Talk:Homeopathy/Archive 6

Homeopathy

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Oct. 20-Nov. 3, 2008

Discussion of ground rules and other issues

I have removed the text below from the article, as the statements are not supported by the reference; an online link to it is now in the article. In addition, I have posted an article on Oscillococcinum.

Some randomized controlled trials that have tested the efficacy of homeopathic medicines have reported positive results, but, as mainstream physicians contend that large randomized controlled trials have generally not shown effectiveness beyond placebo effects, except for the fact that four large trials (totaling 1,194 patients) have found efficacy from Oscillococcinum 200C in the treatment of influenza.

The text above is somewhat hard to parse, and the statistical data is a bit more than "mainstreams physicians contend." It also does not reflect the studies. There were seven, not four, trials. Four were of treatment and three of prevention; the 1,194 figure above only reflects the treatment trials, not the prevention trials in 2,265 patients.

It was the conclusion of the Cochrane reviewers that only two of the studies were statistically adequate. Looking at all seven, however, they concluded Oscillococcinum had no preventive effect, but showed enough treatment effect to warrant further studies. They did not consider it ready to recommend as first-line therapy.

I have also removed from the article

Homeopaths counter that the vast majority of these larger trials tested a single remedy given to every patient without any individualized treatment, suggesting that these larger trials did not maintain external validity to the system of homeopathy and are therefore not valid tests of it.

If there is a specific homeopathic publication or presentation that counters these specific findings, it should indeed be in the article, with sourcing. The text above, however, implies that homeopaths reject the specific Cochrane study, but give no specific arguments against it.

I'm honestly puzzled, and would appreciate being educated, on why homeopathic remedies, based on symptoms, would be used as preventive measures. Honest question: does homeopathic theory say that the administration of a remedy will prevent, as well as treat, the symptoms in question? Howard C. Berkowitz 22:35, 20 October 2008 (UTC)

Thanx Larry. I am not at all clear how much of your comments are directed to me or to other people here. To date, I have not engaged in any edit wars, and although I have occasionally deleted some material, I always try to add comments and discussion. If and when I err here, please alert me. That said, our lead previously made four references to mainstream doctors not accepting homeopathy. This redundancy, within a short section, seemed non-encyclopedic. Heck, one could choose to have a "skeptical" comment after every sentence here, but needless to say, that would be too too much. Let's seek a middle ground.

As for the term "skeptic," I do not see that it is prejorative (in fact, many skeptics of homeopathy are very proud of their skepticism). I personally think that the term is simply descriptive of some people's attitude towards the subject of homeopathy...and it would seem that "mainstream physicians" is not an adequate description of the variety of people who are skeptical of homeopathy.

As for Howard's statement above, the written info on Oscillococcinum in this article is correct. I didn't highlight the "prevention" studies because the subject at the time was "large trials" that had a positive result for this medicine. The preventional trials did not have a positive result, while the treatment trials all had a positive result. As for prevention trials, I do not at present see any statement in our article that says or suggests that homeopathic medicines have been shown to "prevent" a specific disease. Dana Ullman 00:28, 21 October 2008 (UTC)

Re the term "skeptic" and "skepticism," I am going to have to disagree and insist that we use another term. Again, Dana, the point is that the other side rejects the term, because it is used in a way that implies that there is some presumption in favor of homeopathy. Suppose a creationist, or a tarot card reader, or some other view you had little respect for, were to insist on labelling the critics of the views as "skeptics" and never as "scientists"; they would prefer to be describe not according to their attitudes to the subject matter, but according to their qualifications: they are scientists. Let's be very clear. This is an expert-guided encyclopedia and it reflects the mainstream, expert view first and foremost. For that reason alone, any presumption is frankly not in favor of homeopathy. That is why it is crucial that there be critical remarks from the point of view of, indeed, mainstream medicine throughout the article. This should not be done in a way so as to interrupt the flow of the narrative, or make it impossible to state the view of homeopathy clearly and even sympathetically. Again, when the back-and-forth in the text of the article occurs, it should be as clear as possible to the reader that such a critical discussion is not done in order to recommend or refute any view of the subject, but in order to give the reader both maximum information and a robust sense that he may make up his own mind as unincumbered as possible by any dogma.

Let's think creatively about other possibilities we might be able to agree upon, please. I am partial to "mainstream physicians," which is precisely descriptive. "Skeptical mainstream physicians" might work as well. But maybe another word or phrase entirely, like "Critics in the mainstream health community" and the like. --Larry Sanger 03:57, 21 October 2008 (UTC)

There is a major controversy in evidence-based medicine over the selective publishing of trials. There is a particular sensitivity about sponsors deciding not to publish results that showed no efficacy, not just where there were no side effects. AIn this specific case, the Cochrane (i.e., Vickers and Smith) meta-analysis addressed both prevention and treatment trials. If the present article does not mention prevention trials, yet there were sufficently large studies to justify meta-analysis, that seems a deficiency in the article. While you might not be using homeopathic preparations for prevention, there are a substantial number of published studies that do. You may not be saying that medicines prevent things, but there are clearly homeopaths who do, and who have conducted trials to investigate that.

Stevinson and colleagues published "Homeopathic arnica for prevention of pain and bruising: randomized placebo-controlled trial in hand surgery" [1]. Jacobs et al. published "Homeopathy for Attention-Deficit/Hyperactivity Disorder: A Pilot Randomized-Controlled Trial" [2]]. A meta-analysis of "Homeopathy for Childhood and Adolescence Ailments" specifically addressed prevention as well as treatment [3]].

Need I add more citations to demonstrate that if the article does not discuss homeopathic approaches to prevention, the problem is in the article's coverage? I'm not making any judgment if these studies showed benefit or not. The point is, Dana, that if there is significant homeopathic work in any area, that needs to be covered in the article about what homeopathy is, rather than how it is criticized. Howard C. Berkowitz 01:01, 21 October 2008 (UTC)

This article should be

about what homeopathy is, rather than how it is criticized.

. I'm wondering what was wrong with

Homeopaths counter that the vast majority of these larger trials tested a single remedy given to every patient without any individualized treatment, suggesting that these larger trials did not maintain external validity to the system of homeopathy and are therefore not valid tests of it.

which Dana had inserted?—Ramanand Jhingade 02:52, 21 October 2008 (UTC)

What is wrong? It says, in very, very general, nonquantitative terms, that homeopaths don't like trials. It doesn't say how homeopathy can be validated beyond "trust me". There are statistical methods for testing individualized therapies, used in fields beyond homeopathy, but there has been no response, by homeopaths, to descriptions of such methodology. It states nothing positively about homeopathy, just negatively about evidence-based medicine. Please don't bring up the argument that people who haven't tried it can't judge it; that is meaningless.Howard C. Berkowitz 03:02, 21 October 2008 (UTC)

Howard, I really don't have the time (I really don't). I'm sure there are statistical methods for testing individualized therapies with respect to homeopathy; for a change why don't you look for those on the Net and include it/them here?—Ramanand Jhingade 03:15, 21 October 2008 (UTC)

First, Gareth and I already discussed such methods as used for pharmacogenomics, and no homeopath responded. Second, why should I go searching for proof that homeopathy is statistically effective? How did it become my problem to prove the homeopathic position from a scientific standpoint?

You say you are sure there are such methods. Why are you sure? Howard C. Berkowitz 03:20, 21 October 2008 (UTC)

I probably di'n't have time to see it. I was requesting you to do so because you have more time than me to do these things. I did see something at, 'http://www.guna.it/eng/ricerca/indice.htm'. There are other such things/sites which I don't have time to look into. Please do the needful. I'm sure you can improve this article by doing so.—Ramanand Jhingade 03:34, 21 October 2008 (UTC)

I'm really confused. Why should I do the research to support your point of view, when I haven't seen much evidence that it works? The reason I spend time on this is for the good of Citizendium's quality, not to be an advocate for homeopathy. Howard C. Berkowitz 03:38, 21 October 2008 (UTC)

It' only for the good of Citizendium's quality that I'm requesting you to do so. I also hope that you can include some matter from the memory of water article in the 'Scientific basis of homeopathy' section to make it more neutral. I also feel that you should reintroduce the sentences where the term, 'skeptic' was used - neither Larry nor I consider that term pejorative/deprecatory. Thanks in advance for all the help.—Ramanand Jhingade 04:06, 21 October 2008 (UTC)

Perhaps I'm confused, but Howard, it sounds to me as if Ramanand is insisting that his view, probably shared by Dana and other homeopaths, be permitted to be included in the article. Are you actually saying that, no matter how confused or misleading their view is, you have decided it can't be included? Surely you aren't saying that, but then I can't figure out what you are saying.

Perhaps it would be better to work with them on a clarified version of the claim and then, when it's as clear as it can be made, you simply add a sentence or two explaining how mainstream medical researchers would (or do) respond to such a sentiment. What's wrong with that? In fact, isn't that what our neutrality policy requires? Maybe I'm confused, it is a little late. --Larry Sanger 04:02, 21 October 2008 (UTC)

Larry, Howard - that is what all of us want, i.e.both sides views should be incorporated in this article. Howard relatively has a lot of time, so I was hoping he could improve the article by incorporating both sides views.—Ramanand Jhingade 04:11, 21 October 2008 (UTC)

No, I don't think all of us want. Homeopathy is not a mainstream opinion. If the homeopaths want to put out their view, and accept that it simply does not have reasonable support by the criteria that would be applied to any medical therapy, fine.

I don't see an equal set of views. One has testable models and consistent scientific theory. One has vitalism and spirit forces. It seems rather like religion and science; they are completely different models of thinking. As far as I can tell, you want homeopathy to be accepted on faith and testimonials. I have no idea how to improve something that has yet to give me any plausible reason that it works in any explainable way. Howard C. Berkowitz 04:29, 21 October 2008 (UTC)

A comment here was deleted by The Constabulary on grounds of making complaints about fellow Citizens. If you have a complaint about the behavior of another Citizen, e-mail constables@citizendium.org. It is contrary to Citizendium policy to air your complaints on the wiki. See also CZ:Professionalism. (I removed a comment that concerned the qualifications of others to participate here. This sort of comment is contrary to CZ:Professionalism.)

I agree with your attitude on the merits of the issues 100%, Howard. That said, I'm afraid you have missed my point. I am not asking you to endorse the position that "there is an equal set of views here," whatever that might mean precisely. I am asking you to let homeopathy state what you regard as nonsense. You lack the right to prevent Ramanand and Dana from expressing some view, even if it is a nonsensical view, of mainstream science and trials and so forth. But I frankly don't understand why you don't simply say, "Fine, now let me explain how mainstream science responds to that." After all, that is what you are, quite irrelevantly, insisting on so strongly here on the talk page. If so, then let them have their say, and (essentially) say what you say in response to it in the article.

The neutrality policy means you cannot speak only for yourself here; you speak for everyone, including your intellectual sparring partners. You must try to express the homeopathic view as sympathetically as possible--while expressing the mainstream reaction to it as sympathetically as possible as well.

And this goes for both sides. I am tempted to remove everyone who has been disputing from this article for a time, and let others have a crack at it, simply on grounds that there is good evidence on both sides, I'm afraid, that people are trying to make the article speak with their own biases, and not working together to present the dialectic clearly. There is far too much concern that our own biases be reflected in the article. Anyway, enough of this--I think I've made my point (once again). --Larry Sanger 04:49, 21 October 2008 (UTC)

Larry, I tried to express the homeopathic view sympathetically. Remember that table where I tried to get a translation of terminology? No cooperation.

"Fine, now let me explain how mainstream science responds to that."

There has been nothing to which a mainstream science response can be made. Mainstream medicine uses controlled experiments, measurable phenomena, peer review. This keeps coming back to anecdotes and "trust me". Howard C. Berkowitz 04:59, 21 October 2008 (UTC)

Au contraire. What you just said is a mainstream medical response, it seems to me.

As for that table to translate terminology, I would like to see it moved to Homeopathy/Catalogs and perfected. --Larry Sanger 13:47, 21 October 2008 (UTC)

Statistic given in article does not appear in cited source

I have deleted this bit:

42% of British doctors refer patients to homeopaths.

The article says that 42% of British doctors "refer patients to homeopaths." I found no such claim in this article, which was cited. All that I could find on a scan of the article was "up to 37% of British general practitioners use homoeopathy." There was also this: "Those who use homoeopathy regularly do so in about a quarter of their consultations, the proportion being higher for hospital and private specialists." A text search for the string "42" did not bring up the statistic.

Our article should note that this source is a review article and not reportage of original research findings. For that reason it is difficult to tell exactly what the statistics mean, without looking up the article's sources. Does the 37%, or 42% (???), represent the number of British doctors who regularly refer patients to homeopaths? Who have ever even once used it themselves, i.e., tried it out? Who use it personally (i.e., not to treat their patients but themselves)? Who use experimental therapies on their patients, that also happen to be used by homeopaths? What? I am sure that 37%/42% does not represent the number that regularly use homeopathy, for the simple reason that the article does also say that "those who use homeopathy regularly do so in about a quarter of their consultations," which seems to imply that there are those who use homeopathy, but not regularly.

The statistic may also not be significant (and this should be stated in the article perhaps after a little discussion) due to the nature of the referrals, i.e., it is entirely possible that people are referred to homeopaths because patients specifically ask for such referrals, not because the physician would make such referrals generally. Moreover, it would be important to know to what extent these physicians refer to homeopaths as a "last resort," after conventional medical solutions are tried, and patient and doctor are desperate to try things even if they may have no effect at all.

I dwell on this point only to underscore a point that I believe Howard, Chris, and others are making here: these sorts of statistics absolutely do not speak for themselves. If you want to make such claims in the article, they have to be either properly clarified, or else qualified, i.e., mentioning the uncertainty about how they are to be interpreted. Even if we have a neutrality policy, the license that the policy gives us all, to state our views forthrightly, does not also license us to make claims that are unsupported by the evidence (as the 42% statistic appears to be) or to make claims that are very vague and, due to their vagueness, misleading as to the evidence.

I believe that all these claims should be checked and removed if similar problems to the 42% problem are found.

Also, to the person who added the 42% statistic--may we please have an explanation?

Finally, as to the point that such statistics are trying to make--that homeopathy enjoys the status and honor of intellectual support from medical doctors in these percentages--well, that doesn't follow from the statistics cited. Someone might refer, or use, homeopathy, and do so being entirely skeptical of it--almost, as it were, superstitiously. Human beings are like that. And on that point surely surveys have been done, and I'd like to see the results. When asked directly, "Do you believe that homeopathy and its remedies are (1) always, (2) usually, (3) sometimes, (4) rarely, (5) almost never, or (6) never more effective than placebo?" what do they say (in different countries)? --Larry Sanger 14:32, 21 October 2008 (UTC)

Slow down, Larry. The exact source of the reference for 42% of British physicians referring patients to homeopaths is: R. Wharton and G. Lewith, Complementary Medicine and the General Practitioner, BMJ, 292, June 7, 1986: 1498-1500. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=3087494

Actually, simply referring a patient to a homeopath is relevant for several reasons. First, the doctor takes on liability issues in doing so, and therefore, s/he doesn't refer unless there is some type of respect or trust that the doctor has in the homeopath or the homeopathic method. In either case, this IS relevant. It may be of additional interest to discover how often a doctor provides a referral, and such present or future surveys that deal with this issue can be added here, but I see no reason that surveys published in high impact journals should be ignored. Dana Ullman 17:03, 21 October 2008 (UTC)

Dana, as I said, the source cited by the article, marked as Fisher, did not contain the statistic. If you can support the statistic with a different source, that's great, but it does not address my point, which was serious. I'm afraid I'll have to ask again: who put the statistic, with that citation, into the article? I ask because I want an explanation of the error from that person. Was it perhaps an innocent typo, somehow?

It seems we can say that in this 1986 survey of 145 mail-in questionnaire respondents, who were Avon, England GPs, 42% had referred at least one patient to a homeopathic doctor or non-medical practitioner. --Larry Sanger 02:56, 22 October 2008 (UTC)

Questioning the answer of 42

Doesn't anyone read Douglas Adams?

While I'd have to look for current data, entirely too many antibiotics are prescribed by mainstream physicians, often to meet the expectations of a patient or parent, but knowing full well that an antibiotic will do nothing for a self-limiting viral infection. They have, however, exposed their patients to toxicity, and the population as a whole to a source of drug-resistant bacteria. My point is that this is not a matter of pride to the medical profession, but something it is trying to fix.

Something worth knowing: how does homeopathy keep reinventing itself and improving its process? Does it?

What are the shared, not the oppositional, concepts? There has been at least one individual, Harold Griffith, fully trained in conventional and homeopathic methods, who received the Nobel Prize in Medicine or Physiology for contributions to surgical anesthesia. When does such a person not insist that homeopathic methods are the best for everything? Sorry, I'm extremely tired of asking and asking about when homeopaths refer, or use medical techniques in which they are trained, and be told "it depends". There are too many consensus guidelines, such as back pain, giving strategies for synergy, to accept that there can be no communication.

Constant repetition about popularity, about how much mainstream medicine is out to get the homeopaths, and how dangerous mainstream medicine may be is not effective communication. Howard C. Berkowitz 17:10, 21 October 2008 (UTC)

Howard, please note that homeopaths seem to honor the Hippocratic tradition with great rigor and vigor than conventional doctors do ("First, do no harm."). Homeopaths prefer to try and sometimes exhaust safer methods before resorting to the "bigger guns" (and more risky therapeutic measures). That said, each situation requires its own guidelines based on the medical urgency, the degree of known efficacy of the conventional medical treatment, and the initial response to homeopathic treatment.

Charles Frederick Menninger (1862-1955), the founder of the famed Menninger Clinic, was the head of his local (Topeka, Kansas) homeopathic society. He asserted, "It is imperatie that we EXHAUST the homeoapthic healing art before resorting to any other mode of treatment if we wish to accomplish the greatest success possible." (1897)...quoted on page 124 of my book, "The Homeopathic Revolution" (I can provide the original reference if desired). Dana Ullman 00:22, 22 October 2008 (UTC)

Dana, I believe the ground rules were to state what homeopaths did, not continue a struggle against mainstream medicine.

Charles Menninger was a great psychiatrist, who died around the time the first effective drugs for mental illness were being introduced (i.e., chlorpromazine) in 1952. Have you some equivalent works of homeopathy from prestigious psychiatrists in current practice, equipped with a bit more understanding of brain chemistry? While I think Menninger was a distinguished physician for his time, and set standards for ethical practice, the main therapeutic technique he introduced, and is still found valuable, is art therapy. Were he to be reincarnated, I'd greet him with joy, and then suggest he take a year or two of current clinical science, and probably two years or so of supervised fellowship, before I'd want him to treat anyone whom I cared about. Bluntly, I don't much care what he had to say about homeopathy, because he was unaware of sixty years' better understanding of neuroscience, cognition and psychopharmacology &mdash and I am not referring to drugs alone. Cognitive behavioral therapy and other methods also have replaced many of the psychodynamic methods he used. Howard C. Berkowitz 00:44, 22 October 2008 (UTC)

Er...guys? This doesn't have anything to do with the article. It seems to be a pointless debate, unless a particular part of the text rests on its outcome, which I doubt... --Larry Sanger 03:00, 22 October 2008 (UTC)

A comment here was deleted by The Constabulary on grounds of making complaints about fellow Citizens. If you have a complaint about the behavior of another Citizen, e-mail constables@citizendium.org. It is contrary to Citizendium policy to air your complaints on the wiki. See also CZ:Professionalism.

Homeopathy/catalog added

At Larry's suggestion, I created the subpage "Homeopathy > Catalog" at http://en.citizendium.org/wiki/Homeopathy/Catalog (how do you wikilink to a subpage?). It is intended to compare and contrast terminology used in homeopathy and mainstream medicine. It has a basic assumption that, in certain cases, there are either terms of art, or words that are used differently.

If mutually agreed words can be found for the same concept, that would be a pleasant surprise. What I do hope to accomplish is, effectively, a dictionary between different systems. Some terms may not translate or be rejected by one side or the other; making that clear would be useful.

Howard C. Berkowitz 18:23, 21 October 2008 (UTC)

Homeopathy/Catalogs --Larry Sanger 03:03, 22 October 2008 (UTC)

Statistical methods for testing highly individualized therapies

It's probably easier to create some notes again than find the previous postings in the archives. Gareth had some very eloquent things to say on the topics.

There are emerging areas of medicine where the traditional randomized controlled trial has methodological problems. Among them is pharmacogenomics, in which therapy is individualized not only based on the medical history, physical examination, and routine laboratory and imaging studies, but also on genetic analysis and specialized laboratory tests suggested by such analysis. Among a group of patients with similar symptoms, it may be found that a specific bad protein is causing damage, but the reason for the protein being damaged could be controlled by a number of different genes, each responsible for an intermediate step in the synthesis of the final protein.

Approved immune-based treatments, such as monoclonal antibodies to tumor necrosis factor-alpha in rheumatoid arthritis, reduce the level of the final protein. By concentrating on that final protein, a large enough group can be collected for a conventional clinical trial.

Increasingly, however, we are aware that the protein synthesis error could happen at an intermediate step, controlled by one of a long list of genes. The least invasive and most effective treatment may be to administer a neutralizing agent that only affects the step where some protein is not created correctly, as defined by genes.

At present, the trial approach being considered is to have a clinical team examine the patient, and prescribe what they consider to be the appropriate treatment. That prescription goes to the pharmacy, where the pharmacist opens the next sealed envelope, which says if this patient is to be assigned to the control group or to the experimental group. If the patient is assigned to experimental, then the exact prescription, individualized to that patient, is made up; otherwise, it will be a control treatment or placebo.

At the end of the trial, measurable outcomes of success — not subjective measures such as "satisfaction" — are compared between the experimental and control groups. Every patient in the experimental group may have received a different, personalized modified monoclonal antibody. If there are better outcomes in the experimental group, the trial confirms the methodology of selecting treatments rather than the treatment proper.

Such an approach, it would seem, could be applied to homeopathy. Has it? Howard C. Berkowitz 19:23, 21 October 2008 (UTC)

Specific immune benefits of chickenpox and measles?

There is a reference to Randall Neustaedter's The Vaccine Guide which is cited for a homeopathic belief that there are immunological benefits from contracting measles and chickenpox, rather than immunizing against them. Could someone, with access to this book, describe these benefits?

Have the benefits of chickenpox been weighed against the future risk of herpes zoster? Howard C. Berkowitz 22:19, 21 October 2008 (UTC)

Howard, this subject doesn't have a place on THIS article. I have, however, read studies that show that people who experience measles have a statistically significant reduced rate of atopic disorders. Although one might conclude that measles provides some type of immunological benefit here, another interpretation could be that the measles vaccination increases atopic states. There is a body of literature on the "hygiene hypothesis." Dana Ullman 00:29, 22 October 2008 (UTC)

Are you ignoring the first paragraph and answering the second? If you are answering the second, fine. Your call. I might point it out myself.

As far as the first point, are you saying the inadequately sourced claim about advantages of measles and chickenpox should go? If so, I agree. This is an encyclopedia: if controversial things are said, they need verifiable sourcing. They indeed may be controversial and stay, but there should be readily available information from credible sources.

Or did you want to talk about atopy, the Prausnitz-Küstner reaction, and better in vitro alternatives? Howard C. Berkowitz 00:51, 22 October 2008 (UTC)

I substituted references to Neustaedter's online articles for the book. In those, I did not see any that specifically said there were benefits to measles and chickenpox, although he does argue strongly against all forms of immunization, with no scientific data.

The adult recurrence of chicken pox, herpes zoster, is a much more serious condition that can be prevented with childhood chicken pox immunization. I gave a citation to Mobidity and Mortality Monthly Report regarding the public health threat of herpes zoster, and the now universal recommendation of herpes zoster vaccine to adults of 60 years and older. Unfortunately, while the incidence of herpes zoster goes up significantly with age, it can also occur in immunosuppressed individuals. Herpes zoster affects 1 in 3 adults, and, in 10-25%, can result in permanent chronic pain, eye damage, or both. Chicken pox is a problem of public health not limited to childhood. Howard C. Berkowitz 20:11, 25 October 2008 (UTC)

Editing "Trials in humans" section for flow and citations

Just to keep everyone informed, I have made several edits on the "Trials in humans" section, first trying to clarify the flow. While I'm still working on it, I tried to move the introductory text by a CZ contributor to the beginning of the section, and put the various trials under subsections below them. Of course, when there is CZ commentary on a particular trial or meta-analysis, the comment belongs in that subsection.

Material on The Lancet controversy was especially hard to follow, because multiple references were all under the same footnote number. I broke them into separate footnotes, and added at least some material about what each author(s) actually said; it was otherwise very confusing.

With respect to the Cochrane meta-analysis of Oscillococcinum (I've started an article on this preparation), I found the actual conclusions of the free summary to be a bit different than the one word, "promising", that described the work.

There was a section under "trials in humans" that was not about trials, pertaining to over-the-counter remedies. I moved it to be with other material on nonprescription remedies, and changed the section from "Popularity of Homeopathy" to a more comprehensive and neutral "Popular opinion and over-the-counter homeopathic remedies". "Popularity", like "Criticism", may not be the best of encyclopedic headings. "Public opinion" may be even more neutral than "Popular opinion".

The last paragraph, under the "Lancet" subheading, appears to be text from a CZ contributor. In its first sentence, it contains a value judgment (my emphasis) that I believe needs to be sourced and explained: "Several of these published responses remarked (incorrectly) that the researchers evaluated only those studies that met certain criteria for “high quality” scientific investigations."

That text ((incorrectly)) was mine. This criticism is repeated in several sources but is simply wrong. The authors used a hierarchical approach - they looked at the outcomes of all studies and then looked at the outcomes if only large high quality studies were considered. Their hypothesis was that if there are factors like publication bias that lead to the selective publication of studies with positive outcomes, then size of effect should be inversely related to sample size and study quality. So it's a common criticism but reflects a fundamental misunderstanding of the study. How would you phrase it? I didn't expand because the preceding text explained the study in terms that I thought made it clear that the reported remark was transparently incorrect. I didn't see it as a value judgement, simply a statement of demonstrable fact. Gareth Leng 15:57, 22 October 2008 (UTC)

Thanks. My first thought would be to take the explanation you just wrote, edit it slightly, and either put it as a subhead of randomized controlled trial, or one of several very short articles (the sort I'm always arguing are too short to need definitions) on trial methodology. Thinking of some of my own edits in totally different areas, I've written articles that state the facts of a matter, and linked to them, making them reusable. Perhaps we need some sort of mini-article format that is variously a FAQ, or a "common error". I can definitely think of things in my computer science book, where I'd insert sidebars explaining that I knew the main text was counterintuitive, but there was a reason for it -- and then either a quick explanation or a citation.

I know you have time constraints, but I find you more eloquent than I on describing study methodology. Thinking about it, there were two problems. First, I was sensitized to some cases where others were throwing in unsupported, sometimes angry comments. Second, I was not sure if the antecedent (referent?) of "incorrectly" was to interpreting publication bias, to the idea of the inverse relation you mention, or something else entirely. Howard C. Berkowitz 16:40, 22 October 2008 (UTC)

I am continuing to follow the citations in the last two sections. Some appear to be evaluating patient satisfaction or subjective assessment as endpoints. While that is a perfectly legitimate thing to study, it should not be confused with the type of endpoint that is generally used in evidence-based medicine.

If I do find subjective endpoints, I propose to create a subsection under what may be renamed again, currently the "Popular opinion..." If formal studies of individual patient subjective response to treatment, as opposed to general opinions of homeopathy, were done, those are significant and need to stand apart from general opinion surveys. Howard C. Berkowitz 02:35, 22 October 2008 (UTC)

Other meta-analyses

Going through some of the trials (see "Other Meta-analyses") that showed promise, but not necessarily statistical confidence, a number of the researchers suggested that perhaps the wrong things are being studies. There may be more to be learned from the quality of interaction between homeopath and patient than there is from deeper insight into the memory of water, or even some large-scale on homeopathic remedies for self-limiting conditions, or where there are generally acceptable treatments.

These arguments tie strongly into a number of conventional medical and nursing arguments for improving the quality of care.

I did remove two items (below) that did not perform a meta-analysis:

• A meta-review of homeopathy in dementia did not actually analyze any studies. The investigators were unable to find papers that met their inclusion criteria, and said they could not assess the extent of homeopathic treatment of dementia. <ref>{{cite journal |author=McCarney RW ''et al.'' |title=Homeopathy for dementia |journal=Cochrane database of systematic reviews |pages=CD003803 |year=2003 |pmid=12535487|http://www.ncbi.nlm.nih.gov/pubmed/12535487 }}</ref>

• One reference was not from a journal, but a lay health encyclopedia produced by the National Health Service. :<ref>{{cite web|url=http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=197&sectionId=27 |contribution=Homeopathy results | title= Health encyclopaedia |accessdate=2007-07-25 |publisher=[[National Health Service]]}}</ref>. It could not be considered a meta-analysis, as it contained little quantitative information.

Howard C. Berkowitz 14:10, 22 October 2008 (UTC)

Good sleuthing Howard. I'm sorry that I didn't catch these ones. Dana Ullman 02:43, 23 October 2008 (UTC)

Text cut

I cut a few lines from the secton on regulation because they didn't seem to belong there, but in Memory of Water, I've placed them pro tem on the Talk page of that article.Gareth Leng 13:18, 23 October 2008 (UTC)

There remains an issue that deals with (diluents? vehicles?) other than water. The introduction says water or ethanol. Plausible ethanol solvents, especially if there are limits on over-the-counter concentrations as in the U.S., have enough water so memory of water, if it exists, could apply.

In the body of the article, however, remain references to lactose and quartz. These were taken out of the earlier introduction. Can we have a decision? If there are homeopathic diluents (yes, they are diluents as pure chemicals before mixing) other than water, let's be consistent between the lead and the body.

Certainly, lactose is very common in mainstream pharmaceuticals, simply to bind small anounts of drug into a tablet large enough to handle. I don't find it implausible that it could be used in preparing a remedy, but that does suggest that memory of water isn't the mechanism. Quartz seems a little more unlikely, but I suppose it's safe if sufficiently powdered; still, it's usually not the greatest idea to put insoluble substances into the gastrointestinal tract.Howard C. Berkowitz 15:28, 23 October 2008 (UTC)

Don't know about quartzm, but it's obviously common to use lactose/sucrose in powder or tablet form. These dry forms contain no water, so I don't know what homeopaths think may be the mechanism in this case; I've added a few simple lines about this.Gareth Leng 15:53, 23 October 2008 (UTC)

Text reverts on 12 October...ongoing

"because homeopathic remedy selection may take time; homeopathic remedies may be used after an asthmatic episode to optimize the immune system and prevent recurrences."

Of course homeopathic remedy selection takes time; most non-emergency selection of medical drugs take time. Even in an acute asthmatic attack, it may take corticosteroids, even intravenously, 8 hours to have an appreciable effect. Saying it may take time to select long-term drugs simply adds words without adding information

As far as "optimize the immune system", that has no meaning in the general scientific usage of "immune system". Why is it wrong to remove those words and leave "prevent recurrences", which is presumably the objective?

If you are using "immune system" in a special homeopathic way, such as the way it has been suggested as a synonym for "vital force", say so. Otherwise, and this is probably not the place in the article, describe exactly what happens in the immune system, as the term is generally accepted. Mast cell desensitization? Neutralization or movement of immunoglobulins? Causing the inflammatory cells, such as leukocytes, to move out of the inflamed area?

Please don't take well-defined medical terms and give them new meanings, or use oversimplifications. Doing so breaks down any hope of communication between conventional and homeopathic participants here. Truly, I would not object if you had said "vital force" rather than "immune system". I don't know what a vital force is and whether it exists, but I am quite willing to accept that it is meaningful to homeopaths, and saying a remedy increases it does not conflict with medical terminology. Without insisting on a definition of vital force, if it were substituted for immune system in several places, I think the article would be more readable for all disciplines. Howard C. Berkowitz 17:17, 12 October 2008 (UTC)

Quite a few reverts later. The inclusion of "because homeopathic remedy selection may take time" has been removed by Howard, Gareth and myself. An explanaition for why this is a critical sentence other than "this is how I treat myself" would be useful to move us forward. Chris Day 14:03, 15 October 2008 (UTC)

Just got reverted again, is "I use it in acute attacks also-most homeopaths do; justify deletion (if you do) on the Talk Page " a convincing explanation? One that convinces Gareth and Howard? Is CZ comfortable "messing with anaphylactic shock"? I thought Gareth made a reasonable point, not to mention the addition seems redundant with the sentence that follows. Ramanand seems to imply that remedy selection does not take much time since he seems to be describing the use of homeopathy to control anaphylactic shock/acute attacks of ashma. I saw that Ramanand reduced the typical time for consultation with a homeopath from one hour to fifteen minutes, I assume with this scenario of "acute attacks" in mind (since it was the edit right after his revert). How do we know this is not an exaggeration or is there no consultation with "acute attacks" (even 15 minutes sounds on the long side here)? And if this remedy for "acute attacks" works so well, have any trials been done to prove to the skeptics that homeopathy is effective, at least for this type of case? This remedy would seem to be a perfect candidate for a double blind trial since individualisation appears not to be required in these cases and alleviation of the attacks should be easy to quantify. Chris Day 04:14, 16 October 2008 (UTC)

Part of the problem is that the severity of the attack is not clear. Is it, as you suggest, anaphylactic shock? Status asthmaticus? Things where it's a minute-by-minute call on whether to intubate, because laryngeal edema is one possibility? Do you have a rapid sequence intubation kit open and ready? Are arterial blood gases available? Even for a relatively mild but urgent case, that patient needs pulse oximetry, O₂ by nasal cannula and by more intrusive means if the SpO₂ drops. Nebulized albuterol,probably with intermittent ipratropium bromide, is almost certainly appropriate, while establishing IV access for epinephrine (unless it's intratracheal). Again assuming a serious event, a loading dose of methylpredisolone should be going on board. Howard C. Berkowitz 04:34, 16 October 2008 (UTC)

Gareth was the one that brought up anaphylactic shock, ramanand uses the phrase acute attacks. You tell me if they are the same? Either way, if homeopathic remedies can alleviate acute attacks in minutes, I'm impressed. That's definitely quantifiable and publishable. Chris Day 04:42, 16 October 2008 (UTC)

I've been verifying this with a reasonably current Lange emergency medicine text, and, while there are similarities between anaphylactic shock and the most severe form of exacerbation of asthma, there are differences.

In both, you want tight monitoring of the airway, but laryngeal edema is far more a threat in anaphylactic shock than status asthmaticus. The tendency to secure the airway by intubation is greater in anaphylaxis, because with sufficient edema, you may not be able to intubate -- you may have to do cricothryotomy or something more invasive. Epinephrine is the first-line drug for analphylaxis, with antihistamines (H₁ and H₂ both). and beta-adrenergic agonists as backup drugs; in severe asthma, beta-adrenergic agonists are the first-line, supplemented with anticholinergics. Both call for parenteral corticosteroids, but those take hours to take effect.

On occasion, my ex-wife managed both. Howard C. Berkowitz 04:56, 16 October 2008 (UTC)

There is some, 'individualization' involved even in acute attacks (of Bronchitis) - & no, I'm not talking of anaphylactic shocks. I did mention some remedies earlier (like Ars.Alb., Nat.Sulph & Ipecac), but it's difficult to explain all that to non-homeopaths, so I haven't included it in the article.—Ramanand Jhingade 03:11, 17 October 2008 (UTC)

Why is it so difficult to explain? I can give a mechanism of action for most pharmacologic drugs, or at least a reasonable approach to one? Perhaps the homeopathic model that there are no causes and effects are making it hard to explain. Howard C. Berkowitz 04:56, 16 October 2008 (UTC)

In any event, if it cannot be explained, and can only be taken on faith, it belongs in a CZ article in much the form "Creationists believe that all forms were created by the deity and there has never been evolution." Try that. "Remedies", as opposed to non-homeopathic-lingo "symptoms", do not explain anything.

Please do not tell me I'd understand if I tried it -- oh, and I happen to consider "skeptic" a compliment, so if you are trying to intimidate me with that, it's a waste of time. Howard C. Berkowitz04:37, 17 October 2008 (UTC)

Latest iteration. Gareth removed it again with the following edit summary: "don't imply homeopathy is a substitute for necessary medical treatment". Chris Day 21:05, 22 October 2008 (UTC) (for the record, I have removed it twice, Gareth has removed it twice, Howard has removed it once. Ramanand has added it back mulitple times.)

Add one more for Ramanand

"it was agreed to let this be, so why was it deleted? Use the Talk Page!"

And one more for Howard

"yes, do see the talk page. Chris, Gareth and I, have all removed it, and will keep removing it. With whom did you think you had an agreement?"

This needs to be decided on the talk page. As yet, i see no agreement for the inclusion of this sentence. See above for reasoning. Chris Day 15:51, 23 October 2008 (UTC)

All homeopaths use it in acute Bronchitis (for both themselves and patients), not just me. I'll have to report this to a constable if the 'ground rules' laid down by Larry aren't followed.—Ramanand Jhingade 03:06, 24 October 2008 (UTC)

Anything other than anecdotal evidence? Chris Day 03:40, 24 October 2008 (UTC)

As Chris said, your unsupported word is not adequate. Even if you can put an available source next to it, it is also acceptable, within the ground rules, to put well-established medical guidelines for dealing with something of this type, and I believe that it can also be documented, from standard emergency medicine texts, that delay to definitive treatment of severe respiratory distress can be quickly fatal.

Part of the problem is there is no understandable definition of the clinical picture of this patient. If you can, Ramanand, describe, in detail, the status of the patient. Even at the EMT-Basic level, I would expect respiratory rate, pulse, blood pressure, skin color, and a description of the visible and audible mechanics of breathing: stridor? cough? discharge? What's the age and body habitus of the patient? Any immediate significant history such as insect bite? Visible swelling?

At a more advanced level of training, I would expect much more. Since you haven't given any details, I'm going to assume a child, and quote from the eMedicine tutorial on stridor: "If distress is moderate to severe, further physical examination should be deferred until the patient reaches a facility equipped for emergent management of the pediatric airway."[4] You said "all homeopaths" use this. What are the qualifications and equipment of "all homeopaths" to manage an airway? Rapid sequence intubation? Cricothyrotomy?

The ground rules absolutely allow objective, sourced criticism to be side-by-side with a not-widely-aceepted assertion. I believe a reasonable interpretation would also consider that the patient presentation is so vague that no one versed in mainstream medicine can even begin a primary assessment. Howard C. Berkowitz 04:02, 24 October 2008 (UTC)

Two points here. First, if you spot edit warring going on (repeated insertion and deletion), please let me know. As it appears everyone knows, a point should be fully discussed rather than allowing the edit war to go on, and if that does not result in a suitable compromise (is a compromise possible in this case?), then contact me immediately, please. I will tell you in most cases that you must find a mutually agreeable compromise. While that is being worked out, one side must be big enough to let the text stand while the issue is discussed. If you need a way to decide that, I'd say to go with the editors--Gareth Leng is a healing arts editor.

Second, to Howard, Chris, and Gareth, let me say that it seems to me that you need to decide what the problem with the disputed text is. Gareth says the problem is that the text implies that homeopathic treatments should be made before conventional treatments, which is dangerous; Chris and Howard then say that the problem is that the mentioned treatment for bronchitis is idiosyncratic and not a common homeopathic treatment (or they are skeptical of this, on grounds unclear to me). The two issues would require two different solutions. If the problem is danger, then as I said below, the text needs to be expanded and clarified and surrounded with clear warnings from the point of view of conventional medicine. If the problem is idiosyncracy (i.e., if it really is true that the mentioned treatment for bronchitis is not in common use by homeopaths), then the whole discussion of the treatment could be removed, and then there'd be no more problem. But, obviously, some research will have to be done to settle the latter question. --Larry Sanger 14:57, 24 October 2008 (UTC)

Very briefly -- one of the biggest question is "bronchitis", or sometimes "bronchitis and asthma" (which may or may not be related) is being used as if it is self-explanatory. Ramanand is not giving enough information to judge if the situation is potentially life-threatening, so a medically-oriented person is going to judge pessimistically. We also don't know what advanced life support equipment and skills are present in Ramanand's office. If he has suction, intubation, several standard drugs, etc., and is qualified to use them, that would be a different matter. Most office physicians in the U.S. do have such equipment, although it might be scary for someone to try to intubate, not having done it in a few years. Anesthesiologists and emergency physicians, and experienced paramedics make it look easy -- most of the time. Even they can have troubles. I know the principles of cutting through the cricothyroid membrane and establishing airway, but I'm not licensed for it and I hope I never am faced with the moral choice of being the only person in range that knows a maneuver that could be lifesaving. Howard C. Berkowitz 15:43, 24 October 2008 (UTC)

Miasms

From the main article lead, I moved the discussion of "miasms" for a bit of reexamination. The article text said

Most also accept the concept of "miasms", a homeopathic concept of disease in which the symptoms of an organism’s imbalance indicate that a specific anti-miasmatic remedy is sometimes needed.

Purely from a standpoint of sentence structure, I look at that and say "huh?" What information is that sentence imparting? It seems completely circular and information free: a miasm seems to be a set of symptoms indicating that an anti-miasmic remedy is needed. No more, and no less, information would be conveyed if "evil", "trigonometry", or "Francisella tularensis" were substituted for miasm; there is no additional definition in the article.

In the current History of Homeopathy article, it is said Hahnemann defined

three fundamental 'miasms' underlie of all the chronic diseases of mankind: 'Syphilis', 'Sycosis' (suppressed gonorrhoea), and 'Psora'. Miasma, from the Greek for 'stain', was an old medical concept, used for "pestiferous exhalations". In Hahnemann's words: "...a child with small-pox or measles communicates to a near, untouched healthy child in an invisible manner (dynamically) the small-pox or measles, … in the same way as the magnet communicated to the near needle the magnetic property..."

Again, I must say, "huh"? Treponema pallidum, Neisseria gonorrheae, and something else underlie all the chronic diseases of mankind? True, gonorrhea is showing multidrug resistance, but, by the April 2007 CDC recommendations a single intramuscular dose ceftriaxone, 125mg., should kill two-thirds of the ills of mankind. Not sure about "Psora" though; Is there a more modern name for it? Variola virus and Measles virus don't have anything to do with transmission of the others?

May I assume that homeopaths accept Koch's postulates, by which cause and effect of everything except psora have been thoroughly demonstrated? If not, I think it's important to have it stated just what homeopaths do, or do not, believe about infectious disease. If homeopaths don't believe in it, that's their privilege, but an encyclopedia article needs to make a clear statement of that.

Now, if these are symptom complexes and homeopaths agree have nothing to do with the pathogens mentioned, fine. If that is the case, then if miasms stay in the article, could we have a definition of the symptoms? Sorry, if the answer is "it's too hard to explain to a non-homeopath", even people with a bit, here and there, of biological background, it is too hard to have in the article.

There is nothing wrong with this article having clearly stated homeopathic beliefs, with a notation that the belief is incompatible with mainstream thinking. If the belief cannot be stated well enough to be evaluated, then there is a problem. Howard C. Berkowitz 01:28, 24 October 2008 (UTC)

Ground rules, criticism, and removal with no discussion

It is a goal of Citizendium to avoid "encyclopedese", while presenting different views fairly. Toward the end of the article, I placed, with appropriate disclaimers, an assessment from a reputable source, who emphasized that to use, or not to use, is an individual choice — but one that he himself would not take.

My emphasis on introductory comment to emphasize individual choice; Sagar's agreement, in the "quote from current article"

"While he is a critic of homeopathy, and this quote is not intended to say that homeopathy is or is not a placebo effect, Sagar sums the choices with a bit of humor:

The choice is entirely with the individual. Those who believe in the power of undetected subatomic fields may continue taking homeopathic medicine with an excellent placebo effect, but at a financial cost that cannot be ignored. Those who maintain faith in today’s science may continue to see their physician and receive conventional medication proven in clinical trials, rather than in succussion. However, if you choose to save money and avoid side effects, a teaspoon of honey (composed mainly of sugar and water) may be more attractive—unless, of course, you are allergic to bees or pollen.

"

<ref name-Sagar2007>{{citation <ref name-Sagar2007>{{citation | url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1948865 | author=Sagar SM | year = 2007 | title = Homeopathy: does a teaspoon of honey help the medicine go down? | journal = Curr Oncol | volume = 14 | pages = 126–127}}</ref>

Ramanand removed that material, without discussion, just an edit note saying he was replacing a critic with a "fact". I agree that the material below is a fact, and it would not have been unreasonable to add the comment.

Qualified health professionals practising homeopathy, on the other hand, believe they can not only diagnose the disease, but also treat it.

It would be equally reasonable to respond to this with a comment that mainstream physicians seriously doubt homeopaths can diagnose or treat disease, which would seem self-evident given their claim that there is no such thing as disease, only individual complexes of symptoms.

Personally, I think Dr. Sagar summed up the individual choices quite nicely. If there is a homeopath with a similar flair for words, I'd be delighted to see it here.

Call whoever you like, Ramanand. The ground rules say that homeopaths can say what they believe, and it would have been appropriate for you to add that — and for someone to make an alternate statement. There is absolutely nothing in the ground rules that bars criticism, especially when the "critic" freely acknowledges that people may choose homeopathy. Howard C. Berkowitz 04:21, 24 October 2008 (UTC)

Ramanand, this is a perfect application of the rule that criticisms must be allowed. You are absolutely not free to remove such criticisms. --Larry Sanger 14:31, 24 October 2008 (UTC)

Controversial text

The text that is subject to an edit war is the following "Situations for which homeopathic practitioners work in a manner complementary to that of conventional medical practitioners include asthma and acute bronchitis, where immediate and certain temporary relief from metered-dose inhalers, nebulizers, or parenteral drugs is sometimes necessary, if homeopathic remedy selection is going to take time. I have deleted and will continue to delete the section in bold, because it implies that homeopathic treatments are an effective substitute for conventional, effective drugs, and suggests that this is accepted by conventional medical practitioners. Homeopaths are notworking in a manner complementary to conventional medical practitioners if they are substituting homeopathic remedies for conventional approaches rather than providing remedies as adjuncts to conventional treatment. What I cannot accept in this article is a) anything that looks like treatment advice b) anything that suggests that homeopathic remedies are considered by conventional practitioners to be an acceptable substitute for conventional treatments. The text as written suggested that a) homeopathic remedies might be acceptable substitutes and implied (by the use of the word complementary) that this was accepted by medics.

I am happy for a statement to appear that homeopaths do use remedies as substitutes for conventional treatment even when the conventional treatment is known to be effective and urgently indicated; perhaps this statement is needed and should be inserted. That must be followed directly by a statement strongly dissociating conventional medical opinion from such practices.

Gareth Leng 11:04, 24 October 2008 (UTC)

I concur. Not suggesting that homeopaths do or do not do this, but the thinking has to be understood. Knowing if the approach will be optimistic (the body will usually heal itself) or pessimistic (the patient's airway could block completely in the next minute -- what do I do?) would help. Howard C. Berkowitz

Isn't this just a matter of crafting a slightly longer text? Surely we can write something to the effect that, while (1) some homeopaths will sometimes advert to conventional treatments for bronchitis if homeopathic treatments will take too long (i.e., place the patient at risk, by waiting), (2) conventional physicians strongly insist that the conventional treatment for the condition be done immediately, and that any homeopathic treatment be done as an adjunct. Have I got that right?

We should, of course, allow homeopaths to state how they treat bronchitis. But, if conventional physicians find this treatment actually dangerous, it is just as obvious (or more so) that we must place in blinking lights (so to speak) warnings to the effect that conventional physicians find the treatment to be dangerous. Moreover, we should say why we find that dangerous. There is no point to skirting around the issue of why it is considered dangerous by conventional physicians. Spelling out the danger is essential to understanding the full range of thinking on the issue. --Larry Sanger 14:20, 24 October 2008 (UTC)

I think you have got it right; I'm hesitating to alter the text myself first because I don't know myself that homeopaths generally would delay conventional treatment, and until I understand exactly in what conditions they might delay treatment, it would be premature to contemplate the possible consequences. I can be certain that conventional physicians would consider any delay in treatment to be disadvantageous, whether there is any evidence that it might pose real risks I'm unsure of. It depends. I'm more concerned aboutthe message for acute asthma "A severe asthma attack is a life-threatening emergency that requires immediate, skilled, professional care. If not treated adequately and quickly, a severe asthma attack can cause death." [5]. We really cannot give the impression that such attacks can be treated by homeopathy; to do so would be irresponsible.Gareth Leng 15:02, 24 October 2008 (UTC)

Clearly, we need to hear more from Ramanand, or perhaps Dana. In the meantime, I think you as Healing Arts Editor would be justified in removing the problematic text provisionally and subject to discussion. --Larry Sanger 15:21, 24 October 2008 (UTC)

Many of these blinking lights are on, in #Text reverts on 12 October...ongoing. I don't think you want books on management of emergent respiratory distress, so I'll just repeat something from up there; more specifics available if you want. I don't know this patient has stridor, but I don't have enough information to know he doesn't.

"If distress is moderate to severe, further physical examination should be deferred until the patient reaches a facility equipped for emergent management of the pediatric airway."[6]

At the EMT level, from Emergency Care and Transportation of the Sick and Injured (4th ed), a standard EMT text from the American Academy of Orthopedic Surgeons, speaking of a patient in the field, in moderate respiratory distress of uncertain etiology:

In the absence of coma, the EMT must be prepared to handle the production of large amounts of mucus with appropriate suctioning, and administer oxygen. If the patient is in a coma, airway maintenance may be needed. Occasionally, full CPR is required for an episode of anaphylaxis. (p. 333)

I'd be much more comfortable saying "sure, try homeopathy, it doesn't seem to be an emergency" if I had enough history and physical to make that as a reasonable decision. Obviously, thousands of physicians handle mild respiratory distress in their offices every days. Most physician offices, however, also have a considerable amount of advanced life support equipment in a closet. Howard C. Berkowitz 15:24, 24 October 2008 (UTC)

The bronchitis business

Sometimes, as I was just telling Howard ;-) , the sheer quantity of text on the talk page gets in the way of our properly communicating.

So let me state very briefly what I want.

• Ramanand, please answer this question: what do you mean by bronchitis? If "bronchitis" is not adequately descriptive, then, in more words, what sort of condition are you saying here that homeopathy can treat?
• Also please answer this: do you believe that homeopathy is a suitable treatment alone, in cases of emergency situations, in which the patient is faced with imminent death without effective treatment?
• Once we have these questions answered from Ramanand, I propose that someone who understands the issues (maybe Gareth) write a compromise text. Maybe a "compromise" won't be necessary because we'll realize that this was a big misunderstanding.

--Larry Sanger 16:06, 24 October 2008 (UTC)

Thanks Larry. I've done some hunting and it is clear that Ramanand is right in that homeopaths do indeed widely recommend their remedies for acute asthma attacks in the first instance; it's not an isolated practise but widespread. It is also clear that conventional medical organisations are concerned enough to issue warnings to patients that there is no evidence that these homeopathic remedies are effective and that it might be dangerous to substitute these for conventional treatment (I've given two examples of links). So I've modified the text to try to follow Larry's very sensible guidance here.Gareth Leng 16:57, 24 October 2008 (UTC)

Homeopaths are not wrong in thinking of Hippocrates' maxim, "first, do no harm". Especially in emergency medicine and trauma, the outstanding people I know are not necessarily taking drastic steps, but are, rather like a fighter pilot or chess player tries to stay ahead of his opponent, constantly thinking "I'll wait for now, or do this for comfort...but I must be ready if A or B or C suddenly happens".

It has not come across, and may be a misunderstanding, that homeopaths start conservatively and want to thoroughly exhaust each remedy before trying something else. I simply have no sense to what extent they are thinking ahead -- both in knowledge and preparation -- of potential catastrophes. I take a lot of advice from the writings of Ken Mattox, who is probably the dean of trauma surgery. Ken not only has the judgment, but the incredible teaching skills, to get across when watchful waiting is appropriate, and when fast and drastic action is necessary. It wasn't with him, but only once have I seen a chest opened in a hallway (I'd prefer not to watch it again); the patient had a gunshot wound to the chest, with pulse stopping in the ambulance that did a lot of other correct things (such as "scoop and RUN"). Saved the patient, but a minute or two of hesitation would have been too long. Without manual heart compression, the patient didn't have enough blood to pump to the brain.

I may be too busy for the next few hours, but I'll try to do a starter article on assessment and emergency management of respiratory distress, from the perspective of emergency medicine.Howard C. Berkowitz 16:33, 24 October 2008 (UTC)

Thanks Gareth, Howard and Larry, I hope things are resolved now.—Ramanand Jhingade 03:36, 25 October 2008 (UTC)

Friends, I am concerned that Gareth above says that there is "no" research that shows any benefits from homeopathic medicine in the treatment of acute asthma. In the future, it might be better to ask IF there is such research first before making such a categorical statement...and/or one might consider doing some searches. Below is some info from my ebook that references 150+ clinical trials.

Research conducted by professors at the University of Glasgow indicates that those patients given exceedingly small homeopathic doses of whatever substance to which they are most allergic can experience significant relief within the first week of treatment (Reilly, 1994). The authors called this unique method of individualizing medicines "homeopathic immunotherapy."

This double-blind, placebo-controlled trial showed that over 80% patients given a homeopathic remedy improved, while only 38% of patients given a placebo experienced a similar degree of relief. A homeopathic physician and a conventional physician assessed the patients. When the patients and doctors were asked if they felt the patient received the homeopathic medicine or the placebo, both the patients and the doctors tended to guess correctly.

The experiment was relatively small, with only 24 patients. In order for statistically significant results, such experiments must demonstrate a very large difference between those treated with a medicine and those given a placebo. Such was the case in this study.

The researchers utilized conventional allergy testing to determine the substances to which the asthmatic patients were most allergic, and then gave a 30th potency of this substance to half of the subjects (neither the experimenters nor the subjects knew who was given the medicine and who was given a placebo).

A double-blind, randomized, placebo-controlled trial was conducted in Cuba on patients with bronchial asthma (Riverson-Garrote, 1998). In this study 63 patients (34 children and 28 adults) participated, 39 of whom were given individualized homeopathic treatment and 24 were given a placebo.

In the treated group, 97.4% improved and 2.6% worsened. 87.2% reduced their use of conventional medication. In the placebo group, 12.5% improved, 16.7 stayed the same, and 70.8% worsened. None of the subjects given a placebo reduced their conventional medication.

Another study prescribed a homeopathic combination remedy (a mixture of various homeopathic medicines) to asthma patients who were dependent upon corticosteroid drugs. This double-blind, placebo-controlled randomized study treated 40 asthma patients on corticosteroid drugs, and it showed that the 20 patients given the homeopathic medicine experienced greater improvement than those given a placebo and were able to reduce the dosage of their conventional drugs (R. Matusiewicz, 1997).

A study in Norway of 200 patients suffering from hypersensitivity illnesses, including asthma, eczema, urticaria, hay fever and other allergies, showed that homeopathy was at least as effective as conventional medical treatment (Launsø, Kimby, Henningsen, 2006). The study was retrospective and comparative, and it evaluated everyday clinical practice of general practitioners and classical homeopaths. Most patients who were treated by conventional medical doctors experienced an aggravation of their symptoms when stopping conventional drugs, while only 1/3 of patients in the homeopathy group experienced such an aggravation (P = 0.002). Only one patient on conventional treatment experienced improvement of symptoms after stopping medication, compared to improvement in 2/3 of homeopathy patients. Patients in the homeopathic group also reported a larger improvement in their general state of health, with 57% improving, compared to 24% in the conventional group (P=0.004). Homeopathic patients also experienced substantially more positive change in their psychological state (P<0.0001). For quality of life 53% in the homeopathy group improved, compared to 15 % in the conventional group.

REFERENCES: Launsø L, Kimby CK, Henningsen I, Fønnebø V. An exploratory retrospective study of people suffering from hypersensitivity illness who attend medical or classical homeopathic treatment. Homeopathy (2006) 95, 73-80.

Matusiewicz, R, “The Effect of a Homeopathic Preparation on the Clinical Condition of Patients with Corticosteroid-dependent Bronchial Asthma,” International Journal of Biological Therapy and Integrated Medicine, 1997,15:70-4.

Reilly, D, Taylor, M, Beattie, N, et al., "Is Evidence for Homoeopathy Reproducible?" Lancet, December 10, 1994, 344:1601-6.

Riveron-Garrote, M, “Ensayo clinico aleatorizado controlado del tratamento homepatico del asma bronquial,” Boletin Mexicano, 1998,31:54-61.Dana Ullman 14:46, 25 October 2008 (UTC)

Thanks Dana. I didn't say there was no research, I did say that medical organisations advise patients that there is no evidence that the remedies are effective - obviously that is their summary overview - that on balance, the evidence isn't there to support a recommendation to take homeopathic remedies for asthma. That's also the message from Cochrane. Obviously, some individual studies report positive findings, but my purpose was not to weigh the evidence but just to report the medical attitude. My main purpose was to mark that for asthma medical organisations do not consider homeopathic remedies to be an acceptable alternative to conventional drugs, and stopping conventional drugs or delaying administration in acute attacks is potentially dangerous.Gareth Leng 16:29, 27 October 2008 (UTC)

Gareth, I understand, but now you see that medical organizations commonly use biased and inaccurate information about research. When they asserted that there was "no" research, they committed this common error. The word "no" is absolute. I hope that you can help this article acknowledge common biases in other places as well. Dana Ullman 01:17, 28 October 2008 (UTC)

To me, it feels like the main point is drifting away. Whether or not homeopathy has done no, some, or huge amounts of research is irrelevant to the point that certain specific respiratory distress presentations are potentially fatal in minutes to hours.

If someone claims to be a healthcare provider, and presumes to treat respiratory distress yet cannot recognize, or denies, the existence, of anaphylaxis or severe asthma, I believe there is an applicable legal term: "depraved indifference to human life." The existence of these and other life-threatening conditions, to which there are well-defined immediate-priority interventions, is not, to me, a matter of research. I don't think there is an unreasonable medical bias that putting a heavy-caliber bullet through the back of the neck is likely to be fatal. I don't think there is an unreasonable medical bias that anaphylaxis and status asthmaticus are real, need immediate treatment, and need different immediate treatment.

The point about research strikes me as a diversion from what, I believe, concerns Gareth, Chris and me. Howard C. Berkowitz 01:34, 28 October 2008 (UTC)

Asthma

Just to be sure that we aren't drifting from the immediate point of discussion, first, several of us are very concerned about homeopathic attempts to treat acute respiratory disease, when a prudent mainstream physician would consider the specific presentation one that may require hospitalization or be an immediate threat to life. I would note that there has been an enormous change in the medical management of asthma over the last roughly 30 years.

In a new section, I did put some comments where there might be some possible areas for better communications. They are worth thinking about, when discussing the significance of research.

Let me put some dimensions on asthma, only one of many respiratory diseases of concern to evidence-based medicine. My primary reference here is the Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma under the National Institutes of Health, with 2007 updates. Main page is http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm. Some dimensions, mostly from 2005 health statistics for the U.S.:

• 22 million people have been diagnosed with asthma. Many have well-controlled disease. Many do not.
• It affects approximately 6 million children
• There are roughly 497,000 hospitalizations annually

While all of these patients are not in clinical trials, it does give some idea of the statistical universe being measured. The EPR3 guideline described some community meta-analyses as "large" with 6000+ patients, but these are often dealing with refinement. Anecdote is not the singular of data, but I have watched quite a few people change from near-invalids when asthma therapy, a couple of decades ago, was based around bronchodilators, and perhaps immunotherapy. The revolution has been treating it as an inflammatory disease, and also providing more education and tools for self-management.

I have not yet read the specific papers you cite, but the largest population appears to have been 200 patients "suffering from hypersensitivity illnesses, including asthma, eczema, urticaria, hay fever and other allergies". As far as I know, most recent medical studies use a quite specific definition of asthma, and deal with asthma alone, usually with a fairly standard treatment protocol as the control arm, because, to use your term, external validity has been well demonstrated of some standard therapies. We can always do better.

Asthma, in part, is a disease of economics. It gets very interesting to plot severe disease against income, noting whether or not the patients are able to get the maintenance preventive medications. Poverty can get in the way of removing some well-understood allergens, such as dust mites.

So, I'll cheerfully agree that it is incorrect to say there is "no" homeopathic research into asthma. Put that in, along with the sizes of the populations, and there can be side-by-side references to EBM trials, noting the sizes and specific criteria. It may also be useful to compare and contrast therapy over time, especially since the consensus was reached that the core of care for moderate to severe asthma was an anti-inflammatory regimen against a hyperimmune disease, and that too-frequent use of rescue bronchodilators was a possible indication of poor treatment.

With this little data, I would not dream of switching a well-controlled asthmatic, whom I cared about, from a working regimen to a homeopathic one based on mechanisms I can't understand. That regimen is based on a very comprehensive understanding of the pathophysiology of asthma and exactly where different drugs &mdash mast cell stabilizers, corticosteroids (primarily inhaled and limited to the airway), leukotriene antagonists, etc — work to prevent attacks. There is always room to improve. The role of long-acting beta-adrenergic agonists is much less clear than it first seemed.

I will agree with you that there is some research. I will not agree that there is a clear theoretical basis for it, or a sufficiently large sample size, to overturn the recommendations of the large-scale consensus panels. Complementary homeopathic treatment could well be the subject of trials, but homeopathic alternative therapy for significant respiratory disease is a nonstarter for most people with a substantial evidence-based medicine background. The article can mention both points of view. Howard C. Berkowitz 15:40, 25 October 2008 (UTC)

Howard, you've shown yourself to be a diligent researcher on the internet, and I'm appreciative of that. However, I hope that you realize that it is more challenging to be an accurate researcher (heck, we ALL make mistakes...I'm certainly not immune). My point is that if you chose to do a review of some of the above studies on asthma, you would have found that 1994 Lancet study that treated asthma patients with homeopathic doses of whatever substance the asthma patient was most allergic, based on conventional allergy testing. It would seem that you of all people would acknowledge that there IS a CLEAR theoretic basis for the use of small doses of allergens to provide some clinical benefits (the difference in this study was simply that the doses of medicines used were in the 30C homeopathic dose. Although this trial was relatively small (28 subjects), the high statistical significance required a substantial difference between placebo and control groups.

While YOU may not want to risk homeopathic treatment, other people are tired of the risks (and sometimes inefficacy) of conventional treatments. In fact, the increased use of steroidal drugs in the treatment of asthma patients has led to a variety of other chronic illness and to increased mortality (previously, very few people died from asthma, but that has changed as the drugs being used to treat it have increased in their immunosuppressive effects). There are risks in everything we do (or don't do). Dana Ullman 01:31, 28 October 2008 (UTC)

Allegations/Criticism

I see that a lot of 'negative statements' are being included in this article. If one keeps inserting all the allegations/criticism one can find on the Net, the credibility of Citizendium will be lost.—Ramanand Jhingade 03:40, 25 October 2008 (UTC)

Without specific examples it is hard to comment. Chris Day 03:50, 25 October 2008 (UTC)

I have to agree with Chris, Ramanand. It does not advance the conversation just to point out that there are a lot of "negative statements" in the article. Could you elaborate? Perhaps try to quantify or otherwise characterize "too many"? Give examples of statements that you think go over the top, somehow? Obviously, we do not want to give the impression that CZ takes an editorial stance against homeopathy; a reasonable, uninvolved reader should get the impression that we are neutral. --Larry Sanger 02:45, 26 October 2008 (UTC)

Rather than start a new section, I reverted out the addition of "although it is practised worldwide.", with the edit comment "the survey says it".

First, the survey does not say it. The survey speaks of homeopathy in a list of countries, a list far smaller than the number of countries in the world. Second, I see no information added by the survey. Third, the survey itself is non-notable; the survey firm has 600-odd occurrences on a Google search; its website has no indication of any qualifications in health matters; the survey itself is written as an advertisement and does not give any methodological information -- but phone numbers to call if you want the company's services.

I think the process in place can give the appropriate credibility for CZ.Howard C. Berkowitz 04:19, 25 October 2008 (UTC)

Some thoughts on compromise

At the end of the section on the Lancet controversy, I tried to flow into some thoughts that arose from a recent paper on external and internal validation in conventional surgery. I freely admit it's near my bedtime, and perhaps I should have put this all on the talk page, but I felt it really flowed from comments in the text, and perhaps complemented them.

Perhaps we are approaching some of this in the wrong way. While I still contend the statistical trial method that has been mentioned for pharmacogenetics could well work for prospective randomized controlled trials of homeopathic remedies, presumably versus a drug control group, there may be another model from evidence-based medicine. It's often not realized that surgical procedures do not need the approval that is required for drugs and medical devices. There is something in common between surgery and homeopathy: it is the profession that decides if a technique is effective.

The difference I see, however, in the approaches of surgeons and homeopaths are that surgeons are not necessarily hostile to attempts to get more statistical rigor into after-the-fact review. The personal, subjective impression of Howard C. Berkowitz is that the homeopaths here, and in citations, seem utterly appalled by the idea that anyone might suggest that any two patients are treated in a compatible manner -- yet there are over-the-counter homeopathic remedies, and there are at least some relatively widely used remedies such as Oscillococcinum. Some homeopaths say that remedies can be preventive, while others deny it, and I must confess that cannot, as Chris put it, wrap my mind around the idea that if symptoms are required to select a remedy, prevention is done before symptoms occur, than how could a simillium be selected?

Anyway, I hope there might be some constructive observations here. It doesn't prove or disprove homeopathy, but I think it gives me insight into why homeopathic and evidence-based medicine people can't seem to communicate. Where alternative medicine has become complementary, it always required both disciplines agreeing on some things. When I read things like miasms, even in the newer discussions I searched, I don't know where to start, and I read so much anti-medicine anger in some of those articles I sense little interest in trying to find common thinking. Can that be fixed?

I might suggest something that would help in this article: move the things 50-200 years old to the history article, other than a brief historical note. No modern physician will argue that the "mainstream" physicians of Hahnemann's day were totally incompetent by current standards. The problem, in my mind, is that there's little homeopathic recognition that medicine has learned by its errors. Pardon me, but homeopathy seems largely stuck in Hahnemann's model -- if there has been progress and reinterpretation, will some homeopath please, please discuss it in terms that a biomedical scientist can understand? Howard C. Berkowitz 05:39, 25 October 2008 (UTC)

Howard, I am strongly against moving historical information out of this article. Please know that conventional docs have asserted that their methods have been "proven" for 150+ years, and homeopaths have consistently questioned that statement and have been consistently accurate. We rarely doubt that conventional drugs "work," that is, they do temporarily remove symptoms, but is it just a coincidence that few drugs have won the test of time (admittedly, with rare exception).

Based on what you've written here and elsewhere in this Talk page, it would seem that you would support a statement in every article on every surgical procedure that there have not been double-blind and placebo controlled trials that have "scientifically" tested this procedure. The bottomline is the good research needs to have internal and external validity, and it is THIS problem that homeopaths question. It is akin to giving every conventional medicine patient antibiotics and then say that this "proves" that antibiotics don't work.

Homeopaths are not against evidence based medicine. Homeopathy has withstood the test of time and has done so internationally.

Howard, a good resource to you is the writings on Paulo Bellavite, MD, a professor of pathology, whose work is available online, though his book, "The Emerging Science of Homeopathy," is also worthy. Dana Ullman 15:08, 25 October 2008 (UTC)

First, a note on terminology. "Placebo-controlled" is not synonymous with randomized controlled trial. The current World Medical Organization interpretation of the Declaration of Helsinki considers placebo controls generally to be unethical in the absence of established treatment.

I would support a statement, on surgical procedures when blinding is not possible, that they have not undergone the testing or review that are applied to drugs or what the FDA defines as medical devices. I would not support such a statement for drug or device therapy.

I don't understand your point about giving every conventional medicine patient antibiotics. Antibiotic therapy and resistance has been a research interest of mine for over 40 years. If you can show me that homeopaths use as rigorous a method as a competent physician uses to prescribe antibiotics -- empirical therapy based on local infection control information when the pathogen and sensitivity are obvious without microbiological lab support; culture, sensitivity, immunoassay, and even bacterial genetic analysis when the diagnosis is in question -- I will be very interested.

Conventional docs now recognize when they were wrong for 150 years. The theory and techniques are radically different. There is constant review and improvement. If you want to argue from 1810, 1905, or even 1955, I feel it appropriate to note that EBM rejects the therapies of those times. I do note very little mention of review and improvement in homeopathy, but an enormous amount of anger, and some of that going back literally hundreds of years.

You are mixing apples and spinach to jump from surgical to pharmacological testing. I would point out that I cited surgeons' concern with validation and how they might improve.

In all sincerity, I would ask you to look at parts of this article, putting yourself in the position of the hypothetical healer from Mars would look at its words and infer that homeopaths are not against evidence-based medicine. Part of my appeal last night was to tone down some of the hostility. I rewrote some of complaints by homeopaths about trials, when I read the actual papers and found they attacked homeopathy far less than the article text suggested. I'd like to see some of the same humility and knowledge that they need to improve that ethical physicians use, not "Homeopathy has withstood the test of time and has done so internationally." The impression this article gives is that homeopaths have largely taken Hahnemann's model and, at best, made minor tweaks. If that is wrong, make it clear, and one of the first ways to do so is to put out examples of where homeopaths have discarded methods. It's not my job to go out and research that homeopathy has done it -- my job here is to represent the view of someone that believes that constant review and process improvement is the standard of conventional medicine, and physicians have developed a lot more humility since 1810. They have taken positive steps to continue improving. Howard C. Berkowitz 16:02, 25 October 2008 (UTC)

Howard, homeopathy has evolved every year since it started, and every year we add new medicine and new insights about healing. Today, the vast majority of homeopaths use expert system software to help them find the indicated medicine for the sick person with greater precision. However, when homeopaths add new medicines, they don't have to throw out the old because the old still work for the syndrome of symptoms that they are known to cause. They have also developed different methods to find the correct method (besides software). While there IS constant evolution of homeopathy, the strength and stability of homeopathy is that the new information is in addition to the old, not in replacement of it.

Howard, you wrote, "Conventional docs now recognize when they were wrong for 150 years." It is easy to admit errors in the past. It is more difficult to admit them in the present. One can get rid of pain with various drugs and call that "evidence based medicine," and yet, inevitably, future Howards and others will admit that they were wrong in the past but insist that they are "right" now. Sad ole story. No anger here, just the fact 'mam.

Historically, homeopaths are considered "empiricists" while conventional docs considered "rationalists." Conventional medicine is rational, while homeopaths use what works. Howard says that physicians have "developed a lot more humlity since 1810." Huh? As you might say, show me the evidence. Dana Ullman 13:24, 26 October 2008 (UTC)

"future Howards and others will admit that they were wrong in the past but insist that they are "right" now" Again, the rules of CZ are not about personal judgments.

Let's see. Physics, chemistry, farming, construction, mathematics, biology, ethics, law, land transportation, warfare, sea transportation, air transportation (well, we still have hot-air balloons, but they've changed), mining, social services, clothing, and other things, have largely thrown away 1810 practice, not added to it (well, maybe not law). The means we are using to have this conversation was inconceivable in 1810. Even in the performing arts, while we certainly use compositions and plays that existed well before 1810, the actual presentation makes them available for immensely larger populations. Only homeopathy, it would seem, had the only true body of knowledge from the beginning, needing minor improvements, and, for some reason, it has not become a consensus of mankind.

Larry, I believe you were saying something about offering compromise? I'm beginning to think, for example, some documentation about the change in repertory and materia medica since 1810, in comparison with the amount of change in virtually any form of human knowledge. To use something indeed ancient, res ipsa loquitur, and, for that matter, sic transit gloria mundi." Howard C. Berkowitz 14:26, 26 October 2008 (UTC)

Hmmm, I hope that everyone can see why some pro-homeopathy show some anger here. I wonder if you would say the same things about acupuncture or herbal medicine. I wonder what you'd write about gravity: it can't be right because it has been around for such a long time, and it hasn't "evolved" enough as compared with other fields. You're on the edge of the ridiculous. By the way, there is one homeopathic software program called RADAR that has been around for around 15 years, and it is in its 10th edition because they continue to update its body of information (materia medica and repertory). The core information is the same in homeopathy, but there has been tremendous development in the field just in the past 15 years. Howard, you're not just wrong, you seem to revel in your anti-homeopathy bias. Please do more homework and consider more humility. That said, it is a tad ironic that you just recently wrote that today's physicians have so much more humility than physicians in the past. Yeah, right. Dana Ullman 22:08, 26 October 2008 (UTC)

Double-checking references

I asked above who added in the "42% of British doctors refer to homeopaths" statistic, and nobody volunteered the information. So I actually had to go through the history and find it myself--something I'm not particularly happy about having to do. If we're all working on this article together, we should be forthcoming about such information.

I would again like to request an explanation for Dana as to the error of the source. I imagine it was just carelessness? The reason I think it is important to ask is, I would like to know how much more of the references we need to check, in order to correct some really egregious and potentially embarrassing errors. Such an error can reflect poorly on all of us who are working on this article. If it was carelessness, I'm afraid that means we should carefully check every single one of the many footnotes Dana has entered.

Anyway, everyone, please do be careful about your claims about what your sources say, and how you characterize the research they contain. --Larry Sanger 03:01, 26 October 2008 (UTC)

Larry, I mistakenly thought that the BMJ article on "Complementary Medicine in Europe" had the above statistic, but I corrected it above with the more exact reference. The bottomline is the information was correct, and the only problem is that an additional reference needed to be added. Thanx for encouraging precision. Dana Ullman 13:05, 26 October 2008 (UTC)

Prevalence of health care provider types

The article now states, with no sourcing,

There are estimated to be more than 100,000 practitioners worldwide, and 500 million people receiving homeopathic treatment, making it the most popular system of medicine after conventional medicine.

Hmmm...so, 5000 patients per homeopath, if equally divided? Pretty good workload, given the lengthy visit times reported in the article. I note that the visit times also aren't sourced.

While I recognize that there are varying levels of homeopaths, and some people are qualified in homeopathy and conventional medicine, let's discuss a little perspective on this number, and see if it really belongs in the article. Going to the UN/WHO health statistics database at http://data.un.org/Data.aspx?d=WHO&f=inID%3AHSR01, I didn't find a worldwide total, and it doesn't easily copy into a spreadsheet. So, as a first approximation, the countries with more than 100,000 physicians are;

Argentina, Brazil, China, Egypt, France, Germany, India, Italy, Japan, Mexico, Pakistan, Russian Federation, Turkey, UK, Ukraine, US.

So, conventional medicine is sufficiently popular that 16 countries each have more physicians than there are homeopaths in the world. Now, in excess of 200,000, the US has 730,801, Russia has 614,183, Italy: 215,000, Japan: 270,371, India: 645,825, France: 207,277, China 1,862,630. Not feeling like doing a lot of computation, let's just round these down and subtract 100,000. That gives 37 extra WorldNumberOfHomeopaths. 37 + the original 16 makes the homeopath to physician ratio 53:1.

Is that a dominant force? During the Cold War, there was an auto race in Moscow, with a Corvette against a Zil. Pravda reported that the Zil won second place, while the American car could do no better than next to last.

I suggest that either these numbers and "popularity" statements come out, or CZ require they be fully sourced. Remember, that means that it's only fair to have a list of celebrities that use conventional medicine.

If necessary, I'll figure out how to add up the UN numbers. Of course, those will be sourced, so it would only be fair that the homeopath numbers be sourced. Shall we do that? Howard C. Berkowitz 03:09, 26 October 2008 (UTC)

External validity of the homeopathic patient loads

The article says "Generally, a typical homeopathic interview can last from 15 minutes to two hours, with 5 to 45 minute follow-up consultations." If I use an average of 45 minutes, that means 3750 hours per homeopath per year, to see each patient once. A 40-hour work week provides 2080 work-hours per year, before holiday, sick time, or professional education are counted. To see that many patients once, it's a 93.75 hour week.

Are we really, really sure these are plausible numbers? I propose to delete them. Howard C. Berkowitz 02:48, 27 October 2008 (UTC)

Upon reflection

I have moved to this talk page the footnote, formerly in the body of text,

"These include some transcendentalists (Goethe, Alfred Tennyson, George Bernard Shaw), politicians (including 11 U.S. Presidents, two British Prime Ministers, Mahatma Gandhi, San Martin and numerous other world leaders), corporate leaders (John D. Rockefeller, Charles Kettering), clergy and spiritual leaders (seven popes and dozens of Eastern spiritual teachers), sports stars (David Beckham, Martina Navratilova, Boris Becker), musicians (Ludwig van Beethoven, Frederick Chopin, Tina Turner, Cher), artists (Vincent van Gogh, Camille Pissorro), and many other cultural icons. Charles Darwin is known to have taken homeopathic remedies, Sir William Osler greatly admired Hahnemann, Charles Frederick Menninger first trained as a homeopath, and C. Everett Koop was inspired as a child by the family homeopathic physician. See [7]."

If this is reasonable to include, surely it is appropriate and neutral to present, side-by-side, the various transcendentalists, politicians, corporate leaders, clergy and spiritual leaders, sports stars, musicials, etc., who are known to have taken mainstream medical treatment.

There is also a bit of mixing of oranges and potatoes here, by switching from those to people who have, for a very wide range of reasons, admired or studied homeopathy or individuals who practiced homeopathy.

I must inquire about the appearance of conflict of interest. The only source given here is www.homeopathicrevolution.com, with no other information about its source. The first lines on that page, however, are

The Homeopathic Revolution:

Famous People and Cultural Heroes Who Chose Homeopathy

— a NEW book by Dana Ullman, MPH

When I have cited my own (peer-reviewed) publications, I have always made a point to fully identify the source in the citation, and make a personal practice of making a disclaimer on the talk page of the relevant article. What are the CZ rules for situations such as this? Howard C. Berkowitz 15:40, 26 October 2008 (UTC)

Personally i find this information adds nothing to the article. I have said this before in now archived sections of the talk page. First, Dana wanted this in the introduction without it even being in the body of the article. I tried to move it to the popularity section as a compromise, this was not popular. I then tried to reduce it to a footnote as it seems more appropriate given it adds little to our understanding of homeopathy. That seemed like a fairly obvious compromise but I do agree it could be cut completely and no harm the article. Actually, it would make the article stronger, in my opinion. I will give a clear rationale for this opinion if needed. Chris Day 17:02, 26 October 2008 (UTC)

For the record, I did not place the above information in the article, though I do think that it has a place in this article. There are MANY academic books by medical historians who note that the users and advocates of homeopathic medicine in the 19th century were the cultural elite: the leading literary greats, the wealthy classes, the royalty, the clergy, and musical greats. It is true that my book is presently the best reference to ALL of them, while other sources are good for each group. Previously, the introduction to this article made reference to the British royals' support for homeopathy, and it seemed to me that this was the best place for adding further information about other leading supporters.

Howard's desire to list all of the "other" famous people who used conventional medicine is more than a tad silly, though he is welcome to do so in the article about conventional medicine, not THIS article (IMO). Dana Ullman 22:24, 26 October 2008 (UTC)

Dana, I would be much more open to that list of names being in the history of homeopathy article, which is more the place for social context. Otherwise, its presence, without a list of people who have remained quite comfortable with conventional medicine, seems a rather contrived way of increasing the social impact of homeopathy.

For the record, I find that celebrity endorsements, much less mention that celebrities may, at some point, had something nice to say about some subject, has little place in an encyclopedia article about any subject. Now, if C. Everett Koop had actually endorsed homeopathy, that would be very significant. Since, however, the quote from his biography said that he admired one homeopathic physician as a boy in the 1920s, there are zero MEDLINE hits on Koop and homeopathy, and his 13-page curriculum vitae at Dartmouth Medical School does not contain the word "homeopathy", there is no reason to believe that he supports the discipline. Koop has never been shy about making his position clear.

I will bring up again that there is no sourcing for the unsourced figure of 100,000 homeopaths, 500 million patients, and it being the second most popular form of healing in the world. Unless someone can source that material, my preference would be to remove it. Otherwise, since I believe Larry has made clear that the article is to be seither a marketing piece for homeopathy nor an all-out attack on it, I shall add the equivalent numbers for conventional physicians, which places homeopathy in demographic perspective. Howard C. Berkowitz 23:07, 26 October 2008 (UTC)

Dana you say "For the record, I did not place the above information in the article," but in the history link Larry cites just above it appears that it is the very same edit where it was added. Your edit, straight into the introduction. Maybe that was not your intention since it was the same edit where you misreferenced the 42% figure? Chris Day 01:06, 27 October 2008 (UTC)

Chris, I meant to say that I did not provide the "reference" to my book to this article. Thanx for keeping me honest.

As for some of the prevalence info in this article, I remember reading in a WHO journal that there are over 100,000 homeopaths in India alone (I will try to find that reference). In the meantime, I do not know any reliable figures for the overall number of people who use homeopathy today. Let's delete the 500 million figure...and let's remove the information about homeopathy being the "second most popular form of healing in the world." Some homeopaths make this statement, but I know it is wrong. Herbal medicine is used by many many more people. Dana Ullman 13:23, 27 October 2008 (UTC) Dana Ullman 13:23, 27 October 2008 (UTC)

I see, I was referring to the content not the reference. i have no problem with the reference. I'm just not sure how we should use the material. As a note I found it to be appropriate, as a list in the article it seems out of place. Chris Day 01:54, 28 October 2008 (UTC)

A good example

Dana, I'm glad you brought up herbal medicine. There seems to be no CZ article on it, although I've been hunting through Medical Subject Headings' and failing to find a good article title. "Phytotherapy" and "Herbal medicine" are defined in a mutually exclusive way, but not under a common term.

I mention this only briefly, but I wanted to point out that there seems to be much better communications, without absolute agreement, between herbalists and biomedical people. This is something I encounter frequently; one of my extended family considers herself an herbalist, and we have gone through some interesting discussions since she is one of the holders of my medical power of attorney. It's been possible for us to agree, "yes, I know you think highly of this particular herbal against cancer. Should I develop cancer and no other treatments are available, I do not want that herbal used. I want palliative care. At the same time, if I were acting for you and you were in the same position, I would respect your wishes and make it available."

There is clear active research into plant-based medications, and refinement of the techniques. There's no question that digitalis leaf preparations are ancient and potentially very effective, but the herbalists I know do not feel their art is contradicted because synthetic digoxin is used; they recognize the digitalis glycosides have so little margin between therapeutic and toxic levels that the predictability of synthesis, of a known herbal component, make sense. We can agree that there is abundant data showing that valerian can do comparably to benzodiazepines and the major reason it is not a therapeutic alternative in the U.S. is that there is no commercial incentive for drug approval.

I can think of several areas of CAM where there is this sort of interaction and seeking of common approaches. Perhaps the problem is that homeopathy is fundamentally an "alternative" or "whole" system. One of the things that should be getting more attention, in this article, is the interaction between homeopath and patient. With no disrespect, even if homeopathic preparations are all placebo, I'm perfectly willing to say that some homeopathic interactions are beneficial. There are complex economic issues in physician time, but perhaps the model of how a homeopath interacts could be very useful for more affordable nurse practitioners or physician assistants, making the physician the powerful drug specialists.

It's rather sad this sort of discussion is not emerging. Howard C. Berkowitz 16:24, 27 October 2008 (UTC)

Howard, Western herbology is primarily used in a similarly reductionistic and symptomatic fashion as conventional medicine, while Eastern herbology, as commonly practiced by acupuncturists, is much more systemic and constitutional and even based on the energetics of meridians.

Andrew Weil commonly talks and writes about digitalis, and he notes that herbal doses of it create various digestive symptoms as side effects (i.e. nausea) of overdose BEFORE causing more serious cardiovascular side effects. The synthetic version of digitoxin has little digestive side effects, while the side effects go directly to the heart, thereby creating much more danger than the herb.

At this point, I both want to express my appreciation to and for you and to apologize for the many times that I have been patronizing to you. You are really trying to understand things, and although we are both primarily working out of our own different worldviews and although we are still struggling to understand and respect each other, I wanted to stop for a minute and say that I want to try harder to communicate clearly with you. Dana Ullman 01:44, 28 October 2008 (UTC)

Thank you. We shall try.

Regardless of what Dr. Weil may say about herbal doses of Digitalis purpurea, I would not rely on nausea as a warning of toxicity from digitalis glycosides. Both digoxin, which does not occur in nature and digitoxin can be synthesized, but digoxin's half-life allows once-daily dosing. The class remains incredibly valuable, but has a very narrow margin between therapeutic and toxic levels. It's an excellent example of a drug with an extremely nonlinear dose-response curve, and a huge number of metabolic and pharmacologic interactions. Perhaps I'm conservative, but I prefer to see it started with hospitalized patients, or with access to frequent cardiac monitoring and blood levels. There was a time I had to take it for a specific short-term indication, and, from my first dose, I kept a close eye on the cardiac monitor (well, once I was conscious). It's a necessary part of the overall treatment of heart failure, but it is no longer the initial drug, but one you try not to need. Its toxicity is such that there was commercial justification to develop a specific neutralizing monoclonal antibody.

Let me pose a thought experiment. Perhaps we might pick a chief complaint that is significantly defined by symptoms, fibromyalgia. There seems little question that the best medical success is with a team approach, and I wonder if there might be parallels between the interaction of team members with the patient, and the perhaps longer individual interaction with the homeopath. There are assorted medical situations where a nurse practitioner or even clinical pharamacologist, who interacts more directly with the patient than do many physicians, seem to get better results. At least in the U.S., economic factors prevent many physicians from having the interactions they believe is proper care. I know an endocrinologist, for example, who made more money and was much unhappier doing general internal medicine as well, under heavy time pressure. When he pulled out of the group and went into solo practice restricted to endocrinology, he spent the time with patients that he believed they needed, not what his business manager dictated. Since few U.S. plans reimburse homeopathic care, the business managers and third-party payors drop out of the practice of healing. Howard C. Berkowitz 02:39, 28 October 2008 (UTC)

I'm not clear what you're proposing. I certainly understand why a doc wants to spend more time with his/her patients, though time and attention alone are inadequate for proper treatment. It is more important what is and isn't prescribed. Dana Ullman 13:32, 28 October 2008 (UTC)

A violation of our rules

Ramanand Jhingade wrote the italicized part here: "Medical organisations advise that there is no evidence that homeopathic remedies are effective in these circumstances, and recommend that they should only ever be used in conjunction with conventional medical treatment; to this, homeopaths say that ignorant people should not comment about something they don't know about because they heal asthma and bronchitis day in and day out successfully - they also point to a study where a homeopathic remedy has been used to shorten the duration of acute bronchitis."

I believe this contains a serious breach of our rules. It is problematic enough to say on talk pages that your opponents are "ignorant," but to put the insult into the article itself is distinctly unprofessional. I'll be addressing this further in e-mail with Mr. Jhingade. --Larry Sanger 03:12, 26 October 2008 (UTC)

What's really frustrating is that many of the questions relating to these issues are ignored on the talk page itself. This problematic sentence is a clear instance where it needs to be resolved on the talk page first. To keep editing such a sentence in the article when there is clearly objections from both sides is not contructive. Let alone throwing out insults too. Chris Day 16:56, 26 October 2008 (UTC)

I have written to Ramanand too to express my desire that he be a lot more diplomatic and respectful to everyone on CZ. I simply ask us all to not tolerate abuse but at the same time to try to sympathetic to those of us different experiences from the majority. Dana Ullman 01:48, 28 October 2008 (UTC)

The Introduction

IMO Howard added a bunch of stuff that didn't seem appropriate for the Introduction. I have made some edits and am open for discussion. We previously had some other material here that was quite balanced, but it isn't there anymore. Perhaps we can begin to resurrect it because it now needs work. That sentence about mainstream medicine is simply dangling (and I have no intention of deleting it). Dana Ullman 23:07, 26 October 2008 (UTC)

I'm open to making that sentence less dangling, but I don't see any way to do so without explaining some of the reasons that, to put it as gently as possible, mainstream medicine and homeopathy aren't communicating. There are, I believe, two separable parts of the problem. One is efficacy of treatment and the very different views on contemporary medication. The other is more theoretical, and gets into what seems to me is a fundamental view of how the human body works. Howard C. Berkowitz 00:55, 27 October 2008 (UTC)

The introduction should primarily provide summary info, and the material that you previously inserted did not do that.

At present, there are now two separate paragraphs in the intro that discuss "vital force." We also need to merge those. Dana Ullman 13:15, 27 October 2008 (UTC)

Again in the interest of compromise, I'm perfectly willing to have that information elsewhere in the article. My understanding of the CZ approach is that the appropriate way to handle that would be to cut it out, paste it to the talk page, and then ask several questions:

• Is this information accurately summarized and/or cited?
• Where is the best place to put it, if not the introduction?
• Just a "this does not belong in this article" is insufficient justification for removal without relocation. In this case, I believe there is value in pointing out some of the fundamental conceptual conflicts between homeopathy and biomedicine, as long as it is somewhere.

Deleting material simply because an individual thinks it is in the wrong place is not within the ground rules. Temporarily moving it to the discussion page is perfectly reasonable.

Without clearly identifying where homeopathic and biomedical viewpoints are clashing, there is no chance of improving the communication, or, ideally, starting some sharing of ideas. You bring up, appropriately, "vital force". That term is a cornerstone of homeopathy, and perhaps it should stand as axiomatic rather than trying to find a possibly-nonexistent counterpart in medicine. I'm not sure that homeostasis is quite equivalent, and I'm sure "immune system" is not. Other collaborative phrasings would be welcome. Howard C. Berkowitz 16:05, 27 October 2008 (UTC)

Howard, IF there was some type of consensus for what you have written, it might have been appropriate for me to follow your desire to cut and paste the deleted material on the Talk page, but there was no such consensus.

Vital force is equivalent to the overall immune and defense system of the person. That said, I have written 8 books on homeopathy, and only one happened to mention the words "vital force." As it turns out, no homeopath has ever noticed that the words "vital force" were not in there. I reason that I don't commonly use the term is that I prefer to refer to a person's immune and defense system...or sometimes, simply to a person's overall defense system.

The word "homeostasis" is not commonly used in homeopathy.Dana Ullman 02:21, 28 October 2008 (UTC)

"Defense system" or "overall defense system" seem perfectly reasonable terms. "Immune system" would worry me as getting into things that are rather specifically defined. We both agree homeostasis should go.

If I don't seem to be going too mystic, :-) I wonder if homeopaths might use terms aligned to some used in Asian martial arts, and associated meditative practices. "Balance" means far more than not having one's weight properly aligned. It may not be homeopathic terminology, but I'm somehow reminded of my sensei demanding "finding one's center". When the terminology isn't being antagonistic, I wonder if there may be multiple paths to a similar destination. I wonder if there may not be more room for agreement about the mind-body relationship than the memory of water.

This doesn't mean that I didn't absolutely agree with the necessity for invasive procedures for my heart disease; it does mean that I didn't want sedation, just my own set of monitors. To the best of my knowledge, however, I remain the only person, in the history of NIH Clinical Center, to have cooperated in a specialized electrophysiologic mapping of my heart to the words of the Monty Python Blue Parrot. The cardiology fellow was English, and we raised a joint defense system to the head of interventional cardiology, who likes Country & Western playing during his procedures. We made it quite clear to him that "Achy Breaky Heart" is inappropriate for the angiography suite. Howard C. Berkowitz 03:50, 28 October 2008 (UTC)

Followup

In the introduction, I'll try to make changes to which I think we are in agreement.

A procedural note: the CZ concept of cutting and pasting to the talk page is not intended for situations where there is consensus, or even consensus in a subgroup. The CZ concept of cutting and pasting to the talk page is intended for situations where there is a lack of consensus, with the intention of seeking consensus through talk page discussion. In general, deletions other than clear copy editing should tend to move to the talk page; there can be exceptions for Constables, Editors, and, perhaps, when there are things that are obvious rules violations.Howard C. Berkowitz 13:30, 28 October 2008 (UTC)

"Balance" and "center" are lovely words, but neither are used in homeopathy. I still believe that the words "immune and defense systems" makes sense, and the references that I previously provided to the work of Dr. Paolo Bellavite show the body of work in this area. Another body of basic science research on one unique homeopathic formula, called Canova, is worthy of your attention (Howard, YOU, in particular, will be surprisingly impressed by this work): http://canovadobrasil.com.br/english/works.htm -- what is so convenient about this site is that readers can access the original published articles. Here's the latest clinical trial, albeit a pilot: http://www.aids2008.org/Pag/Abstracts.aspx?AID=15800 Dana Ullman 13:27, 28 October 2008 (UTC)

I just made some changes to which I thought we agreed, and tried some flow editing to move some dangling text. Is it not accurate to say that homeopaths no longer use vital force, but Hahnemann did use it and it will appear in historical works?

"Defense system" is fine, but as soon as "immune" is added, that creates an expectation, to most people of a conventional biomedical bent, that there will be measurable immune stimulation (e.g., with GM-CSF: granulocyte-macrophage colony-stimulating factor), immunosuppression at various levels of specificity (e.g., fairly general with corticosteroids and methotrexate, but much more specific with anti-rejection drugs such as tacrolimus and thalidomide -- and yes, the more specific category may suppress the results of immune response, such as tumor necrosis factor-alpha, rather than the immune response itself).

Can we stay with "defense" to avoid setting off the medical medical defense against immunity? :-)

I will look at that article today, although it is a day subject to interrupts -- at some point, the household mechanical genius will finish work on my new used car, and will want to ride immediately. For most of my adult life, I lived in cities and avoided driving. For almost three years, I've had to live, carless, in some semi-rural areas. In Cattish, hissSPIT! Howard C. Berkowitz 13:45, 28 October 2008 (UTC)

Argument for restoring deleted text in introduction

Dana deleted,

This concept comes into conflict with the control systems theory that underlies modern understanding of homeostasis. Homeostatic mechanisms such as neurotransmission are closed loops, with oversecretion variously prevented by reuptake or by inhibitory neurotransmitters &mdash biological systems control themselves by generating "unlikes" or suppressing "likes". autoimmune diseases are caused by a hyperactive immune system, in which there is too much of a "like" Much of homeopathy is rejected by mainstream medicine. Hippocrates is celebrated for his ethics and his powers of observation, but his theories about what we now call physiology are totally discredited.

He replaced it with

and which has been used in various medical treatments since then by a wide range of cultures.refLinn Boyd, The Simile in Medicine. Philadelphia: Boericke and Tafel, 1936. This book was dedicated to the Regents of the University of Michigan, where Boyd served as professorref

The ideas in the deleted text, I believe, is important to have in the introduction, because it is important for the reader to understand some of the conflicts between medicine and homeopathy. "Like cures like" is a fundamental premise of homeopathy, and it is restated elsewhere in the article. Somehow, it has gotten mixed in with vital force and homeostasis.

"Like cures like", I believe, grates on anyone familiar with homeostatic mechanisms. Homeostasis, as I mentioned, is essentially a closed loop control system. Such systems are regulated by what control engineers call degenerative or negative feedback. The output of a public address system is amplified sound "like" the input to the microphone. When that amplified "like" feeds into the input, a horrible squeal results, and the system is out of control.

A great many unlike mechanisms are basic to homeostasis and to bodily response mechanisms. These include inhibitory neurotransmitters and presynaptic reuptake to control that there isn't too much "like", the balance among T4 and T8 lymphocytes, etc.

I can live with some words, to be worked out, that homeopaths regard the vital force as something like homeostasis, if it is made clear that is an analogy. I believe, however, that the systems biology rejection of "like cures like" is as basic to the comflict between medicine and homeopathy as is the Avogadro argument. There has been no balancing language about that principle, and the article needs it to be encyclopedic.

Rather than compromise and agree that "like cures like" is a problem, the response was to put yet another non-comtemporary endorsement of homeopathic principles.

A proposed compromise: take out the control systems theory, and simply state that biological science does not accept the principle of "like cures like", noting that it is a cornerstone of homeopathy, necessary to homeopathy, but an area where the disciplines clash. Rephrase that to say even more strongly that it is a foundation of homeopathy.

Could we PLEASE cut back on justifying things based on things decades, centuries, and millenia ago? Howard C. Berkowitz 23:23, 26 October 2008 (UTC)

Howard, perhaps my deletion of your material and my addition of new material should have been two separate edits. I didn't mean my additional material to be a "replacement" for yours. Please treat them as separate.

Are you suggesting that the human body is a closed system? I hope not because that would be wrong.

And no, homeopathy has a history, and its present status is connected to it. Like I have said elsewhere, should acupuncture only be presented in light of modern or "reductionistic scientific" understandings? (I hope not) Dana Ullman 13:05, 27 October 2008 (UTC)

Many of the control systems of the human body are closed loop. I use closed loop in a specific sense of control system theory, in which a mechanism is controlled by degenerative feedback. As one example, presynaptic neurons regulate the amount of serotonin or norepinephrine they release, using reuptake to control the amount of neurotransmitter that can affect the postsynaptic neuron. Where these are excitatory neurotransmitter, GABA is an inhibitory neurotransmitter.

Closed loop has various implementations, but they include the receiver sending an inhibitory signal, or the transmitter self-monitoring and reducing its output. Unfortunately, while in an interpersonal sense, the term "positive feedback" is a nice thing to hear, in the specific context of control system, allowing a transmitted signal to feed into the transmitter's input will send it into oscillation.

Many neuromuscular disorders are due to a failure of degenerative feedback mechanism, in which the muscular control centers in the brain either become unable to use proprioceptive information, or the information is not being sent by peripheral neurons.

Medicine has a history. Most general articles on medicine, however, refer to recent developments, or specific and repeatable basic understandings. There is a history of homeopathy article. There are various articles on historical aspects of medicine, such as Hippocrates, and many more to be written.

Apropos "laymen" in the introduction

I believe it would be more correct to say "mainstream physicians and laymen" share that view of symptoms and disease that homeopaths do not use. It is fair to say, without accusations, that this is one of the most fundamental reasons why there are failures to communicate.

Biomedical thinking certainly accepts susceptibility factors as part of the overall picture of infectious disease, but they focus on the pathogen. Koch's postulates, as evolved, do not address susceptibility; they address the subset of infectious disease that involves the pathogen. The medical emphasis, however, is much more on the pathogen. Now, there is certainly the awareness of genetic resistance factors, such as the value of the sickle-cell trait to the most lethal form of malaria caused by Plasmodium falciparum. The idea of opportunistic infections that take place when a person is immunosuppressed is rather fundamental, but the approach taken depends on the nature of what causes the immune disorder. Genetic errors such as severe combined immunodeficiency, or disease such as advanced HIV attacking T4 lymphocytes, are treated with measures such as chemoprophylaxis or passive immunization. When a myeloproliferative disorder is involved, more active measures to stimulate or replace damaged marrow are taken. One of the greatest challenges, of course, is to manage graft-versus-host rejection of transplanted organs; ideally, one would suppress only the immunity against the transplanted cell antigens.

Using "symptom" as a broad term to include signs, laboratory tests, etc., killing a pathogen may not be the goal of medical therapy for an infectious disease. With botulism, there are probably no Clostridium botulinum cells active in the patient. With tetanus, especially when the entry point of Cl. tetani is unknown, the emphasis is on neutralizing the bacterial exotoxin and treating its toxic effects such as convulsions; an antibiotic active against the organism would probably be given, but seen as supportive. Management of cholera, especially during epidemics, absolutely requires proper fluid replacement, but antibiotics to kill Vibrio cholerae are not required for most patients. Howard C. Berkowitz 02:26, 29 October 2008 (UTC)

Objection to quoting the one word "promising"

Need I quote the text surrounding that word, again? Putting the one word in quotes overemphasizes, I believe, the actual language, making more of an argument for homeopathy than do the investigators. To get some consensus, here are the last three sentences of the abstract, with promising in context:

Though promising, the data were not strong enough to make a general recommendation to use Oscillococcinum for first-line treatment of influenza and influenza-like syndromes. Further research is warranted but the required sample sizes are large. Current evidence does not support a preventative effect of Oscillococcinum-like homeopathic medicines in influenza and influenza-like syndromes.

Source: http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001957/frame.html

The conclusions are not quite an endorsement for homeopathy. Other changes made to the text, changes which I cannot interpret as other than an attempt to deflect anything that is not strongly homeopathy positive, included:

"there is no established mechanism of action" became "there is no definite or widely accepted mechanism". What was untrue about "established"?

Further, the earlier text containing the promising read: "Data from the treatment trials showed enough efficacy that further trials were recommended, but that the remedy could not be recommended for first-line therapy." This was changed, I believe substantively and inaccurately, to "Data from the treatment trials showed enough efficacy to be consider [sic] "promising," though further trials were recommended and that the remedy could not be recommended for first-line therapy."

Larry, I cannot interpret this as other than an attempt to rephrase a straightforward, and not completely anti-homeopathic, text into language that became actively supportive of it. The changes, I believe, distorted meaning. I reverted them. Howard C. Berkowitz 23:37, 26 October 2008 (UTC)

Yeah, I look forward to hearing Larry's input here too. Although I inserted the word "promising" because THAT was the word used in the text, our information on this study also provided the SAME qualifications that are provided in the rest of the sentence. The only part of the sentence that was previously left out was the word "promising" (thus, it deserves to be put back in for accuracy).

As for "established" vs. "definite or widely accepted," I thought that I was providing more precision to the article. I'm not clear on what "established" means here, while "definite and widely accepted" is a lot more clear. Dana Ullman 13:11, 27 October 2008 (UTC)

In a cooperative spirit, "The Typical Homeopathic Visit"

Hoping that some author-author interactions yesterday, helped the mind-mind relationship, I looked at some things that might improve clarity and flow. Waking up (too early, and now having to search for a reserve of coffeemaker filters), I was also happy to see Gareth had tightened a few things that had bothered my editing sense.

Turning to a larger topic, the section, "The Typical Homeopathic Visit", is a mixture of useful information, point-counterpoint argument of increasing intensity, and a bit of redundancy. As a start, I inserted some lower-level subheads simply to help things I'd like to address. Italics are not saying that there is not important information in the subsection, but, if possible, it should be moved to another part of the article and internally wikilinked; the arguments interfere with understanding something I consider very key: the homeopath-patient interaction. While I shall be bombarded by clathrates and microbubbles for saying this, I believe understanding the dynamics here may be more important than yet another Avogadro-related argument.

• Conflict as to when conventional medicine may be necessary Can we find some wording, acceptable to both viewpoints, that acknowledges that medicine is concerned that certain seemingly mild conditions may need immediate life-saving interventions? The issue of delay in seeking appropriate medical treatment when delay is important but not actively dangerous is another. Anecdote not being the singular of data, I lost a relative and close friend who had continued to see an alternative practitioner, not a homeopath, who kept treating a complaint of pain according to his discipline, over a two week period. The nature of the pain and other symptoms should have strongly suggested an internal organ origin, but only after he collapsed, rushed into the emergency department resuscitation bay bypassing the paperwork, was a rupture of an abdominal aortic aneurysm confirmed. We have better and more widely available interventions now, but, at this time, there was nothing to do than a deathwatch of 18 hours.

Treatment of cancer and other, more controversial conditions where many physicians are open to complementary, but not alternative care, for life-threatening conditions are another matter.

Let me be clear that I've either taken a person for whom I was the advocate, or done it myself, and left a physician office, going to an emergency room or to a specialist I could reach quickly, because I was convinced the physician was making bad assumptions. I've also fired physicians from hospital care. Physicians are definitely not perfect, but they are much better than they were in 1810, 1910, or 1960, and I have a sense homeopaths either reject that idea or are just angry about the past.

• Approach to the entire patient: this is an important section where much more detail about homeopathic thought would be welcome. Even if the remedies may do nothing, I will accept that there may well in the interpersonal part of the process. At the same time, I'd like to reduce the insistence that conventional physicians never consider the entire patient, emotional state, etc.
• Conflict on individualization: Again, we get into one of the areas that homeopaths seem to insist is unique to them, but, purely from a mathematical standpoint, does not seem consistent with points made here. Can we condense here, try to find a less antagonistic formulation, and have the detailed discussion elsewhere?
• Conditions where individualization may not be needed, in part, repeats points in Homeopathy and trauma. If nothing else, there is internal conflict even in the subsections, and I believe there is a need for more material on homeopathic thinking on trauma and other conditions for which surgical intervention may be appropriate.Howard C. Berkowitz 12:56, 28 October 2008 (UTC)

Organizational question

In the present article, there are two top-level sections on safety issues at the end of the article. While the language toward the very last has the flavor of a wrap-up (as opposed to conclusion), certainly, in medical testing, safety is assessed before efficacy.

I propose to combine the last two sections into a top-level heading of "Safety concerns", with the two existing sections moved, complete, into subsections below it. There would be brief transitional text below the main heading.

Once that was done, I propose to move the "safety" section after "scientific basis of homeopathy" but before efficacy. As I've said, safety tests (FDA Phase I) precede efficacy tests (Phases II and III), so I believe the proposal would make the article have a more customary flow.

Since human subject review boards, even before safety studies, want to see theoretical, in vitro, and in vivo studies in nonhumans before approving Phase I or the national equivalent, I believe this material should precede "Safety". I'm not sure "Scientific basis of homeopathy" is the most descriptive title, and would be open to hearing alternative suggestions.

If the idea of trying to follow the structure of ethically approved testing makes sense, I would also propose moving the in vitro and animal studies into whatever-theory-gets-called.

I'm not sure of the best way to handle the flow of matters such as the Lancet controversy. The best that I can say is the text preceding the specifics should have a reasonable summary of the issues. Indeed, the introductory text at the start efficiency might have a summary of, and justification for, each of its major subsections. Howard C. Berkowitz 14:55, 28 October 2008 (UTC)

Vital force and Symptoms

Friends, I got misunderstood (but understandably such). I have rewritten some info in the Intro about the "vital force" (although I don't usually use this term myself, it IS a part of homeopathic theory...and it should be mentioned...and then explained, which is what I tried to do. I hope that I've rewritten this in a way that is understandable and clear and am willing to work with you all to make it better. Dana Ullman 01:59, 29 October 2008 (UTC)

Harold Griffith, MD

Howard previously expressed great respect for Harold Griffith, MD, and Howard expressed surprise to learn that Griffith was also a homeopath. Howard has been resistant to bring "historical" references in this article, while I insist that history is an integral part of homeopathy's story, especially for an encyclopedia. I am inserting here an excerpt from my book, "The Homeopathic Revolution," to give Howard and others a sense of how somewhat distant history merges with quite research history, as is the case with Griffith and his father. Of special interest is Griffith's experience in using homeopathic medicines to treat many serious illnesses and claim quite significant results with homeopathic treatment. While it may not be appropriate to give reference to just any person or physician who makes such claims, this information may deserve achieve notability because of its source.

Needless to say, because I own the copyright to my book, I am allowed to insert this material here:

"Although the name of Dr. Harold Griffith (1894–1985) may not be familiar, he was a giant in the field of anesthesia. In fact, one of Dr. Griffith’s biographers succinctly summarized his medical contribution: “It has been said there are only two eras in anesthesia, before Harold Griffith and after” (Canadian Anesthesiologists’ Society).

Harold Griffith’s father was Alexander Randall Griffith, MD, who graduated from New York Homeopathic Medical College in 1891 and from New York Ophthalmic Hospital’s specialty program in 1892. Dr. Alexander Griffith was medical chief of the Montreal Homeopathic Hospital from 1898 until his death in 1936, at which time his son, Harold, succeeded him. Harold’s brother James was surgeon-in-chief from 1937 to 1966.

As children, Harold and his older brother Hugh contracted diphtheria, and with both conventional and homeopathic treatment, they were among the few people to survive this deadly disease.

Harold Griffith was trained in medicine at McGill University, but due to his special interest in homeopathy, he obtained a homeopathic medical degree from the Hahnemann Medical College in Philadelphia. He moved back to Montreal to work alongside his father and brother, both of whom were homeopathic physicians at the Homeopathic Hospital of Montreal. He became chief of anesthesia at the hospital, where for forty-three years he served as chief anesthetist and thirty-nine years as medical superintendent (today, this hospital is known as Queen Elizabeth Hospital). Under his direction, the Homeopathic Hospital of Montreal was the first in Canada to have a surgical recovery room (Shephard, 2004). Griffith made medical history in 1942 when he became the first doctor in the world to use curare to relax the muscles of a patient undergoing an appendectomy. He was the first president of the Canadian Anesthetists’ Society upon its founding in 1943, and in 1955 became founding president of the World Federation of Societies of Anesthesiologists. In 1951, he became chairman of the department of anesthesiology at McGill University. One of Griffith’s classmates at the Hahnemann Medical College was Henry Ruth, MD, who stayed and practiced in Philadelphia. Ultimately, this fellow homeopath Dr. Ruth became the founding editor of the leading journal in their field, Anesthesiology, which was published by the American Society of Anesthetists.

Griffith maintained a lifelong appreciation for homeopathic medicines to prevent the need for surgery, but he was ready, willing, and certainly able to provide his surgical skills when necessary. He prescribed homeopathic medicines to many patients pre- and post-surgery to help in their recovery. During his years at the homeopathic hospital, the most commonly treated diseases included pneumonia, typhoid fever, tuberculosis, puerperal fever as a complication of childbirth, syphilis, pernicious anemia, and diabetes. Despite the serious nature of these and other illnesses, Griffith maintained that homeopathic medicines were a useful therapy in which 60–70 percent of patients responded favorably (Bodman, R., and Gillies, D. Harold Griffith. Toronto: Dundurn Press, 1996, p. 38)." Dana Ullman 00:46, 30 October 2008 (UTC)

First, Dana, you are again assuming you know what I think, not what I write. You don't.

Second, I never expressed surprise that Harold Griffith was a homeopath. What I have said about Harold Griffin is that the work for which he received the Nobel Prize in Physiology or Medicine was for anesthesia techniques that, to put it mildly, did not use tiny doses of drugs to reproduce symptoms.

What I do believe about Griffith is that he was more willing, than many homeopaths, to recognize that there can be other ways, and that homeopathy can be a complementary as well as an alternative discipline. I don't know how to respond to "Despite the serious nature of these and other illnesses, Griffith maintained that homeopathic medicines were a useful therapy in which 60–70 percent of patients responded favorably ", because there are absolutely no specifics, just a statement of opinion.

I suppose I might be, indeed, a bit surprised that there were only two eras in anesthesia, unless, I suppose, one assumes anesthesia of some sort always existed before Griffin. For some strange reason, I'm reminded of a surgeon commenting, in the Bulfinch Dome at Massachusetts General Hospital, "Gentlemen, this is no humbug."

When an encyclopedia article still does not give a good sense of the day-to-day current practice of homeopathy, but variously leaps into ancient history or argues primary research trials, I do see a problem.. I can think of few areas where human beings practice a discipline for which they cannot outline a coherent set of principles. While somewhat tongue-in-cheek, I did so for rocket science today, with the caveat that it is a lay term for a set of engineering disciplines. The meat of the structure is in the "related articles" section. If, however, one did want to discuss the specifics of an approach to a tactically innovative way to have a boost-phase intercept of a ballistic missile, one could express a start as in NCADE.

Human beings have been using secret means of communications for as long as there has been written language, but it is possible to summarize the fundamental principles of cryptography in a few paragraphs. Fundamental principles are different than explaining how a Feistel structure helps introduce nonlinearity. Infectious disease is a tremendously complex field, but there are basic structuring concepts such as Koch's postulates.

Pablo Picasso tended to frustrate would-be students, for as a basic qualification, he would ask them to draw a clear picture of, oh, a wine bottle and some flowers next to the lamp in the corner. Can't do that? Sorry about that. Come back when you can express the fundamentals. I've spent enough time around artist and galleries to be able to speak of the interesting dynamic of the interwoven conceptualizations of the artist's vision, but I can also draw a cat that looks like a cat, and, indeed, even suggests the texture of a cat.

You have spoken, with apparently high regard, of Sir William Osler. His classic textbook, still being updated, is The Principles and Practices of Medicine. The first edition clearly distinguished between things he knew, things he did not know, and a systematic way to approach real patients. I still seek an equivalent description of how one actually practices homeopathy. With due respect, and hoping that I shall violate neither the family-friendliness policy nor unprofessional language, I shall share a parable, with appropriate updates for non-sexist language, that describes what I have not yet heard. One individual spoke of individual's lover, a gymnast, and how grace and strength made wonderful their lovemaking. The next scoffed, and spoke of a poet as a an even more transcendent lover, who never ceased to cradle with words embracing the soul, as they made physical love.

The last, however, laughed at the other two. The lover of that individual was a marketing representative for a Major Computer Company, and, while they never actually made love, it was just wonderful to hear how good it would be when it was finally delivered.

There have been wonderful things said about how wonderful the effects are of homeopathy, but I can't quite figure out exactly what it actually does when it does it. Shall we stop dancing around and write a clear article? So far, I can think of more specific descriptions from Michael Harner and Sir James Frazier.Howard C. Berkowitz

01:31, 30 October 2008 (UTC)

I'm sorry if my above comments were offensive to you (THAT was not my intent), and I'm a bit confused that you ignored so much of the content here, especially "During his years at the homeopathic hospital, the most commonly treated diseases included pneumonia, typhoid fever, tuberculosis, puerperal fever as a complication of childbirth, syphilis, pernicious anemia, and diabetes. Despite the serious nature of these and other illnesses, Griffith maintained that homeopathic medicines were a useful therapy in which 60–70 percent of patients responded favorably." So, after more than a half century of clinical practice, Griffith found remarkably high results in treating serious illnesses.

As for "complementary medicine," most MD homeopaths I know also use some conventional Rx, but they prefer to use safer medicines before resorting to the "bigger guns." On the other hand, it is the average MD who has seemingly little or no interest in real integrative medicine and instead use ONLY conventional Rx as though they were the only possible or effective treatment. Dana Ullman 01:52, 30 October 2008 (UTC)

Let me try again. I hae absolutely no idea what he actually did for what illness. There is a sentence with a list of illnesses. There is a sentence saying he found homeopathic medicines useful. I don't know if he treated type I diabetes with a 30X dilution of glucose, or protamine zinc insulin. During at least some of his years of practice, there were no effective medical treatments for some of those diseases. Yes, typhoid fever was quite prevalent until water treatment systems were in general use. Now, was he treating typhoid frequently before the effective antibiotics became available? At some point in major cities, it wasn't there.

I keep hearing generalities, about how good it was when someone got it, but I don't know what "it" is. I hear complaints about "average MDs", and don't know your sample. Simply as a patient, much less with the physicians I've worked with on an institutional level, I certainly thought the competent primary physicians took "integrative" approaches, although I can't say I knew any that used homeopathic techniques or referred to homeopaths.

I see data that suggest that there are good things to be learned from the interpersonal dynamics between homeopath and patient, but I keep getting history rather than the approach in the consultation. The major item of detail I've seen, and unfortunately lost the link, was a repertory that Matt Innis found, but symptom recognition wasn't there.

I hear a lot of bitterness about physicians, and I'm sure there is reason for bitterness in both directions. I tend to get a bit peckish with people who never seem to get specific, and no, I'm not talking about the memory of water. No, I'm not talking about physicians that see only one way of approaching things. I have no (CZ-family-unfriendly) idea when a homeopathic MD decides that there can be no delay in using a well-defined "big gun", and how decisions are made, in less emergent situations, when to work with a homeopathic remedy. I don't know if you are suggesting that Griffith, for the specifically named infectious diseases, did not use antibiotics for confirmed and active disease, once such a drug was available. There are chronic pain conditions in which I personally believe in a very wide range of conventional and complementary means, but that doesn't, at the present time, include homeopathic remedies because I have no clue what would be selected or why. Somehow, I manage to muddle through understanding how and why things are done in ICU, but I am completely baffled on how one begins to get an equivalent or lesser understanding of homeopathic technique.

What I'm searching for, in this article, is not vaguenesses and metaphors. I have a rather small trauma surgery handbook that fundamentally deals ONLY with the situation when nothing is going according to plan, every physiologic and surgical technique must be adapted to the moment-by-moment situation. It then goes into setting priorities, adapting to the patient and not the chart, not doing too much or too little.

I can equally think of things like multidisciplinary chronic pain centers that don't slam everything with drugs -- but don't hesitate when heroics are needed. So, if you want to keep complaining about conventional physicians, you are free to do so. I will continue to be unable to get any real insight into homeopathy, and I guess I've gotten along so far without doing so. Maybe there's something there, but the emotion and rhetoric seem to be blocking my understanding. My interest in what Hahnemann, in dealing with real-world situations, is about as great as knowing that pernicious anemia could be treated with raw liver, and then injected liver extract, and, eventually, a rather benign approach. George Minot, I'm sure, was a great guy, and it's a wonderful story that he was saved from death as one of the first insulin patients, to go on and get the Nobel for a treatment no one would use. I'm more interested in how to treat pernicious anemia today, and I'm perfectly willing to listen to complements for adequate vitamin B12 delivery, but not substitutes. Howard C. Berkowitz 03:23, 30 October 2008 (UTC)

Howard, despite all that you've read about homeopathy here and elsewhere, you still do not seem to understand it. The problem here is that you are looking at it as though it is and even should be just like conventional medicine but just with different drugs. It is NOT like this. What you call "vague" is simply your desire for a "this medicine for that disease" mentality. I hope that one day will be begin to understand that there is a big difference between treating "syndrome" and treating "disease" (to clarify, disease is a part of an overall syndrome). Although there are rare instances where one can say that there is one specific homeopathic medicine for a specific disease (Oscillococcinum for the flu, for instance), this is the exception to the rule.

And yes, Griffith says that he was able to prescribe ONLY homeopathic medicines in the successful treatment of many of the most serious chronic disease that people experienced when in a hospital, even many serious infectious diseases and he even notes diabetes in his list. I sincerely hope that you can understand the system of homeopathy and stop asking or insisting on what medicine was given for a specific ailment. Homeopathy and acupuncture have this in common. Dana Ullman 04:25, 30 October 2008 (UTC)

I have offered compromise, and failed.

First, you are not hearing me. I did not say "what medicine was given for each ailment." What I have asked for, repeatedly, is how the homeopath approaches the individualized encounter.

Second, if acupuncture and homeopathy are alike, than we have more of a problem, because I have what seems to be a reasonable understanding of the Traditional Chinese view of acupuncture theory (e.g., the many pulses used in diagnosis, chi, meridians, acupoints), mixed methods by physicians with both OMD and MD degrees and Virginia licenses in both (acupuncture requires medical licensure in Virginia but not Maryland), and the acupuncture-derived methods used by non-certified pain-management anesthesiologists who worked under the guidance of their acupuncture-expert colleagues. For example, in one pain management group, the acupuncture consultant had degrees from a TCM school and a MD school, and was a board-certified OB/GYN. The anesthesiologist who was their specialist in myofascial and sympathetic injection procedure. They worked in sequence, and they were exploring means of adjusting drug injection points, and even needle manipulation, to add acupuncture to the neurologic approaches. They were making much more use of electrically stimulated acupuncture needles at classic acupoints, and, depending on the individual patient, might change the modality but not the location; they found if non-electrified and electrified acupuncture needles did not work or gave partial response, especially the partial responders might get additional relief from TENS or electrostim. Drugs were used, or not used, depending on the specific situation. I have had partial relief of some pain conditions, and, with the full involvement of my primary internist, the best moderate-term relief was from a clinician dual-certified in chiropractic and physical therapy, who used electrostim, heat, massage, and manipulation. Admittedly, it was especially fascinating to listen, at great length, to My Friend Who Was Female and in a U.S. OMD school; she is about six feet tall, likes very high heels and was an interesting visual contrast to the Asian immigrant faculty. Nevertheless, I have direct experience with MDs, OMDs, DCs, DOs, PTs, assorted meditative and visualization practitioners, and all of whom were happy to discuss, coherently, both their approach and how it related to their colleagues' approach.

Third, as I understand the system of homeopathic practice, the key is the history and physical, and perhaps agreement on integrative practices between homeopath and patient. This is what I have repeatedly asked about, not what medicine for what disease. I'm trying to understand the assesment by which homeopath characterize entire patients, which, somehow, whenever addressed to you becomes "what medicine for what disease", rather than the question I actually asked.

Fourth, I regard the continued answers to the question on when Griffith used non-homeopathic methods, and homeopathic in combination with medial methods, as being evasive. Clearly, he developed a number of anesthesia techniques that would kill a patient not receiving intensive support; those are hardly the "safer medicines first". He indeed might have chosen to use a traditional homeopathic remedy first, but, in some cases, eventually decided a medical method was needed as well or as a replacement. I have been asking for examples of such decisions, and also confirmation that he did or did not go to medical methods directly in such narrowly defined situations as culture-confirmed severe infection, or type I diabetes. At this point, I must conclude that either we cannot communicate on the most fundamental level, or that you have your reasons for not answering repeatedly rephrased questions which are not seeking the information you keep repeating I seek, or that homeopathy is more a faith-based practice, much like those that tell me that if I accept $DEITY and sincerely pray to her, all will become clear and I will have a peace that passeth understanding.

I give up. Go ahead and write whatever you want. If I find some of that to violate (especially) safety-of-life considerations, or a very different medical position, I will state the position side by side, as provided by CZ policy. If I find that you have written material I consider actively dangerous, or rhetorical rather than informative, I shall propose deletions on the talk page, and, if required, go through a formal dispute resolution that might consider how, for example, we have excellent articles discussing the interaction of chiropractic in medicine.

As opposed to your repeated characterizations of my motivations, I don't want to speculate on yours. I shall simply focus on a CZ process, in which sincere attempts to discuss and understand repeatedly are deflected into what I find content-free admonitions of my wanting the faith to be other than what $INTERPRETATION of $DEITY says.

With the trademark penultimate sentence of an infamous British quiz show in mind, I shall deliver her final comment to a departing contestant: good-bye. From Cool Hand Luke to Martin Luther, here I stand. I can do no else. Have mercy on me.Howard C. Berkowitz 14:04, 30 October 2008 (UTC)

Howard, at your encouragement, I have added info about the homeopathic interview and some basic info on what a homeopath does to find the best remedy for a sick patient. Dana Ullman 05:06, 31 October 2008 (UTC)

Well, let's see if we can jointly improve this. Perhaps it will help if I gave one horrible medical example which, IMHO for all the wrong reasons, is going before the U.S. Supreme Court. I'll take another example or two from medicine, at least one of which is likely to be an indication that a case might be good for individualized medication.

On November 3, the Supreme Court is to hear the case of Wyeth v. Levine. No one will find me an apologist for pharmaceutical companies that do not document side effect, or suppress trial data. From the legal documents [blog commentary http://www.healthbeatblog.org/2008/10/the-case-of-pat.html]], I am utterly baffled about why this case is turning around a pharmaceutical company's labeling, when the drugs involved were:

1. Injected by an injection technique that is inherently risky and is to be reserved principally for life-threatening conditions; a migraine is not such. This is How-to-Inject-101; the actual injection was by a Physician Assistant
2. The drugs used are old and well-known, and anyone giving them should know the risk factors. They are generic. I don't actually give them, but I knew the doses and warning from memory.
3. This was a combination of an opioid analgesic and an antihistamine, neither of which are preferred analgesics and antihistamines. Further, if it was a true migraine, the first-line drugs are not painkillers, but triptans that bring the cause of the pain under control. There may be contraindications to triptans and this hasn't been brought out.
4. Nothing was said about why the patient was in an ER for a migraine, but chronic headaches, especially of the migraine class, are best prevented rather than suppressed. Prevention relies on a good history, which may find a trigger to be avoided. Since the inherent mechanism is a overdilated blood vessel, many pain specialists will, possibly in conjunction with specific preventives and possibly without, may recommend meditative, biofeedback, relaxation or other alternative methods that can relax that vessel.

Now, individualization and listening to symptoms. As a matter of fact, I had to deal with this in a housemate yesterday. Twice in a day, she had a nosebleed, which is very unusual, but it was minor. The second time, she said she was getting a severe headache, and I ran to get a blood pressure cuff. While it is a rare event, the combination of an unusual bleed with a sudden and severe headache has to be considered a potentially immediately life-threatening hypertensive crisis with intracranial bleeding. When her blood pressure and pupillary response were normal, the next things we looked at were room humidity, air filtration, and aromatherapy, if you will, with eucalyptus oil, often safer and more effective than vasoconstrictive decongestants.

In a pain management group, the exact wording a patient uses to describe the pain can be very informative. Now, a good team agrees that whenever a patient reports distressing pain, that is real for that patient and needs to be understood. There are certain ways of describing headaches and trunk/back pain that must have critical factors ruled out; A simple, whispered, sudden "this is a terrible headache" were Franklin Roosevelt's last words; "This is the worst headache of my life" also will set off alarms. If, however, a patient uses exceptionally vivid language, such as "a thousand demons run up and down my head, stab with their pitchforks, and rub salt into the nerves", experience shows that while there may be a vary real abnormality, it's very likely that nonpharmacologic means will help reduce the long-term distress.

You will see, Dana, that, other than a blood pressure, I described no diagnostic tests. I was listening for patient-reported symptoms to help guide the response. Many of the preferred responses include complementary, nonpharmacologic techniques, and, as in the court case, the preferred pharmacologic responses are preventive rather than reactive; without going into the details of prevention, I'll loosely say that most techniques, picked carefully, are stabilizing, or, if you prefer, restoring balance.

Now, I was able to describe this in interpersonal terms, without referring to either a neurology textbook or a repertory. Just as with the data I have from that court case, a PA made some terribly bad choices that should have been basic training.

You have made the point that a homeopath listens carefully to the patient. I have just given examples of how competent medically oriented clinicians listen to the individual experience, and, after emergencies are ruled out, emphasize prevention and stabilization with nonpharmacologic and the safest pharmacologic means. That seems to me to what you describe in the homeopathic session, but there's just a list of history-taking categories and reference books. There's nothing about the cognitive process of the homeopath in assessing the patient. There's nothing about how the interaction brings out these broader aspects of how aspects of the patient's life, which are not strictly disease-oriented, are brought out — a skilled history taker can bring out things of which the patient may not be consciously aware.

So here I am, with specific examples, presenting an integrative, using the least risky treatments including complementary methods, and in a medical setting. This seems to be much as you've described an optimal homeopathic encounter. I'm looking for equivalent homeopathic approaches, such as the way a traditional acupuncturist will try, from pulses, point sensitivity, and discussion, to identify the problems with chi flow on the classic meridians.

Do you see what I am trying to get? It is fairly specific and basic, and does not need generalities about historical homeopaths, how physicians have been mean, structure of water, etc. I am a patient on a first-time meeting and I tell you I am here because I have terrible headaches that the idiot doctor couldn't cure. What happens next? Howard C. Berkowitz 11:58, 31 October 2008 (UTC)

Howard, I simply do not see an encyclopedia become a personal health guidebook, nor should it be a review of the "cognitive processes" of a homeopath, unless you or someone wants to have a separate article on that subject (go for it, if you are seriously interested). Our article presently provides detail enough about what a homeopath will interview the patient and what methods the homeopath will do to select a medicine individually chosen. To clarify, homeopathy is not about just "listening" to the patient (heck, if that were the primary benefit, psychologists and psychiatrists would be much more effective because they have weekly hour-long sessions with patients...and having friends would be even more therapeutic).

If, for personal reasons, you want more information on how a homeopath would treat your headache, why don't you consider going to a homeopath (if you wish and if contact me via email, I will extend myself and make a referral to you). Can I also ask you to try to reduce the length of your postings (the above post is a good example of something that could easily have been said in half as many words). By the way and once again, "restoring balance" has no meaning in homeopathy. Dana Ullman 13:03, 31 October 2008 (UTC)

Regretfully, I find this response evasive

First, it's not yet "our" article, because there is nothing approaching CZ consensus. Second, there already is a history of homeopathy article. Third, there are abundant medical articles, and ones that seem to have interest, that very much deal with the cognitive processes of prevention, diagnosis, and treatment.

I do not have a headache, although this line of discussion could give me one. I used a hypothetical example, a common and reasonable writing technique, to set a representative scenario in which an interaction could be described. You may rest assured that it is entirely irrelevant, at present, for me, to want to know how a homeopath would treat a hypothetical headache of mine, since, based on the lack of information on homeopathy presented here, I would never go to one because I have no specifics on what homeopaths actually do. Please stop attributing personal motivations; it is unprofessional at CZ.

Yes, that was a lengthy post. It was lengthy because I find you nonresponsive to most questions, and I wanted to give you multiple analogies for two reasons. One is that you actually might see something that resonated as a point of departure. Two, I demonstrate that there are abundant ways of describing encounters with healthcare providers and the approach taken, except, apparently, with homeopaths.Howard C. Berkowitz 14:23, 31 October 2008 (UTC)

Just because I have a different opinion that you do on what should be in this article does not mean that I am being evasive, and I find that your decision to express your angst in headlines is quite melodramatic and not constructive. And just because you and/or others have created a separate article on the history of homeopathy does NOT mean that there should be no history here. In fact, your insistence and repetition on this issue is getting tiring. Sadly, I am giving you a headache, and you are giving me fatigue. Despite our difference of opinion, we are appropriately expressing our own POV. I am hearing you, just differing with you. I hope that you're hearing me.

The reason that I think that your idea of writing about the cognitive processes of a homeopath would require detailed "materia medica"* discussions of the many common medicines that homeopaths use for headaches, each known for its own certain pattern/syndrome of symptoms. Perhaps someone will want to create something like this in the future when we have many more sub-articles on homeopathy. ("Materia medica" is Latin for the materials of medicines used in homeopathy, and this term is both used to describe a body of symptoms associated with a specific medicine, and it is a single or set of books that do this). Dana Ullman 00:12, 1 November 2008 (UTC)

Well, we seem to be at an impasse, since your description of homeopathy seems to require it be treated differently than any other discipline. What I hear is that homeopathy, as you describe it, must be accepted on faith, and I am not willing to accept that outside a religion article. My own silly observation, from 40 years of experience in complex decision support, is that the starting point would be not the materia medica, but the metadefinition of pattern/syndrome.

I'm really not going to engage in what I regard as pointless and circular discussion of what I believe to be reasonable encyclopedic writing requirements. I shall simply continue to edit what I believe to be attempts to suppress less than positive statements about homeopathy, and the relevant Editor or Editor in Chief will have to resolve the dilemma, if the article is ever to progress. Perhaps your becoming familiar with a few other articles, even, dare I say, in medicine or biology, might give you a better idea of expectations that are not mine alone.

You are, in my opinion after writing and editing an article or two, here and there, on CZ, expecting homeopathy to be treated differently than any other topic of which I'm aware. Eventually, you may find that it is your POV about encyclopedic standards that is more a matter of concern than the arcana of homeopathy. Until then, I say what Clark Gable said to Vivien Leigh. Howard C. Berkowitz 01:30, 1 November 2008 (UTC)

I earlier expressed concern that you've been melodramic lately and your reference to Clark Gable and Vivien Leigh is additional evidence of this. Of greater concern, I cannot see how or why you would say that this article is based on "faith." If so, please show me any (!) religious article on CZ for which there is reference to numerous double-blind and placebo controlled clinical trials and basic science trials. If you cannot do so, please stop making such silly statements, and let's move towards constructive comments. That said, we all occasionally write stuff that we later regret. You can and do provide good constructive comments here. Let's get back on track. Dana Ullman 22:05, 1 November 2008 (UTC)

Melodrama? Ah, I shall draw from Edith Piaf, and sing, "I have no regrets" (well, if I could sing in French). My repeatedly deflected questions are not about clinical trials, but about the regular practice of homeopathy. You keep assuring me that the clinical decisionmaking cannot be explained other than by having studied the inner mysteries, and I should accept that the general practice of homeopathy works because you say it does, but you can't tell me, except in concepts, its basic practice. Well, in response to that, I respond with a reasonably decent parallel to that explanation: Ontological argument for the existence of God. No specifics, just concepts.

I would respond with inviting you to find a medical article on CZ for which an advocate repeatedly insists that the cognitive process cannot be explained. Actually, though, I think I can be even more on track with a good article on sympathetic magic, which I am writing. Some of Hahnemann's writings resonate extremely well with 150 years or so of anthropological observations of the practice of sympathetic magic. What, you say? But you use modern methods routinely now? I still haven't found out what they are in the context of a homeopath-patient encounter, yet I can easily describe them for a wide range of general and specialized medical areas and yes, even some complementary methods. As you keep saying, homeopathy has stood the test of time, and you've never rejected his language about miasms, so I see no reason not to put his theories in context. In fairness to the man, he made very wise observations given the information available at the time.

If "on track" means a song of praise of homeopathy, with "simplification" of the actual language from clinical trial abstracts that have a few more caveats than "promising", enjoy your exercise. Periodically, I shall glide by, on raptor wings, check references, and restore a bit of balance...oh, that's right.

"By the way and once again, "restoring balance" has no meaning in homeopathy. Dana Ullman 13:03, 31 October 2008 (UTC)"

My point exactly. Howard C. Berkowitz 22:32, 1 November 2008 (UTC)

Howard, I was being diplomatic when I said that I felt you were being melodramatic. More accurately, you are too often writing meaningless stuff and providing misinformation. I never said as you assert above, "the clinical decisionmaking cannot be explained other than by having studied the inner mysteries." I simply said that I didn't consider this information to be appropriate for CZ and that doing so would require detailed comparisons between 2-20 (or more) medicines. Please show me where on CZ that anything like this is done, but like I said, if you want to do this, maybe you should do the research and create a sub-article on this subject.

What I am more concerned about is that you seem to enjoy baiting me. You exaggerate what I write and do not show intellectual honesty by doing so. This is not conducive to collaboration. Even your quote about from me about "restoring balance" was my critique of some silliness that you wrote, even though you were previously informed that "restoring balance" is not a homeopathic concept.

Although I appreciate some of what you do here (I do!), this tends to be an exception to the rule. There is a good reason that a lot of people here do not respond to your postings; it is because they are not worthy of further discussion. I urge you to be more selective in what you write, both in quantity and in quality. Dana Ullman 02:48, 2 November 2008 (UTC)

Section moved down from above

First, I shall announce that yesterday, I made the best rye bread I have ever made, which is making me feel better this morning. Alas, I know of no networking technology that can transfer fresh-baked bread.

Larry, apparently I misunderstood that you wanted a much more extensive "mainstream medcine" response. I read some of the homeopathic request to mean that I was being asked "go on the net" and find evidence of solid statistical methodology and results that made the response "equal" in their responses. I was also frustrated by what seemed to be, simultaneously, citing of statistics about questionable merit such as popularity and referrals, but either selectively reporting things that were there, or denying there was any way to make homeopathy compatible with mainstream standards of substantial evidence.

Note that last: evidence, not proof. While every field has its charlatans and outright idiots, there is a trend in medicine to have the humility to accept that diagnosis and treatment need constant revision and improvement. With essentially the same genetically related heart problems, I've outlived my father for 18 years, and he spent the last several years as a cardiac cripple. I look back to what was available at the time of his serious decline in health, and most of the relevant drug classes had not been invented.

I also think of some interdisciplinary medical seminars I've attended, and was fascinated to see, for example, orthopedists and chiropractor working to bring their specialized expertise to clinical problems, with both listening to an expert in pain physiology to hear techniques that could complement their work. While I recognize there are different schools of thought in chiropractic, and $DEITY knows enough (substitute non-family-friendly term) in orthopedics, the point is that everyone was looking for, and finding, common ground. No one was saying the other field couldn't ask hard questions. Most importantly, there was an eclectic, but general consensus about using evidence, and fitting treatments to mechanisms we can always understand better.

Contrasting those workshops with the discussion here simply makes me sad. Oh, there's no question that someone may offer an aphorism, about the clinical encounter, from Osler, but no one is stuck in the professional jealousies and defensiveness of 100 to 200 years ago. While this article clearly needs some historical context, some of the most bitter statements, as well as quotes justifying homeopathic positions, are over a century old — sometimes two. Let the material about the early homeopathic and medical squabbles move to History of Homeopathy. Include enough history to understand terminology (and there's the "catalog"), but concentrate on current work. I would be delighted to explain how bad conventional medicine was at the time of Hahnemann. A century later, Osler observed that there were principally two drugs that consistently did something (digitalis and morphine), with roughly ten more that have stood the test of time. I take a sometimes daunting range of medications for the same diseases as my father, but, running through the list mentally, as many as 12 didn't yet exist at the time of his death. How often are new homeopathic methods demonstrated? How often are things added to materia medica? When do homeopaths remove remedies from use because they have been demonstrated to be unsafe (including avoiding effective non-homeopathic treatment) or to be ineffective?

There is almost nothing in the article about homeopathy as complementary medicine; there is a great deal about homeopathy as an alternative to mainstream medicine. There are some awfully vague comments about using medical testing and diagnosis, but I am still completely bewildered by how the disciplines can work together. At the same time, I have both personal and scientific exposure to very effective collaborations between mainstream and complementary practitioner.

I have occasionally made errors, and when it is noted, I acknowledge it. We all make errors. I sincerely hope that Howard will acknowledge this error below. Ramanand above noted, This article should be

about what homeopathy is, rather than how it is criticized.

. I'm wondering what was wrong with

Homeopaths counter that the vast majority of these larger trials tested a single remedy given to every patient without any individualized treatment, suggesting that these larger trials did not maintain external validity to the system of homeopathy and are therefore not valid tests of it.

which Dana had inserted.

Howard then responded, "What is wrong? It says, in very, very general, nonquantitative terms, that homeopaths don't like trials. It doesn't say how homeopathy can be validated beyond "trust me".

My concern here is that Howard doesn't seem to understand what is meant by "external validity," which is an important statistical concept. The test of one homeopathic medicine in the treatment of a condition for which it is rarely, if ever, used is NOT a good, adequate, or "scientific" test of homeopathy or the homeopathic method. The Shang analysis actually included one trial on the use of Thyroidinum in the treatment of "weight-loss." This study had no external validity. Likewise, Shang analysis included tests of Oscillococcinum in the PREVENTION of the flu...as well as a separate inclusion of a study of Oscillococcinum in the TREATMENT of the flu. There is a long history of use and success in using Oscillo in the treatment but NOT the prevention of the flu. A competitor (Dolisos, Inc.) to the makers of Oscillo in France funded the prevention study, which again, had no external validity. It was no big surprise to find out that this medicine didn't prevent the flu.

These poor scientific studies are akin to prescribing antibiotics for viral infections and then asserting that "antibiotics do not work for infections." That statement is misinformation.

Ultimately, there are rare instances where one homeopathic medicine can be successfully prescribed to people with the same disease, though most of the time, effective homeopathic treatment requires individualized treatment. In sum, Howard, I certainly didn't say or infer that homeopaths do not "like trials" (we just don't like poorly designed trials that are set up to not adequately test homeopathy). Dana Ullman 16:51, 21 October 2008 (UTC)

Dana, I agree that a specific trial should only be testing the homeopathic remedy for which it is designed, but it is still not clear to me whether this precludes clinical trials or not? Obviously precribing is highly individualistic so this make selecting the patients for a trial more problematic. Are there any cases of trials that have occurred where a homeopath does control the remedy but it is also blind from the perspective of the homeopath and the patients? And this comes to another issues that i have still not really wrapped my mind around. If everything is so individialised how is it possible to have homeopathic remedies available for sale from a store? I just can't understand how remedies are robust enough to be sold from the shelf yet a population of patients cannot be found that that all use the same remedy in a blind clinical trial. Chris Day 17:25, 21 October 2008 (UTC)

Any thoughts on these questions? Chris Day 17:06, 26 October 2008 (UTC)

Any thoughts? Chris Day 16:02, 30 October 2008 (UTC)

As for Chris' questions about good blinded trials in homeopathy that are respectful of the homeopathic method. Absolutely! The Jacobs' diarrhea trials, the Chapman mild traumatic head injury study, there have been a couple ADD/ADHD trials, a study at the University of Vienna Hospital on severe sepsis (individualized homeopathic treatment led to a 50% reduction in mortality as compared to patients given a placebo!)...and many others. There was even an interesting asthma trial that gave potentized doses of whatever the patients was most allergic, based on conventional allergy testing...with the medicine being a potentized dose of the allergen.

It is interesting that Howard seems to think that it has been conventional medicine that has helped him outlive his father (who seemingly had a similar ailment as he has), when, in fact, Howard also acknowledges that he has used acupuncture, chiropractic, and perhaps other treatments which also may have changed his health status. Good for him in any case.

I'm confused by a lot of the above...but there is one part above that is WRONG. Homeopaths have no problem with scientific investigations/trials, but we just don't like trials that are poorly designed and that do not adequately respect the homeopathic method. I'm sure that Howard and Chris would not like a trial that tested an antibiotic in the treatment of a viral infection, especially if its negative result leads anyone to conclude that this antibiotic is ineffective for "infections." Similarly, one cannot simply give ONE homeopathic medicine to everyone with a specific disease (except in rare exceptions, which I have in part given previously).

I do need to say that I am surprised, even shocked, that Howard seems to believe that physicians today are humble (his word was having "humility"). While I certainly agree that some docs are humble, they are rare. More often, they are extremely arrogant, and worse, they are extremely antagonistic when patients have an interest in unconventional treatments (several studies have shown that 70% (!) of patients who use alternative therapies do not tell their doctors about it...ouch). While this antagonism has diminished recently, the arrogance of doctors is normalcy (sad but true). I am not saying this to attack docs. I am reporting the state of medicine today. I see much much more humility from homeopaths and alternative practitioners than from conventional docs, though there are exceptions on both and all sides (of course). Dana Ullman 00:23, 31 October 2008 (UTC)

Deletions of commentary unrelated to specific cited material.

There can certainly be comments of homeopathic opinion, but not in a place that would suggest they are part of the citation. In the first cut below, I removed the struck-through text, because it was an apparent individual comment of emphasis, not related to the citation. The citation has been "nowiki'ed" so the context can be seen.

• Begin text from article

Homeopaths also cite a study where "a homeopathic remedy" has been used to shorten the duration of acute bronchitis<ref>{{citation | journal = Phytomedicine | date = 2008 May | volume = 15(5) | pages = 378-85. | title =Pelargonium sidoides for acute bronchitis: a systematic review and meta-analysis. | author = Agbabiaka TB, Guo R, Ernst E. | url = http://www.ncbi.nlm.nih.gov/pubmed/18222667 }}</ref>and thereby heal a patient.

when an attack is shortened, it will heal.—Ramanand Jhingade 03:25, 3 November 2008 (UTC)

• this article does not include the word "homeopathy", so it cannot be inferred whether it was, or was not, used in homeopathic therapy, without further citation from the article. I inserted what I believe to be accurate compromise text:

it does in the body, so I've inserted that.—Ramanand Jhingade 03:25, 3 November 2008 (UTC)

Concentrated plant extracts may be used as mother tinctures, or the starting point for dilution, but such use is not mentioned in the Phytomedicine article. Howard C. Berkowitz 03:59, 2 November 2008 (UTC)

• Again, I show, with strikethrough below, text about homeopathic positions that was inserted into a specific statement of medical principles. Whether or not individualized remedy selection is a must in homeopathy is irrelevant to a specific statement, with supporting station, about what conventional medicine does.

Conventional medicine also has consistent clinical and pathological definitions of asthma, with considerable customization for individual patient needs but still enough common criteria to allow significant retrospective analysis in large populations<ref name="NAEP">{{citation | author=National Asthma Education and Prevention Program | title = Expert Panel Report III: Guidelines for the diagnosis and management of asthma| publisher = National Heart, Lung, and Blood Institute, 2007. |id = NIH publication no. 08-4051 | url = http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm}}</ref>; which is because individualised remedy selection is a must in homeopathy.

that was a grammatical and syntax error which I've set right.—Ramanand Jhingade 03:25, 3 November 2008 (UTC)

• Further, I deleted ", but this article has references to studies/trials which show homeopathy is effective." from the simple footnote defining a term of art, not arguing about it. To me, it's useful and neutral to know that homeopaths use "remedy" as a specific term; in this context, it's roughly equivalent to say that conventional physicians write "prescriptions", which is a term of art in conventional medicine.

Howard C. Berkowitz 04:19, 2 November 2008 (UTC)

the article does mention positive studies, so your removing that is against the ground rules.—Ramanand Jhingade 03:21, 3 November 2008 (UTC)

I don't really plan to argue with you, but simply to pass this to Larry Sanger, and perhaps he can explain it in a manner you will understand. The ground rules do not allow you to insert homeopathy-positive phrases into the middle of text that is simply defining a term, or is presenting a negative medical analysis. They do allow you to write a clear statement of homeopathic position before or after it.

Note that I said "present". CZ editorial rules do not allow arguments in the text. Opposing views can be presented and let the reader judge. You may not attack a medical position, but you may include appropriately sourced homeopathic positions near it, in a grammatically reasonable way. Howard C. Berkowitz 03:39, 3 November 2008 (UTC)

Well, you did not provide sources for those comments (I can provide sources for my comments, but I don't have the time just now).—Ramanand Jhingade 03:51, 3 November 2008 (UTC)

Mistaken deletion?

It was not my intent to do anything more than a minor edit, but somehow Howard correctly did an UNDO on what seems to have been a mistaken deletion of a large body of text. Thanx Howard. Before going to constabilary route, in the future you might check-in with me (or whoever the person was who seemingly did a large delete). Dana Ullman 19:24, 2 November 2008 (UTC)

Or might not, when it immediately follows what I now regard as a completely failed attempt at collaboration, and results in 80K in deletion, which is very hard to consider an accident. Oh, I've accidentally made such deletions, but immediately saw them and fixed them.

Essentially, until there is an active editor involved again, I have given up trying to discuss matters on the talk page. There are fundamental difference not simply about the subject matter, but on the nature of a reasonable encyclopedia article. I see no further point to discussion, although I will follow the rules and make a straightforward explanation, for the record, of why I made other than typographical edits. Howard C. Berkowitz 19:38, 2 November 2008 (UTC)

Howard, first, I had NO idea of any large deletion of mine until I noticed your edit...and I immediately thanked you for that. I had no reason to do that deletion on purpose. As for your desire for an "active editor," actually, I have never "pulled rank" previously, but I guess that you have not yet noticed that I am an editor (Larry Sanger deemed me such). I haven't pulled rank because I prefer to work in a collaborative fashion...and still do. Finally, your statement above shows bad faith, and I sincerely hope that you will redirect your energies or consider working on other articles. Dana Ullman 03:43, 3 November 2008 (UTC)