (CDT)

I wonder if we should use Chaplin's work as a template. Even Roy and colleagues refer to Chaplin's work as the most comprehensive and the most valuable review! Once again, Dana, you prove that you're the expert here.

I'll compare the relative importance of both works. I'll see what I can do for the formatting. Wikilinks, reference formatting... those kinds of things.(?)

Pierre-Alain Gouanvic 14:15, 13 September 2008 (CDT)

• I read: Novel Insights From Materials Research; Potential Relevance To Homeopathy (2005) R Roy, WA Tiller, I Bell, MR Hoover - Materials Research Innovations. This is a superfluous chaotic article, that I would have rejected without any trace of doubt had I been the referee. In addition, I wish to point out that Rustum Roy, the first author, is also first author on a paper (same journal) in which it is proved that seawater can burn. It would take me too much time to explain my position, and I'm sure that it would start a prolonged discussion on this page that would lead to nowhere. Let me just say that my reasons to judge as rubbish both papers of Roy are purely scientific, I've nothing against burning seawater or homeopathy. --Paul Wormer 06:07, 24 September 2008 (CDT)

I said "this is a dense and informative article, that I recommend (32 pages)". The reply: it is a "superfluous chaotic article", not fit for publication ("that I would have rejected without any trace of doubt had I been the referee)", or, in simpler terms, "rubbish".

I see that Dana enhanced my text:

For a theoretical overview of the structure water from a leading professor of material sciences, see Structure Of Liquid Water; Novel Insights From Materials Research; Potential Relevance To Homeopathy (2005) R Roy, WA Tiller, I Bell, MR Hoover - Materials Research Innovations.

instead of

For a more detailed analysis, see

Which is obviously very supportive of what I was saying. However, this whole situation reminds me too much of bad experiences I had on Wikipedia. Call it a Post-Wikipedia stress disorder... or an idealistic understanding of what "strong collaboration" means. But the bottom line is that I won't be able to take part in any more discussions here, or in any other articles where similar situations can occur. Sorry. I can be reached through email.

Pierre-Alain Gouanvic 00:56, 25 September 2008 (CDT)

Pierre, sorry to hear that. I appreciate your work (and learned a few things along the way!). I would have liked to hear Paul's work on water as well, but I suppose it may stray too far from our purpose here, which is to write about Homeopathy. I don't have any problems with having a subpage explaining this thoroughly, just as I think a DNA article could have a subpage explaining all the potential bonds that form. I also think it is just as appropriate to talk about the psychosocial effects of the doctor patient relationship in healing. D. Matt Innis 14:41, 26 September 2008 (CDT)

Thank you Matt. You see, the truth for me is that the inclusion of the research by serious experimenters in mainstream science ("normal science", as Kuhn puts it) is not dependant on the quality of their work but on the theoretical work that is done on the plausibility of homeopathy. And the plausibility of homeopathy rests only on the materials science of water, glass containers, and alcohol. This is unfortunate, but, on the other hand, some people like me really want to know how absent molecules work. It is perhaps more politically acceptable to say that homeopathy "is a system of alternative medicine that uses extremely small doses of drugs", "much smaller and specially prepared doses". But it is false. Remember the Avogadro limit. As I said earlier on this talk page, homeopathy uses preparations that contain little or no molecular trace of the initial molecule or extract. The definition of homeopathy in this article is false. Of course, when one tries to discuss what homeopathy is, trying to understand the properties of the solvent, like I do, it brings all kinds of problems: people don't agree on what they're talking about.

Put the definition of homeopathy in the homeopathy article: then we'll be in business!

Pierre-Alain Gouanvic 02:31, 27 September 2008 (CDT)

The psychosocial effects of the doctor patient relationship in healing is exactly why I don't reject homeopathy (especially for the illnesses where the regular doctors don't have a good remedy).

If somebody would be interested, I could explain in some detail why I call the paper by Roy et al. "scientific rubbish". Moreover, IMHO, the paper has hardly any bearing on homeopathy (or on the structure of water for that matter). --Paul Wormer 02:27, 27 September 2008 (CDT)

A super professor once taught me that we can't ignore the history. The way I see it is that homeopathy started long before scientific medicine, when vitalism was the mainstream. Homeopaths were the mainstream practitioners in the 1800s. I am not an expert on homeopathy, but I am assuming that the concept of "likes cures likes" did not start with doses so low that there were no molecules apparent. In other words, giving small doses of rabies to patients with rabies in the 1800's may well have been in dose limits that were "real" and may well have been the ground-breaking work that gave birth to immunizations, I truly don't know, but would be interested to read about it. I do know that in the US, at the turn of the century, homeopaths were the majority practitioners until the Flexnor report. I have also read that, at that time, due to the lack of "modern" labs, most of the homeopathic schools were closed as inadequate and homeopaths were absorbed by medicine by grandfathering them in. I assume anything that was potentially molecular was accepted, but those that couldn't be explained without invoking spiritualism were not. Because these low dose remedies had no substance, they weren't dangerous and therefore not regulated by the federal government and was unable to restrict their use to MDs. Those remedies that were left over could be given by anyone without an MD degree and are what we now know as homeopathy.

Those who were treated less than desirably by the medical profession (women for instance), took hold of these alternative methods and developed them. I'm not sure, but I am thinking that once the idea of Avocadro's limit became apparent, the only explanation at the time was to revert back to the "spiritual" roots that all healthcare once believed. Now that reductionism is beginning to see it's limits, opening the door for other possibilities such as "the structure of water" to explain what we see (or don't see), opens the door for these same explanations to be used elsewhere. There is nothing wrong with using scientific thought processes to rethink what homeopaths think they see. We have some bright minds here that could make some really reasonable arguments. I think that the bar that we need to reach for inclusion in our article should be whether homeopaths are talking about it - or even those that are talking about homeopathy. For that we need to give way to our homeopathic experts and give our science experts a chance to look things over and keep it real, as long as they are willing to do the background work. It would be wrong to dismiss homeopathic remedies just because we can't explain it. So let's keep going - take our time and get it right. I agree that our definition needs work and that the structure of water has some holes in it, but we can discuss them rationally. D. Matt Innis 12:23, 27 September 2008 (CDT)

Fascinating info, Matt, particularly the first para. If true, then I think the entire article ought to be *seriously* rewritten in order to reflect this info. That would explain, for instance, something that has always baffled me: Why the royal Brits have a Royal Homeopath or whatnot to treat them.... Commenting here as a general reader, nothing more.... Hayford Peirce 13:07, 27 September 2008 (CDT)

You must be right Matt. I am a strong supporter of the approach you describe: let's "take our time and get it right". This article might become one of Citizendium's most impressive achievements. But to get there, we must let this page become like a big bazaar of ideas; take my mithridatization, for instance. It was proposed for deletion by one author, and another editor concurred. The question is: what's the urgency? Who sets the timeline? Not me, for sure! So I spent some of my precious time to rescue this idea. And found that mithridatization was an important historical-scientific foundation of the philosophical thinking of the founder of the GIRI, a research group devoted to the understanding of homeopathy. See the mithridatization and hormesis section. My intuition had brought me on more solid grounds than I thought. But if I hadn't read your kind and supportive words, I would have left completely this (pseudo?)-collaboration. I wonder if I should urge deletionists to be more collaborative and patient. On the other hand, it is not my job to explain what a gentle expert guidance should look like. What I can say is that it is essential, in well-regulated human interactions, to ask the originator of a proposition to explain his or her motives or motivations, when the proposition manifestly misses its goal. If the marvels of wiki collaboration don't allow an enhancement of the ethics of deliberation, what will?

And notice that I'm only talking about a successful rescue of content. When Ramanand invokes various frontier science topics (pseudo- or proto- science, if one prefers), in the quantum physics and nanobubbles sections, I view this as a precious reminder, while others will, more or less rightly, judge that it is off-topic. Well, yes, I agree that it is off-topic. But we'll lose much more if we delete without formally asking: "Who wrote this? Why did you think it was important?" It's not wikipedia here. We are committed to authorship and authority. We don't function by the rule "survival of the nerdiest, most active contributor". If Ramanand has little time to explain where he's coming from, let's wait; and some like me will perhaps add some insight which suddenly will make the off-topic intervention precious, albeit surprising.

Pierre-Alain Gouanvic 21:14, 27 September 2008 (CDT)

Environmental Toxicology

I have added a new section on this subject. There is more research on this topic than I have provided, but this is a good beginning. Dana Ullman 13:38, 13 September 2008 (CDT)

Dana, I was eager to see something specifically about homeopathy used as an antidote. I was saying, above in the talk page,

Beyond placebos (cont'd): in animals

I found a good one. We're dealing with mice, there is a variety of controls, and both principles of homeopathy are involved : 1) a toxin, arsenic, is used to mitigate the effects of arsenic; 2) the doses used are well below Avogadro's limit (no arsenic left). I'dd add that the study was "highly accessed" and published in a BMC journal;

And I emphasised, with the following quote, that homeopathy was considered as a near-ideal solution to a hard to solve problem, arsenic intoxication in several poor countries:

our initial aim was to find out suitable antagonists of arsenic poisoning, which should be i) easy to administer, ii) effective in low doses, iii) inexpensive and iv) without any toxic effects of their own. In course of our search, a potentized homeopathic drug, Arsenicum Album-30, was indeed found that showed highly promising results in combating arsenic intoxication in mice (....)

I think that it will be important to devote some room, perhaps in the closing remarks, to the social, economical, and political stakes involved in the acceptance/rejection of homeopathy. On the skeptics' side, homeopathy is a waste of time and public funds (critics are often revolted by the sums of money used by public health officials to beat the dead horse of this antiscientific CAM); a threat to public education (back to the dark ages, magic...);

On the homeopathy side, there is a concern that the rejection of this therapeutic is costly in terms of human quality of life, missed occasions to address problems (such as arsenic intoxication) that conventional systems are perhaps too slow to adress, especially in poor countries (I think that the World Health Organization and Médecins aux pieds nus (Barefoot doctors?) are favourable to homeopathy (?)).

In other words, it seems justified to describe the wrath of so many conventional scientists, the ridicule thrown on those who dare to study the subject (cf Randi's conferences and public interventions), and, conversely, the disappointment of homeopaths (publication bias (see the bibliography subpage), rejection of the right to respond to critical editorials in mainstream journals.

I don't want to light a fire. It is clear, for me, that controversies require sociological/epistemological considerations.

Pierre-Alain Gouanvic 18:42, 13 September 2008 (CDT)

Broad comments

I'm afraid I have little time just now to help. Generally I see positive and interesting things. Two points, I think it must be made clear that in general scientists and medics doubt that homeopathy has any basis other than placebo effects; I think this has been lost through the edits and I have tried to restiore the key point simply and clearly. The large clinical trials statement I have edited; the statement as written seemed to imply that the trials were designed deliberately to fail. It's a fact that in general such trials are not supportive. Why that might be could be discussed, but please be careful to keep any such discussion neutral, and the intro is not I think the place for that.Gareth Leng 16:36, 13 September 2008 (CDT)

Is homeopathy plausible? The structure of liquid water

Gareth, I agree that CZ articles should not contain an excessive number of sections and subsections. But what we're trying to do, before the great day when we submit this article for approval, is to sort out all the info we are gathering, so that we can summarize it and make it more readable (and entertaining).

There are dangers to deleting the codes for sections. Some of your edits were clever, but when I see that "Structure of liquid water" was lost in the table of contents, I got worried. The structure of water is the basic issue that we have to address. Your intervention made me realize that, in fact, instead of the dry "fundamental research" we could use "Is homeopathy plausible? The structure of liquid water" as a title for ths section.

If we represent correctly the research that is done on the structure of water (both in homeopathic preparations and in the body), we will be able to determine if the claimed "imprint" made in the water by the homeopathic process can be demonstrated or not; we will be able to say if homeopathy is falsifiable or not.

So I reverted your change to reintroduce "stucture of water" as a high priority topic.

Pierre-Alain Gouanvic 02:00, 14 September 2008 (CDT)

That's fine, it wasn't my intention to de-emphasise that as an issue.Gareth Leng 05:50, 14 September 2008 (CDT)

Clearly, there is fundamental progress being made on previously unsuspected structure and activity of water. There needs to be stronger connection between water structure and the physiologic effects of homeopathy, as well as verifying that homeopathic remedy preparation affects water. Apropos of the latter, is anyone aware of mass spectrometry of homeopathic remedies, which should be able to verify the presence of clathrates? Howard C. Berkowitz 06:50, 14 September 2008 (CDT)

You may be interested by a recent contribution; I quoted: "the light scattering technologies of Raman spectroscopy and Fourier transform (FT) infra-red (IR) spectroscopy permit examination of remedy samples without fixatives or other potential contaminants (and) allow the co-operative nature of structural differences to be detected".

Inspired by your other question, I created another plausibility section about the other side of the issue: water in living systems. It's empty...

Pierre-Alain Gouanvic 13:21, 15 September 2008 (CDT)

Is this article about homeopathy or the structure of water? In my opinion it is becoming very unbalanced. Chris Day 02:05, 24 September 2008 (CDT)

"homeopathy or the structure of water?" I don't understand. Why don't you elaborate on this in the article? Why does an article exploring the plausibility of homeopathy becomes very unbalanced when it deals with the structure of liquid water?

Pierre-Alain Gouanvic 03:23, 24 September 2008 (CDT)

I'm assuming a reader wants a general overview of homeopathy. An analogy would be the article on DNA focusing too much on hydrogen bonding. Obviously it is important for the function but does it need to be so much of the article? Water structure is also not well understood with regard to function in this case either, unlike hydrogen bonding with respect to DNA, so masses of detail is not really appropriate. It should be mentioned, of course, but as it stands now (and it looks like it is likely to expand) it is an analysis of the primary literature discussing individual (controversial) ideas and (controversial) experiments. Some of the connections that are being made from the chemistry of water to the function in diluted states are not even clearly relevant, yet, there seems to be a narrative forming suggesting this is common knowledge that it is important for homeopathic function. In short there is too much certainty being placed on too little data. Chris Day 04:16, 24 September 2008 (CDT)

Changes to lede and Intro

I made some mostly cleanup, clarifying and filling changes to the lede and the introduction. If I have changed anything in an unacceptible way, feel free to set me straight. D. Matt Innis 21:50, 17 September 2008 (CDT)

I can't parse the phrase "likes cures likes," unless it's an allusion to the title of a story about rodents by Ellis Parker Butler. Bruce M.Tindall 22:16, 19 September 2008 (CDT)

Concerning this long quote

I feel that we have to emphasise that, once again, the textbook explanations are wrong (see first sentence of the quote), and that water has a previously unrecognized role in the whole enzymic machinery (following sentences; abridged). And of course, the notion of water clustering is central.

It is tempting, as well, to salute the visionary insight of Szent-Gyorgyi.

But now, help would be appreciated, especially from the biologists in CZ, and those who will (no doubt) rush to read and enhance this article, during Biology week!

Pierre-Alain Gouanvic 02:16, 18 September 2008 (CDT)

I don't think we can emphasise that at all. The essential involvement of water in all protein function is very well recognised, and not controversial (and when people say that textbook explanations are wrong, I am unimpressed and uninterested; to an expert, textbook explanations are always wrong :-)). There is some question about whether at a subatomic level, the water that is in close proximity to macromolecules might be forced into an altered structure. It seems plausible that it might, although there is dispute about whether it does. However to say that A in a macromolecular matrix the structure of water is distorted is one thing, to say B that it retains this structure when not confined is something else, and to say C that this structure could be recognised and used adaptively by biological mechanisms would be something else again. My view as a biologist, is that A sound interesting but I'm not a chemist. B seems very unlikely, but I'm not a physicist, and C is something for which I cannot conceive any mechanism nor can I imagine how any mechanism could have evolved through natural selection.Gareth Leng 08:30, 18 September 2008 (CDT)

Gareth sums up the "expert" opinion accurately here. I can relate to all his comments, especially the 'textbooks are wrong' one. Chris Day 08:56, 18 September 2008 (CDT)

Definition by Boyd

Matt, you diluted the definition by Dr.Boyd so much that it did not seem to be his quotation. In any case, it was you who gave us the exact quote in the first place. If what I've done is unacceptable, please let me know.—Ramanand Jhingade 20:25, 22 September 2008 (CDT)

Hi Ramanand, I have two issues with the quote: First, having such a long quote in the lede appears as though we can't explain it in our own words and, second, I don't think the average reader will take the time to try to understand what it says. How about paraphrasing it for me.

Homeopathy has been defined as, "a therapeutic method which assumes that a deviation from the fundamental mean within reversible limits, can be restored to normal by means of a stimulus, usually applied in the form of drugs, only sub-physiological doses of which are necessary because of hypersensitivity in disease and whose action is always directed toward normal by virtue of altered receptivity to stimuli in disease".

D. Matt Innis 09:08, 23 September 2008 (CDT)

I agree with Matt here. I think that this quote is too cumbersome and not precise enough to be used in the lead. I think that we should look for another quote or use our own words. Dana Ullman 21:03, 23 September 2008 (CDT)

Dana, much better concerning the quote and you even helped elucidate the "likes cures likes". I am having trouble leaving the latter part of the quote concerning immunizations, etc. as it seems to suggest that immunizations are homeopathic... Can you separate them more. I think it gives the impresssion that an attenuated virus might be part of a homeopathic remedy. It isn't, is it? Do any homeopathic remedies actually include parts of a virus, or just compounds that mimic the symptoms of the disease that that virus would cause? D. Matt Innis 20:39, 24 September 2008 (CDT)

Matt, actually, some doses of homeopathic medicines ARE viruses, just in very small dose. For instance, Influenzinum is made fresh every year. Many (most? all?) homeopathic manufacturers obtain the same 3 types of flu viruses that the Pasteur Institute defines as the most common and that are typically in a "flu shot." The difference is that the doses are simply smaller than those in a flu shot. It is commonly sold as a 9C (1:100 dilution NINE times), thus maintaining some molecular dose. It is also available in the 30C or 200C or 1M (1,000) or higher potencies. The bottomline is that the homeopathic "principle of similars" is at the heart of vaccinations.

Taking this further, I quote from my new book, "The Homeopathic Revolution: Why Famous People and Cultural Heroes Choose Homeopathy," here's part of the section on Emil von Behring (the father of immunology!): Emil Adolf von Behring (1854–1917) won the first Nobel Prize in medicine or physiology for his discovery of the diphtheria antitoxin. Later, he discovered the tetanus antitoxin. For many years he served as military captain of the medical corps to the Pharmacological Institute at the University of Bonn, and then was given a position at the Hygiene Institute of Berlin in 1888 as assistant to Robert Koch (1843–1910), one of the pioneers of bacteriology. He then became professor of hygienics in the Faculty of Medicine at the prestigious University of Marburg. Because of his significant discoveries in immunology, Behring retains a highly regarded place in its early history.

In 1892 Behring actually experimented with serial (homeopathic) dilutions and found paradoxically enhanced immunogenic activity, but he was advised to suppress this experiment due to the aid and comfort it would provide to homeopaths. Only after he won the Nobel Prize did he feel comfortable in making public these experiments (Behring, 1905; Coulter, 1994, 97).

Behring broke from orthodox medical tradition by recognizing the value of the homeopathic law of similars:

"In spite of all scientific speculations and experiments regarding smallpox vaccination, Jenner’s discovery remained an erratic blocking medicine, till the biochemically thinking Pasteur, devoid of all medical classroom knowledge, traced the origin of this therapeutic block to a principle which cannot better be characterized than by Hahnemann’s word: homeopathic. Indeed, what else causes the epidemiological immunity in sheep, vaccinated against anthrax than the influence previously exerted by a virus, similar in character to that of the fatal anthrax virus? And by what technical term could we more appropriately speak of this influence, exerted by a similar virus than by Hahnemann’s word “homeopathy”? I am touching here upon a subject anathematized till very recently by medical penalty: but if I am to present these problems in historical illumination, dogmatic imprecations must not deter me." (Behring, 1905) Reference: Behring, A. E. von. Moderne Phthisiogenetische und Phthisotherapeutische: Probleme in Historischer Beleuchtung. Margurg: Selbsteverlag des Verfassers, 1905. Dana Ullman 23:30, 24 September 2008 (CDT)

As you say, vaccination was introduced long before there was any understanding of its mechanisms of action, and Behring was quite reasonable at that time in pointing out the analogy between homeopathy and vaccination. At that time there was no clear molecular theory. In particular, it was not understood that there are fundamental limits to how much a solution can be diluted while still retaining some of the diluted material, nor was it understood that physiological mechanisms require a process of molecular interaction. If homeopathy involves specific activation of the immune system, then this should be reflected in specific antibody production, and this is something readily measurable; as far as I know it doesn't result in specific antibody production. If I am right, the analagy might be relevant, but it shouldn't be presented as though it could be an explanation for why homeopathy might work.Gareth Leng 04:45, 25 September 2008 (CDT)

Gareth, the bottom line is that both homeopathy and vaccination have something in common and that is that they both use the "principle of similars." We both agree that the analogy IS relevant. Although scientists today give their explanations for specific molecular processes for how vaccines work, they ignore the underlying principle that may explain why they do so.

I have no problem maintaining some humility here, and therefore, we should not say that the homeopathic "principle of similars" explains HOW homeopathic medicines work but that this principle in nature may provide an underlying basis for various phenomena, including vaccination, allergy treatments, and homeopathy.

By the way, for a drug to help prevent a specific disease, there are various processes of the immune system and other defenses at work, not just antibody production. Dana Ullman 13:40, 26 September 2008 (CDT)

Yes I agree that the analogy is relevant, it's not so much that scientists ignore the principle of similars, as that they simply don't accept its validity as a scientific principle. So only a homeopath would say that both vaccination and homeopathy use the principle of similars, but it's fine to say that here. Of course you're right in that the immune system is more than antibody production. Gareth Leng 11:36, 27 September 2008 (CDT)

Nanoparticles

?does this have anything to do with homeopathy? Gareth Leng 11:16, 24 September 2008 (CDT)

Nah, I've been waiting to see if that line develops, but I think it's time to take that one out. D. Matt Innis 11:23, 24 September 2008 (CDT)

Gareth, I would also like to see your post above concerning A, B and C appear in some form in the article. Any chance you can write something up stating something like that in the article proper? D. Matt Innis 11:27, 24 September 2008 (CDT)

Hyperimmune

I've deleted a section of text here - hyperimmune responses are those elicited as a result of excess antibody production - don't think this is relevant here. the messenger pathways are complex and I don't think that this is the place for that kind of detail, it seems to be likely to confuse rather than clarify.Gareth Leng 04:34, 25 September 2008 (CDT)

Mithridisation

I'd suggest deletion of this section. Mithridisation seems to be an archaic term. The basis of tolerance to snake venoms seems to be the same as the basis of vaccination - protection is incurred by the production of antibodies to the venom. See e.g. Coral Snake Venom : Antibody Response in Rabbits. Nature (1967) 213:820-822. Gareth Leng 09:06, 25 September 2008 (CDT)

I agree 100%...with more clean-up soon. Dana Ullman 20:20, 25 September 2008 (CDT)

Dana, Gareth,

I'll copy the contents of my response to Matt :

You must be right Matt. I am a strong supporter of the approach you describe: let's "take our time and get it right". This article might become one of Citizendium's most impressive achievements. But to get there, we must let this page become like a big bazaar of ideas; take my mithridatization, for instance. It was proposed for deletion by one author, and another editor concurred. The question is: what's the urgency? Who sets the timeline? Not me, for sure! So I spent some of my precious time to rescue this idea. And found that mithridatization was an important historical-scientific foundation of the philosophical thinking of the founder of the GIRI, a research group devoted to the understanding of homeopathy. See the mithridatization and hormesis section. My intuition had brought me on more solid grounds than I thought. But if I hadn't read your kind and supportive words, I would have left completely this (pseudo?)-collaboration. I wonder if I should urge deletionists to be more collaborative and patient. On the other hand, it is not my job to explain what a gentle expert guidance should look like. What I can say is that it is essential, in well-regulated human interactions, to ask the originator of a proposition to explain his or her motives or motivations, when the proposition manifestly misses its goal. If the marvels of wiki collaboration don't allow an enhancement of the ethics of deliberation, what will? And notice that I'm only talking about a successful rescue of content. When Ramanand invokes various frontier science topics (pseudo- or proto- science, if one prefers), in the quantum physics and nanobubbles sections, I view this as a precious reminder, while others will, more or less rightly, judge that it is off-topic. Well, yes, I agree that it is off-topic. But we'll lose much more if we delete without formally asking: "Who wrote this? Why did you think it was important?" It's not wikipedia here. We are committed to authorship and authority. We don't function by the rule "survival of the nerdiest, most active contributor". If Ramanand has little time to explain where he's coming from, let's wait; and some like me will perhaps add some insight which suddenly will make the off-topic intervention precious, albeit surprising. Pierre-Alain Gouanvic 23:54, 27 September 2008 (CDT)

I think the problem here is that "mithridisation" is a term that has no hits at all on PubMed (and PubMed includes at least some homeopathy journals). It has no presence at all in science because (in referring to desensitisation as a result of chronic exposure to a toxin) it refers to many different kinds of things with quite different mechanisms of action (for example, in the case of venom, it's antibody production, in the case of other drugs it can be receptor downregulation). So while it's reasonable to have an article on mithridisation to clarify its historical usage, I don't think it has a place here, because it doesn't help to understand homeopathy (as far as I can see anyway). Hormesis I'm similarly unsure about. Hormesis (in drug actions) refers to agents that have different actions at low concentrations to those at higher concentrations. This can arise in many well known ways, and again, hormesis is a term used very seldom in the pharmacological literature because it embraces several different mechanisms. In itself, hormesis has nothing to do with homeopathy; we're not talking here about the high dilutions that homeopaths use, nor are we talking about anything outside conventional scientific explanations.

I've no problem with waiting to see if something makes sense with further edits. I was just declaring here that, at present, I don't see where the sections on mithridisation and hormesis can go usefully. Gareth Leng 15:55, 28 September 2008 (CDT)

No. You said: "I'd suggest deletion of this section."

Pierre-Alain Gouanvic 20:24, 28 September 2008 (CDT)

Isn't that the same thing? If you "don't see where the sections can go usefully" then one would probably "suggest deletion of this section". No? I don't see these as being mutually exclusive comments. Chris Day 00:38, 29 September 2008 (CDT)

Chris, I'd "suggest deletion of" your comment.

Just joking. Pierre-Alain Gouanvic 14:11, 29 September 2008 (CDT)

Gareth, Matt, I sincerely hope you can consider the opinion of the others before deleting anything. I can explain things (so can Pierre-Alain and Dana), but I don't have the kind of time y'all do, so I request you to be patient.Thanks in advance for co-operating.—Ramanand Jhingade 21:58, 28 September 2008 (CDT)

Pierre-Alain, I don't have a problem giving you time to explain how and why you think is info IS important. It is good, for instance, that you mentioned that the head of GIRI refers to mithridisation, but Gareth is absolutely correct in noting that if it is not mentioned in Pub-med, it may not have notability. On the other hand, hormesis IS big and very notable. Dana Ullman 00:25, 29 September 2008 (CDT)

My preliminary research on mithridation/mithridatisation (using * can be helpful in pubmed) indicates that Mithridate is considered the first toxicologist. A pubmed + google scholar + dictionary search will reveal that English will tend to speak about Mithridates, about mithridates (=antidotes), about mithridaticum (a specific antidote that was famous for centuries, which contained poisons but also other drugs). My language, French, has a preference for another "plane" ("EN has a preference for reality, FR for reason", as we're taught in translation courses), and will use "mithridatisation" more often - the head of GIRI is French. But still, in the review by Khudar-Buksh we (?; see talk) were talking about (in the lead), the "Mithridates effect" (note that English prefers to point to a reality, the Emperor, and add "effect", rather than to add "ation" or "ization") is mentioned as well. I'd like to emphasise that notability is not assessed by putting a word in pubmed and hitting the enter key. It's the first step. Here, we have a topic that is important in the history of medicine, which helped at least two researchers on homeopathy to think about homeopathy (you know how the history is useful when thinking about homeopathy). I would say that these historical considerations will be especially useful when we introduce hormesis.

The journal "Dose-response", which is entirely devoted to hormesis, doesn't seem to describe hormesis in the same terms as Gareth. In particular, they have published positive results with *very* low doses (right at the point of non-existence of the molecule, Avogadro's limit). It was with cisplatin. These researchers who investigate hormesis wish its mechanisms were well-known, but they aren't. Hence this broad definition; hence the publication of research on tiny, tiny doses. And you have electromagnetic hormesis, a hot topic in this day and age. Nobody assumes that the mechanisms are well known or self-evident, but we call it hormesis.

Finally, I would caution against the use of such expressions as "conventional scientific explanations". It is an appeal to authority. Nobody here is an expert on hormesis. Let's take our time.

Pierre-Alain Gouanvic 14:03, 29 September 2008 (CDT)

Mechanism of action

Pierre-Alain mentioned Khuda-Bukhsh's research into the mechanism of action of homeopathic remedies. Can we have that in the Lead (is it Lead or Lede?) please.—Ramanand Jhingade 22:33, 28 September 2008 (CDT)

I do not think that Khuda-Bukhsh's research on mechanism of action has any place in the lead. His research on this subject has not been experimentally verified and his research has not been replicated. The lead should only have the most important, basic, and verified info. And please, Ramanand, please provide summary info in your edits. You've been told this before...and it IS important. Dana Ullman 00:29, 29 September 2008 (CDT)

As an observer of this article I suggest, again, it is becoming far too detailed down to the level of individual papers. I mentioned this above for the water section and now I see the same thing here. We need to rise above the details of discussing individual studies. Surely that would be for other articles? Chris Day 00:41, 29 September 2008 (CDT)

There is already a reference to this review paper (not a research paper) (Khuda-Bukhsh AR (November 2003). "Towards understanding molecular mechanisms of action of homeopathic drugs: an overview") in the lead section:

There have been various suggestions about how homeopathic medicines might work,[2][3].

the other one being the special issue of Homeopathy (2007) that you brought to our attention, Dana.

This brings us to the central problem of the definition of homeopathy, again. The sentence goes on:

but there is no generally accepted mechanism of action for the extremely small doses used in homeopathy, and this remains a stumbling block to its acceptance by mainstream medicine and science.

Which is indeed a serious stumbling block, considering that it's not even the issue. Those two references deal with the structure of water, not with the effects of "extremely small doses".

Sorry for the digression; Ramanand, are you saying that we should give to the reader a general idea of what these "various suggestions" are? I would say that not doing so would amount to say that they don't *deserve* to be in the lead. I'd say it's self-evident; we have to tell the reader that the scientific research on homeopathy tries to understand the materials science of these preparations.

Pierre-Alain Gouanvic 02:17, 29 September 2008 (CDT)

I want the mechanism of action to be mentioned in the Lead - that small reference can't even be read. I think Dana can do something about that.Ramanand Jhingade 03:33, 30 September 2008 (CDT)

Like cures like

Please, I have edited the lead to remove the suggestion that medicine uses this principle. I do not wish to misrepresent the beliefs of homeopaths in any way at all. However, we must not distort modern medical and scientific beliefs either. The principle of "like cures like" is not one used in any form by modern medicine or science. There are very few principles or laws of any form that are accepted in biology; in physics there are many, because these are founded in a detailed mathematical understanding and are universally applicable. The principle of "like cures like" has no theoretical basis accepted in science. It is quite wrong to say that vaccination is an application of the principle of like cures like; it may be (to some) an illustration of the principle, but modern vaccination is simply an application of contemporary understanding of the immune system. As for the generality of like cures like, remember that medicine used to be contrasted as the application of the opposite principle - allopathy - that medicines should be opposite in action to symptoms. Representing that as a principle was equally inappropriate. Gareth Leng 03:13, 29 September 2008 (CDT)

First, allopathy is NOT the use of opposites. That would be "contrapathy." "Allopathy" derives from "other" or "different" from the "pathy" (disease). In other words, sometimes allopathic medicine uses opposites, sometimes similars, and sometimes something different from the disease itself, though it happens to get rid of symptoms, at least temporarily. Although physicians can describe physiologically or biochemically why vaccinations work, it is also true to refer to vaccinations as the use of "like to cure like." I previously gave a quote from the "father of immunology" about this. Is there a middle ground where we can say what both of us are trying to say? I personally do not think that it is simply "coincidence" that two of the few modern medical treatments that augment immune response (vaccination and allergy treatments) just happen to use medicines in small dose that CAUSE a disease in larger dose. Dana Ullman 19:03, 29 September 2008 (CDT)

Well, consider diseases with the same symptoms; different strains of influenza, and say Weill's disease which has symptoms essentially indistinguisghable from flu. An influenza vaccination will protect against only one or perhaps a few closely related strains of influenza, will have no protective effect against Weill's disease, and in no case will be a cure of any sort against an established infection. So in what sense exactly is this analagous to the principle of "like cures like"? They're not cures, they are preventatives, and they prevent infection by the specific organism, not against like organisms, and do not cure diseases with like symptoms. Allergy desensitisation treatments unlike vaccination, work by depressing immune responsiveness (when they work which is variable, and they can be very dangerous). They work by exposure to the specific agent, not another agent - if you are allergic to housemites and cat fur the symptoms will be the same, you might sometimes "cure" the allergy to housemites by repeated exposure to the house mite allergen (though this is very often ineffective), but if that works you will still be allergic to cat fur (except in rare cases, such as oral allergy syndrome).

As for this article, I think that what homeopaths believe and do should be displayed clearly, fully and fairly. But there should be no misrepresentation about what scientists and medicine believe in the process. It's fair to say that homeopaths believe that the principle of like cures like underlies vaccination. It would be quite wrong to suggest that scientists or medics think this at all. Gareth Leng 03:29, 30 September 2008 (CDT)

George Bernard Shaw offers an interesting perspective on vaccination and homeopathy. I get the quote from Dana's free chapter (see link above), that I devoured:

The test to which all methods of treatment are finally brought is whether they are lucrative to doctors or not. It would be difficult to cite any proposition less obnoxious to science than that advanced by Hahnemann, to wit, that drugs which in large doses produced certain symptoms, counteract them in very small doses, just as in modern practice it is found that a sufficiently small inoculation with typhoid rallies our powers to resist the disease instead of prostrating us with it. But Hahnemann and his followers were frantically persecuted for a century by generations of apothecary-doctors whose incomes depended on the quantity of drugs they could induce their patients to swallow. These two cases of ordinary vaccination and homeopathy are typical of all the rest.

(...) "Here we have the explanation of the savage rancor that so amazes people who imagine that the controversy concerning vaccination is a scientific one. It has really nothing to do with science. Under such circumstances vaccination would be defended desperately were it twice as dirty, dangerous and unscientific in method as it really is."

What later determined the acceptance of vaccination, but not homeopathy, may have little to do with what we construct now as conventional logical explanations, post hoc. See Matt's comment's about the Flexner report, and Dana's chapter. Pierre-Alain Gouanvic 21:54, 30 September 2008 (CDT)

Life time of water clusters

I removed the view that water clusters are short-lived is "outdated". Every year hundreds of articles appear in the regular peer-reviewed literature (model calculations, many kinds of spectroscopy) that prove the opposite. Why are we to believe the claims of Roy and a few of his disciples? Roy is the person who claims that 13.56 MHz radio waves (of which there are plenty in the ether) decomposes salt water into oxygen and hydrogen and ignites the mixture. If he were right all oceans would be afire.--Paul Wormer 08:55, 29 September 2008 (CDT)

"(...) it is pertinent to discuss the evidence suggested by the many scientists who deny water its ‘memory’. (...) They mostly concern arguments involving the ease with which hydrogen bonds between water molecules may break. Individual hydrogen bonds do not last long in liquid water (about a picosecond). Based on this one fact the opinion may be proffered that the mesoscopic structure of water must change on about the same time scale.

Such arguments are completely fallacious as is easily recognized if metal hydrates or solid water (ice) are considered. In the case of ice the hydrogen bonds also only last for the briefest instant but a piece of ice sculpture can ‘remember’ its carving over extended periods. Cation hydrates exist and are commonly described with particular structure (eg the octahedral Na+(H2O)6 ion) but the individual water molecules making up such structures have but the briefest of residence times (<microseconds).

What such arguments fail to address is that the behaviour of a large population of water molecules may be retained even if that of individual molecules is constantly changing. Such behaviour is easy to observe: a sea wave may cross an ocean, remaining a wave and with dependence on its history, but its molecular content is continuously changing.

The remaining evidence presented against the memory of water concerns whether water clusters may retain their organization for time periods greater than a fraction of a second. Evidence denying the long-life of such water clusters is generally based on computer modelling but also includes NMR and diffraction data.5 There are several good reasons why such methods would not show any significant clustering properties for liquid water.

Computer simulations only operate for nanoseconds of simulated time, although taking hours or days of real time. Such short periods are insufficient to show longer temporal relationships, for example those produced by oscillating reactions.6 They also involve relatively few water molecules (of the order of 100–1000 or so) over small (nanometre) dimensions, insufficient for showing large scale (not, vert, similarmicron) effects. They utilize models for the water molecules that are inherently flawed, showing poor correspondence to the real experimental properties of water (except for those properties on which they were individually based) and hence poor at predicting known properties and likely to be highly inaccurate at predicting unknown properties.7 NMR and diffraction both determine individual water molecules as structures averaged from throughout the sample (akin to averaging the world’s population of men and women and coming up with an illusory ‘average’ person) and are incapable of detecting imprecise and mobile clusters where components may change."

Martin Chaplin, expert on water structure, courtesy of Pierre-Alain Gouanvic 14:32, 29 September 2008 (CDT) (you can find this if you follow reference 2 in our article)

Why don't we quote Roy and also reference Chaplin, but also give Paul Wormer an opportunity to add something. However, Paul should not bring to this table other statements by Roy that deal with other subjects. I have no opinion or expertise on the fire and water issues, but let's maintain a focus here on THIS subject. Dana Ullman 19:10, 29 September 2008 (CDT)

Before I saw this reaction, I answered Pierre here. As I say there, this discussion saps my energy and obstructs me from writing other stuff for CZ, so I stop participating in it. Good luck with your superstition about liquid water, I find that it degrades the quality of CZ, mais c'est la vie. --Paul Wormer 05:01, 30 September 2008 (CDT)

Certainly this is not a homeopathic superstition, is it? Shouldn't it be in the Water article. Perhaps Paul could talk about it over there and then we can just link it here. I think this gets too technical for what I envision as an introductory article on homeopathy, as I expect this is why it was in a reference rather than in the article. D. Matt Innis 08:39, 30 September 2008 (CDT)

Famous People and Homeopathy

In the lead, there is reference to many famous people who use and/or advocate for homeopathy. Some of you may know that my newest book is a highly referenced review of hundreds of the most respected "cultural heroes" of the past 200 years, including literary greats, politicians, corporate leaders, clergy and spiritual leaders, sports superstars, musicians, artists, monarchs, and film/tv celebrities. For details, see: http://www.homeopathicrevolution.com/ (see the link to the Table of contents). See this review from a peer-review journal: http://ecam.oxfordjournals.org/cgi/content/extract/nen024 Due to conflict of interest issues, I will not add these references and will let others decide if it is worthy of inclusion. By the way, reference in the lead section is to the British Royal Family. This book has the most detailed chapter on the history of monarchs' involvement in homeopathy, and the Foreword to this book is written by Dr. Peter Fisher, the Physician to Her Majesty Queen Elizabeth II. Dana Ullman 22:21, 29 September 2008 (CDT)

I'm thinking that this is not the place. There are lots of celebrities that use all sorts of controversial cures, Steve McQueen comes to mind. It's another form of "appeal to authority" that I see as a distraction for an article, though as a marketing tool I'm sure it works well, but we don't want to go there. D. Matt Innis 08:52, 30 September 2008 (CDT)

I'm comfortable with selected historical references, uncomfortable with anything that might look like celebrity endorsement. I am happy with adding Dana's book to the bibliography list linked to the review and with a brief account of its coverage; I'll ddo that when I have the time (please forgive me here).Gareth Leng 08:56, 30 September 2008 (CDT)

That sounds reasonable, thanks Gareth. D. Matt Innis 09:00, 30 September 2008 (CDT)

Appeal to authority is when an expert of x says that we should believe him on y, when the link between x and y is not in fact clear.

What Dana has done is that he has collected a serie of case reports of people whose lives were changed by a therapy that they have no expertise on.

The large RCTs are heavily criticized for their lack of external validity, or lack of accordance with the principles and practice of homeopathy. A recent meta-analysis by the Lancet called for the end of homeopathy trials (it's all placebo! it's all water!); its transparency, methodology and interpretations were violently criticized and even mocked.

Dana, in response to this deadlock situation, brings the problem in the citizen's arena, with case reports which should have a sociopolitical impact and should appeal to common sense. He makes the case of clinical plausibility (while Roy, Chaplin and others bring the biological-physical plausibility in the citizen's arena as well. See my comments under the crystals section).

Of course, the fact that notable physicians and scientists "came out of the medicine closet" (Darwin, William Osler, Cushing, von Behring, etc.) and left a trace of their acceptance of homeopathy (and of its effects on their lives) is impressive (good marketing??), and can be taken as a fallacious appeal to authority. But none of these people contended that they had found how homeopathy works biologically or that it works (statistically) and that we should accept their expert opinion. They wrote or said, despite of the risks associated with such an endorsement, that it worked for them. I'd say those are very, very interesting case reports.

Because now, the mainstream scientific opinion is that they all experienced placebo effects motivated by pseudoscientific beliefs.

NB: We may find interesting things about the Flexner report and the dissapearance of homeopathy in America.

Pierre-Alain Gouanvic 00:31, 1 October 2008 (CDT)

There is a misconception here; the placebo effect has nothing to do with pseudoscientific beliefs; it is a strong, robustly demonstrated effect caused by suggestion or of expectation; exactly how the placebo effect works is not known, but that it is often a very significant effect is - which is why all drug tests must be placebo controlled. Gareth Leng 04:35, 1 October 2008 (CDT)

Sorry if I promoted this misconception. But my point here is that the the suggestion or the expectation, for these bright minds, is that homeopathy can't work. It is not true to say that the placebo effect has nothing to do with pseudoscientific beliefs: the expectations are often motivated by beliefs.

Let me point out as well that, no matter how significant placebos may be, they are often considered unethical, as I pointed out in the EBM page, because it's basically negligence. All drug tests must be placebo controlled? Controversial.

Those case reports may refute that we're dealing with placebos.

Pierre-Alain Gouanvic 12:31, 1 October 2008 (CDT)

In the course of making a general edit of the article, I've moved the list of "celebrity endorsements"--which, however interesting, is essentially what they are--to a footnote. This gives adequate detail for purposes of putting teeth on the general claim. My concern about having the long list in the article itself is that this seems to imply that CZ is very impressed that all of these people have, perhaps once, received homeopathic treatment. But, believe me, not all of us are. It's equally unimpressive to me that Nancy Reagan relied on horoscopes, and all sorts of very smart people (I remember one philosophy grad student--of all things--in particular) take them half-seriously.

One other point: we absolutely do need a source for such a detailed list of names--I'd ask Dana or someone to add that in. --Larry Sanger 13:33, 1 October 2008 (CDT) --Larry Sanger 13:33, 1 October 2008 (CDT)

Needless to say, we should all be honored that Larry is participating in this article. Thanx. Although I consider this information to be worthy of inclusion in the article itself and not just the footnote, I will let others decide this. This information is in part an "appeal to authority" but it is also notable history. Homeopathy has a long history of support from the most respected cultural heroes of the past 200 years, not just monarchs but leading literary greats, sport superstars, corporate leaders, world leaders, and on and on. My own father was a pediatric allergist and professor emeritus at UCLA, and although he was skeptical of homeopathy, he was impressed to learn that Yehudi Menuhin was the President of a leading British homeopathic organization. The bottomline is that we all use different information to determine whether something is worthwhile or not, and "scientific research" is not the only means to this end, especially since there are many barriers to good research (just ask any surgeon--surgery is not amenable to double-blind studies; and just ask any psychologist; let alone the limitations on availability of research funding).

Actually, my new book provides detailed references to each person mentioned in the footnote...and a lot of others. It may be more beneficial to not simply reference the website for this book but the book itself. I have no problem providing the information in the book, but I would prefer if someone else placed the specific reference in the article (it was published by North Atlantic Books, Berkeley, 2007). Because one of the amazing and well-referenced stories in the book is of Charles Darwin, I chose to provide some summary information at my website: http://www.homeopathic.com/articles/view,128 (If anyone here considers this worthy of reference in the article, I would prefer if he/she placed it there.)

For those people who wish to beef up this article, my new book is a veritable treasure trove of historical and modern-day information about homeopathy. See for yourself. Dana Ullman 17:50, 1 October 2008 (CDT)

Water Crystals

Does this have anything to do with homeopathy? We have to draw the line somewhere. Just because somebody thought of something doesn't mean we have to write about it - and more importantly - paint it as mainstream. These things take time. D. Matt Innis 08:50, 30 September 2008 (CDT)

Chaplin, Roy, Emoto, Wüthrich (a Nobel 2002 co-laureate (multidimensional nuclear magnetic resonance spectroscopy in the study the structure of proteins)), and others took part in a new documentary on water, Water: The Great Mystery, which is promoted by the What the bleep site. As most of us know, What the bleep (do we know) was a huge success, despite of the fact that it wasn't featured in most theaters (and mainstream science, evidently). It's a growing phenomenon, and it's causing great controversy.

If we choose to ignore this movement of citizen+expert (pseudo?) science, we decide that they're not bringing a paradigm that may better explain water and homeopathy. We may as well reject Roy and Chaplin's works, which are already rejected by mainstream journals (in the sense that they don't get a fair hearing or a right to properly respond; our colleague Dana received an answer from FASEB's editor which exemplifies my point quite well). Where do we draw the line indeed: Roy and Chaplin with Emoto in a documentary for the general public, not ok? Roy and Chaplin in the scientific community, ignored or misrepresented, ok?

I'm not assuming that you have already made your mind, Matt, and I understand that this contribution seemed far-fetched. I wouldn't accept it "as is".

I think that we need a philosopher of science. I will consult The structure of scientific revolutions, by Thomas Kuhn.

Pierre-Alain Gouanvic 21:20, 30 September 2008 (CDT)

As you say, the work is rejected in mainstream circles. We know that things are rejected that might subsequently gain acceptance; science in general does not claim that its theories are true, only that they are the best explanations currently available by their criteria. As editors we must seek to report facts and disputes neutrally, without appearing to take sides in disputes. Where appropriate, we report that a theory is not generally accepted (or is generally rejected) by science and medicine (as shorthand for the community of academic scientists and medics), if we are sure that this is the case. Scientists and medics get things wrong lots of the time and don't always agree with each other. Fringe theories can be covered on Citizendium, but their status should be clear and they should be written about neutrally, without editorial endorsement or denigration. If you want to cover a theory about the structure of water, it must also cover its status and any known objections to it that explain its status. I think this will be a diversion from this article, which is about homeopathy. Personally I think that this article would be better served by a simple acknowledgement that there is no accepted understanding of how homeopathy might work, that some ideas have been suggested (with references) but these are not at present accepted as adequate scientific explanations. Sometimes, the less said the better, especially where I don't think anyone would claim to be able to explain how homeopathy might work, any more than I would claim to know how placebos work.Gareth Leng 12:05, 1 October 2008 (CDT)

The debate on the scientific plausibility of homeopathy, today, as I quoted above (Chaplin answering to Paul) and emphasised both in the article and the talk page, is that

a)the establishment rejects as null and void the notion that water can retain anything (no memory of water, no long-term structures). It can be stated in two sentences

b)the other side, represented by mainstream researchers who went nuts / came to a high degree of sophistication, questioned the textbook assumptions that make the structure/memory of water look like a mere superstition.

This can be explained, but in more than two sentences and with several links to the water page and to several subpages that we may create. If this technique, which was used in Diderot's Encyclopedia to insert paradigmatic considerations, can be a middle-ground (between your less-is-better and my less-is-biased), so be it. The requirement is that this article must state clearly that the subpage is a scientific refutation that has not been addressed by the mainstream (a refutation which states that the assumption a) is, according to the evidence presented by b), not scientifically defendable).

This is in the best interest because those who think a), which makes the majority of CZ's potential readers, won't have to listen to what the mainstream circles don't address. But they will find the response, stated in all fairness to its degree of sophistication, if they want to.

I reiterate that Kuhn's work and philosophy of science may be useful. We do have 2 paradigms here. Materials science vs. molecular science. Mesoscopic vs. microscopic. Water vs. H2O. Things aren't that bad after all: both sides are not talking about the same thing.

A subpage for that as well?

Pierre-Alain Gouanvic 14:41, 1 October 2008 (CDT)

Actually, I'd suggest this was a whole different article not a subpage. In the context of the "homeopathy related articles" subpage above, that would be a subtopic. It would also be a subtopic of water (Water/Related Articles). Chris Day 14:55, 1 October 2008 (CDT)

literary greats and politicians

Why should we, or anyone else for that matter, be impressed by the assertion that "literary greats and politicians" have advocated for homeopathy? If you told me that Sabin, Salk, DeBakey, and people of that ilk practiced it I would be more impressed. Hayford Peirce 13:24, 1 October 2008 (CDT)

It is irrelevant as far as i can tell. Or is the idea that great thinkers do not denounce homeopathy? But being great in one field does not preclude ignorance in other unrelated fields. Actually, even being great in genetics does not preclude you being a dunce in biochemistry and vice versa. Chris Day 15:02, 1 October 2008 (CDT)

I'll wait a day or so, then remove it unless there are strenuous objections from others. Hayford Peirce 15:10, 1 October 2008 (CDT)

The other edit that is needed in the sentence is "Many well-known people, including literary greats and politicians, have used or have advocated for homeopathy..." They could have used it and found it worthless. Or have used it and found it fabulous and therefore now advocate for it. I've "used" that little red string on the Band Aid (R) pack and found it hit or miss, I've "used" the string on the old Quaker Oats (R) box and found it absolutely useless. I find that for me, a cold lasts seven days if I use Vitamin C and one week if I do not. Aleta Curry 16:28, 1 October 2008 (CDT)

I would strenuously object to the deleting of this information about the various respected cultural heroes who used or advocated for homeopathy. See my recent writing above under the earlier topic about famous people. I can also add: Facts are facts, and these facts are notable. As for famous physicians and scientists, the list of such individuals whose experiences or quotes are discussed in my book include: Charles Darwin, Sir John Forbes, Sir William Osler ("the father of modern medicine"), Emil Adolf von Behring ("the father of immunology"), Sidney Ringer, Charles Frederick Menninger (founder of the Menninger Clinic), August Bier (inventor of spinal anasthesia), Harold Randall Griffith (father of modern anesthesia), Royal S. Copeland, William J. Mayo and Charles H. Mayo (founders of the Mayo Clinic), C. Everett Koop, Brian Josephson (Nobelist). That said, it IS notable that so many literary greats, world leaders, and other cultural heroes used or advocated for homeopathy because such information suggests that homeopathy is some type of "new age" treatment or some type of "quack" therapy. While it may not be notable if there were only a handful of such individuals, it is helpful for people to know that so many cultural heroes used AND appreciated this often neglected and often misunderstood medical system. Dana Ullman 18:44, 1 October 2008 (CDT)

You don't explain why it is notable that a writer uses homeopathy, no matter how famous he may be -- why should we be impressed by the fact, say, that Ernest Hemingway, say, used it? Maybe William Faulkner used acupuncture. And maybe 60 other Nobel Prize-winning authors went to regular doctors. What do writers know about medicine? Or even about their own health? I used to know a lot of famous science-fiction writers, names on request -- I wouldn't trust their advice about medical matters as much as I would my internist's. Also, I don't know that we can take at face value citations that come from your own book. Hayford Peirce 18:59, 1 October 2008 (CDT)

In due respect, I do feel that I have explained why it IS notable when famous cultural heroes, whether they be literary greats, world leaders, clergy, corporate leaders, and other major people who have had a major influence on culture, have used or advocated for homeopathy. That said, there is a range of use and/or advocacy that varies from each cultural heroes. For instance, I have uncovered only one instance in which the Mayo brothers mentioned homeopathy in a mildly postive way, while most others listed above, including Sir William Osler, von Behring, Bier, Menninger, and Josephson have given many positive statements over many years. My point is also that smart and successful people who are not physicians still have their own experiences with homeopathy (and have their own intellectual appreciation of its system and its principles), and these experiences are valid, are notable, and have had an impact on culture. I am therefore curious how many of you have gone to the website previously mentioned...and then saw the one sample chapter that I placed online...the one on literary greats...see it here: http://www.homeopathicrevolution.com/pages/excerpt.jsp Enjoy it...it may even intrigue you to read more chapters...and to learn more about the richness of homeopathy's history and present status. Dana Ullman 00:38, 2 October 2008 (CDT)

Typical homeopathy consultation

This section should be greatly expanded, made another top-level section, and include information about what the patient says to the practitioner, how the practitioner examines the patient, as well as what typically goes through the head of the practitioner thereafter (how the homeopath decides upon the remedy), how the remedy is prepared and administered, etc.--and whether the practitioner ever refers a patient to a physician. There should also, in this section, be some critical remarks reflecting the views of mainstream medicine about what is going on in such consultations, and also some comparison and contrast between such consultations and regular physician consultations. Such a narrative would shed great light on the nature of homeopathy, I suspect. --Larry Sanger 14:45, 1 October 2008 (CDT)

Linked articles

The linked articles, History of Homeopathy and Homeopathic proving appear to have been imported from Wikipedia a year or two ago, and, except for Chris adding an image, don't appear to have had any substantive changes since then. As I understand the CZ rules on Wikipedia material, unless it is actively updated, it should be deleted.

The material in those articles may be in this main one. Are the links to them, or the articles themselves, still needed? Howard C. Berkowitz 15:53, 1 October 2008 (CDT)

It depends what our experts say. One of our approved articles, Barbara McClintock, has changed very little from the original wikipedia version. Chris Day 15:55, 1 October 2008 (CDT)

Accuracy and clarity, please

Hi all,

I find the opening sentence confusing, and I think opening sentences in CZ articles should be easy for the layman to understand.

I suggest simply 'Homeopathy, or homoeopathy, is a system of alternative medicine Its practitioners, called homeopaths, intend it to be a therapeutic method.' Then go on to explain the method of using small doses of drugs, blah blah.

Also, in reading the Note no. 6, I was directed to an advertisement for Dana's book. Now, I have no problem with Dana quoting from his own work if it is definitive on the subject. My problem is that the cited reference does not reflect what the note says that it does, specifically, that the British Royal family has advocated homeopathy since the 1830s. Such a broad and bold statement should be accompanied by specific examples. A simple (even factual) statement that HRH Royal Name is Patron of the Society for Better Widgets does not cut it, as the Royals patronise a great many societies in which they may or may not have any expertise.

This makes me question the validity of other notes, without having the least bit of interest in examining them all for accuracy. I feel that readers should not question the validity of CZ notes, that sort of thing makes us lose credibility very quickly.

Aleta Curry 16:20, 1 October 2008 (CDT)

Aleta, I agree that you that the opening is not good. Just as the article on acupuncture doesn't need to say that people who practice acupuncture are called acupuncturists (this is somewhat obvious and is unnecessary for the 1st paragraph), the 2nd sentence is useless...and the 3rd sentence is insulting and has no meaning. I will take a stab at rewriting this opening and am open to feedback.

It seems that Aleta has not read my book or may not have seen some of the above comments about it, but the chapter on monarchs in this book is the most definitive body of information on the use of homeopathy by monarchs presently available. The fact that the British Royal Family does advocate for homeopathy and has a long established history of doing so is notable. They choose their subjects of advocacy very carefully. As for "expertise," Prince Charles was the President of the British Medical Association. You seem to be seriously under-estimating his and others expertise. It seems that you are suggesting that only "medical doctors" or "scientists" are experts on health subjects, when, in fact, they are like our President Bush, a politician who uses "select intelligence" rather than real intelligence. Please correct me if I'm wrong, but isn't one of the differences between wikipedia and citizendium that CZ is written by experts, while on wiki, experts are often considered to have an "conflict of interest." Dana Ullman 19:05, 1 October 2008 (CDT)

Aleta, thanks for the critique! We need more, so keep it coming. Dana, don't take anything personally, these guys don't bite ;-) Do rememeber, it's not written by the experts, it's gently guided by the experts. That doesn't mean authors have to be gentle, just professional. Of course, that also includes experts that disagree, even in their own fields, much less the controversial ones. But, that is what should make a collaborative effort more credible, if you don't implode :-)

D. Matt Innis 19:40, 1 October 2008 (CDT)

I have really tried to stay out of this, but citing Prince Charles as qualified to comment, because he has been president of the British Medical Association -- an honorary role -- is as plausible as saying Her Majesty Queen Elizabeth II is qualified to compare the AS90 and M109 155mm howitzers because she is current Colonel-in-Chief of the Royal Artillery Regiment. For Aleta, the Queen might really have a conflict of interest, since she is also current Colonel-in-Chief of the Royal Regiment of Australian Artillery.

The second paragraph of the lead comes across as sneering at "mainstream physicians". A point I have made, and Gareth has observed as well, is that there are types of randomized clinical trials that are highly appropriate and statistically valid in dealing with individualized medical testing, as in pharmacogenetics. That which is being tested in such a trial is not the "remedy", but the means of selecting the remedy in a statistically significant group.

There's also a continuing suggestion that randomized clinical trials are necessarily placebo controlled. This is simply not consistent with current principles of medical ethics, as articulated by the World Medical Association current version of, and commentary on, the Declaration of Helsinki. I offer some analysis in the article I wrote here on informed consent. If there is a recognized medical treatment for a condition, then the control arm will receive the "gold standard" treatment, not placebo. See point #29 (and footnote) at http://www.wma.net/e/policy/pdf/17c.pdf.

Dana, I do not claim to know, in detail, how a homeopath approaches a consultation or treatment. I would, in turn, ask the homeopaths to stop characterizing what people in medical sciences think and do. There is not the slightest question that at the time of Hahnemann, no one had a particular idea of molecular medicine, so suggesting Jenner's 1796 work on vaccination as somehow justifying 21st century ideas of immunologic theory, in my mind, is questionable.

I will again give my opinion, formed, in part, by nearly 40 years of analyzing physician communication in order to build clinical decision support software, that words as basic as symptom and diagnosis are being used quite differently by homeopaths and contributors with a background in conventional medicine and medical sciences. Too many errors, in conventional medicine, come from imprecise wording; much current work in reducing medical error is focused just on confusion caused by misunderstood terminology.

May I suggest that this article would be more valuable if the sneering were reduced, and, to take Larry's suggestion, do things like detail exactly what is done at a homeopathic history-taking, consultation, or whatever the correct word or phrase is done at a professional encounter? I assure you that anyone experienced in medical history and physical examination, even without getting into specialized areas, could give a quite specific, organized description of what happens in a first encounter. Howard C. Berkowitz 21:24, 1 October 2008 (CDT)

I don't know what Prince Charles has to say about homeopathy but this summer he had the following to say about GM crops. "the biggest disaster, environmentally, of all time". He also said that biotech corporations are "conducting a gigantic experiment with nature, and the whole of humanity, which has gone seriously wrong". This sensationalist, and frankly ignorant, kind of comment is exactly why we should ignore celebrity testimonials. Chris Day 21:48, 1 October 2008 (CDT)

He's also well-known for his (expert, hehe) views on architecture. They can be mentioned prominently in any architectural articles that CZ generates. Hayford Peirce 22:55, 1 October 2008 (CDT)

See also my new comments above in the section, Literary Greats and Politicians. The bottomline is that it IS news and therefore noteworthy when certain cultural heroes speak on certain subjects...history is made by such actions, and these advocacies play a role in culture. When just one or a handful of cultural heroes express support, it may not be noteworthy, but when larger and diverse groups of cultural heroes do so, it is once again noteworthy, especially for bodies of information like CZ that seek to be encyclopedic. Lord (and others) know that the sources of our information must not just be reductionistic science but more comprehensive sources too. Dana Ullman 00:50, 2 October 2008 (CDT)

An impressive list. Some very great people on it, but I'm afraid I seem not to be finding something. You remind me, though, that everyone on that list deserves at least a stub article, and I shall create those; for that I thank you. Indeed, I am familiar with most; I had already contributed to the Osler article, and started the Bier and Griffith articles.

• Sir William Osler, (1849-1919). Certainly one of the greatest healers and teachers of history. The textbook he started, teaching the art as well as science of medicine, is still being updated today. Those updates tend to be more in the science than the art, because in Osler's day, there wasn't very much science.
• Auguste Bier (1861 - 1949); invented spinal anesthesia and intravenous regional sympathetic block
• Harold Randall Griffith anesthesiologist; introduced total skeletal muscle relaxation for surgery in 1942
• C. Everett Koop(1916-) pediatric surgeon and U.S. Surgeon General
• Brian Josephson (1940-) Nobel laureate in Physics

I had not known that Griffith and Bier had homeopathic as well as allopathic training, and I have personally experienced both the Bier block and the muscle paralyzation (well, I was already unconscious for the latter), but watched the surgery for decompression of my right radial nerve with no pain control other than the Bier block.

It concerns me, however, that you cite very good physicians who did most, or all, of their work before there was any molecular understanding of the drugs they used. Curare, lidocaine, ethylene, and guanethidine are certainly not used in homeopathic doses. Curare is obsolete in medicine, because, years after Griffith's work, enough became known of the molecular pharmacology involved that much better agents could be synthesized.

So, I'd be far more likely to agree that homeopathic training was key to their success. Literally, they did not know the principles by which their drugs worked; much of the theory was developed decades later. Now, if you were to quote contemporary physicians that have been trained in both homeopathic and allopathic techiques, and can use molecular medical principles if they choose, I'd be much more impressed than by work done no later than the 1940s.

I'm afraid these come across as an appeal to authority, but without enlightening the value of homeopathy. Could you provide some current physicians as respected in both fields? Howard C. Berkowitz 02:06, 2 October 2008 (CDT)

Perhaps this information is more responsible for popularity. Maybe as long as we write it in such a way as to qualify that these people may have helped make it popular, but making it clear that this doesn't add validity to it's usefulness would help the reader understand how something that medical science does not support can be so popular. I also think that, in order to protect the integrity of CZ, rather than citing Dana's book, we cite the sources that Dana uses in his book and put Dana's book in the bibliography. D. Matt Innis 07:40, 2 October 2008 (CDT)

Matt, that's a good way to handle it. To take something that I consider a U.S. shame in conventional medicine, consider direct-to-consumer ads for prescription drugs, and now medical devices as specific as a coronary stent. Interventional cardiologists are much troubled by conflicting large trials about whether to use stents, and if so, what kind of stent. I follow the literature fairly well, and the issues are extremely complex. I doubt many of those cardiologist could coach a winning football team, so why is a football coach (and a good one) pushing complex devices?

I think it's perfectly fair to say that some of these outstanding physicians were formally trained in homeopathy as well as allopathy, but to make clear that much current relevant theory — not clinical trials, but the conceptual models that came first — I cannot see much similarity between the action of what is seen as a preparation that helps the wisdom of the body, and a drug that paralyzes the wisdom of muscles required for breathing.

Apropos books and such, if I might make a suggestion that I use for my own published material. Even when I cite public domain peer-reviewed publications, I try to mention that on the talk page to avoid the suspicion of conflict of interest. If I quote from one of my commercially published books, it's usually a very specific illustrative point. When I mention my books in a bibliography subpage, I make a point of including potentially competitive ones, although it's a narrow subject. In some cases, when I had an illustrative and funny example, I paraphrased it and put it on a signed articles subpage. Just some thoughts that I think help CZ credibility. Now, there were times at The Other Place when I kept correcting an error, and finally cited the definition in a peer-reviewed, public domain technical specification of which I was an author or coauthor. History is a little softer to use than explaining the difference among an Internet Service Provider core router and an interprovider border router and a customer border router. In the latter case, I was not speaking of history, but of current research in which I was involved, and was accepted in peer review. Howard C. Berkowitz 11:36, 2 October 2008 (CDT)

Activity today

Good to see lots of good activity today. I know sometimes it looks confusing, but after re-reading, I think the net movement was good. I agree with Larry that the section about the homeopathic consultation could use some expansion so we can know what to expect; do they treat cancer? Do they use MRIs? Do they refer?, etc.. I was afraid we'd open a bag or worms with the "name dropping" and I still don't think it belongs in this type of an article, other than perhaps a brief mention - I know the Prince of Wales made a speech in which he advocated the increaseed usage of homeopathy, so that is probably important for many reasons. The rest is just good advertising (though I raised a brow when I saw C. Everett Koop - the past US Surgeon General), so I guess there is some value there.

There are several places where the same concepts are repeated in section after section, so some consolidation might be in order. Remember that sometimes less is more. There is no reason to say things more than once; it is more important to place it so that the ideas flow in order and questions are answered even before the reader thought to ask them. In particular, there are several places that pronounce that Hahneman developed it.... and several places that the memory of water concept is explained again and again. If I am reading this article all in one sitting, I only want to read that once.

Hope this helps. How close are we to approval? D. Matt Innis 19:33, 1 October 2008 (CDT)

Interdisciplinary cooperation

It's worth repeating two things about randomized clinical trials

• They are not always placebo controlled (see informed consent) if there is a recognized treatment
• They can be adapted to individualized treatment.

Could we agree on a term, acceptable to homeopaths and people involved in "the other side", to describe a clinical trial adapted to individualized treatment? This is, for example, something that is being done in pharmacogenetics, where treatments are selected based on an individual's genetic coding. If so, I'd like to develop an article that discusses the methodology of such trials.

An issue that may have hurt homeopathic trials of the past is that that large trials of the path used a broader separation by major diagnosis. Just as placebo control is not always appropriate,

What such a trial tests is not necessarily the drug/remedy, but the method used to assign patients to categories of treatment. Cruder versions of such methodology might subdivide, for example, breast cancer patients into premenopausal and postmenopausal. An area where I've participated in some research is the first drug to be used for high blood pressure: there are 3 or 4 choices, all of which are roughly equivalent in the general population. When one starts looking at pre-diabetic states or active diabetes, pregnancy, and possibly ethnicity, the choices are not equal.

In other words, the trial is not examining whether a thiazide diuretic or a beta-adrenergic receptor antagonist or a calcium channel blocker or an angiotensin-II converting enzyme inhibitor is effective against early hypertension. We know they all are, in a large population. What we don't know, but strongly suspect, is that there are subpopulations where each class would be a best or worst choice. What is being tested is the ability to recognize the subpopulation, not the remedy.

If homeopathic treatment is such that every patient of every homeopath will get completely different treatment, there's no way to test the treatment; there's no way to compare it. I really doubt that is the case. What is true in medicine is that first nothing was available for women with metastatic breast cancer, and then a few randomly selected protocols (e.g., CMF, 5-drug Cooper), but now the clinician checks menopausal status, the presence of the BRCA2 gene, receptor sensitivity, etc. With some, but sadly not all, subpopulations, it is possible to say "there's a good chance you will die of something other than breast cancer."

Competent physicians constantly improve methodology and throw out ineffective treatment. So far, I'm hearing testimonials going back to the 18th century, and some possible means of water memory that, as yet, have no linkage to biological mechanisms. I think we can all do better than that, right here. Howard C. Berkowitz 14:20, 2 October 2008 (CDT)

Urgent

Sorry to interrupt, Howard.

I recently edited the plausibility section (see here). Paul Wormer, who has left the discussion and the article, told us: "Good luck with your superstition about liquid water, I find that it degrades the quality of CZ, mais c'est la vie."

Now, I received an important email which has an incidence on these recent edits. I won't discuss these personal matters, but I can, however, provide an example of what is expected from me: before; after

My recent edits of the plausibility section I was talking about will receive the same treatment, since they were also (my own honest) attempts to adapt Paul's contributions.

I will let editors take care of my "superstition about liquid water". My conscience dictates that I should not obey and revert what I just did (it was before I received this email).

If editors agree that discussing and editing with me is a waste of time, energy and a regression for CZ, well, be assured that I'll know how to professionally and politely deal with all this. CZ will remain the most promising project because it welcomes and respects experts. All experts.

Pierre-Alain Gouanvic 16:13, 2 October 2008 (CDT)

Help me understand what is at the links you gave, and how you'd like it regarded. I'm especially confused about the link, in the bibliography part, which links to the home page of a journal, Materials Science Innovations that describes itself as

Because of its super peer review procedures, the journal is especially suited for the publication of results which are so new, so unexpected, that they are likely to be rejected by tradition-bound journals

The journal is produced by Maney Publishing UK, but I get link errors trying to go to Maney's home page or "about us". Their jobs page does seem to work.

Please correct me if I misunderstand, but is this journal, its review process, and the specific paper by Roy the key thing that you think is relevant to the CZ homeopathy article, or am I taking that out of context? This journal claims to have a nontraditional peer review process, and, while this is not the place for it, I do believe, especially in the U.S. and with its funding conventions for research journals, there are some systemic problems to address.

Increasingly, though, I'm confused on the role of detailed discussions about new theories about the properties of water in an article on homeopathy. Let me try an analogy. In 1929 or so, Sir Alexander Fleming published a paper saying a substance, later called penicillin, inhibited the growth of Staphylococci in culture plates. During WWII, it was tried in people. It was a good deal later when the molecular activity of penicillin, in interfering with mucopeptide synthesis in the cell wall of bacteria, was understood.

Today, however, if one publishes an article on a new class of drugs, both the structure and unusual properties are discussed, but it is also expected to explain how these characteristic affect specific biological subsystems at a molecular level: they interfere with the synthesis of some protein, or sensitize a cellular surface receptor, or increase intersynaptic levels of a neurotransmitter by blocking reuptake.

Let's assume that all manner of unsuspected properties of water have been identified, and in thoroughly reproduced experiments in reputable journals. I do not, however, then see how this maps to those properties have specific effects on human cells that have a health benefit. That is where I lose the thread of what things from physical chemistry have to do with homeopathic medicine.

What am I missing in your rewrites? I'm also confused about what qi means in this context and why it is significant. Howard C. Berkowitz 16:52, 2 October 2008 (CDT)

(apologies for indentation changes and inline comments; tell me if you hate it and I'll go back to the traditional way. Inline, with signatures, is something I find to reduce the size of talk page posts)Howard C. Berkowitz 20:05, 2 October 2008 (CDT)

a very short answer, for the reasons explained above

qi: it's Paul's contribution.

Roy's paper: like Chaplin's, its a bone of contention (skeptics of homeopathy discuss these papers)

biological mechanisms: I have begun to address this, after Gareth's intro (in water in living systems). My addition is... judge for yourself. For more on this, you can read Dana's work. (keyword: nanopharmacology)

Pierre-Alain, I cringe a little every time I hear the phrase "skeptics of foo"; it has a negative connotation, to me, as "unbeliever", or, when used in a very similar context in theological discussions, can imply "sinner who will go to the Pit if they do not accept the True Faith." Will you bear that in mind? I certainly have scientific disagreements with colleagues, even with a largely shared context. I don't speak of "skeptics" of link state routing or clindamycin for certain infections. I hear their arguments and often agree to disagree, or agree on specialized requirements for both. Your use of "skeptics" suggests anyone that does not accept homeopathy, at least to the extent one accepts conventional medicine, is wrong and needs to be converted to the True Way. Howard C. Berkowitz 20:05, 2 October 2008 (CDT)

peer review, super peer review, etc.: we need a section on the difficulties associated we publishing in mainstream journals when dealing with homeopathy. See Dana's recent responses in this talk page (and mine). I also put useful references in the bibliography subpage, a long time ago).

Pierre-Alain Gouanvic 18:07, 2 October 2008 (CDT)

We? It would be more accurate to say that advocates of homeopathy have difficulty publishing in mainstream journals, and the entire peer-reviewed journal process deserves its own article. Sometimes journals reject things for good reasons, and sometimes for bad. Two people named Barry J. Marshall and J. Robin Warren won an all-expenses-paid trip to Stockholm to accept the 2005 The Nobel Prize in Physiology or Medicine for their discovery of "the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease". Earlier, what is perhaps the most prestigious single journal, the New England Journal of Medicine, rejected their paper. I haven't stopped reading the NEJM as a valued source. In this case, they continued submitting and presenting, until their work was considered the standard in the diagnosis and treatment of gastrointestinal disease. In general, however, I find the peer-reviewed system is generally fair, and, so far, I have not seen here the level of correlation among cellular mechanisms, molecular pharmacology, and clinical correlates that would meet the standards needed to publish a report on a new class of antibiotics.

Be very, very careful in assuming that CZ is an appropriate place for homeopaths' arguments that the medical establishment discriminates against them. I am hearing a great deal of desire that this article take such a position, or that the article should assume that homeopathy works. In contrast, look at biogenic amine receptor. It's still very stubby, but that would be the sort of structure I'd need to see for any serious proposal to accept a given class of medicine. Second-generation antidepressant is even stubbier, and, while there is solid evidence that certain of the drugs often work for certain of the conditions, that article needs its place for "skeptics" about there being alternatives, safety issues, and their use for conditions other than depression. Filling in the gaps in an article like that seems more core to CZ than being a place of argument about lack of faith in a paradigm that, other than believers, seems to be lacking quite a few details of how and why it works. You haven't said it to me, but comments such as "you can't know it until you try it" are pure emotional arguments and, IMHO, do not belong in CZ. Howard C. Berkowitz 20:05, 2 October 2008 (CDT)

There are quite a few issues of the scientific journal publication process, many which have nothing to do with homeopathy. In principle, for example, work done under U.S. government funding is public domain, but most journals are not online and are very expensive. Just having the authors put their work on webpages, however, doesn't deal with the review process, which is where a good deal of the journal subscription cost goes. There's no simple answer.

If you wanted to have a sentence or two in this article saying something like "non-mainstream fields, including homeopathy, may suffer from problems in the peer-reviewed scientific publication process", I would not object, and I would help write an article on the process. That the process may be hostile to homeopathy, however, is an editorial comment that belongs in this article only if sourced or as a signed article.

The purpose of this article is to describe homeopathy, and, reasonably enough, to describe there is resistance to it in mainstream journals. I do not see it as remotely appropriate to CZ to have the homeopathy article arguing that the scientific establishment is biased against homeopathy. Stating that, with a source, is acceptable. Arguing the point is in no way neutral.

In this specific matter, there is also a huge gap that has not been bridged. Assume that peer-reviewed journals had agreed to everything about water memory. Just as a medical journal will normally want an explanation of the molecular pharmacology of a new drug, I believe it a reasonable editorial standard to say "if water memory causes homeopathic effects, the way water changes biological effects is XXXX." I have not yet seen anything beyond "well, homeopathic preparations may alter water", and "there are theories about water memory". Unless there is a clear connection between the two, it isn't even original research, but guessing that doesn't belong in a CZ article. Howard C. Berkowitz 18:35, 2 October 2008 (CDT)