Talk:Alternative medicine/Archive 16

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Two new RS by two authorities on this subject

An article:

A soon to be released book:

-- Fyslee / talk 00:06, 9 April 2008 (UTC)

Simon Singh, as a physicist who has written popular books on mathematics and physics is, suddenly, an "authority" on complementary and alternative therapies. Interesting. Well, at least he has the courage to make comments under his real name. I will have to get the book from Amazon and see how good the "science" really is, at least I will once I have finshed my own; should be with the publisher next month. RichardKingCEng (talk) 06:31, 9 April 2008 (UTC)
He has written and been active dealing with these subjects for some time, but regardless of his status (he's certainly a "notable" commentator), Edzard Ernst is certainly an authority on the subject, both as a patient, practitioner, researcher, the first professor of complementary medicine, and the editor-in-chief of two medical journals. He started as a believer, and when he brought the scientific method to alternative medicine he hoped to see good evidence for it, but was sorely disappointed. He has been courageous enough to continue to apply the scientific method to the subject, and to report his findings, for which he (naturally) receives nothing but criticism from true believers. -- Fyslee / talk 14:01, 9 April 2008 (UTC)

There's some coverage from today's Times Higher on the book. Nomoskedasticity (talk) 09:18, 25 April 2008 (UTC)

The book is published in the UK as

  • Simon Singh, Edzard Ernst (2008). Trick or Treatment?: Alternative Medicine on Trial. Bantam Press, ISBN 0593061292.

There have been a rash of books recently on alternative medicine, such at Shapiro's Suckers, but this looks like the most definitive. Twiga Kali (talk) 00:26, 1 May 2008 (UTC)

NPOV dispute

This is not an article about Alternative Medicine, this is an article against it. more than two-thirds of the article contains criticisms of the subject. I will be cutting the critique down to a reasonable percentage with a fairly ungentle hand, so if there are comments that you think need to be retained, please note them here so that I can try to work them in. --Ludwigs2 02:22, 10 June 2008 (UTC)

if you know of any other cases where Alternative Medicine is getting unfair treatment from editors - particularly if they are using excessive wp:FRINGE arguments - please leave links and diffs on User:Ludwigs2/AltMed. thanks. --Ludwigs2 02:28, 10 June 2008 (UTC)

What makes you feel as if alternative medicine is getting unfair treatment? Zimbardo Cookie Experiment (talk) 02:32, 10 June 2008 (UTC)
well, this article, for one. as I said, this article has become a grandstand for criticizing AltMed. further, I have seen too many cases lately of editors trying to exclude any positive discussion of alternative medicine (usually through wp:FRINGE arguments). it's beginning to annoy me, both on methodological and fairness grounds. so I'm going to look around. perhaps I'm mistaken, and there's no significant anti-altmed bias in WP articles. but the evidence I have seen so far does not give a lot of credence to that viewpoint. --Ludwigs2 03:05, 10 June 2008 (UTC)

I've removed a section that had remained unsourced (citation requested) for several months. Apart from that, however, I don't agree with the notion that anything here is fair game for deletion unless one speaks up to defend it in advance; that doesn't sound like a normal mode of editing. I don't think it's possible to make a reasonable judgment that, because an article contains a large amount of criticism, it is unduly critical. It depends on the nature of the topic: articles on some subjects contain a lot of criticism because in the real world many people are critical of the subject. Scientology seems like a good comparison in that regard. Most of the criticism section here is well-sourced, and I disagree with the notion that there is a problem in this article with NPOV. Nomoskedasticity (talk) 07:20, 10 June 2008 (UTC)

I am not concerned about the sourcing (which I haven't as yet checked); I'm concerned that the article is over-burdened with criticisms. I'm simply going to re-establish fair weight as I see it re: undo weight. that seems like perfectly appropriate editing behavior, yes? and I didn't post this to ask permission; I posted it to open a discussion on the matter, so that I don't unintentionally remove things that really ought to be here.
as I see it, wikipedia articles should be about their subjects, not for them or against them. if you'd like to argue that this article presents a balanced presentation about AM, please do so - it looks very against to me. --Ludwigs2 18:10, 10 June 2008 (UTC)
ScienceApologist - please compare these versions of the end of the lead:
mine:

If orthodox scientific investigations show that an alternative medical approach is safe and effective it may be adopted by conventional practitioners. such accepted practices are often licensed and regulated in the same way as conventional medical practices.

yours:

Often, the claims made by alternative medicine practitioners are not based on rigorous scientific investigation. However, if scientific investigation shows that an alternative medical approach is safe and effective, it may be adopted by conventional practitioners. Even if there is no evidence showing efficacy, many alternative practices are often licensed and regulated in ways similar to conventional medical practices.

I'm objecting to the use of weasel words, and phrasing designed to discredit AM in advance. can you comment? —Preceding unsigned comment added by Ludwigs2 (talk • contribs) 19:43, 10 June 2008 (UTC)

The only weasel word I see in the two versions is the word "orthodox". There is, indeed, no such thing as an "orthodox" scientific investigation. Either an investigation is scientific or it isn't. Aside from that, I see my version as being more accurate. Even if there is no scientific evidence for the efficacy of an alternative medicine (e.g. homeopathy) it is still regulated in similar ways (e.g. one must get a prescription for homeopathic remedies claimed to cure cancer). ScienceApologist (talk) 19:54, 10 June 2008 (UTC)

It seems to me that the article ought to devote a fair amount of space to criticisms of alternative medicines, because alternative medicine relies on a series of claims that are outside the usual scientific consensus. However, a look through other articles in the same class--creationism, baraminology, energy medicine, Flat Earth Society--suggests to me that we have disproportionately more criticism. In particular, it seems like the subsection "Safety" is way too long.
I'm not concerned about "balance," in that I don't think that pseudoscience needs to be balanced against science. But I do agree that the criticism section could be tightened up a bit. Zimbardo Cookie Experiment (talk) 19:50, 10 June 2008 (UTC)
As long as the criticism isn't marginalized or ameliorated, making the wording more concise and easier to read is a laudable goal. ScienceApologist (talk) 19:54, 10 June 2008 (UTC)
sorry, gave the wrong WP cite. I meant to use this one: wp:Words_to_avoid#However.2C_although.2C_whereas.2C_despite. the words 'often' is clearly a weasel word (except from the perspective of someone who already believes the evidence-based approach); further, the negative conditional phrasings 'often ... are not based on...' and 'even if there is no...' are poor grammar, and bad usage in that they implicitly cast doubt on alternative medicine practices (rather like saying "your husband is probably not a serial killer...'). simple affirmative statements are better where possible. --Ludwigs2 20:10, 10 June 2008 (UTC)
Science apologist. please do not revert large constructive edits without comment. I removed very little information from the article; I simple restructured it into footnotes. --Ludwigs2 20:15, 10 June 2008 (UTC)
Well, we can say "generally". It is pretty much an undeniable fact that proponents rarely use reliable interpretations of scientific investigations to validate their claims. The clauses you mention are actually very good grammar, so I'm not sure where you are coming from that regard. What's more, your large edit was hardly "constructive". It removed a great deal of scientific information in violation of WP:WEIGHT and WP:FRINGE. I'm happy to discuss rewording the section, but removing facts and citations is beyond the pale. ScienceApologist (talk) 21:02, 10 June 2008 (UTC)
Zimbardo - if you are not concerned about balance on the page, than I respectfully suggest you stop editing, and stop complaining. go somewhere and write OR monographs, and then we will incorporate your opinions when you become famous. --Ludwigs2 20:17, 10 June 2008 (UTC)
This is an uncivil personal attack. I suggest you refactor the comment. I'm also going to place a warning on your user talk page. ScienceApologist (talk) 21:05, 10 June 2008 (UTC)
I don't feel attacked, but I do feel a bit confused. I haven't complained at all. I was agreeing with Ludwigs2 that the criticism section was out of whack when compared to other pseudoscience pages. I'm not sure what this is all about.
In any case, I think we need to make sure that, as Ludwigs2 says, we don't make the page a page about how alternative medicine is wrong. But there isn't any sort of balance to be had between facts and non-facts. Zimbardo Cookie Experiment (talk) 02:21, 11 June 2008 (UTC)
looking back at my comment, I will confess that it sounds harsher than I intended, and I apologize for that (to both you and SA). my bad, and I'll do better in the future. :-)
to your other point... well, I'm not interested in removing any facts from the article. I'm not sure about your phrase 'balancing facts and non-facts,' though. what do you consider to be 'non-facts' in this case? tell you the truth, I'm more interested in balancing impressions. my concern with this article is that it feels like a lot of effort has gone into 'giving the impression' that AltMed is dangerous, untrustworthy, and unsafe - that's what I'm trying to address. --Ludwigs2 02:42, 11 June 2008 (UTC)

Ludwigs2, I think you know how this works: get consensus for changes, when it is clear that your edits are going to be controversial. Nomoskedasticity (talk) 21:38, 10 June 2008 (UTC)

ScienceApologist,
  1. if you think that suggesting to someone that they refrain from editing when they have admitted that their viewpoint is biased, then I don't know what to tell you. place all the warnings that you like, and we'll deal with things as they come.
  2. I removed none of the facts and none of the scientific information; I simple restructured everything so that it took up a lot less space (1 paragraph vs. the 6 or 7 that were there). this brings it into an appropriate size with respect to the actual discussion about alternative medicine.
  3. where you say "It is pretty much an undeniable fact that proponents rarely use reliable interpretations of scientific investigations to validate their claims," you are not anywhere near NPOV. you have adopted the evidence-based perspective whole-hog. I'm not saying you're wrong, mind you, just that you're speaking from within a perspective.
  4. please examine this [diff] and tell me what is wrong with the changes I made here.
  5. I have no idea why you are referring to WP:FRINGE, which seems not to apply here at all. or are you suggesting that AM is to be considered a fringe group in its own article? that seems patently bizarre.
  6. you have not even tried to address my comments about negative conditionals, and I can not accept your viewpoint as neutral until you do.
I will now go and restore my edits, and I think that will exhaust the changes we can make today under 3RR. I'm very easy-going, really, and I'm more than willing to talk about things. please answer my objections, and I'm sure we'll reach a reasonable compromise.
Nomoskedasticity: I see nothing in these edits that is controversial; in fact, I'm not adding or subtracting from the content, I'm just rearranging to bring the article in balance. if you disagree with specific changes, I'm more than willing to discuss the matter, but I do not believe the status quo of the article is acceptable, and I have very good reasons for that belief. and remember pillar number 1: Be bold!  ;-) --Ludwigs2 00:10, 11 June 2008 (UTC)

I have compressed the critique section in another big change. mostly this was removing redundancies and pushing things off into footnotes; I tried not to remove anything vital. I did remove some things, though, listed here:

  • the section titled 'Critics' explanations for the appeal of alternative medicine' - this sounded a bit too much like a 'why idiots do idiotic things' section. if we want an 'appeals' section (which wouldn't be a bad idea) it should be from the perspective of people who use AM, with critics opinions added for flavor.
  • I've warped the 'issues of regulation' section into the regulation section higher up. I think that whole section needs work, though.
  • I've cut the Alastair MacLennan quote because it seemed too anecdotal.

--Ludwigs2 02:59, 11 June 2008 (UTC)

Proposed removals from the "criticism" section

Since this has been a pretty tense discussion, I thought I'd suggest some ways of cleaning up the Criticism section. (Written before Ludwig's latest changes)

  • "They advocate a classification based on evidence-based medicine, i.e., scientifically proven evidence of efficacy (or lack thereof). According to them it is possible for a method to change categories (proven vs. unproven) in either direction, based on increased knowledge of its effectiveness or lack thereof." Does this last sentence add anything? Obviously if we're going to categorize things into things that have been proven effective and things that have not, we believe that things can be proven effective.
  • The paragraph that begins "Some argue that less research is carried out on alternative medicine because many alternative medicine techniques cannot be patented" is a mess. First, that initial claim is unsourced. Second, if we want to present the argument that research hasn't been done on alternative techniques because they aren't lucrative, then the fact that drug companies have ghostwritten studies isn't relevant. The lines about the NCCAM and the German Federal Institute are responding to the complaint that alternative research isn't being done, which seems like it ought to be considered separately.
  • The paragraph on the placebo effect under "Efficacy" seems like overkill. The first sentence of it seems sufficient, and can be merged into the first paragraph about double-blind trials.
  • The example of grapefruit seed extract has nothing to do with safety and ought to be removed.
  • The ABC Online anecdote about delay in treatment seems like overkill.
  • "Nevertheless, attempts to refute this fact with regard to alternative treatments sometimes use the appeal to nature fallacy, i.e. "that which is natural cannot be harmful"." Unsourced crowing.
  • The reference to Homeopathy seems simply like an excuse to point out that Homeopathy doesn't work, and doesn't seem related to Safety.
sorry... wish I'd seen this before I made my edit, it would have helped. I'll have to go back and look over what I did to see how it fits with your suggestions. --Ludwigs2 03:57, 11 June 2008 (UTC)


All specious argumentation and special pleading

I reject wholesale every last one of Ludwigs2 arguments as special pleading and an attempt to mitigate the well-sourced criticism of alternative medicine included in this article. I have reason to believe that Ludwig2 has a special interest in this subject in promoting the subject and also have reason to believe that Ludwig2 derives income from hawking alternative medicine (a violation of WP:COI). As it is, I recommend starting from this version and moving forward. ScienceApologist (talk) 04:14, 11 June 2008 (UTC)

wow, for someone who advocates the scientific method, you do reach for the ad hominems quickly.
if you would care to be reassured that none of the accusation you just made are even remotely valid, then please tell me how we can accomplish that, and I will happily comply. you are correct that I am trying to mitigate the well-sourced criticism that is in this article, but the reason that I am doing that is that it is entirely and unfairly excessive. I would happily talk about that, as well
ranting is not going to help, here. please discuss instead.
p.s. - I'm going to leave a note on your user page about incivility... --Ludwigs2 04:23, 11 June 2008 (UTC)
And it was promptly removed, and you were left a warning for personal attacks. Your do yourself no favors by engaging in this type of activity. SA's comments were valid, and a review of your edits indicate SA is completely correct.OrangeMarlin Talk• Contributions 04:41, 11 June 2008 (UTC)
I'm sorry OrangeMarlin. when ScienceApologist left that exact same warning on my talk page, I assumed that that was acceptable behavior for editors. I see know that it is only acceptable for editors that you happen to get along with.
as for the rest, you are entitled to your opinion, even if it is incorrect.  ;-) --Ludwigs2 04:47, 11 June 2008 (UTC)
But it is correct. ;-) Since alt med is fringe and it is classified as "alternative" until it becomes mainstream (that happens when it becomes proven using good research), criticism should actually be the major content and thus your attempts to "mitigate" the "well-sourced criticism" are uncalled for. It would probably be advisable to just leave well enough alone, unless you want well enough to be improved to comply with WP:WEIGHT, IOW to make the article mostly criticism. Even I would rather leave it pretty much as is. Please don't make such large changes of a relatively stable article. The changes you made undid months and years of hard work by many editors who collaborated to make that version. -- Fyslee / talk 05:02, 11 June 2008 (UTC)
Thanks Fyslee. I'm too beat fighting other battles to explain it to Ludwigs. This should suffice. OrangeMarlin Talk• Contributions 05:04, 11 June 2008 (UTC)
Unfortunately, Fyslee, that argument doesn't hold any water. your reasoning is the definition of evidence-based medicine as given in the article, and evidence-based medicine is a perspective that certain American (or at least western) physicians have on the proper classification of medicines. it can not, therefore, be taken as an unbiased deciding factor in this debate, since (of course) western medical doctors are already predisposed to western medical practices. this would be equivalent to citing Catholic priests as the dominant authorities in an article about, say, Wicca... you have created a construction in which the evidenced-based perspective is implicitly assumed to be correct, with little or no basis for that claim. of course, I may be mistaken, and am willing to listen to whatever bases you can offer.
with regards to your other statements: I respect the previous work of other editors, and have tried my best to accommodate it. I really am trying to improve this article, you know, not unglue it. however, I can only respect that work on the basis of rational discussion. I'd ask you not to introduce social factors except where absolutely necessary. --Ludwigs2 19:13, 12 June 2008 (UTC)
as an afterthought: by what criteria are you referring to AM as 'Fringe'? several of the systems that self-classify as alternative medicine are used in major hospitals; others are used by huge numbers of people world-wide who don't have access to modern medicine. are you making the assumption that *all* alternative medicine is quackery by default? because if you're not making that assumption, then you're criticism is over-applied, and ought to go on the articles about medicines that are fraudulent, not be attached to alt-med as a whole. --Ludwigs2 19:34, 12 June 2008 (UTC)
I'm basing my criteria on definitions of AM (that which is not fully accepted as mainstream medicine - at least not yet), and by definitions that are based on objectively verifable and repeatable evidence of efficacy or lack thereof. (Most methods currently classed as AM having little or no chance of ever becoming fully accepted as they are disproven and often nonsensical methods.) Once a method (that was previously categorized as AM) is shown to be efficacious, then it becomes classified as mainstream and is universally accepted, no longer being considered "alternative" medicine. This has nothing to do with the number of believers or users, or even if some methods are practiced in some mainstream hospitals (keep in mind that hospitals are in it for the money and often couldn't give a flying f*** about efficacy). When acceptance is pretty much universal, you will discover that skeptics will long since have ceased to criticize the method, since they are often on the forefront of watching the research and comparing it with actual practice. Long before that they will have changed their position and been backing up inclusion and acceptance. They criticize anyone (especially licensed MDs) who make big claims about methods, when those claims aren't backed up by good research that has been duplicated successfully, and especially if they make claims for methods that have actually been disproven. "Disproven" needs to be understood loosely, since the scientific method includes a fundamental clause that opinions must be changed according to the latest evidence, if that evidence is very strong. Even then, most methods currently classified as AM have little chance of ever making it and can safely be discarded and criticized.
Such criticisms will often include charges of quackery or even outright fraud. The approach used by scientific skeptics towards the scientific method is basically identical with Wikipedia's NOR policy - we don't like or allow it. Wikipedia and scientific medicine are agreed: Wikipedia forbids the inclusion of crystal ball OR (content that isn't backed up by good sources), and scientific medicine considers it unethical to advocate and sell methods that aren't backed up by good research. At Wikipedia we call editors who do that fringe POV pushers, and in science we call such persons quacks and sometimes frauds. The FDA, FTC, FBI, BBB, etc. agree with quackbusters on those issues. That's why you will usually find that editors who support mainstream science and medicine will be on the winning side of discussions with pushers of fringe ideas - the pushers of those ideas simply have Wikipedia policy against them and should learn and adopt the scientific method as their guiding light. They need to learn critical thinking.
MastCell puts it well:
-- Fyslee / talk 00:02, 14 June 2008 (UTC)

pardon me for re-indenting, but the right sides of my eyes were starting to ache.  :-)

first, I do not believe it is wikipedia policy to call people 'fringe POV-pushers;' I don't think Wikipedia encourages placing editors into category types, or lumping them under names of any sort. if you choose to do that on your own you won't find me complaining, but please do not act as though this is the "Wikipedia Way". that would be a gross misrepresentation.

second, I will point out (again) that you have used the definition of evidence-based research as though that were the universally accepted norm of scientific research, rather than a particular perspective advocated by a coterie of scientists. you either don't realize or haven't fully considered that the particular model of medicine you are advocating makes perfect sense within its own specific context, but fails miserably in any situation where tightly controlled experimentation is impossible. note, for instance, that by those standards we would have to reject all epidemiological findings (those that look at the transmission patterns of diseases through regions and societies): statements like 'safe sex prevents the transmission of AIDS' could only be taken as anecdotal.

third, dismissing the behavior of hospitals as self-serving does not do your argument any favors. you open the door for me to dismiss the opinions of all medical doctors because they are in financial competition with AM providers. I don't think either of us wants to go that route.

all that aside, I am concerned that your approach divides the medicine world into two groups: practices accepted by the AMA, and dirty, fraudulent, scoundrel-ish, evil practices. I don't think the majority of doctors in the world hold that kind of absolute distinction - I think most recognize that there is a vast gray area of practices that have not been, and maybe cannot be, studied, which may in fact have a perfectly valid place in the therapeutic universe. in fact, your approach seems to violate wp:crystal ball since you broadly criticizing current 'alternative medicines' when when you have no idea which of those might eventually end up as mainstream.

with all due respect to MastCell, a serious encyclopedia is not supposed to engage in efforts to dictate the meaning or understanding of a topic. it is simply supposed to explain it. I have no interest in removing the criticisms that you've put in this article, since I think they are an essential part of the topic at hand. but I do want to tone them down to the point where the article gives a clear and unbiased presentation of AM, good points as well as bad. --Ludwigs2 02:48, 14 June 2008 (UTC)

Things are not so black and white as you make it out ("... and dirty, fraudulent, scoundrel-ish, evil practices.") Far from it. You apparently don't know much about me or my knowledge of alternative medicine, both as a former practitioner and user, including multiple deaths in my family and having treated terminal patients with worthless methods. I've "been there and done that," and can see things from both sides. No, most believers and practitioners are basically honest people who just don't understand the importance of proper testing and the difference between real evidence and anecdotes. That's of course putting it rather simply ;-) If you want to have any success here, I'm giving you an opportunity to learn, and MastCell is also one who can do it well. Since you seem averse to learning, I fear for your future here. There is a culture here and it's best to learn it as quickly as possible. -- Fyslee / talk 06:32, 14 June 2008 (UTC)
well, I am glad to hear that things are not that black and white, because it's really hard to pick up on that by reading the article. admittedly, I was hyperbolizing a bit... :-)
I am sorry to hear that you've had poor experiences with alternative medicine; my heart goes out to you. and really, sad to say, I don't know very much about you at all. that's maybe the worst side of the internet. it leaves us stuck in our own heads, making assumptions about the people we encounter that are almost invariably wrong. hard to get past that.
so look: I understand that there's a culture here, and if you think that I'm averse to learning you are dead wrong (unbelievably wrong - learning is my life). but I am also very honest, and very smart, and very principled, and I am not at all the kind of person who bows to culture just because it's bigger than me. If you, or MastCell, or whomever else want to try to educate me, ok. I enjoy those kinds of conversations and love getting down to the meat of things and figuring them out. but you're going to have to be open to the thought that I might very well know more about these issues than you do, and that regardless this conversation is certainly going to be a two-way street. --Ludwigs2 07:33, 14 June 2008 (UTC)
I guess I'm a bit concerned about your statement "I think most recognize that there is a vast gray area of practices that have not been, and maybe cannot be, studied, which may in fact have a perfectly valid place in the therapeutic universe." If a medical practice hasn't been studied, performing it on the patient could represent the worst sort of malpractice. If a medical practice can't be studied, the doctor can't possibly gauge its effectiveness well enough to determine that it has a valid place in the therapeutic universe (because otherwise we could perform a study of the doctor's patients).
As I wrote above, I think the criticisms in this article are disorganized, redundant in places, and too long. But when you say you want to "tone them down to the point where the article gives a clear and unbiased presentation of AM, good points as well as bad," I am not at all clear on what the "good points" are. Whether or not the evidence-based medicine perspective is too limited or represents too narrow an epistemological framework, restricting the claims in an article to those that have been made inside the peer-reviewed scientific community is a conservative principle that will ensure that Wikipedia meets its obligation to be factual.
If the page were unprotected, what other than the "Criticisms" section would you change in order that the article better reflect the "good points" of alternative medicine? Zimbardo Cookie Experiment (talk) 15:56, 17 June 2008 (UTC)
hmmm... to address your first concern, I'm going to have to delve into a discussion of the nature of scientific methodology. I could go into this topic at great length, but I think it's more appropriate to keep things brief. If I'm too brief, please let me know and I'll expand.
science in general, including medical science, relies on the clarity of hindsight to reach its conclusions - science looks back at a string of events in the past to make assertions about similar events in the future. modern research is simply a set of techniques that create a controlled set of historical events for analysis, because that control lends legitimacy to the conclusions drawn by the research. for instance, Native Americans knew from practical experience that chewing the bark of a particular tree would relieve headaches; modern chemistry isolated the active component (aspirin) and created variations on its chemical structure (like acetaminophen and ibuprofen), but the original practice of Native Americans was not less scientific, it was merely less technically refined.
now, one of the trade-offs in scientific research is that the more assumptions you can safely make, the more power your research can give, but the more restricted its applicability becomes. this is why scientists use 'controlled' experiments where they can; if one can control for factors A, B, and C, then one can safely assume that A, B, and C do not contribute to any observed effect, and therefore it is much safer to assume that factor D is the operative factor (except, of course, where your assumptions about A, B, or C are suspect - all bets are off, there). This is why double-blind experiments are used for drug testing wherever possible: the first blind controls for any expectations the patient might have from knowing that they are (or are not) receiving medicine, while the second blind controls for any expectations the physician might have from knowing that he is (or is not) dispensing medication. These assumptions (that the interactions between patient, physician, and treatment can be controlled) are largely valid for drugs intended to treat objectively verifiable conditions, but are not universally applicable for all medical and health issues. For a somewhat silly example, most physicians (most people, in fact) would say that rest and relaxation in a comfortable environment is useful for recovering from minor illnesses, but in fact, there is no objectively verifiable measure of how much rest and relaxation a person is getting, or of how comfortable their environment is. It would be impossible to design an effective double-blind experiment to test that theory (and if one designed one anyway, the results would be meaningless). I don't think anyone would argue, though, that we should not try to get comfortable rest and relaxation when we have a cold, just because we can't double-blind test whether it actually helps.
'rest and relaxation' is one of those difficult-to-study practices that has a perfectly valid place in the therapeutic universe. now, when we give up the assumption that we can control for the patient, physician, treatment interaction, we do not necessarily give up scientific practice; we merely give up a particular mode of scientific practice. there are certainly any number of other ways to reason systematically from historical experience. for example, we could consider massage: massage in its basic form would clearly fall in the more-or-less approved of 'rest and relaxation' category, and some schools of 'therapeutic' massage make theories about and study the effects of different kinds of massage techniques... why should that application of scientific reasoning move therapeutic massage into the realm of unacceptable practices? your use of the term 'malpractice' in this context is problematic. Malpractice implies that that a practitioner violates the accepted practices of a field and causes harm to a patient; most serious forms of alternative medicine are as quick to distinguish between proper practice of their techniques and malpractice as any medical doctor. the fact that a particular procedure has not been legitimized by a particular mode of research does not even imply that that procedure is ineffective, much less that its use automatically constitutes malpractice.
by the same token, I can't agree that restricting claims "to those that have been made inside the peer-reviewed scientific community" is a meaningful or valid move. my concern would be that "peer-reviewed scientific community" is a euphemism for people pre-committed to a scientific modality that does not apply to many forms of alternative medicine. as I mentioned before, this would be similar to claiming that Christian scholars and Catholic priests are the only sources acceptable in an article about Wicca - even if they were acting in good faith, their opinions would be irremediably biased. this restriction could only be based in an implicit assertion that the scientific modality found in peer-reviewed journals is the only valid scientific modality, an assertion that has no credible basis, and that (regardless) is beyond the scope of wikipedia to make. it is not our job to assert that medical science is 'right' and that that proves that alternative medicine is 'wrong'; we only need to clarify what they are and what their relationship is.
to your last point: I'm not really concerned at this point with advocating for alternative medicine, in whole or in part. I simply want to create an article such that an unknowledgeable reader can read the page and gain a decent idea of what AM is and means, without having to wade through a set of concerted efforts to discredit and minimize it. there might be some minor tweaking I'd like to do beyond the changes I've asked for below, but mostly I'd be content to with the edits I've already made. --Ludwigs2 19:46, 17 June 2008 (UTC)

pp and RfC

I've requested page protection to stop your collective edit war, and I am going to request an RfC on this topic. apparently that is the only effective way of communicating with you.--Ludwigs2 05:13, 11 June 2008 (UTC)

ok, SA and OM, I've filed for an RfC (hopefully I did it correctly). I'll make a section for it below. I've also files a wikiquette request wp:Wikiquette_alerts#alternative_medicine because of your bad behavior. I'll make a section for that as well. I'll leave notices of the last on your talk pages as well.
no worries, I'm patient, and I trust that the community consensus will bear me out.  :-) --Ludwigs2 05:43, 11 June 2008 (UTC)
Keep in mind that you are a relatively new user who is edit warring and destabilizing an article that has arrived at its present position (before you arrived) after long months and years of warring and collaborations. Don't make big changes, especially if it means deletions of well-sourced material. Better to be an inclusionist than a deletionist. You would do well to slow down and listen to more experienced users (among them SA and OM). This article is a powder keg and meddlesome fingers can easily start another long series of edit wars that are fruitless wastes of time. Just back off and take it easy. Learn to collaborate with editors who hold opposing POV. That results in the best articles. A combative attitude will only cause you unnecessary trouble. -- Fyslee / talk 05:57, 11 June 2008 (UTC)
I'm sorry Fyslee, I thought this was supposed to be about the article rather than about me. if that's not correct, please let me know. at any rate, I always recognize my mistakes, and I usually learn from them. I hope you can forgive me a one-time indiscretion.  :-)
with respect to the article, if you would take a look at my changes [here], you will note that I removed very little from the version I found. the majority of my changes were restructuring sections (basic cleanup, really) and compressing information in the criticism section by moving text into footnotes and combining redundancies. everything is still there, it's just in a more compact format. I did this because in the original version of the article more than 50% of the article was dedicated to criticisms of alternative medicine. while I understand the need for critique, the overall impression was that the article was dedicated to condemning AM rather than discussing it. my version reduced the criticism visually to about 1/3 of the article without losing any essential critical information.
I guess I'm confused about why my version got rejected so strongly, since it was clearly in good faith, and seems to bring the article back to a more neutral presentation of the subject. I'm more than willing to go through my changes (and why I thought they were needed) point by point, if you'd like to discuss it. --Ludwigs2 20:16, 11 June 2008 (UTC)
If you're still confused about why others have rejected/reverted what you have done, then I'm not sure how hard you're "listening" to what others are saying here. For instance, you claim your edits are uncontroversial, but the mere fact that others disagree makes that claim incorrect. On "difficult" articles, change happens quite slowly. Nomoskedasticity (talk) 20:44, 11 June 2008 (UTC)
Nomoskedasticity - thanks, I'm listening quite carefully. unfortunately, no one has really tried to explain what's wrong with my edits. the responses I've gotten so far (if I remember correctly) are:
  • it's too massive a change, I should use the talk page first: probably true, but doesn't get to content issues at all.
  • it removes vital material: not true - I made an effort to preserve everything I could when I made my changes.
  • it's pov-pushing: I don't think this is true - my intent was to bring the article to a more neutral perspective. regardless, no one has actually pointed out how my changes represent a particular pov rather than a neutral perspective. if someone could, that would go a long way to settling this.
I haven't even gotten feedback on simple, direct questions, like where I asked about the use of conditional negatives in the intro.
I'd really like it if someone would spell out specifically what was wrong with my edits (in terms of their content, mind you), so that at least we have some talking points to start with. --Ludwigs2 21:40, 11 June 2008 (UTC)
edit: add 'doesn't conform to understandings of 'evidence-based' medicine to the list above. I've responded to Fyslee on this point in the previous section. --Ludwigs2 19:16, 12 June 2008 (UTC)

Generally, the onus is on the one wanting to make the change to justify the changes in talk. So, let's do a trial run, Ludwigs. You propose a change to a sentence or a paragraph and offer your justification for the change. If it is truly uncontroversial, then I'm sure people will agree that you should change it. I can see already a number of different problems with your edits, more than enough to justify wholesale reversion. The problem is I don't have the time to go through and selectively revert and since I don't see your version as being a significant improvement, there's really no justification for me not to revert back to the previous version. ScienceApologist (talk) 05:15, 13 June 2008 (UTC)

well, if you read above, you'll see that I have justified the changes I made. I did it on each step as I made changes, and in each case the changes were reverted without a whole lot of substantive discussion. and now, no one seems much interested in discussing my changes, even though I'm actively trying to get feedback. interesting pickle, no?
If you can "already see a number of problems" with my edits, why don't you tell me what those problems are, so that I can respond to them. you don't need to go through and selectively revert; you simply need to communicate, and I'll work with you on the issues. if I may be frank, right now I'm thinking that the reversions of my edits were more of a reaction (based in the historical problems this page has had) than an actual rejection of my edits. if that's not true, and there actually are substantive problems with my edits, I would really like to know what they are.
I don't think either you or I want this page to sit in dispute limbo for an extended period. I'm not particularly attached to my version as given, but I do have some concerns with the current version that need to be quelled. that can only happen through discussion. --Ludwigs2 17:53, 13 June 2008 (UTC)

you know, I'm beginning to think that no one actually has any substantive objections to the changes I made, which is odd considering the clamor that got made over them. I'll give it a few more days to see if anyone would like to add anything, but if no one does then I will take that silence as consensus, and ask to have the page unprotected in order to restore my edits. comments? --Ludwigs2 17:44, 15 June 2008 (UTC)

Normally, when someone starts an RfC, there is a proposal of some sort to discuss. The section below is empty - there appears to be nothing to discuss. If you actually want some comments, you might want to provide something to comment on. For examples, see the list here and have a look at one of the articles. Right now all you have done is to start a section on this page - but an RfC, done properly, will list this article in an appropriate category and bring it to the attention of a wider range of editors. But first, you need to propose an edit. Nomoskedasticity (talk) 18:15, 15 June 2008 (UTC)
I'm sorry, I've never done an RfC before, and I'm not really clear on the process; have I done it improperly? to be honest, I had simply assumed that the RfC was quashed in pretty much the same way my wikiquette request was (since it doesn't appear on the RfC pages), so I haven't really pursued the issue. I will go and review the procedure, though it would be helpful if you could give an idea or two about what's expected.
I'll add, though, that I'm no longer certain that it's necessary. to my mind, an RfC is useful when the various sides in a discussion are making good-faith efforts at reasoning through a problem, but failing to reach agreement. in this case, I seem to be the only one interested in reasoned discussion. it's not my job to make other people communicate, and if they don't choose to, I am constrained to assume that they don't really have reasoned comments to make.
if it would help, I will take a few moments and spell out (again) precisely why I think my edits are an improvement. I'll put it in the RfC section below. --Ludwigs2 18:53, 15 June 2008 (UTC)
I'm not sure another attempt at justification is necessary. What would be helpful, in my view, is a proposal for an edit. You seem to be looking for approval for wholesale changes along the lines of your own thinking. I doubt this will be forthcoming. What I have been trying to suggest is that you take things more slowly - propose a new version of a particular paragraph, say. As for RfC, it hasn't been "quashed"; you simply haven't included the right "instructions" to make it appear in the relevant list. If you go to one of the pages on the list I linked to and enter the edit box in the RfC there, you'll see what is required. Nomoskedasticity (talk) 19:01, 15 June 2008 (UTC)
sorry, I didn't see this post before added my comments below, otherwise I would have refrained. I'll go follow those links now and see what I did wrong, but as I already said, I'd prefer to get comments back from the editors here before before proceeding with the RfC. it may turn out to be entirely unnecessary.
with respect to your other comment, I'm afraid I have to disagree. the changes I made were good faith effort trying to improve an article I found to be in sorry shape, and as far as I can see there is no other way to redeem the criticism section except by a fairly large transformation. plus, since the page is currently protected, going slower (or faster) is not really an option. I've provided links and diffs to the relevant versions below, so I think we have the tools to compare the versions and begin a discussion; no sense reinventing the wheel.
and please do not put 'quashed' in scare quotes. that is precisely what happened to my wikiquette request (see here - the dispute was was marked as resolved before I even got to participate in the discussion), and so you can imagine that I no longer have a lot of faith in wikipedia procedures. I've decided to stick to my strong suit - reasoned discussion - and leave the political games to people who like to play them. okie-dokie? --Ludwigs2 20:35, 15 June 2008 (UTC)
edit: I see what I did wrong with the RfC - my bad, and thanks for pointing me in the right direction. I'll go ahead and register it now, because it certainly can't hurt to get more opinions. --Ludwigs2 20:47, 15 June 2008 (UTC)
Read carefully, my friend - I didn't say the wikiquette request wasn't quashed - I said that it wasn't true that an RfC was "quashed". As for going slow/fast: while the page is protected, if there is agreement on a particular edit then an admin can be requested to come along and implement it. So my suggestion stands: propose an edit. Nomoskedasticity (talk) 20:50, 15 June 2008 (UTC)
Have you perhaps noticed that I've already done the RfC for you? Nomoskedasticity (talk) 20:52, 15 June 2008 (UTC)
lol - yes, I just noticed that a moment ago, and no, I did not know that. I merely assumed that page protection was a complete freeze. seems I get to wear the donkey hat today.  :-) thank you for your assistance; I am learning a lot here. let me consider a couple of small changes and put them out for discussion; we'll see what responses they get. --Ludwigs2 21:09, 15 June 2008 (UTC)

per discussion, small edits for consideration

I would like to offer the following two changes for comment, listed individually, with explanations. I will restrict myself to issues in the lead for now, since the main change in the body is difficult to subdivide.

  • I would like to remove the following two phrases from the second paragraph of the lead: "but by definition are not based in the standards of conventional medicine" and "Often, the claims made by alternative medicine practitioners are not based on rigorous scientific investigation." in context, the phrases are intended to reinforce the fact that alternative medicine can base itself in theories that are not accepted or validated in conventional medicine. this would be acceptable (if somewhat redundant) except that the strength of the phrases seems to imply that AM can never be up to the standards of conventional medicine. I don't think they add anything significant to the understanding of AM, and I think they shade into a particular POV that detracts from the neutrality of the article. I would be open to discussing a less didactic version of the first phrase.
  • In the last line of the lead, I would like to replace "Even if there is no evidence showing efficacy, many alternative practice are often licensed and regulated..." with "such accepted practices are often licensed and regulated..." The first phrase sounds almost scandal-ridden (that's the result of using negative conditionals in language); the second strikes me as more neutral. I'm not sure the second is the best formulation possible, mind you (it may swing slightly too far in the other direction), but I think it's an improvement over the first.

--Ludwigs2 00:54, 16 June 2008 (UTC)

Thank you for engaging in discussion. Both of your proposed revisions to the second paragraph of the lead concern what seem to be fairly standard and easily sourced statements. These sentences both serve to demarcate Alternative medicine from medicine. From a stylistic standpoint, it is important to make this distinction early. The nuances of how practices are (in)validated using the scientific method were when last I checked treated adequately in the body of the article. Please also keep in mind that this article is about the social and political impact of the subject and is not a science article in the same sense as, say, black hole thermodynamics.
I think you may have a point at least stylistically regarding the last line of the lead. The socio-historical context of AM requires, however, at least a tangential mention of the difference between governmental sanction and licensure on the one hand and validation and acceptance by the scientific and medical communities on the other. Perhaps replace the terminal two sentences with "An alternative medical practice may be adopted by the medical establishment if scientific investigation indicates that it is safe and effective. Even in the absence of such evidence, many alternative medicine practices are licensed and regulated in certain jurisdictions."? - Eldereft (cont.) 05:51, 16 June 2008 (UTC)
my pleasure to do so. I'm still climbing the learning curve, so please be patient with me.  :-)
in response to your first point, I don't doubt that that these statements are easily sourced. however, the issue here is neutrality, not verifiability. it seems to me that - historically speaking - the discourse in the greater world proceeded like this:
  1. first: there was (conventional) medical practice, which was just simply called medicine
  2. second: a collection of practices came to be known as Alternative Medicine - they came into prominence for a number of reasons (off-hand list: dehumanized and dehumanizing practices in standard medicine, medical costs, a shift towards maintaining health as opposed to curing disease, etc...)
  3. third: in an effort to rationalize the rather sprawling mess of alternative medicines, a group of scientists began advocating the concept of 'evidence-based medicine', which in practice tries to dispose of the concept 'alternative medicine' entirely by reducing it to "medicines that have been tested and medicines that haven't" (or any of a number of similar formulations...).
in short, the phrase "but by definition are not based in the standards of conventional medicine" is a conception that came after alternative medicine as an attempt to rationalize it away. it can hardly qualify as a neutral statement about alternative medicine.
further, I'll point out that certain forms of alternative medicine (I'm thinking particularly of chinese herbal medicine, though it applies to others) are in fact quite methodologically sophisticated. of course, they do not fit into the standard western medical model. the western medical model assumes that (a) subjective impressions of health and well-being can never be trusted, and (b) both diseases and cures can be treated as isolated events, without reference to the rest of the organism; assumptions which many (if not most) forms of alternative medicine reject. to the extent that we want to say that AM doesn't fit the modern western medical model, I'm with you, but I think it's an unfortunate misrepresentation to imply that AM is not and cannot be scientific. as I said, I'm open to a less didactic version of the first phrase, because I understand the desire to make the distinction. I just can't see how to phrase it right at the moment, and I think the phrases as given are far too strong.
with respect to your second point... how about this? "Whether or not there is such evidence, alternative medicine practices that are widespread in communities are often licensed and regulated..." I just don't like the "even if there is no evidence" construction. --Ludwigs2 15:59, 16 June 2008 (UTC)
The use of the term "holism" in connection with AM was discussed in this thread above. We cannot describe AM using the jargon of adherents, both as an NPOV matter and as a practical one.
I think we can move forward on your other point, though. When talking about regulation, I would prefer "jurisdiction" to "community", though I think you have a good point that popularity and effectiveness are logically distinct. How about replacing the final two sentences of the lead with: "Alternative medical practices are licensed and regulated in many jurisdictions, and may be adopted by the medical establishment if rigorous scientific investigation indicates safety and effectiveness."? - Eldereft (cont.) 16:51, 16 June 2008 (UTC)
let me deal with the second point first, because I think we're close to agreement there. my only concern is close what you stated, that there is a distinction between popularity, legitimacy (a better term than effectiveness, since of course we have no knowledge of effectiveness with untested procedures), and regulation. so a tweak on your formulation: "Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them, and where the medical community establishes their safety and effectiveness according to accepted standards, it may adopt them as conventional practices." again, I'm shying away from 'rigorous scientific investigation' as being an overly-strong phrase without clear definition, and I felt (perhaps unjustly) that 'medical establishment' gives the appearance of a monolithic entity that has a single viewpoint across all places and people. I sincerely doubt that the 'medical establishment' in China would be in complete agreement with the same entity in the US, for instance.
with regard to your first point - well, I'm not sure I fully agree with the logic of the discussion you linked, but regardless, it's irrelevant to this case for the following reasons.
  1. this is a talk page, not article content - a looser form of language is allowable here.
  2. I did not call AM holistic. what I said was that conventional medicine is atomistic and dehumanizing (a criticism that is amply sourced), and that this was part of the impetus behind the growth of alternative medicine. this is not the jargon of adherents, but language that occurs in debates within the medical community itself.
  3. it was a loose comment tagged onto a discussion of the historical development of the terminology. the main argument (that you cannot use a theory designed as a means of rationalizing AM out of existence as a neutral description of AM) is unaffected by it.
if it helps, I'll happily refactor that comment from the list given above so that the main argument stands out more clearly. --Ludwigs2 17:44, 16 June 2008 (UTC)
edit: sorry, I misread my own writing on point 3. the phrase in question does not occur in the historical list, but rather in the discussion of the western medical model in the paragraph below that. the comment still stands though, to the extent that I see a distinction between saying that AM does not fit into the western medical model and implying that AM is not scientific. --Ludwigs2 01:26, 17 June 2008 (UTC)
A) Good point about medical community vs. establishment, I concur. I think accepted standards underemphasizes the power of rigorous scientific investigation to make statements untainted by prior beliefs and biases. I think, though, that I like your wording "Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them." I read it as nice and neutral. What if we take that as one sentence and follow it with "If scientific investigation establishes the safety and effectiveness of an alternative medical practice it may be adopted by conventional practitioners." Rigorous is an unneeded modifier here. I do think that it is important to retain the conditional to avoid misleading the reader with a false sense of inevitability. Most ideas even from trained medical researchers are wrong.
B) Yes, the standards of talk page discussion are of necessity much looser than the full article requirements. I did not intend by linking to the prior discussion to squelch talk page discussion, but to forestall further argumentation about article presentation that seemed to be implied by your post. My apologies if this was presumptuous or unnecessary. - Eldereft (cont.) 14:33, 19 June 2008 (UTC)
your (A) looks good to me. if there are no other objections or discussion points, I think we can request an admin to make the changes as given there.
no apologies necessary re (B), please, as it's surely partly my fault. communication is hard enough in the real world; over the internet, misunderstanding is the rule rather than the exception. If I had thought it through more carefully myself, I would have probably realized that that was what you were after and saved us some confusion. C'est la vie...  :-) having given it some thought, though, let me offer this as a compromise edit (the following is intended to replace the first three sentences of the second paragraph): "Alternative medical practices may incorporate or be based on spiritual, metaphysical, or religious underpinnings, pre-modern medical traditions or traditional healing practices, newly invented techniques or unorthodox medical theories, or other practices or concepts that lie outside the standards of conventional medicine." a bit rough, that, but maybe a start? --Ludwigs2 15:21, 19 June 2008 (UTC)

{{editprotected}}

 Done PeterSymonds (talk) 17:18, 23 June 2008 (UTC)

(undent) Replacing the current final two sentences of the lead with

"Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them. If scientific investigation establishes the safety and effectiveness of an alternative medical practice it may be adopted by conventional practitioners."

sounds good to me. Shall we leave it until Monday for additional comments and then place {{editprotected}}? - Eldereft (cont.) 16:37, 20 June 2008 (UTC)

that works for me. --Ludwigs2 02:57, 21 June 2008 (UTC)


pp and RfC 2

ok, can we revisit my other point now? I still think that the passage "but by definition are not based in the standards of conventional medicine. Often, the claims made by alternative medicine practitioners are not based on rigorous scientific investigation" in the middle of the second paragraph should be removed entirely, or replaced with something less didactic. I'd suggest deleting the second line (the weasel word 'Often' makes it problematic), and rewriting the first line to say "but by definition are not practices approved of or legitimized by conventional medicine." I think that gets the point across clearly and cleanly. --Ludwigs2 00:57, 24 June 2008 (UTC)

That section was getting a little long, so I gave us a section break to encourage further participants and save some scrolling.
On this point I think that we are much further from agreement. For one thing, I see nothing wrong with didacticism in an encyclopedia provided it is free from editorial slant. On the other hand, I am perfectly open to questions of presentation and summary weight. I think that you made a good case for legitimate earlier, but it should not be presented as a matter of the reigning system refusing competition. As a matter of presentation, I could see organizing the 'incorporates / is based on' material in one sentence and the 'effectiveness unproven or disproven' bits in another, possibly interposing our sentence about jurisdictions. Proposed second paragraph (the two sentences agreed upon in the preceding section have been rearranged but not altered):

Alternative medicine practices are as heterogeneous in their underpinnings as in their methodologies. Various systems incorporate or are based on elements of traditional pre-scientific beliefs, folk knowledge, spiritual, metaphysical, or religious ideas, or newly invented approaches. Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them. The claims made by alternative medicine practitioners are often not founded in scientific investigation and do not meet the standards of evidence-based medicine. If scientific investigation establishes the safety and effectiveness of an alternative medical practice it may be adopted by conventional practitioners.

I think that the heterogeneity of the practices will force us to use incomplete generalities (often, many, several, most) in order to have a meaningful introduction. The frequency (by claim, by dollar, by number of patients) with which alternative medical claims are made independently of evidence I think justifies "often not" (though "not often" might apply if properly sourced), though some qualifier is necessary since any good medical advice would not be invalidated by the source. Which is to say, we cannot say that everything any alternative medical practice says is unsupported or contradicted by evidence, but every alternative medical system diverges from objective evidence to one extent or another. - Eldereft (cont.) 05:53, 25 June 2008 (UTC)
hmmm... I think you may be misinterpreting my objection towards these two phrases. Frankly, I feel as though 'scientific investigation' and 'standards of medicine' are being used less as analytical concepts and more as totems here. for instance, 'evidence-based medicine' is (in this conversation) circular to the point of being meaningless. as I pointed out before, evidence-based medicine is a concept designed specifically to uproot the concept of alternative medicine, and so obviously nothing in AltMed can meet the standards of ev-based med. this is not 'by definition,' it's 'tautologically,' but the use of the phrase makes it sound as though ev-based med were a standard that AltMed could live up to, but doesn't. further, saying it is not founded in scientific investigation is either patently false, or uses a desperately restricted view of science. if we were to upfront and say that AltMed cannot be demonstrated in conventional double-blind trials that would be closer to the truth, but this loose 'not founded in scientific investigation' is prone to misinterpretation. many forms of Alternative medicine are in fact quite scientific, it's just that they can't be studied due to limitations in modern medical methodology.
put more simply, I feel like these phrases set up a false dichotomy - stuff that's scientific and stuff that isn't (whatever scientific means) - when what we really should be pursuing is a trichotomy - stuff that's been legitimized by modern medicine, stuff that's been debunked by modern medicine, and stuff that modern medicine doesn't have effective tools to analyze.
so following your lead (and swapping out a couple of words here and there...), I'd be looking for something more like this:

Alternative medicine practices are as diverse in their foundations as in their methodologies. Specific practices may incorporate or base themselves on traditional or pre-scientific understandings of medicine, folk knowledge, spiritual, metaphysical, or religious beliefs, or newly contrived approaches to healing. Even though the claims made by alternative medicine practitioners are generally not verified or accepted by the medical or scientific community, jurisdictions where these practices are sufficiently widespread may still license and regulate them. If scientific investigation later establishes the safety and effectiveness of an alternative medical practice it may be adopted as conventional.

incidentally, I changed the word 'invented' to 'contrived' - seemed more appropriate for new, unapproved approaches. --Ludwigs2 06:57, 25 June 2008 (UTC)
I've been lurking here, and I feel like you've made some good points in these discussions. I like this rewrite. TimidGuy (talk) 11:24, 25 June 2008 (UTC)
Your first two sentences look nice. They drop the standards point, but I think that that is adequately treated by the final sentence. To save being a drain on volunteer administrator time we should probably hold off for the nonce on requesting the change.
I think a more useful trichotomy to consider would be medicine, not-medicine (unproven) and not-medicine (disproven). The possible efficacy of prayer (viz. the question of whether anything might hear and heed) is not well-suited to RCTs, but the actual efficacy is. The lead is intended to introduce the topic and summarize the most pertinent points of the article. The difference between medicine and practices which make health claims without or in the face of evidence is a fairly major point, and should be accurately presented at the outset. Moreover, the mainstream view, that such evidence is proper and necessary before any practice is considered legitimate medicine, should inform the tone of the article. This is not to contend that we should pen an attack screed, only that proof of efficacy should not be treated as a mere formal hoop necessary for legitimization but not use.
Building from those first two sentences:

Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them. The claims made by alternative medicine practitioners are generally neither accepted by the medical community nor verified by scientific investigation. If scientific investigation establishes the safety and effectiveness of an alternative medical practice it may be adopted by conventional practitioners.

I left the sentences agreed on in the preceding section intact but rearranged. Rewording remains on the table, but I like nice simple direct statements. - Eldereft (cont.) 20:21, 26 June 2008 (UTC)
fascinating conversation, I have to say.  :-) ok, it seems that this middle group - the one you're calling not-medicine (unproven) and I'm calling medicine (not legitimized) - is the problem child of this discussion. established medicine and quack-job medicine are categories we agree on, but not the middle one. digging deeper, I think the problem here is that you believe everything in the middle group will (eventually) be tested and fall into the 'established' or 'quack-job' categories (the main theory of evidence-based med), whereas that assertion strikes me as methodologically suspect (I don't think scientific criteria are as cut-and-dried as you're making it). put in these terms, my main concern is that we don't imply anything about this middle group that the scientific community is not willing to imply. this is why I'm uncomfortable with the phrase nor verified by scientific investigation that seem to imply that they have been investigated scientifically without any results. I'd like some allowance given to practices that just don't lend themselves to the methodological assumptions of modern medicine. the poster-child here would be something like acupuncture, which has a handful of legitimate and verified uses in modern medicine, but which could never be accepted or tested as a uniform technique because the assumptions behind it have no place to fit in the testing methodology of the medical community. can you think of any way to soften that phrase a bit, so that it doesn't imply something that medical researchers themselves aren't willing to imply?
really, it's just these five words - nor verified by scientific investigation - that get me, otherwise I'd be perfectly happy with your last version. well, that and the way you snuck evidence-based into the medicine link. shouldn't that really be medical? --Ludwigs2 03:01, 27 June 2008 (UTC)

(undent) I was not aware of that article but it fits just fine, thank you. I would not characterize that EBM link as an easter egg, but water under the bridge. Considering the lack of importance assigned by the EBM movement to prior plausibility, its bias-reducing methodology would seem the natural ally of unconventional approaches. I would say more that I think everything either can at least in principle be tested or cannot be medicine, but that comes with a mess of caveats that thankfully we do not seem to need to argue at the moment. At least for the lead, the weaker "have not been investigated" would seem preferable to a lengthy discussion of "cannot be investigated". I was reading "not verified" without any connotations of having been tested and found wanting, but I can see your point. Some alternative medical practices fall into the disproven category, but I agree that it would be a fallacy of composition to use this to imply anything about the rest of the practices under the AM umbrella. How about if we end that sentence at lack of acceptance by the medical community, then craft a new sentence before the 'route to legitimacy' sentence to differentiate between unproven and disproven? Alternatively, if you see a good way to work this into the 'diversity' sentence at the beginning of the paragraph, that might be even better.

Alternative medicine practices are as diverse in their foundations as in their methodologies. Specific practices may incorporate or base themselves on traditional or pre-scientific understandings of medicine, folk knowledge, spiritual, metaphysical, or religious beliefs, or newly contrived approaches to healing. Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them. The claims made by alternative medicine practitioners are generally not accepted by the medical community. Evidence-based assessment is not available for the safety and efficacy of many of these practices. If scientific investigation establishes the safety and effectiveness of an alternative medical practice it may be adopted by conventional practitioners.

I also changed the scientific investigation wikilink in the final sentence to point to Biomedical research. It seems more narrowly relevant, but I am not confident that it would be better. - Eldereft (cont.) 22:44, 27 June 2008 (UTC)

sorry for the delay in response - seems I missed this post in my watchlist. I think I can agree to this revision; the use of the evidence-based link seems appropriate in context, and the biomedical research link (while maybe not the best) works well enough. that's a detail that can grow later. the only suggestion I might make is to to throw in a 'because' before 'evidence-based assessment - "The claims made by alternative medicine practitioners are generally not accepted by the medical community, because evidence-based assessment..." - I don't think that causal assertion is wrong in this case, and I do think it makes the passage read smoother. I'll leave that up to you to decide; either way I'm good with it. if no one else has any objections or comments, I say let's go with it. --Ludwigs2 19:56, 30 June 2008 (UTC)
No worries. Because works fine for me. Does anyone else want to comment? - Eldereft (cont.) 07:46, 1 July 2008 (UTC)
In general, this article seems quite good. I really appreciate the attention that's being giving to areas that could be improved. One question I have regarding the paragraph above and regarding the article in general is that it tends to imply that modern medicine is evidence-based. That is indeed a worthy goal, but my impression is that much modern medical practice isn't evidenced-based. Is that correct? See, for example, this recent article in the New York Times.[1] TimidGuy (talk) 20:00, 3 July 2008 (UTC)
I haven't looked over your link yet (busy day) but just off-hand... as I understand it, the 'evidence-based' medicine thing came about as a reaction to, or maybe an attempt to rationalize, the inroads AltMed had made into the medical scene. it's more of an assertion than a practice: it says that there's stuff that we have evidence works, and stuff that we don't have evidence works, and only the former can really be called 'medicine.' I think it's fine in this context because that's literally what's being said, that when conventional medicine has evidence that some particular AltMed is effective, they'll adopt it (more or less) as part of conventional medicine. other than that, I'd tend to agree with you that medicine isn't quite as evidence-based as we sometimes might like to think. but that's a discussion for a different talk page.  :-)
let me read over your link, though, to see if its something that needs to be used on this page. --Ludwigs2 22:15, 3 July 2008 (UTC)

References 2 and 6 - two proposals

The current reference 2 points to this graph, which is Figure 1 from this report (Reference 6, 20 page pdf). Deep linked as it is, this page provides no easy way for the curious reader to navigate to the full paper. This reference is used twice, once alongside the full reference, and once after the statement Studies indicate that alternative approaches are often used in conjunction with conventional medicine., which it does not support. I would like to propose that the redundant instance be omitted and the other be replaced with a citation to the full report (It appears that the majority of people use CAM as a complement to conventional medicine, not as an alternative (1,3,5).).

As a point of pedantry, the cited report is also hosted on CDC webspace: summary with link to full pdf. The study was performed under the auspices of the National Center for Health Statistics, a division of the CDC. NCCAM personnel coauthored the study and it is relevant to their raison d'etre so it makes sense for them to mirror the (public domain) document, but linking to the NCHS summary and official copy would be more correct. It also avoids linking directly to a pdf. I would like also to propose that the link be changed. - Eldereft (cont.) 18:03, 24 June 2008 (UTC)

I'll need to look through this more closely, but on a cursory level this change seems perfectly appropriate to me. let me check it out in more detail, but assume that I'm in the 'yes' camp on this change. --Ludwigs2 18:42, 24 June 2008 (UTC)
I concur with the change to link the full report and the correction to the text to refer to CAM rather than Alt Med regarding complementary use. --Jack-A-Roe (talk) 17:38, 2 July 2008 (UTC)

Obvious problems

I'm surprised, given the amount of attention this article has attracted recently, how bad this article is. Are the issues close to being addressed?

  1. Alternative_medicine#Efficacy -- Substantial weasel-wording and no sources for the mainstream views in the beginning of this section. In fact there is tons of weasel-wording throughout the article: "critics contend, proponents object". These should be avoided and specifically cited.
  2. Citing CSICOP for the German monographs on herbs is not appropriate (ref 38). Glancing at the article, it does not seem to mention the German monographs. We should look for a summary of the Commission E conclusions. I'll admit I haven't read the monographs, but I imagine that they were rigorous but not dismissive of the power of herbs. According to this article, in Germany herbs "are standardized, often prescribed by physicians, and generally covered by insurance". I'll admit that I use just one herb: kava. I did my research prior: a Cochrane Review concluded that evidence suggests that it does reduce anxiety. Highly recommended -- although there are worries about liver damage, these are likely connected to the use of leaves rather than roots (no liver damage in Fiji Islands, where it has been used for a long while). But I digress.

The page in general seems disorganized and ugly. We should open it up to editing. II 08:07, 4 July 2008 (UTC)

I don't know anything about the history of this article, or the reasons that it was originally closed for editing; but it should definitely be opened up. In the first SENTENCE of the article, there exists a grammar error; there are two double quotes ending a quote. Since the article is protected, I cannot change this error; and since the article is protected, I don't even want to. -GilbertoSilvaFan (talk) 15:10, 5 July 2008 (UTC)

one small study does not generalize

This text is not useful for the article:

A Norwegian multicentre study examined the association between the use of alternative medicine and cancer survival. 515 patients using standard medical care for cancer were followed for eight years. 22% of those patients used alternative medicine concurrently with their standard care. The study revealed that death rates were 30% higher in alternative medicine users than in those who did not use alternative medicine (AM): "The use of AM seems to predict a shorter survival from cancer."[1]

Although it is sourced, it is a single, small study (only 112 patients used altmed along with conventional med); that is not statistically sufficient for general conclusions. Also, the study's results are vague, quoting from the abstract: "suggesting that AM use may predict a shorter survival". This does not provide any real information for readers of the article; as a study, it does only one thing - it shows that more research is needed.

This kind of text that appears in Wikipedia articles that result from long-term disputes; a study is found to support a POV, and because it looks scientific, it seems hard to contest. That's not a useful method. It's original research to interpret and generalize in that way. If altmed is dangerous when used along with conventional medicine, there will be reliable sources available to support that statement as such, without requiring generalization of one small study with a weak conclusion.

I have no affection for altmed; generally I don't believe in its methods. But my personal feelings about the topic are not the point; it's important that the availability of a marginally relevant source is not used to add weight to a viewpoint that is not directly and clearly stated by that source. --Jack-A-Roe (talk) 02:43, 6 July 2008 (UTC)

I think that your reasoning is sound for both this and the grapefruit extract paragraph - there is far too much reliance in WP articles on possibly unsubstantiated primary literature - but please allow at least a little time for discussion. This is a contentious article, and it can be difficult to ratiocinate beforehand which edits are uncontroversial and which will lead directly to renewed page protection. Please, be gentle in your changes. - Eldereft (cont.) 04:58, 6 July 2008 (UTC)
Sure, no problem. That's why I entered the above comment. I understand and respect the concerns you mentioned. --Jack-A-Roe (talk) 06:16, 6 July 2008 (UTC)
If there really is a problem (and I don't think it's as large as you seem to think), then the solution is to attribute it and/or tweak it. Actually following 515 patients for eight years is pretty darn good! Since it happens to be the largest and best study of its type, to the best of my knowledge, then we should use it. It was well-controlled and properly performed using university facilities nad national health care dollars (well, Norwegian kroner ;-). No one has ever questioned the reliability of the study method used, and no one has ever questioned the reliability of the sourcing, TTBOMK. We use the available literature and we don't wait until a study is performed that studies 100,000 patients. We can't wait for perfection. We use what is published in RS, and this one certainly qualifies. We should just attribute it and possibly tweak the editorial comments that accompany it. Read the sources. I added it originally and have studied it in Norwegian, Danish, and English, including the related research, the leading researchers' reputations and their other research, and the newspaper articles at the time. It all checked out as about as good as it can get. Until we have better, let's be careful. I think you'll find my wording follows the sources pretty exactly without any twisting or bias. -- Fyslee / talk 06:49, 6 July 2008 (UTC)
I'm not questioning the accuracy of the study, but it's very small, not sufficient in size to generalize statistically. They followed 515 patients, but only 112 of them used altmed, and of those, there was a difference of only 14% in the death rate. That's a tiny number statistically. Using that as a source to show that alternative medicine is dangerous and can cause death is incorrect. That's not how statistics works.
Attribution will not solve the NPOV issue. Adding the name of the people who did the study does not do anything to alleviate giving readers the impression that something has been proven when it has not been. And if it's not been proven, then it's only a guess, a hint that further research is needed. The idea that use of alternative medicine is harmful to the point of increasing death rates, when it's used in addition to and not instead of conventional medicine, is a rather extreme claim and would need much more than one study with a difference of around 20 people out of 515 to support.
Please don't get me wrong on this. I am not arguing either way whether altmed is safe or not. I am arguing this only in regards to accurately presenting information without skewing it in any direction. --Jack-A-Roe (talk) 07:41, 6 July 2008 (UTC)
Actually the wording doesn't generalize beyond what the research stated. It describes one study and makes it clear it was about cancer and the exact number of patients and time length of the study. It's quite specific. You're welcome to try better wording, but don't remove anything from the article without discussion as you've done. Deletionism just doesn't cut it here. You've charged into a relatively stable article like a bull in a china shop and exercised bad faith towards the hard work of lots of editors who have brought it to what it is after months and years of hard work, collaboration, and compromise. If you have problems with anything, then discuss the changes here FIRST. Being BOLD on controversial articles only creates hard feelings and starts edit wars. I would suggest you revert every single one of your changes, since many of them are very controversial. Just do a mass revert, rather than one of us having to do it, since that's about the only way to do it. Then discuss each one here, unless it's simple spelling and grammatical changes, or improving references. We work by concensus here, not by single-handed BOLD removals of concensus version stuff. Sure changes can be made, but first after seeking and getting concensus through discussion here. -- Fyslee / talk 14:11, 6 July 2008 (UTC)
this is actually not a bad study, as medical studies go. a sample size of 515 is (statistically speaking) large enough to draw conclusions, assuming reasonable distributions in the subject population. I mean, their base p-value is borderline (5.6% in a field that generally looks for .01% cutoffs), but there's enough there to indicate a trend, which is all the authors seem to be aiming for. I would like to know what ECOG PS (Eastern Cooperative Oncology Group Performance Status) means, though. the authors imply that this result is stronger for some subset of the population, but I can't piece out just which subset that is. --Ludwigs2 18:17, 6 July 2008 (UTC)
It's much too small to do anything other than what it concludes -it "suggests" that altmed use "may predict". It's enough information to show that more research are needed, but nothing more. The sample size is way too small; of the 515, only 112 of them used altmed, with a 14% differential in survival rate, that's only around 17 people. It's also not clear what it means that those 112 used altmed in addition to conventional therapy or how that might be interpreted. Was it the same altmed therapy for all of them? If it was, then only that form of altmed is included. If not, then the number 17 is spread among different therapies - how many? That makes the statistics even weaker. Different altmed modalities can't be grouped together in their effects - they're as different as herbs to Reiki - from substances consumed to "spiritual energy"; how could one study with a few people result in such a sweeping statement about a large range of very different methods? The use of that study to support any kind of general statement about altmed is original research. --Jack-A-Roe (talk) 18:52, 6 July 2008 (UTC)
look, I don't want to get into a deep methodological discussion here (if you'd like to do that on my talk page, I'd be happy to). The fact is that with a 'perfect conditions' case (where the distribution of scores is nicely Gaussian and there's no bias in sampling) a sample size of 100 is more than sufficient to make predictions. the accuracy of statistics is not related to the size of the population, it only has to do with the size of the sample, and the validity of the assumptions that get made about the distribution of scores in the population and the selection of samples. Now medical studies (from the perspective of a statistician) are notoriously troublesome in their use of assumptions, and so I'd be a bit leery of this study on that ground. but you can't just criticize the sample size. you'd have to say something like 'given a non-normal or non-representative distribution present in the sample, a larger sample size would be needed for accurate results.' except there you're jumping off into original research, and we shouldn't do that on wikipedia. --Ludwigs2 20:37, 6 July 2008 (UTC)
Sample size is one issue among several. There is also the weakly stated result and the lack of specificity about what kinds of altmed were involved. One can't generalize results about herbal remedies to bodywork or energy therapy (or whatever forms of altmed were used by the sample).
If there's any question about POV here, I don't have a bias in either direction. I'm biased about some topics as we all are, but on this one, it just happens that I don't have strong feelings. Take a look at my later edit to that section; I added information about dangerous altmed combinations with conventional medicine based on a reliable source; that edit is on the other side of the issue from my prior edit.
What I'm addressing regarding this study is the way that small, non-reproduced (or not-yet-reproduced) primary research is often used in Wikipedia to support content not supported by secondary sources that have interpreted those studies; that's not how science works. Researchers don't accept one small study like that and then assume it describes the situation; a body of work is needed before that happens. Wikipedia's mandate is not to make new information. It's not right for us to state that altmed used together with conventional medicine increases the cancer death rate over conventional medicine alone. That has not been proven and is not accepted by science. It is accepted that certain types of altmed are dangerous and can have bad results when used with conventional medicine; that can and should be stated, with identification of the relevant altmed modalities. --Jack-A-Roe (talk) 20:57, 6 July 2008 (UTC)
(undent) that's actually a decent argument. sorry, by my profession I tend to take primary sources for granted, and I keep forgetting that WP should adhere to the 2nd-hand/3rd-party rule. so if I read you right, what you're saying is that this article should be removed because it is an improper synthesis of primary research, right? give me a moment to think about it, and if I decide that's correct I'll remove it from the article myself. --Ludwigs2 21:07, 6 July 2008 (UTC)
Thanks for your thoughtful response. Yes, your restatement of my point is accurate. Regarding the edit, I already did that yesterday; I added this section here to discuss it to make it clear it was not done without due consideration. If you don't agree, I'm interested in your further thoughts. --Jack-A-Roe (talk) 21:16, 6 July 2008 (UTC)
no, I've decided I agree with you, and moreover that I need to keep that in mind when I'm looking through other sections and articles. thanks for raising the issue. --Ludwigs2 21:29, 6 July 2008 (UTC)
If WE, as editors, are editorializing beyond what the source itself says, THEN we'd be guilty of OR. We aren't doing that. If we are, then do what I've already suggested - tweak our comments, don't delete. This is pretty serious and I'm not at all happy about this development. That information has been in the article for a long time and no one has questioned it before. Suddenly one editor comes along and considers his POV better than the collective wisdom of the host of editors who has edited this article for years. That's very uncollaborative. That's not good and I once again request that Jack-A-Roe show some good faith and restore that section. Tweak it, don't delete it. -- Fyslee / talk 06:36, 7 July 2008 (UTC)

I'd prefer to leave it in, but severely cut down. "One study suggests that cancer patients who use alternative medicine die younger than those who don't." My only reasoning is that it is interesting. Many, and perhaps even most, reviews that I see don't critically appraise primary articles anyway; they simply report on them. An unusual study like this may never be replicated, and probably won't. No policy states that only reviews should be included; primary articles cited just need to be in clearly readable language. By the way, I've raised a RfC discussion on primary/secondary sources thing over at at MEDRS here. It is a pretty length discussion. (Hopefully this doesn't qualify as "canvassing".) II 06:08, 7 July 2008 (UTC)

Thanks for the links. The section at WP:MEDRS#Some definitions and basics addresses the concerns I brought up.
Your suggested text ("One study suggests that cancer patients who use alternative medicine die younger than those who don't.") is a good example of why the study should not be used. It's an extreme claim that altmed causes is associated with an increased death rate, something that would need more sources that one small study to support. Also, the text does not address the various modalities of altmed as to which might contribute danger and which might not. It's not a homogeneous field that can be lumped together that way. The idea that something completely innocuous like bodywork or aromatherapy could increase the death rate is unrealistic, yet is not excluded by that wording. The bottom line though is that the primary source study is only a suggestion, a hint that more research is needed to delve into that question. There is no general conclusion drawn; if there were, it would be a big deal. Hundreds of millions of people use altmed, so certainly if there were solid evidence that altmed were causing an increased death rate there would be many secondary sources discussing it and we would not need to mine primary sources to find it. --Jack-A-Roe (talk) 06:39, 7 July 2008 (UTC)--Jack-A-Roe (talk) 06:39, 7 July 2008 (UTC)
My suggested sentence makes no such claim. It deliberately leaves open the "why". It's entirely possible that alt. med. users die younger because they tend to be more sickly than those who don't use alt. medicine. Perhaps those using alt. med. had grimmer prognoses. We don't know. But I do think that a sentence is justified, and others seem to agree with me. II 07:00, 7 July 2008 (UTC)
I've corrected my paraphrase, though the rest of the comment still stands. You're right that one of the problems with that statement is that confounding variables can be affecting the results. That's only one of the reasons it's misleading though. There is no general consensus in science that altmed use decreases cancer survivability. Using a small study to imply that is the case is original research. It's also not needed to make the point that altmed can be harmful when used with conventional med; there is already another reference in the article noting that, but without the extreme claim based on vague results by a primary source. --Jack-A-Roe (talk) 07:18, 7 July 2008 (UTC)
honestly, I'm really skeptical of this passage now, and I think it should be kept out of the article. it's primary research, without third-party verification or secondary review, and its conclusions (even in their mildest form) have dramatic implications for the topic. I can't see any way that its inclusion in the article would not constitute or promote an improper synthesis. I'm willing to listen if someone can explain it to me, but it seems pretty cut-and-dried. --Ludwigs2 07:28, 7 July 2008 (UTC)

Our purpose on Wikipedia is not to report scientific consensus. If we did, our content would be limited indeed. For the vast majority of scientific knowledge, there is no consensus, there is just suggestive research. There's no dramatic implications from this study -- we put it in a short sentence in the safety concerns section. People can take what they may of it. Did you read my sentence, Ludwigs? There's no synthesis there. This is not cut and dried. II 07:32, 7 July 2008 (UTC)

I've known many people who've died of cancer, and in every case they tried alternative medicine because there was nothing more that conventional medicine could do for them and they only had a few months to live. That would greatly skew the results of such a study. Which brings me to my question to Fyslee or anyone who's actually looked at the study: Doesn't the study itself mention this obvious consideration? And others? Usually a study would. TimidGuy (talk) 11:39, 7 July 2008 (UTC)
This study is interesting because it was done very carefully over a long time, and because it included only those patients who weren't given up, but who were actively undergoing mainstream treatment. It then looked at many variables, and one that stood out as significantly interesting was that those who were concurrently using various alt med therapies were dying quicker and in greater numbers, all while still in the system. Other studies have speculated about what happens to cancer patients after they leave mainstream care. Cancer quacks make plenty of claims that they are curing such patients, but we can obviously not trust their versions. This study is an eye opener. It's not a pilot study, but it certainly can function in that manner because of it's very solid and well justified conclusion. Now just why is that happening? Why are these cancer patients dying quicker? Now that's where we could get into interesting OR. On this talk page it wouldn't harm, but we can't do it in the article unless we find good sources who do it. -- Fyslee / talk 14:40, 7 July 2008 (UTC)
Thanks. What do you mean by patients who weren't given up? And why does the study say predict rather than cause? TimidGuy (talk) 15:02, 7 July 2008 (UTC)
You have two questions:
  • "...weren't given up" means that they were undergoing care and hadn't been given up by their doctors. They hadn't left mainstream treatment. Even more significantly, they weren't even sought out for this study. This study was a study of a large number of cancer patients. Period. One result was very noticeable, and that was something that had never been studied before, hence the obvious paucity of studies. It was quite dramatic. A 30% worse prognosis based on one factor is pretty significant! Unfortunately for those patients, it wasn't even a prognosis. They actually are dead.
  • "...predict rather than cause." No evidence was found, nor sought, as to specific causation, but the very fact that these cancer patients who used alt med concurrently with mainstream care were dying at a 30% greater rate was so significant that one could use it as a predictor of the future, IOW it is a prognostic factor. Now cancer specialists can add alt med use as a negative prognostic factor when discussing their cancer patients' future with them: "Do you really want to diminish your chances of survival by 30%? OK, just keep on using alt med." It's just like when scientists discovered the role of tobacco in lung cancer and other diseases: "Do you want to die of lung cancer? OK, just keep smoking and you will increase your risk by XX%."
Now we, as editors, don't know which of many possible confounders are responsible. Maybe some future studies will enlighten us and we can use them when that happens. Is it the very mentality that also leads some people to choose to use alt med? Very likely. (That mentality often includes skepticism towards MDs and standard treatment, as well as tendencies to "go it alone", "I can beat this thing naturally", etc.. My mother and both MIL died largely for these reasons, among others.) Is it some of the specific modalities used? Maybe in some cases, and not at all in others. (Homeopathy is harmless.) Is it a tendency to use alt med instead of standard care? Normally a very strong "yes", but NOT IN THIS CASE! In this case that wasn't a factor at all. On the contrary.
On another note: Obviously any cancer patient who uses alt med alone is going to experience the same death rate percentages we used to see before better screening and treatments were developed - nearly 100%. The patients in the study who didn't use alt med concurrently with standard care were experiencing 70% better results in one way or another from their standard treatment. Either they lived longer before dying, or they were actually cured. Those who experienced 30% worse results were experiencing what 100% of previous cancer patients have experienced, although, since they were actually probably getting some benefit from standard care, that's not totally correct. Their statistics were in relation to a group who did better than previous cancer patients. -- Fyslee / talk 02:37, 8 July 2008 (UTC)
ImperfectlyInformed - please allow me to quote from wp:reliable#scholarship

In science, single studies are usually considered tentative evidence that can change in the light of further scientific research. How reliable a single study is considered depends on the field, with studies relating to very complex and not entirely-understood fields, such as medicine, being less definitive. If single studies in such fields are used, care should be taken to respect their limits, and not to give undue weight to their results. Meta-analyses and systematic reviews, which combine the results of multiple studies, are preferred (where they exist).

the problem here is that this study will be read by almost everyone as evidence that AltMed is dangerous, and that will give the study an unavoidable undo weight. there's no way that you can temper the threat of death by the thought that it's a tentative, preliminary study. --Ludwigs2 19:47, 7 July 2008 (UTC)
I concur with this Ludwigs2's clear statement of this important point. --Jack-A-Roe (talk) 19:52, 7 July 2008 (UTC)
Indeed. We should not give it too much weight. I would say that one short sentence is not too much weight. II 02:00, 8 July 2008 (UTC)
On reviewing this study and how it was presented, I do not think that it was being given undue weight. This is precisely why I exhorted everyone to suggest all changes here before hacking away at the article. We of course should neither state nor imply that the study proved more than it did, but that does not mean that it cannot be the basis for a valuable contribution to this article. 24 citations (GoogleScholar) in five years is pretty respectable, and the journal easily passes WP:RS. I have not checked the rest of the critical appraisal, but Edzard Ernst cites it favorably here. - Eldereft (cont.) 05:16, 8 July 2008 (UTC)

More on the Risberg Cohort Study

That study needs to be returned to the article. We can also cite many other sources that comment on it or use its results, since it is quite noteworthy. It is worth developing into a separate section that needs addressing.

Here is just one interesting comment about it:

  • "In 1992, Risberg and colleagues surveyed close to 1,000 Norwegian cancer patients about alternative treatments for cancer. Their initial purpose was to determine the prevalence and determinants of alternative medicine use.29 The investigators later realized that it would be possible to link their data to the Norwegian Statistical Registry to obtain information on survival. They found that alternative medicine use was associated with poorer survival; 79% of alternative medicine users died during follow-up compared with 65% of nonusers. This analysis was confounded by the poorer clinical status of users at the time of the survey. As might be expected, a patient with a treatable early cancer might be less likely to turn to an alternative cure than a patient with advanced disease and few remaining conventional treatment options. A multivariable Cox regression was used to control for baseline differences in stage, performance status, time since diagnosis, and other prognostic variables. There was a trend for alternative medicine users to have shorter survival (hazard ratio 1.30, 95% CI, 0.99–1.70; P = 0.056), a result that was robust to various sensitivity analyses. The authors hypothesized that shorter survival might be explained by "patients’ correct perception of the gravity of their disease." Whatever the explanation, the study certainly finds no evidence that use of alternative medicine improves survival.30 " Source

That final conclusion can certainly be used. -- Fyslee / talk 07:20, 8 July 2008 (UTC)

Thanks, Fyslee, for the further information. As it is, the article seems to imply that alternative medicine causes death. Yet the comment above doesn't go quite so far, and says that alternative medicine doesn't improve survival. Seems like it's a fairer conclusion, based on the evidence. TimidGuy (talk) 11:44, 8 July 2008 (UTC)
The article can and does quite legitimately state that alt med causes death in some cases, and we have refs for it. In the case of the Risberg study, it doesn't (didn't) even imply that. The study only states that it is an indicator, IOW useful as a prognostic factor. The comment above is very cautious and even speculative, yet it still makes a very solid and safe conclusion about the study - that alt med "certainly" doesn't help cancer patients to live longer. We can safely include that comment in conjunction with the reinclusion of the Risberg study:
  • "Whatever the explanation, the study certainly finds no evidence that use of alternative medicine improves survival."
That study is just too important (since it's the only one of its kind, TTBOMK) to be left out. -- Fyslee / talk 14:20, 8 July 2008 (UTC)
Thanks. I do prefer this way of stating the result, because it seems less prone to misunderstanding and the inference that this study showed that alt med causes death. Sorry, I just haven't had time to get the study myself. I do wonder about Jack-A-Roe's point that it lumps together all modalities. Does the study list them? TimidGuy (talk) 14:53, 8 July 2008 (UTC)

a few changes - conversation about a few more

I've made the following changes:

  • modifications to the regulation section to remove exaggerations (medical testing is batch-oriented, not dose-oriented)
  • added a 'dismissiveness' tag to to the 'Critics' explanations' section
  • removed a regulation section that duplicates something already presented in the main regulation section

I'd still like to make changes to 'Efficacy' section to remove redundancies and compress the criticism some - do we need to open a discussion on that, or can I start editing and see what happens? --Ludwigs2 20:54, 6 July 2008 (UTC)

Pretty good changes. There is one thing I find disturbing, and I've commented on the talk page for the template. The "Dismissiveness" template isn't based on Wikipedia policies, even though it mentions them. It's a POV tag that actually violates NPOV by enabling editorializing. The template is itself editorializing. There is no policy called "Dismissiveness". If sources are dismissive, then they can be quoted as dismissive, without violating policy. We can't start banning sources that are dismissive. Otherwise you made some good edits.
Other changes that could be controversial should be discussed here first. This article is a forest fire ready to blow and we need to avoid BOLD editing except for minor technical stuff. -- Fyslee / talk 06:30, 7 July 2008 (UTC)
I can swap the template if you like - I was going to go with the NPOV-section template, but I saw the dismissiveness template and thought it was more appropriate. but you're right, it's not really core policy. I might actually make an 'Unfair Tone' template as an alternative - that is core.
and ok, I'll open another section here tomorrow to discuss other changes - lord knows I don't want things to get out of hand; this article was protected long enough. --Ludwigs2 07:33, 7 July 2008 (UTC)
  1. ^ Risberg T, et al. Does use of alternative medicine predict survival from cancer? Eur J Cancer 2003 Feb;39(3):372-7 Abstract
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