Talk:Homeopathy/Archive 12

Homeopathy

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September 2009 - October 2009

In an effort to move this forward, I've gone backward

I think we bit off more than we could chew when we tried to make some needed adjustments to the current approved version of Homeopathy by making too many changes at once. Ideally, I think the process should take it one step at a time. I've looked at the history of changes and have reverted to the first group of changes that were made mostly to the science sections by our science editors. This was the version number 100486956 dated 12:27, 12 May, 2009I then replace the intro with the intro from tha already approved article, because that seemed to be something that was agreeable to we three editors that approved the article initially. I then added a slightly stronger statement about why science finds it hard to support. Hopefully, that would lead to a more likely chance of getting the incremental changes that would be improvements rather than total rewrites. I thought this might be a rational place to start.

From here, I will take another look and see if I feel it is something that I can nominate for approval. D. Matt Innis 02:12, 3 September 2009 (UTC)

Sorry, Matt, but that introduction is far too weak. There isn't any mention of disagreement by physicians until the third paragraph, and the issues about the danger of such things as homeopathic treatment of asthma remain buried. It's exactly that burial that brought the most outside criticism, which I think was justified. Howard C. Berkowitz 02:35, 3 September 2009 (UTC)

No reason to be sorry, a perfectly good point. All I am saying is that I might be able to endorse this version. You can make whatever changes you want and I might like them, too, but I can't speak for others. This is just my starting place, because the older version was in a state of stalemate that has left us with that version that you don't like so much. Besides, the new introduction wasn't anything I could endorse, not because of content, but because it was a mesh of wishywashy baloney. Sorry, but you have to agree it's true.D. Matt Innis 03:14, 3 September 2009 (UTC)

I've added back some detail on the proving of bamboo. While provings sometimes include placebos, it is unclear what use is made of this, as there seems to be no practice involving any rigorous comparison of placebo effects vs remedy effects. In this case, which I chose because it had been cited as an example of a well conducted proving, the placebo had effects that were explained away. I think it shows that provings, whatever their merits, do not conform to the conventional scientific method. As you will know, my preferred style is to state the facts and let them speak for themselves without editorial comment, so I don't feel it necessary to point out the divergence from scientific practice, but do feel it's appropriate to describe accurately what seems to be regarded as acceptable practice in homeopathy.Gareth Leng

Thanks Gareth, looks accurate to me. D. Matt Innis 02:04, 17 September 2009 (UTC)

Nominated for Re-approval

Okay, I've nominated this version for re-approval as a baby step that addresses some of the issues that Paul, Daniel and Howard had with the current article. I believe it to still be essentially accurate and neutral, but will consider arguments to the contrary. D. Matt Innis 19:13, 20 September 2009 (UTC)

In some correspondence with certain other Citizens I was given to believe that the article cannot be changed without the approval of Dana Ullman. Is this still the case? Raymond Arritt 19:42, 20 September 2009 (UTC)

No, it never was, it just needs three editors from any of the workgroups on the metadata template. D. Matt Innis 21:02, 20 September 2009 (UTC)

I have made some changes and would like editors to review these changes for the newest version. Dana Ullman 02:20, 22 September 2009 (UTC)

I have a serious problem with the sentence about the risks of not obtaining treatment being removed from the first paragraph. Yes, it is mentioned elsewhere, but it is so strong a position of the "other side" that I consider it unbalanced, especially in outside eyes, not to have it in the lede. It isn't saying homeopathy is flatly wrong, but that there is serious question of it -- a fact. Howard C. Berkowitz 02:24, 22 September 2009 (UTC)

Everything in the first paragraph should be highly notable. There is not much evidence that there is greater risk in seeking homeopathic treatment and therefore foregoing conventional treatment, especially in the light of the much (much) greater risks associated with conventional treatment. Dana Ullman 03:05, 24 September 2009 (UTC)

Nonsense, until you find some firm notable evidence that no homeopath will try homeopathic treatment in status asthmaticus or other emergencies, which a homeopath specifically said, in this article, he would do here. I find your statement a distinctly non-neutral defense of homeopathy by attacking the danger of medicine.

Neutrality and the avoidance of self-promotion, incidentally, rules out citing one's own popular, not formally reviewed works, from which one receives financial benefit. Howard C. Berkowitz 03:17, 24 September 2009 (UTC)

Title?

Dana added: Professor Luc Montagnier, the French virologist who co-discovered HIV and who won the Nobel Prize in 2008 conducted a series of experiments . I believe this can be shortened to: Montagnier conducted a series of experiments.

I write regularly about work by great scientists. If I would write in that style, I would write, for example:

Professor Albert Einstein, the Swiss physicist famous for his two theories of relativity and 1921 Nobelist, wrote in 1926 to the German professor Max Born, who was one of the co-founders of quantum mechanics and who won the Nobel Prize in 1954, that the "Old One does not throw dice", because he (Einstein) wanted to explain to Born his difference of opinion with professor Niels Bohr, the Danish discoverer of the quantum theory of atoms and founder of the famous Copenhagen interpretation of quantum mechanics for which he obtained the 1922 Nobel Prize.

Instead of simply:

Einstein wrote in 1926 to Born that the "Old One does not throw dice", because he wanted to explain to Born his difference of opinion with Bohr.

--Paul Wormer 11:31, 22 September 2009 (UTC)

Montagnier's findings are interesting, and at present unexplained. I don't think however that it's right to include them at this stage in an encyclopedia article. Essentially, there needs to be time for the results to be considered, replicated and sources of error to be identified and tested - the requirement that we normally cite reviews (secondary sources) rather than primary articles is just an important cautionary check to ensure that apparently important but flawed results are not incorporated prematurely into the body of accepted knowledge. I suggest that this section be moved into the Bibliography page so that it isn't lost, but not appear in the main article itself.Gareth Leng 12:02, 22 September 2009 (UTC)

I agree fully with Gareth. (I also will try to find and read Montagnier's article, because I don't know what a "distinct electromagnetic signature" is supposed to mean). --Paul Wormer 13:54, 22 September 2009 (UTC)

Paul...you made me laugh (thanx). However, it seems that you are exaggerating a bit here. A short bio of Montagnier is appropriate here, though it would be a problem if there were short bios of many players in this paragraph (and there isn't). Montagnier is quite a notable scientist, and for the record, this work is already highlighted at his bio on wikipedia (it seems that this addition was not made by anyone associated with homeopathy). http://en.wikipedia.org/wiki/Luc_Montagnier#Electromagnetic_signals_from_bacterial_DNA Dana Ullman 16:17, 22 September 2009 (UTC)

Dana, we have links. If you want to write anything about Montagnier be bold and edit the article Luc Montagnier.

In the meantime I followed your link and read the Montagnier et al. article. I completely agree with Gareth. The results of Montagnier et al. are very preliminary, their signals are very weak, and obtained with an apparatus invented 15 years ago by Benveniste and not developed any further. They do not have the beginning of an explanation of where their EM waves come from, and most importantly: the authors do not link their work to homeopathy. It is very audacious and (to my taste far fetched), in particular in an encyclopedia, to relate their findings to an explanation of homeopathy—especially at this very early stage of their research. In short, the paragraph about Montagnier's recent work should go.--Paul Wormer 17:01, 22 September 2009 (UTC)

Paul, did you know that the article in "Nature" by Benveniste in 1988 also never mentioned homeopathy or homeopathic? And yet, everyone understood that the implications were to homeoapthy. The Benveniste research, like Montagnier's, used water as the dilutant and acknowledged that the effect required vigorous shaking. Both studies also found that certain high temperatures erased the previously observed effect. Please note that what I wrote about this new work did not say that it was a homeopathic study, but like Benveniste's work, it has implications for homeopathy. Dana Ullman 22:01, 22 September 2009 (UTC)

I agree that we should leave out both the Montagnier work and the bamboo proving. Both subjects could be discussed in adjunct articles when we get there, maybe even the Memory of water article? Right now, the bibliography is probably a good place for it. D. Matt Innis 00:14, 23 September 2009 (UTC)

Updated re-approval version

Thanks all for the comments and edits. I've made some mostly style edits that better explain the homeopath's premise before the science and medicine comment on their premise. I have updated the re-approval versionD. Matt Innis 15:39, 22 September 2009 (UTC)

OK...but I am totally against the insertion that European MDs who use homeopathic medicines do so only or primarily for "self-limiting conditions." That is patently false, and Gareth continually inserts it without any references. Below are plenty of references that prove him inaccurate. I have changed the article accordingly.

A 2005 survey on the use of complementary and alternative medicines (CAM) among cancer patients in Europe reported that 36% of those patients with cancer used one or more CAM therapy.[2] Herbal medicines and remedies were the most commonly used CAM therapies, together with homeopathy, vitamins/minerals, medicinal teas, spiritual therapies and relaxation techniques.

A 2008 survey of German children with cancer was conducted and which found that 35% of the responders had used CAM.[3] The most frequently used methods were homeopathy, dietary supplements and anthroposophic medicine including mistletoe therapy. Factors which increased the probability of using CAM were the previous use of CAM, higher social status and poor prognosis of the child's disease. An impressively high percentage of parents of patients (89%) reported that they would recommend CAM to other parents.

A 2005 survey on the use of complementary and alternative medicines (CAM) among cancer patients in Europe reported that 73% of the Italian cancer patients had used CAM, a number well above the European average of 36%.[4] The most popular treatment modalities used by cancer patients in Italy were high use of homeopathy, herbal medicine, and spiritual therapies. A 2008 survey in Tuscany, Italy found that the incidence of CAM use after cancer diagnosis was 17%, with the most widely used forms being herbal medicine (52%), homeopathy (30%) and acupuncture (13%).[5] Use was higher in the urban area and among women, breast cancer patients, and persons with a higher education.

A survey of Italian children with cancer who were being treated at a conventional pediatric oncology unit found that 12.4% of the children used at least one type of CAM, with homeopathy being the most popular.[6] 83% of the parents of these children reported benefits, ranging from improved immune defenses, regression of diplopia, or improved blood values). This study confirmed the observation of many other surveys which found that users of CAM tended to be more educated than those who did not use CAM.[7] [8] [9]

---

[6] Clerici CA, Veneroni L, Giacon B, et al., Complementary and alternative medical therapies used by children with cancer treated at an Italian pediatric oncology unit. Pediatric Blood Cancer. June 2009. doi 10.1002/pbc.22093.

[7] Gomez-Martinez R, Tlacuilo-Parra A, Garibaldi-Covarrubias R. Use of complementary and alternative medicine in children with cancer in Occidental, Mexico. Pediatr Blood Cancer 2007;49:820–823.

[8] Gozum S, Arikan D, Bu¨yu¨kavci M. Complementary and alternative medicine use in pediatric oncology patients in eastern Turkey. Cancer Nurs 2007;30:38–44.

[9] Nathanson I, Sandler E, Ramı´rez-Garnica G, et al. Factors influencing complementary and alternative medicine use in a multisite pediatric oncology practice. J Pediatr Hematol Oncol 2007;29:705–708.Dana Ullman 02:47, 25 September 2009 (UTC)

The claim is that European MDs who use homeopathic medicines do so only or primarily for "self-limiting conditions." This claim is not contradicted by these studies (I think the above is from Dana - signature missing)), clearly many patients use CAm for other conditions - but not prescribed by MDs. These are studies of usage, not reports of prescribed treatment. Indeed the first states clearly that "In almost all cases, oncologists were not informed that a child was using CAM, posing a risk of any interaction with pharmacological treatments being inadequately understood" and the second states clearly that "but in most cases, the treating physician was not informed about this practice." Some MDs in sveral contries are happy to prescribe homeopathic remedies at the patient's request for minor self-limiting conditions. But prescribing for other conditions is I think very rare. It's very important to be clear that for MDs to prescribe homeopathic remedies for serious conditions is not regarded as acceptable generally.Gareth Leng 16:04, 24 September 2009 (UTC)

Yeah, the above references were from me. It seems that Gareth is shooting from the hip and is simply guessing what MD/homeopaths do or don't do. Unless you can provide notable references to your "evidence," please let go of this one. It seems that your knowledge is completely American-centric and don't seem to realize how much "medical chauvinism" runs your perspective. Lots of MDs in Europe use homeopathics in a full medical practice as their primary drug treatment and resort to using conventional medicines only as a secondary option. Here's some more facts and references to patients with serious or severe chronic illness and who seek MD/homeopathic care:

In 2004 a total of 7.5 million Italians use homeopathic medicines, 2.5 million more than a survey showed in 2004. Approximately 14% of Italian women and 10% of men prefer homeopathic medicine to conventional medicine. A total of 9.6% of children between three and five years of age are treated with homeopathic medicines. Almost 90% of Italians who have used such medicines say these treatments helped by them, with 30% saying that they used homeopathic medicines for pain syndromes and 24% for severe or chronic diseases. Refenence: ANSA English Corporate Service, 7.5 Million Italians Use Homeopathic Drugs, May 20, 2004.

Five hundred and fifty-two patients who had inflammatory bowel disease and who were under treatment at a tertiary medical referral center completed the questionnaire; 156 (28%) reported using alternative and complementary therapies, of which mainly involved homeopathy (43.6%), followed by controlled diets or dietary supplements (35.5%), herbs (28.2%), exercise (25.6%) and prayer (14.7%). An improvement in well-being (45.5%) and inflammatory bowel disease symptoms (40.3%) were the most commonly reported benefits. A higher education (p=0.027), a more frequently relapsing disease (p=0.001) and dissatisfaction with the doctor's communication (p=0.001) correlated with alternative and complementary therapy use. Non-compliance with conventional drugs, disease severity and curiosity regarding novel therapies were predictors of alternative and complementary therapy use. Reference: D'Inca R, Garribba AT, Vettorato MG, Martin A, Martines D, Di Leo V, Buda A, Sturniolo GC, Use of alternative and complementary therapies by inflammatory bowel disease patients in an Italian tertiary referral centre, Dig Liver Dis. 2007 Apr 10. Dana Ullman 02:47, 25 September 2009 (UTC)

I think Gareth's point is that there is nothing in any of these sources that says that MDs are the ones that prescribed the homeopathic remedies. They say that patients use them (along with other CAMs - if I remember correctly, the biggest were prayer and herbal supplements), but if anything they tend to infer that the patients are doing this without their MDs knowledge. (I use MD as "medical professional" as I understand other countries have different degrees bestowed upon medical staff). I think if we are going to make such a statement in our article, we should have something that specifically states such. Considering Gareth's credentials (and citizenship), I think he would be the best here to assess what an MD thinks. I do trust Dana knows what homeopaths think. So let's trust Dana for homeopaths and Gareth for MDs. D. Matt Innis 04:24, 25 September 2009 (UTC)

Thanks Matt, you're right, many people use homeopathic remedies, but they are not prescribed by MDs. Yes, homeopathy in Italy has been used at least once by about 24%% of the population, but it is not widely prescribed by MDs. In fact, of Italy’s 250 000 allopathic physicians, only 5000 use complementary/alternative techniques, according to WHO [1], and those who do use it are mainly GPs or pediatricians. This is 2% of allopathic physicians - not "lots" by my reckoning. In both cases the main use will be for self limiting conditions as placebos (pediatricians often prescribe placebos to reassure anxious parents). The costs of homeopathic remedies are not reimbursed by Italy's national health system. Surveys on usage of homeopathy are not relevant to prescription patterns. And by the way, I am of course European.Gareth Leng 14:29, 25 September 2009 (UTC)

Let me reinforce your observation: Use of CAM does not mean use of homeopathy. If I were to have a low back pain incident, after ruling out any unlikely but life-threatening etiology, I'd likely go to one of Matt's colleagues. Chiropractic, according to the NIH Consensus Confererence, has the best outcomes for acute back pain. Chiropractic falls under CAM, but my consultation should not add to statistics used to support the widespread use of homeopathy.

I saw my primary internist yesterday for a skin infection; he prescribed one antimicrobial and one food product. Was that a CAM encounter?

Ah, the homogeneous Europeans...starts off with one of the old jokes putting the Italians as the lovers in heaven and the managers in hell. Howard C. Berkowitz 15:30, 25 September 2009 (UTC)

high rate of patient satisfaction.

"high rate of patient satisfaction." That's nice, I suppose. I remember hearing about how satisfied a community was with their physician, as he managed to get to every one of his frequent patient funerals.

I've been depressed in working with some marketing-driven hospitals, with multi-hospital systems insisting they could only have satisfied patients if there was full wireless access in every patient room. Others found they could improve patient satisfaction with better decor.

When I was in a very pretty hospital room, following pacemaker insertion, I watched as my heart monitor leads fell off and the monitor presumably flatlined. There was insufficient staff to respond to the call button; I eventually called the hospital on an outside line, got the chief nurse, and explained I was a patient in asystole, if anyone cared.

Indications of reduced mortality and morbidity is one thing. Patient satisfaction, at least for anything not self-limiting, is essentially irrelevant and does not belong in this article; it's snake oil as far as objective outcomes. Howard C. Berkowitz 03:37, 24 September 2009 (UTC)

Yeah, I'm not sure how relevant patient satisfaction is. Grant, for the sake of argument, that the skeptics are right about homeopathy - that there is no scientific backing to homeopathy and that it relies solely on placebo - then comparatively, patient satisfaction would be very high, as would other placebo-based treatments. Lots of people being satisfied is not an argument for something being true - as you say, other factors play into it. Patient satisfaction in a hospital is great, but it's really a much less important factor than, say, the effectiveness of the interventions, the mortality rate and so on. It would be very strange to have a CAM intervention that is placebo-based and had a low patient satisfaction rate - both because the patient satisfaction is part of what makes the placebo work, and also because CAM interventions, unlike orthodox interventions, are generally pursued through the marketplace rather than through a national health system, they are likely to be selected through a capitalist process for patient satisfaction rather than the satisfaction of, say, the National Institute of Clinical Excellence or some other body who decide things on mostly objective criteria. The same is true of every field: you'll have a much easier time convincing a room full of teenagers that Harry Potter is the greatest book ever written than convincing a room full of literature professors. Given that, should patient satisfaction be included in the article? Of course. The lack of patient satisfaction - if it is so - that comes from something like chemotherapy would be duly noted on an article page. But just as lack of patient satisfaction is not an argument against chemotherapy's clinical efficacy or safety, lots of patient satisfaction for homeopathy isn't an argument for homeopathy's clinical efficacy or safety either. The only time when you might want to use that, as far as I can see, is if you've got two interventions that are both as efficient and as safe as each other, but patients have a higher rate of satisfaction for one than the other - it's a pretty good tie-breaker. —Tom Morris 17:57, 24 September 2009 (UTC)

Apropos of appropriate interventions with little patient satisfaction, [2]

There are at least two questionable arguments being made here, one of patient satisfaction, and the other based on attacks on the hazards of medicine. At least in U.S. medicolegal theory, there are the doctrines of res ipsa loquitur, of the "reasonable man", of the concept of manslaughter as "depraved indifference to human life." Whenever I hear "well, there's not much evidence that people are not getting medical treatment because they go to homeopaths," and I fail to hear a homeopath make an unambiguous disclaimer about emergency situations, I don't think the article is ready for approval. Now, I make use of complementary medicine (not homeopathy), but I wouldn't dream of it in a situation that is potentially life-threatening and where there are medical interventions of demonstrable efficacy, as in asthma, especially status asthmaticus or anaphylaxis. Howard C. Berkowitz 18:13, 24 September 2009 (UTC)

Actually, I challenge ANY health or medical professional in a family practice to prescribe just SUGAR PILLS to people and see what "patient satisfaction" they get. When they get calls late at night and on weekends because their sugar pills were not effective for the asthma attacks, for the pneumonias, for the migraine headaches, for the arthritis, etc. And for the record, people who seek homeopathic treatment are more educated than those who don't (that does not "immunize" them to a placebo effect, though uneducated people are much more easily fooled by than the more educated). You can make fun of patient satisfaction all you want, but my statements are backed up by evidence. What are yours backed up by? Dana Ullman 02:35, 25 September 2009 (UTC)

Nice change of subject from the issue of response to emergency situations. Speaking of backup, I see the citation of "Dana Ullman (2007) The Homeopathic Revolution: Why Famous People and Cultural Heroes Choose Homeopathy. Berkeley: North Atlantic, 2007; www.HomeopathicRevolution.com." You have, I trust, read CZ:Policy on Self-Promotion? Howard C. Berkowitz 02:44, 25 September 2009 (UTC)

I see an expert writing in their area of expertise. Howard, I don't see your point. Russell D. Jones 02:57, 25 September 2009 (UTC)

It's a book written for a popular audience, without expert review, and not speaking of science but of "famous people and cultural heroes." When I have cited my work, it has been of things that went through thorough peer review from academic presses. Further, I don't have advertisements for $100 autographed copies. [3] Sorry, I see self-promotion. Howard C. Berkowitz 03:00, 25 September 2009 (UTC)

(undent)I have no problem with a statement that patient satisfaction rates are high as there are surveys that state that it is so. I think it is generally true for all the reasons that you state above. I also think the statement speaks for itself and doesn't need any commentary about why this is only half the story. Dana's book does reference some good sources. It should be in the bibliography. D. Matt Innis 05:06, 25 September 2009 (UTC)

I think Dana's book should be cited by someone other than Dana if it is to be cited at all, but would like to add that if Dana's work should go into the bibliography, then we should certainly see more reference to the work of Edzard Ernst, what with him being a professor of complementary medicine, author of several books, etc. I was surprised to see no reference to Ernst and Singh's Trick or Treatment? Alternative Medicine on Trial as well (although given this statement, perhaps Matt is not best-placed to approve anything involving Singh's name). John Stephenson 11:40, 25 September 2009 (UTC)

I'm okay with having both books in the bibliography, John, feel free to put them in. If you have a problem with my qualifications to approve anything, feel free to bring that to the appropriate forum and I'll be glad to address charges accordingly. D. Matt Innis 22:06, 26 September 2009 (UTC)

I was reluctant to add them given your statement elsewhere, but OK, I'll put them in. John Stephenson 03:15, 27 September 2009 (UTC)

Dang, must have been a pretty strong statement to scare you. Don't you live in China?! Now that's scary :-) D. Matt Innis 04:00, 27 September 2009 (UTC)

Japan. And you live in North Carolina, which is pretty scary as well. :) John Stephenson 06:29, 27 September 2009 (UTC)

Haha! Yes, you have to watch out for those Dukes of Hazard drivers and Nascar fans! D. Matt Innis 14:09, 27 September 2009 (UTC)

At least semi-lower-case "e"ditorial

The paragraph below is contradictory--how can it be a better metaphor if it's not used or understood?

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

Something I think we discussed before -- footnotes should not contain substantive discussions. It's one thing to define qi or symptom, but the discussions of measles, gas gangrene, etc., either belong in main text or links, where they are more subject to scrutiny. Especially with a multi-screen article, I don't usually jump down to each footnote to check if it's more than bibliographic.

I haven't yet moved any of those substantive discussions.Howard C. Berkowitz 19:02, 26 September 2009 (UTC)

Well, it can be a better metaphor than an alternative that is completely hopeless, so it's not self contradictory (better is a comparative, something can be better while still poor). I think metaphor is the right word here, and although Mithridization is maybe an esoteric notion, I guess the explanation makes sense of why it's a plausible metaphor.Gareth Leng 14:41, 30 September 2009 (UTC)

I remain unconvinced that metaphors are useful in a description of therapies. Howard C. Berkowitz 21:56, 30 September 2009 (UTC)

To approve

I think, above, there was some agreement with my suggestion to move the Montagier passage to the Bibliography, which I've done. I'm happy to support approval with that change. Gareth Leng 14:41, 30 September 2009 (UTC)

Thanks, Gareth. Matt, do you support that change? If so, you should have a look at any other changes that have been made and consider updating the version to be approved. Then Gareth can add his name to the metadata template. --Joe (Approvals Manager) 15:25, 30 September 2009 (UTC)

I've updated the metadata to the last version it appears Gareth would have seen. In subsequent versions, I edited the last sentence and would also approve those changes. Any copy-editing of the intro is appreciated as well. D. Matt Innis 00:29, 1 October 2009 (UTC)

Any particular reason my edit was reversed?

I think what I said was pretty reasonable. Why's it disappeared? –Tom Morris 21:33, 30 September 2009 (UTC)

Tom, if you are referring to the change starting "Skeptics...", I was actually going to edit it, but it disappeared before I could. The method you describe is not at all restricted to skeptics of homeopathy, but is a quite reasonable approach to any therapy, including things quite science-based, that are considered "low-responder" or inherently individualized such that a traditional randomized controlled trial won't work. Clinical trials in pharmacogenomics very well may use that method, since therapies customized for individual genotypes also don't lend themselves to large trials with a standardized control and treatment arm. Howard C. Berkowitz 21:55, 30 September 2009 (UTC)

Re-approval

Joe Quick is going to have to look at this article and straighten things out again. There *seems* to be a more recent edit by Tom Morris since the version nominated. But has it gone missing? I'm goin' fishin' until I have absolutely clear orders about what to do. And the nominated version is the same as the latest date. Or Matt can do it.... Hayford Peirce 18:35, 9 October 2009 (UTC)

Oh, that's right, Matt can't do it since he's an Editor here. So it's up to Joe and/or the Editors to get things to the point where I can understand them. Hayford Peirce 18:35, 9 October 2009 (UTC)

I've stated this multiples times before: the version that is approved does not have to be the latest version. It would be great if the approving editors all agreed to update the version to incorporate the most recent changes but they need not do so for approval to go through. They all approved the version Matt first nominated for approval. If the version is not updated, then the old version that they all supported is to be approved. --Joe (Approvals Manager) 19:51, 9 October 2009 (UTC)