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Talk:Orthomolecular medicine, Edit history Jan 2006-Mar 2008

Archive

I've archived the enormous talk page, using the "move page" method to preserve the edit history. Let's start over, with a clean slate. Maybe we could discuss something simple, like whether #Orthomolecular doctors and #Orthomolecular scientists could be merged, before getting back to the complications of writing a perfect lead. WhatamIdoing (talk) 05:32, 2 April 2008 (UTC)

Notable

"Notable OM Drs & Scientists" would be okay with me. I prefer the previous 3-4 column format, too.--TheNautilus (talk) 12:09, 2 April 2008 (UTC)

What do you think about "Notable supporters"? The word "doctor" makes me itch, because it can legitimately include PhDs, but is usually received as "licensed physicians." WhatamIdoing (talk) 18:30, 2 April 2008 (UTC)

Ooooh, outed my cultural assumptions. "Notable OM Physicians & Scientists"? AFAIK, most, or at least the notable non-PhD/DSc "doctors" are MDs and foreign versions.--TheNautilus (talk) 18:50, 2 April 2008 (UTC)

I can support that. On further reflection, it has the added advantage of keeping the size of the list under control. "Supporters" could have been interpreted as "anyone with a website or quoted in a magazine article." Would you like to merge the two sections? Perhaps we could alphabetize the names, and use {{div col}} or some such template to make the information more compact? WhatamIdoing (talk) 20:47, 2 April 2008 (UTC)

Lead

I also agree that leaving the lead alone for a while in the form approved by the RfC is an excellent idea. Tim Vickers (talk) 17:08, 2 April 2008 (UTC)

Thanks for your prompt attention, I said 2 days off. I thought we should try a more neutral, less injurious version on for size, we could still talk. The "faddism" and "quackery" are not acceptable lede material, they are poisonous attacks given WP:UNDUE weight often based on highly flawed allegations & distortions, even trivially obvious in the scientific senses. Because of the historical facts on major OMM areas, although I will agree that vitriolic critics are notable in the general sense, their inflammatory misrepresentions & coverage promoting distortions & scientific misconduct that scientifically & commercially interferes & unfairly deprecates others' legitimate results should be discussed where there is space for balancing quotes, references and reader's (yawn) voluntary continued interest.--TheNautilus (talk) 17:44, 2 April 2008 (UTC)

Yes, there are some concerns with the lead, but let's give it a rest for a while. Perhaps over the weekend, we can start a fresh subpage to edit the lead -- edited just like it was the real article, until we can get a reasonable compromise that we can then paste into the article.

One suggestion in the meantime: If there's something that you want to eventually be included in the lead, would you please make sure that it's present in the main body of the article? The guidelines state that the "lead section should briefly summarize the most important points covered in an article," and I'm inclined to enforce the covered in the article bit fairly strictly. So if you want any particular point in the lead, please make sure that it's appropriately represented in the article. WhatamIdoing (talk) 18:40, 2 April 2008 (UTC)

At the moment the first paragraph summarizes "basics" and "method" (those have to go first, so the reader can grasp the subject) the second paragraph deals with the material in "history" and "criticism". The section on "popularity" isn't covered in the lead, that could go as part of a new second paragraph with the "history" summary. Tim Vickers (talk) 18:53, 2 April 2008 (UTC)

Link offensive text dif and moved text to subpage. That last sentence has never been agreed on and as far as I am concerned, has all the lede legitmacy of a KKK scholar's published scholarly opinion ca 1915-1924 on various ethnicities. That kind of last sentence is material that needs to be discussed, not the default article.--TheNautilus (talk) 19:11, 2 April 2008 (UTC)

Indeed it was discussed in the RFC, with 3/4 uninvolved editors preferring this over your version. Just because you disagree with this consensus is no reason to pretend this hasn't been discussed. I've unarchived the RfC, since this was still listed as active. Perhaps more uninvolved editors will comment. Tim Vickers (talk) 19:22, 2 April 2008 (UTC)

For poorly founded, inflammatory material, it was not clearly agreed in the manner & time I have learned to expect, where less troubled, more neutrally worded versions are available. Also there are in essence three versions. I appreciate the input but I will consider facts and policies as best as I know how. Strict numbers aren't the basis of good editing on RfCs or consensus, either, especially in partisan & conflict of interest situations. I also think that the RfC proposition was too narrow and has changed.--TheNautilus (talk) 19:29, 2 April 2008 (UTC)

Request for comment on the attribution of criticism in the lead

Which version do people prefer, in light of the NPOV policy? Tim Vickers (talk) 17:22, 21 March 2008 (UTC)

Version 1

Some therapies that meet the criteria Linus Pauling established to define orthomolecular medical therapies, such as the use of vitamins and nutrients to treat dyslipidemia, are also used in mainstream medicine. However, the scientific and medical consensus is that the broad claims of efficacy advanced by advocates of orthomolecular medicine are not adequately tested as drug therapies, where oppononents and partisans have even described it as a form of food faddism and quackery. Proponents of this approach to medicine note that some research investigating the therapeutic use of nutrients have been published in mainstream sources, and that vitamins are used in conventional medicine as treatments for some diseases.

1. Guyton JR (2007). "Niacin in cardiovascular prevention: mechanisms, efficacy, and safety". Curr. Opin. Lipidol. 18 (4): 415–20. doi:10.1097/MOL.0b013e3282364add. PMID 17620858.
2. Stuart Aaronson et. al. "Cancer Medicine", 2003, BC Decker Inc ISBN 1–55009–213–8, Section 20, p76
3. Jarvis WT (1983). "Food faddism, cultism, and quackery". Annu. Rev. Nutr. 3: 35–52. doi:10.1146/annurev.nu.03.070183.000343. PMID 6315036.
4. Eat it up and be a good boy. The Economist, February 2, 2008
5. Gesch CB et al, Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners. Randomised, placebo-controlled trial., Br J Psych, 2002, Vol. 181, pp. 22-28 2002
6. Research backs theory that vitamin C shrinks tumours. The Independent, 28 March 2006

Version 2

Some conventional therapies use nutrients, such as using niacin to treat dyslipidemia, and some research investigating therapeutic uses of nutrients has been published in mainstream sources. However, the scientific and medical consensus is that the broad claims of efficacy advanced by advocates of orthomolecular medicine are unsupported, with the American Medical Association saying that the idea that most diseases can be prevented by nutritional interventions is a myth. Orthomolecular medicine has even been described as a form of food faddism and quackery.

1. Guyton JR (2007). "Niacin in cardiovascular prevention: mechanisms, efficacy, and safety". Curr. Opin. Lipidol. 18 (4): 415–20. doi:10.1097/MOL.0b013e3282364add. PMID 17620858.
2. Eat it up and be a good boy. The Economist, February 2, 2008
3. Gesch CB et al, Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners. Randomised, placebo-controlled trial., Br J Psych, 2002, Vol. 181, pp. 22-28 2002
4. Research backs theory that vitamin C shrinks tumours. The Independent, 28 March 2006
5. Stuart Aaronson et. al. "Cancer Medicine", 2003, BC Decker Inc ISBN 1–55009–213–8, Section 20, p76
6. Complementary and Alternative Therapies: Orthomolecular Medicine American Cancer Society, 19 June 2007, Accessed 20 March 08
7. Report 12 of the Council on Scientific Affairs: Alternative medicine American Medical Association June 1997, Accessed 21 March 2008
8. Jarvis WT (1983). "Food faddism, cultism, and quackery". Annu. Rev. Nutr. 3: 35–52. doi:10.1146/annurev.nu.03.070183.000343. PMID 6315036.

Involved editors comments

• I prefer version 2, since it directly cites a notable medical organisation and does not use the POV term "partisan" in describing the author of the review in Annual Reviews of Nutrition that described this form of alternative medicine as food faddism and quackery. Tim Vickers (talk) 17:22, 21 March 2008 (UTC)
• Version 1 provides a substantial summary notice that there is notable disagreement from various opponents and economic interests. Anymore detail, even with balancing quotes, overloads the lede and favors the critics by obscuring the basic coverage, description & definition of orthomolecular medicine, where so many, including its "expert" critics cannot even get orthomed's basic concepts, science, experimental/clinical evidence & history straight.--TheNautilus (talk) 17:32, 21 March 2008 (UTC)
• I find version 1 more appealing. Version 2, however, would be great if it were expanded to include the fact that Linus Pauling emphatically disagreed with the notion that his claims were unsupported. There are multiple WP:RS for this.--Alterrabe (talk) 17:54, 21 March 2008 (UTC) We could separate the debate over partisan from that about including the ACS in the lead.--Alterrabe (talk) 18:07, 21 March 2008 (UTC)

I've added a section on the history to the lead, which explains the role of Pauling in establishing this field and tried to remove the wordiness by condensing the rest of the text. Hopefully this will make the lead more readable and summarise the article better. Tim Vickers (talk) 20:49, 22 March 2008 (UTC)

Uninvolved editors comments

Comments by Antelan (talk · contribs)

• OK, well I'm a bit confused about the reference to food faddism in the lead if it's not in the body of the article. If someone could explain that to me I'd appreciate it, and I'll hold off on making a judgment between the two versions until then. Thanks, Antelan 20:15, 21 March 2008 (UTC)

I've added an expanded definition of that term to the "Views on Safety and Efficacy" section, added a paragraph on the history of OM to the lead, and trimmed the wordiness a little. Tim Vickers (talk) 22:24, 22 March 2008 (UTC)

Thanks. I find Version 2 more useful for the following reasons: (a) it avoids the point-counterpoint argument being set up in Version 1; and (b) it points to specific, rather than general, criticisms. Antelan 23:00, 22 March 2008 (UTC)

Comments by WhatamIdoing (talk · contribs)

• In terms of a well-written introduction, I don't really like either of the options. They are both wordy (for example, "opponents and partisans") and assume knowledge that the first-time reader doesn't have (like why Linus Pauling's definition matters). Furthermore, the paragraph could be accurately summarized simply as "Critics think this controversial field needs more scientific research to support its claims." I dislike option two slightly less than I dislike option one. Option one promotes the wrong standard for testing the field (you test a specific compound for a specific disease in a drug trial, not the "broad claims" of all advocates). If option one is chosen, then the word "partisans" should be struck from the first option as being POV and redundant to boot. However, I think that reading WP:LEAD and starting over entirely might be the best option. WhatamIdoing (talk) 22:41, 21 March 2008 (UTC)

Your comments on one of the recent, one paragraph lede, a previously more stable version would be appreciated. To see the wordsmithing and then some (d)evolution of the lede, it appears to start about here. I have set up the subpage for editing and comparing suggestions & changes.--TheNautilus (talk) 00:26, 22 March 2008 (UTC)

It is getting wordier and more poisonous POV pushing the lede instead of a one sentence note that there is strong disagreement to be expanded upon in the body.--TheNautilus (talk) 06:51, 23 March 2008 (UTC)

Comments by Filll (talk · contribs)

I am sort of confused since they both have criticism in the LEAD. However, I ahve to agree with Tim Vickers that I like the attribution to the AMA. I do not mind the point, counterpoint, but it might be a bit much for the LEAD. Better to save this for the body.--Filll (talk) 23:46, 24 March 2008 (UTC)

Comments by Vuo (talk · contribs)

• For reliability as a source, it is necessary to mention the American Medical Association's criticism if the title includes the word "medicine". Also, consider scenarios (1) and (2): (1) an official body (AMA, FDA, etc.) does not consider the treatment scientifically tested for efficacy, and this is the general consensus in medicine (2) there is a general state of disagreement in the medical/scientific community about the efficacy. If the situation is like (1), then it has to be written differently, with no "sides of disagreement". If it's like (2), then you can have "sides" even in the lead. The reason is that there are theories rejected as unscientific in all sciences; their proponents tend to "teach the controversy", and make an impression that there is genuine disagreement within the scientific community. It is necessary for an encyclopedia to be "shielded" against attacks like these that attempt to use the site as a soapbox / for free hosting. --Vuo (talk) 16:15, 26 March 2008 (UTC)
  • Summarizing, Version 2 is better, because it is shorter and doesn't introduce "proponents" and "opponents". Everyone can be a proponent or opponent. Everyone isn't a PhD in Medicine. --Vuo (talk) 19:07, 26 March 2008 (UTC)

• Can someone list the respective sources used by the two versions ? It will greatly help me (and possibly other uninvolved editors) judge whether the statements reflect, (1) what the cited sources say and (2) whether the sources are being properly weighted and characterized. Thanks. I am too lazy to read the version in edit mode! :) Abecedare (talk) 19:58, 2 April 2008 (UTC)

This updated, shorter version (3c), with handy references, attempts to address the text and reference issues. Because of the extremely contentious nature of this area, *and the construction of the lede* it seems RS would demand a higher quality reference for such an unbalanced quote with partisan sources, where the implied imprimatur is abused at both the AMA level (for non peer reviewed references), and here, both as OR and an attack, where there peer-reviewed counterexamples, such as mainstreamed megavitamin therapies. As a source for "A controversial field deprecated by some critics..." in (3c), it would be less problematic, but strictly speaking, IMHO, WP:OR.--TheNautilus (talk) 20:57, 2 April 2008 (UTC)

Comments by Abecedare (talk · contribs)

Having gone through the cited sources, I think version 2 is better in terms of accurate and NPOV representation of the material (remember, NPOV does not mean equal weight to all sides). Following are some more detailed observations:

• Problems with version 1
  • The "he said-she-said" formulation is unsatisfactory since it fails to provide sufficient information to the reader in the main text, about who the opponents and proponents are that would enable him/her to form an educated opinion about the credibility and authoritativeness of the two sides. Naming AMA in the second version at least partially ameliorates this concern.
  • The phrase "opponents and partisans" is clearly POV.
  • "Proponents of this approach to medicine note ..." See words to avoid
  • Aranson's "There is no evidence ..." is better characterized by the word "unsupported" in Version 2, than the "not adequately tested" in Version 1. (Minor point: The sentence in version 1 is grammatically incorrect, since it implies that the claims are "not adequately tested as drug therapies").
• I am not sure that the two sources on behavioral benefits from nutrient supplements are relevant to the sentence they are used to support, since as far as I see this is not "research investigating the therapeutic use of nutrients." Note that neither of the two sources talk about "therapy".
• The role of Linus Pauling as a "significant force in promoting 'orthomolecularism'" (Jarvis, 1983) should be mentioned somewhere in the lede, though not necessarily in this paragraph.

Abecedare (talk) 21:07, 2 April 2008 (UTC)

Thanks. Your first 3 points are an interesting guide development of the future text. The 4th point is a discussion (later).

Your 5th point has two answers. One on the BJP & Economist references, version 1 above, this OMM article used to explicitly include OMM and "optimum nutrition", not just "OM medicine". "Optimum nutrition" has tended to get lost in the scuffles over the lede. Second, is that the referenced supplements are more like OMM "optimum nutrition" in five components: GLA, DHA, EPA, chromium, and molybdenum. The multivitamins and other minerals are relatively ordinary but still more than the standard "diet alone" nutrition views.

Your sixth point about Pauling's role is fine, however other references already make the point about Pauling's effect probably better. Jarvis was a frequent contributor to (tiny, WP technically unreliable) NCAHF extremism, where WP article improvement is reference improvement for more mainstream views that are in the mainstream of science writing. I hope that you will consider Menolascino's (1988) criticism as a much more scientifically informed and balanced mainstream medical reference.--TheNautilus (talk) 23:31, 2 April 2008 (UTC)

A quick response about my Linus Pauling comment: I didn't mean to suggest the exact wording for the inclusion or that Jarvis should be used to reference this fact. I only meant to indicate that the "LP-othomolecular medicine "association seems significant enough to be mentioned in the lede somewhere. Sorry for not being clearer. Abecedare (talk) 23:57, 2 April 2008 (UTC)

This is mentioned in the current version of the lead, this RfC is only considering the final and controversial paragraph of the lead. Tim Vickers (talk) 00:35, 3 April 2008 (UTC)

Comments by EdJohnston

• I came here because of the notice at WP:RSN. I am satisfied with Version 2 of the lead. I don't believe that entire pedigree of the AMA needs to be placed in evidence before we can simply give what is almost a direct quote from their statement. Relevance to the topic of this article is clear; they might be misguided but that is what they said. They didn't use the word 'orthomolecular' but they did say the thing that is attributed to them in Version 2. Orthomolecular medicine does have something to say about nutrition, and the AMA was giving a general comment on the idea that "most diseases are caused by faulty diets and can be prevented by nutritional interventions". EdJohnston (talk) 17:00, 4 April 2008 (UTC)

The AMA quotes are obsolete from flawed sources and loaded/overqualified e.g. "most" is misleading, "prevention" only is misleading too. Simply good sources for the "skeptipedia" mainstream on orthomolecular are tough to get - which is interesting since "mainstream" sources should be easy, especially for "mainstream" WP editors with better libraries and databases. Partisan AMA committees keep pushing tobacco quality research and reporting, or AMA keeps this serving this obsolete 1997 stuff after the major changes in vitamin C & D research status, I suspect AMA is going to shrink some more just for doctors' self-preservation. We need better *summaries*, not personalized or so much factional POVish sound bites. I also notice some of the recent skeptical books have ducked criticizing orthomed "megavitamin" topics (maybe they don't want to be AMA tobacco class buffoons down the road).--TheNautilus (talk) 03:39, 5 April 2008 (UTC)

I hear you criticizing the AMA but I don't hear you disagreeing either with (1) relevance, or (2) that they were correctly quoted. EdJohnston (talk) 04:01, 5 April 2008 (UTC)

I stress date of reference a great deal because several events ca 2001, particularly with increased vitmain D, say RDA of 1000-2000iu vs 200-400iu, and IV vitamin C in the research results of mainstream medicine, form sort of a line in the sand with organizations like AMA, ACS about "science" and therapeutic nutrients, 1,000,000 BC vs 4 AD and obsolete or "tobacco buffoon" quotes. Again, I do not think it appropriate to use unrebutted material in the brief lede section, especially poorly attributed statements (without "orthomed...") from less RS & current sources. In unfamiliar nutrition areas, seemingly small surface differences noticed to the unwary often reflect indications of larger differences, so indiscriminate "nutrition" quotes as orthomed are highly suspect for RS and accuracy. I think fair summary is more appropriate anyway, across the industry, similar to this second paragraph Draft version that could use some collaborative suggestions.--TheNautilus (talk) 09:23, 5 April 2008 (UTC)

Comments by Hcberkowitz

I also came to this discussion via RSN, and, frankly, see serious problems with both leads. Yes, it is true niacin is used to treat certain dyslipidemias, and can be excellent for the right set of abnormal lipids, and, more important, that a patient can tolerate it in the doses used for dyslipidemia. While I fully understand the singular of anecdote is not data, my allopathic physician and I, after reviewing the literature and getting a second cardiologist opinion, decided niacin was an appropriate treatment. Unfortunately, while it did great things for my lipid profile, it gave me acanthosis nigricans, or leathery and bleeding skin that was disabling. As soon as the high-dose niacin was stopped, my skin came back to normal, and my lipids are just fine with other drugs. I emphasize drug, because the niacin doses that do have demonstrable effect are very high, and can induce toxicity.

Another problem I have with both leads is that I was unaware -- and I'm willing to stand corrected -- that Pauling had proved any medical benefit for anything. Disproved some studies for bad methodology, yes. Offered bypotheses that could be evaluated in a randomized clinical trial run by qualified clinicians, yes. Directly doing human experimentation, no.Howard C. Berkowitz (talk) 19:20, 4 April 2008 (UTC)

Pauling and a Scottish physician did perform some clinical trials. The results and their interpretation are still debated to this day.--Alterrabe (talk) 20:35, 4 April 2008 (UTC)

I am not sure what text the "proved" part concerns Pauling. Pauling was associated with molecular disease research and ameliorating metabolic errors in the 1950s that involved *withholding* certain nutrient substances. His degree of "credit" and "proof" - will have to work on it. Pauling worked with Scottish surgeon Ewan Cameron on ameliorating cancer in an area that had amongst the highest cancer rates in the (industrialized?) world at the time and half the US RDA on vitamin C in a closely controlled and observed hospital setting with intravenous and then oral vitamin C. Later Pauling worked to support Abram Hoffer on his clinical cancer series studies with complementary and oral vitamin C + other increased nutrients.--TheNautilus (talk) 03:20, 5 April 2008 (UTC)

It's hard to comment on proof without a better idea of the study design. If the work with Cameron was in an area where, presumably, there was a high incidence of cancer in the community, are you saying he hospitalized people without cancer, gave them IV and oral ascorbic acid, and then drew conclusions about a decrease in the incidence of cancer? How does one compare a hospitalized patient environment with a community environment? IV therapy on an outpatient basis is bleeding-edge today.

To me, the best community studies are things like the Framingham or Nurses' studies, which use large populations over a long period of time, but in their community environments. The variables indeed may be diet, or supplements, or presumably prophylactic drugs. Howard C. Berkowitz (talk) 23:10, 6 April 2008 (UTC)

The Pauling-Cameron clinical studies were done against local controls provided by other doctors' treatment of matched patients (Controversy #1). My primary point is to highlight just a little how different all aspects of testing were between Moertel and Pauling-Cameron's methodology and their patients. Bleeding edge? Historically, vitamin C deficiencies were associated with cancer related descriptions in old sources. IV vitamin C therapy is only new to the young MDs, an orthomed pioneer used it at least as early as the early 1940s, routinely reaching 30 - 150 grams IV ascorabate in the 1950s, his results repeated clinically by others in different decades and languages. As the IV amount cruises past 100 grams ascorbate per day, attention to osmolality and electrolytes balance apparently becomes important, and then crucial above 200 or 300 grams. The bleeding edge basis of human experience with IV ascorbate apparently extends, well, very high, to an osmolality limit. A generation ago, to recover a hopeless MRSA vancomycin resistant case in an ICU, involving a family of well connected lawyers, a hospital apparently allowed the staff to try a "hail mary" treatment to save *one* of these lawyers, from near dead to walking out in 10 days. Who said lawyers are useless to medicine?--TheNautilus (talk) 00:19, 7 April 2008 (UTC)

No, you misread: IV therapy on an outpatient basis is bleeding-edge today. WhatamIdoing (talk) 03:24, 7 April 2008 (UTC)

Sorry, to clarify, most/many of the IV treatments within 150 grams/day since the 1940s (Klenner) seem to have been done on an outpatient basis, homes and dr's office. From the available papers, someone needing over 150 grams/day is in dire shape that is likely to already be in the hospital. My point was simply where OMM's (b)leading edge has already been.--TheNautilus (talk) 07:58, 7 April 2008 (UTC)

I'm confused as how the selection was done. Did one group of physicians select both controls and treatment group? That's fairly standard, with the treating physicians blinded as to why a patient was selected. Correct me if I misunderstand, but did the physicians giving the IVs know whether they were giving ascorbate or placebo? I may be wrong, but so far, it doesn't sound as if there was randomization or blinding.

I'm also not sure about your VRSA example. While, today, we have vancomycin alternatives like the streptogramins, vancomycin or methicillin resistance does not mean resistance to all combinations of conventional antibiotics. A good infectious disease specialist will also dust off some of the older drugs, rarely used, on the not totally random chance that the infecting strain has not kept the resistance to things that were many generations of natural selection back. Is it useful to the bacterium, for example, to "remember" how to defend against sulfadiazine? It's not unreasonable to suggest that there is a metabolic cost, to the bacterium, of maintaining every possible resistance factor.

Now, it is arguable whether saving lawyers is a social good. :-) Nevertheless, in quite a few years of looking at medicine, if there isn't RCT evidence, then we are at a point where I want to see some molecular pharmacological explanation of how a "hail mary" treatment is going to work. It happens that my medical surrogate has a strong interest in herbalism, but we have agreed, over her protests, that if I had terminal cancer, I want palliative measures, not a "hail mary" herbal cocktail whose inventor was too busy to have any mainstream reserchers evaluate it. I'm not opposed to all CAM, but I expect CAM practitioners to know their limitations. While I've had chiropractic treatment referred by an allopathic physician, I also lost a close relative to a chiropractor that kept insisting that what any minimally trained clinician would know was visceral pain was a backache caused by misalignment. By the time his aortic aneurysm blew completely, 100 miles from Houston, it was too late to move him.

If the orthomolecular people aren't willing do dbRCT, or give a explanation of why their approach works, within current standards of molecular pharmacology, I'm not willing to play with them on Misplaced Pages.Howard C. Berkowitz (talk) 03:43, 7 April 2008 (UTC)

I thought the "connected lawyers" part was interesting because it took that big of a hammer to concentrate the hospital's thought processes (there is another story of an accidentally hospital damaged lawyer, few connections, that started as $50+ million in lawsuits, settling for under half...almost a generation ago, where they sued everything (mfrs) & everyone in the area). From the doctors' pt of view (no love lost...), the thought that experimental rats usually cost, rather than pay, seemed a piquant turnabout.

Most historical orthomed clinical evidence is from clinical series or repeated, dramatic recoveries from the almost dead or dire straits, class II evidence.

Orthomed doctors have repeatedly applied & struggled for support for studies (they complain through the decades, Pauling's rebuffs were not the first), and apparently have been almost uniformly denied since ca 1937, Sabin "retesting" Jungeblut's work. Sabin "proved" Jungeblut's IV vitamin C didn't work on polio by cutting the dosage to 1/4th and increasing the severity of the infection technique, deprecating his failure as vitamin C's failure. For polio, Klenner came along ca 1948-9, increased Jungeblut's dosage with multiple treatments per day, plus thiamine for neural damage, and claimed 100% success on polio, 60/60, including already flaccid cases.

Almost no funding - in the 1990's, privately raised funds supported Riordan to investigate and document protocols similar to Klenner's in cancer, leading to the NIH studies published in CMAJ and PNAS, including pharmacology & pharmacokinetics that happen to pretty much agree with the 1930s-50s discovery era research & hypotheses mentioned by Klenner in the early 1950s. There is some NIH dbRCT study on pure IV vitamin C in progress right now. What is sad is that IV vitamin C in *large* doses has always been considered most reliable for antiviral use and most toxins, still waiting on funded support 60+ years from Klenner (70+ yrs if you count Jungeblut). Pauling represents orthomed's lowest vitamin C doses for statistical improvements and first scratchy throat. LP's recommendations have never been tested either despite dozen & dozens of tests at much lower doses & frequencies (e.g. once/day vs hourly) that are quoted to "refute" him.--TheNautilus (talk) 07:58, 7 April 2008 (UTC)

AMA discussion

In response to your concerns about the inclusion of this source, I have posted a question at the RS noticeboard so people can discuss the issue. Tim Vickers (talk) 17:16, 2 April 2008 (UTC)

I think that RS/N is premature, as I said before , since, after naming its targets, the AMA doesn't even state "orthomolecular" anywhere - that makes it Original research or offtopic. Also many editors *are* AMA members or unfamiliar with the underlying issues that especially concern orthomolecular medicine.--TheNautilus (talk) 17:44, 2 April 2008 (UTC)

...Um... do you have any evidence that editors are AMA members? Shoemaker's Holiday (talk) 11:25, 3 April 2008 (UTC)

Yes, but presenting that would get me in trouble and be improper for several reasons. See also Doctorfinder. I think that it is easier to confirm that they routinely claim here to be physicians and often have similar views. Also note the "or" part, which is largely my OR, but the Talk pages here (and elsewhere) are my evidence.--TheNautilus (talk) 14:33, 3 April 2008 (UTC)

Well, perhaps, but aren't pretty much all American doctors AMA members by default? I mean, if we're talking about them being high-ranking AMA members able to set policy, that's one thing, but I think you're presuming professional bodies have more control over their members than is reasonable if simply having membership in an organisation which almost every American in the medical profession gets membership in by default is your evidence of bias. Also Tim Vickers, who along with you is the main editor here in the last couple weeks, is Scottish, and the American Medical Assosciation is not generally considered to have power outside of America. Shoemaker's Holiday (talk) 14:49, 3 April 2008 (UTC)

My note is mostly cautionary. The doctors are in and out. Many editors I do have to invest substantial effort in education about orthomed items to carry a conversation. Tim's interests appear to me to be antithetical to most basic orthomed claims.--TheNautilus (talk) 15:27, 3 April 2008 (UTC)

Reportedly, 15–20% of practicing physicians are AMA members. While the actual number is a bit nebulous, it's almost certainly a minority. I'm not a member, though they keep sending me enticements. The AMA looms large as a bad guy in the alternative-medical world for largely historical reasons. I doubt there are editors who are here to push a "pro-AMA" POV, though I suppose it's possible. I think it's more likely that many editors simply regard the AMA's statement as a notable and reliable source describing one element of mainstream medical opinion. Familiarity with the in-universe aspects of orthomolecular medicine isn't a requirement to edit the article. MastCell  16:15, 3 April 2008 (UTC)

highly UNDUE wt on minor indirect reference (Jarvis) in lede

Move relevant part even remotely supported by quotes to body, "Guackery" not quoted. The 17 page 1983 paper, whose brief *criticism of Pauling and Bronson Pharmaceutical*, mentions "orthomolecularism" and "orthomolecular psychiatry" once each in passing while criticizing Pauling's book and Bronson Pharmaceuticals (Pauling's supplier). Note: This (un)"scientific" criticism rests on precisely zero (0) relevant tests (none remotely close to orthomed's dosage & frequency) of even Pauling's lowest , still after 37 years, no relevant mainstream work published, at all! Jarvis: "Food faddism meets a persistent human desire. As Maple (54) says, "In the face of the great leveller, Death, we are all children listening fearfully for the footsteps of doom, and relieved only by the whisperings of hope. This is suggested in the opening of Nobel Laureate Linus Pauling’s book, Vitamin C and the Common Cold, a significant force in promoting "orthomolecularism" and widespread excessive vitamin C supplementation. Pauling states:

" The idea that I should write this book developed gradually in my mind during the last five years. In April 1966 I received a letter from Dr. Irwin Stone, a biochemist whom I had met at the Carl Neuberg Medal Award dinner the previous month. He mentioned in his letter that I had expressed a desire to live for the next fifteen or twenty years. He said he would like to see me remain in good health for the next fifty years, and that he was accordingly sending me a description of his high-level ascorbic-acid regimen. ...and second,

"Bronson Pharmaceuticals makes books available at discount prices to medical doctors that promote scientifically questionable theories on megavitamin therapy, orthomolecular psychiatry, and the use of vitamins to prevent colds, flu, cancer, allergies, and so forth. Of the 25 titles listed by Bronson in their 4-81 "Special Book Offer," not one appears on the list of nutrition references recommended by a respected professional association (10), while several appear on its "not recommended" list. Bronson may be..."

I have no idea what the above text refers to and can't understand the writing enough to work this out. Could you please rewrite this comment so that your meaning is clearer? Tim Vickers (talk) 16:32, 4 April 2008 (UTC)

Bronson sells firearms? Please read your messages carefully before you click the "save page" button. If your computer is set up for it, have it read the text back to you. Frequently it's easier to "hear" the problems than to see them. WhatamIdoing (talk) 17:59, 4 April 2008 (UTC)

That was a PDF cut and paste text error, fixed, thanks.--TheNautilus (talk) 18:12, 4 April 2008 (UTC)

Tim, ~70% was quoting Jarvis from *your* reference article

1. The quote from Jarvis' paper does not support the text. No "quackery" quoted, "faddism" on Pauling's lower dose C is implied by section title, but that is not the same as (all) "orthomolecular medicine", either for vitamin C or the rest.

2. The 17 page paper, twice, just barely mentions "ortho- anything" anywhere, never "orthomolecular medicine".

3. Jarvis' explanation retreats to psychological mumbo-jumbo, nary anything relevant biologically or biochemically based.

4. Jarvis' opinion & criticism rests upon *no* tests in the orthomolecular range of colds & flu. (after Hemila, 2006 - there is still no such testing). Sort of like pseudoscience...

5. This profound "mainstream" refusal to fund or test any part of the orthomolecular antiviral range has been going on not only since Pauling's book 37 years ago, but at least 60 yrs, after Fred R. Klenner's paper.--TheNautilus (talk) 18:12, 4 April 2008 (UTC)

70% of what? What on earth are you talking about? Tim Vickers (talk) 04:22, 5 April 2008 (UTC)

70% of "my" text, immediately above your first response here, are direct quotes from Jarvis' paper. I assumed you were familiar with your source text.--TheNautilus (talk) 08:51, 5 April 2008 (UTC)

Your comments are becoming increasingly difficult to understand. Could you please try to use complete sentences in plain English. The distinction between an "unproven alternative medicine sold for profit" and a "quack remedy" is not one based on biochemical tests, what assay would differentiate between these two forms of words? This is an opinion and a judgement mostly on the motivation of the people peddling these pills, not a scientific assessment of the efficacy of a remedy. Your comments about the lack of data in these expert's opinions therefore misses the point entirely. This source discusses the use of "quack nutrition" to treat disease and even specifically cites Linus Pauling and "orthomolecularism" as a prominent example of this. This is the opinion of the author and it is published in a unimpeachably authoritative source - The Annual Review of Nutrition, the premier scientific review journal in the field. Tim Vickers (talk) 22:34, 5 April 2008 (UTC)

Your are fabricating verbal connections, and giving greatly disproportionate, undue weight to a brief non-scientifically based opinion that discusses "quack" and/or "faddism" in different places in an old article. And I have to say any respect for ARN goes down with such a non-technical POV piece with such ambiguous, prejudicial words. Non-scientifically based criticsim: orthomed may have lower levels of evidence, its critics usually have no relevant data but are too dishonet or incompetent to admit it, especially on the vitamin C part.--TheNautilus (talk) 21:52, 6 April 2008 (UTC)

If the statement is not backed up by actual science, then its more of an expert opinion then a scientific finding, and should be expressed as such. Consider, then, that Linus Pauling also has expert opinions (or assessments, if you prefer) -- except Pauling earned a Nobel Prize and devoted his life to studying this stuff. Also, I don't see TheNautilus's comments as difficult to understand. You just need to read slowly. I'm coming into the middle of this and I'm understanding the issue fine. If this is your best source, you don't have much, Tim. Impin | {talk - contribs} 07:48, 13 May 2008 (UTC)

UNDUE wt & sentence construction on minor Jukes' reference in lede

Hardly anything there in Jukes article for the "less temperate..." slams in lede, UNDUE weight even if there were direct quotes in a few paragaphs. A few paragraphs where Jukes nitpicks details on Pauling's interview skills against a tape recorder and then makes an ass of himself, where time *has* moved the mainstream RDA (90+mg) and NIH's last recommendation (200 mg) way past Juke's flat "anyone" assertion of 60 mg vitamin C. Jukes monologue continues, pp 16-17:

QUACK REMEDIES FOR CANCER (~28 lines of text in three (3) paragraphs)

My involvement with laetrile, a name under which the cyanogenic glycoside, amygdalin, was illicitly peddled for treating cancer...laetrile...pangamic acid... In general, legal action against quack remedies is a protracted process. By the time a court decision is reached, the defendants have moved on to other, greener pastures.

Vitamin C came into prominence as a universal remedy. Bogus claims for vitamin C were made as a result of its hyperenthusiastic promotion by Dr. Linus Pauling (49), and I appeared as a rebuttal witness against him in San Francisco and Santa Rosa, California.

Linus Pauling published the following account of a discussion with me(50):

I am reminded of an experience I had in 1984 on a radio medical program (on station KQED) in San Francisco. There was another guest on the program, a retired professor of nutrition from the University of California in Berkeley. I made a statement about the value of a high intake of vitamin C... The retired professor of nutrition said simply, "No one needs more than 60 mg of vitamin C per day," without giving any evidence to support his flat statement. I then presented some more evidence for my large intake, and he responded by saying, "Sixty mg of vitamin C per day is adequate for any person." After I had presented some more evidence, this retired professor said, "For fifty years I and other leading authorities in nutrition have been saying that 60 mg of vitamin C per day is all that any person needs !" There was just time enough left on the live radio program for me to say "Yes--that’s just the trouble: you are fifty years behind the times."

What actually happened is described on the official audiotape of the broadcast, May 7, 1984. (LP = Linus Pauling, DW = moderator, TJ = T. Jukes).

LP:Well, I failed to mention that if I am traveling and people are sneezing in my face and get pretty tired and think that I may be coming down with a cold I go up to as much as 50 grams of Vitamin C in a day and that stops it.

DW: Do you think that is recommended for all people, Dr. Jukes, to take that much Vitamin C?

TJ: Well, I certainly don’t.

DW: Based upon your previous observations.

TJ: Based upon my previous observations and my studies of literature and my conversations with vitamin experts for about the last 50 years.

DW: All right.

LP: You know it’s too bad that these vitamin experts have been making the same statements for the last 50 years and haven’t caught up with the times yet.

TJ: Yes, but their statements are based on controlled observations. This shows a lack of agreement between what Pauling reported and what actually happened.

MEGAVITAMINS

The Food and Drug Administration proposed that an upper limit should be set on over-the-counter vitamins of 150% of Recommended Daily Allowances (RDAs) per tablet. This modest proposal was seen as a challenge by the megavitamin industry. The National Health Federation organized a letterwriting campaign to Congress for the support of the "Proxmire Bill" that specifically prevented FDA from making such a regulation. The Proxmire Bill was opposed by the American Institute of Nutrition and other scientific groups. It was supported by Prevention magazine, the National Health Federation, Linus Pauling, and Roger Williams. The Proxmire Bill passed the Senate by a vote of 81 to 10 in September 1974.

Another successful nutritional deception is the "organic food" industry. The term organic to describe food and a particular farming style was originated by the late Jerome Rodale, an electrical contractor who moved from... (same material as Jarvis, 1983 continues on Rodale etc)--TheNautilus (talk) 03:09, 5 April 2008 (UTC)

Apparently Tim is having trouble reading what Jukes' short mention shows, clearly and implied. This flawed reference's short blub is being POV pushed as a sweeping indictment of (all) orthomolecular medicine in the lede in a conclusory manner. What Jukes(1990) really shows, is one of Jukes' continued personal attacks on Pauling, who here appeared to mock Jukes' expertise for longstanding lack of investigative curiosity and scientific rigor (*zero* high range vitamin C data). Here Jukes vilifies Pauling with an innuendo, where Jukes, a vitriolic personality, long despised Pauling's ultraliberal politics (many WP:V observations available on Jukes' personality, politics and his anti-Pauling antipathies), especially about banning nuclear arms tests as well as their clashes over the human range of vitamin C benefits, where Jukes never shows *any* relevant data.

If one reads Jukes' & Pauling's statements closely with the transcript fragment, it seems clear that what has likely occurred is that Jukes has snipped several earlier, relevant statements from the "damning" KQED transcript to make Pauling look bad without actually uttering the implied libel. It appears to be an innuendo, where allowing for Pauling's recall of a conversation two years earlier, Jukes' version is roughly the last half of Pauling's version.

(1) This appears to be a WP:OR violation to generally claim Jukes' section title "Quack Remedies for Cancer" that positionally sweeps in Jukes' personal attack on Pauling (mentions only his vitamin C use above 60mg/day for respiratory illnesses) is WP:RS, V for all vitamin C much less orthomed, it simply is not.

(2) Jukes' 1990 statement would not reflect current mainstream research findings, either, where (Cochrane Collection vitamin C author) Harri Hemila's papers, accepted and published, have systematically reanalyzed the misstated "mainstream" analyses of earlier vitamin C papers to show a small positive therapeutic effect, increasing with dosage of vitamin C in the range ~8x to 250x under the quoted 50 grams Pauling mentioned. (see Hemila, 2006 for a collation of Hemila's vitamin C papers)

(3) It appears likely Jukes' short blub is a demonstrable example of the systematic bias, distortions and misconduct that have been used to repeatedly attack Orthomolecular medicine and its proponents. It may be more notable as such a demonstration in the body of Jules' biography depending on the exact WP:V conversation recorded, which will probably take six weeks to get. This is not current or scientific opinion, it appears to an old, scurrilous personal attack leaping two huge steps to a POV in the lede.

(4) This use of Jukes' short personal attack appears to be a WP:NPOV and WP:SOAP violations where Tim is attempting to force an obsolete view as current *medical science* with undue weight. It is not. If this were 20 years ago, I would agree that it reflected current thinking. That time has passed. Both vitamin C questions, for cancer CMAJ (2001), PNAS (2005), CMAJ (2006),ANN INTERN MED (2004), PNAS (2007) and viral respiratory illness,Hemila papers, 1991-2006, are recognized as *open* by authoritative medical science figures.--TheNautilus (talk) 20:54, 6 April 2008 (UTC)

Olson's Preface on Jukes (1990)

Part of the problems above seem to be that Tim is not quoting Jukes' paper directly. Rather Tim quotes the linkable content to editor Robert Olson's politicized comments in the Preface that *add* severe characterization and opinion onto "megavitamin therapy", far beyond Jukes' published opinion & innuendo on Pauling - the original source that I quoted, above. Rather than summarizing Jukes, Olson's editorial comments, More recently, he has come to the defense of science in the public sphere by confronting creationism, food faddism, and various forms of quackery including megavitamin therapy., are an interesting expansion on Jukes' text since even Jukes' (non-technical bio) paper did not actually say what Olson credits Jukes with. One can certainly imagine that Olson "knew" what Jukes meant or Jukes' history. But Olson's editorial swipe at megavitamin therapies, scientifically unfounded in Jukes' bio or analysis, greatly exceeds even Jukes' use of his autobiography as a platform for another attack (innuendo) on Pauling. Such brief political commentary is an unreliable source for the lede to assert potentially false light/defamatory comments in a prominent, semi-conclusory manner on active science issues, especially where the notable & quotable scientific misconduct lies with the supposed mainstream-of-something- but-certainly-not-science.--TheNautilus (talk) 08:22, 9 April 2008 (UTC)

too wordy, inadequately supported, POVish dated lede material

In other early research in this area, orthomolecular physician Abram Hoffer was part of the group who discovered in 1955 that niacin could be used to treat dyslipidemia. -- too long, too detailed, too much personality detail, and there are others from the 50s with Pauling's acknowledged *molecular medicine* that turn out to also be orthomolecular in nature.

However, the current scientific and medical consensus is that the broad claims of efficacy advanced by advocates of orthomolecular medicine are unsupported, and these ideas are not accepted in mainstream clinical practice, with the American Medical Association saying that the idea that most diseases can be prevented by nutritional interventions is a myth. -- 1980s QW/NCAHF type loaded statements that seriously mislead readers. Highly flawed QW/NCAHF type material from QW/NCAHF authors for the AMA references, flat earth - not current nutritional and biological science on myth, where there *are* "many" recognized diseases and conditions treatable or percentages preventable with nutrients recognized now with WP:V sources.

Less temperate critics have even classed orthomolecular medicine as food faddism or quackery. -- not supported by text, either direct words or orthomed in general--TheNautilus (talk) 03:20, 5 April 2008 (UTC)

off topic link removal

I am moving the UK source, an off topic link, The closest approach to Orthomed was near the end the audio. I listened to the audio, very entertaining. BenGoldacre's page and audio has nothing Orthomed, not even much there concerning orthomed. Orthomed is not about patent medicines, corn flakes, Hadacol, BG's cranks - didn't sound orthomolecular. Get this, orthomed is science based, a lot of its most effective critics have involved clear cases of scientific misconduct. This scientific misconduct might have been exposed sooner, if (1) most people weren't so experimental science illiterate, (2) medical information and media were less limited by gatekeeping before the internet.

Tim, you continually seem to confuse all "nutritionists" with orthomolecular medicine and orthomed MDs. How about we lump all Christian scientists in straight with your corporate & research scientists too.--TheNautilus (talk) 08:47, 5 April 2008 (UTC)

If you wish to remove all material from the article that does not specifically reference "orthomolecular medicine" then we would have to remove most of the references in "History and development" and all of the clinical trials for nutrients in the section on "Relation to mainstream medicine", such as those dealing with vitamin E, niacin, selenium, zinc. Insisting that a reference use the "in universe" jargon is illogical, if if a source discusses the usage in alternative medicine of megavitamins or dietary supplements than this is exactly the same as the topic covered by the jargon term "orthomolecular medicine". Tim Vickers (talk) 22:29, 5 April 2008 (UTC)

I'm with Tim on this one: we need to consider "all the facts and circumstances", not just whether or not a specific and relatively new term appears in the text. WhatamIdoing (talk) 23:11, 5 April 2008 (UTC)

Indeed, it would cause a major NPOV problem as well - imagine if an article could only use references that use the exact terminology originating from the group the article is discussing, that would be unworkable. To use a close equivalent, it would mean references discussing dilution could not be used in the article on homeopathy, only the sources that called dilution "succession". Or references that called a Nazi group's views "holocaust denial" couldn't be used if the group instead called the holocaust "The Jewish Exodus". We can't let the subjects of articles set the criteria for the inclusion of material based on their own opinions. Tim Vickers (talk) 23:24, 5 April 2008 (UTC)

If logical rigor and precision are maintained, I'm all for a liberal interpretation of what therapies make it into the orthomolecular article. But what must not happen is that therapies not endorsed as "orthomolecular" by "orthomolecular" people are used to discredit them.--Alterrabe (talk) 13:21, 6 April 2008 (UTC)

Indeed, you need to be careful about specific claims about specific treatments, it would be inappropriate to discuss herbalism here. However, when a authoritative source makes a general review of the use of nutrients in alternative medicine's attempts to treat and prevent disease, then orthomolecular medicine is part of the area covered by that review. Tim Vickers (talk) 15:23, 6 April 2008 (UTC)

You are pushing unreliable references, greatly overstating their content and currency, more on previous discussion, adding your POV into the lede. I've added another demonstration of this below.--TheNautilus (talk) 20:33, 6 April 2008 (UTC)

3 strikes and hold the mayo...another unreliable source

The brief, coverage of orthomolecular medicine on Aaronson's Ch 6 of Cancer Medicine is not a technically reliable source as proposed by Tim because it is so misinformed (-ing) with several major WP:V failures on source text comparison and fact checking.

1. claims that massive doses of vitamin C could cure cancer... Greatly misleading. Pauling, Cameron, Hoffer all proposed to treat cancer into longer remission periods with lifelong treatment, not a "cure". Orthomolecular pioneers, starting with Klenner, probably in the 50s, were often at pains to recommend receiving compatible conventional treatments with vitamin C rather than as a standalone attempt to treat or cure. Klenner, Cameron (with Pauling) and Hoffer (with Pauling) certainly followed this statement for surgery, radiation and/or many forms of chemotherapy. Both Klenner and Pauling et al, openly acknowledged that vitamin C, despite their most favorable clinical impressions of vitamin C's contribution in cancer treatment, was usually inadequate as a standalone therapy. Pauling stated that only a lucky small fraction would obtain a long term remission on Cameron's IV/oral vitamin C protocol alone. Three follow on points are important: (1) the vitamin C amelioration claims on both cancer and on other conventional cancer treatments themselves made vitamin C beneficial to most of patients, (2) CAM advocates are looking for alternative IV and oral chemotherapeutic adjuvant combinations, e.g. menaquinones (vitamin K₂), alpha lipoic acid, tocotrienols, tocopheryl succinates, ubiquinones (coQ series), herbal extracts, etc as well as Hoffer's complementary treatment regimen.

2. ...were disproved in clinical trials, Said "clinical trials" were correctly long identified as highly flawed or even fraudulently misrepresented. These trials at a (in)famous small city medical center are more notable, see Vitamin C and Cancer: Medicine or Politics? (E. Richards 1991) for their failure to follow basic scientific methodology such as experimental control (inadequate residual C test frequency 1-2 orders, inadequate residual C testing of the patient population coverage by ~1 order of magnitude of patients, inadequate urinary residual test sensitivity ~2 orders of magnitude, inadequate urinary residual selectivity (interferences), medicant access control failures - available at the corner drugstore vs Cameron's confined population), multiple failures of replication (skipping the intravenous treatment phase altogether, different oral treatment chemistry, rather brief applications rather than lifetime), drastic interferences (e.g. intervening chemotherapy, cold turkey discontinuation of megadose ascorbic acid), failure to note population differences (e.g. refractory, single type cancer; Scotland vs US, genetic, environmental and nutritonal), different measures and mileposts of improvements, failure to adequately research or integrate prior literature, art, experience & advice, and failure to adequately disclose protocols, data & results. Many are not sure what the "clinical trials" (~1975-1985) really proved, but hubris, incompetence, systematic bias, scientific misconduct, breeches of social contract & specific promise seem to have had a pretty strong demonstration.--TheNautilus (talk) 20:30, 6 April 2008 (UTC)

3. There is no evidence that megavitamin or orthomolecular therapy is effective in treating any disease. At this point, mere parrot-like cant of Cassileth's sound bite, or perhaps earlier, factually challenged adversaries. Megadose niacin has long had published evidence that it treats CVD patients' dyslipidemias, with the Canner study (1986) on post heart attack survivors showing an average of two years increase in lifespan following an average of six years treatment. Also there are niacin references on rapid relief for anginal and post infarct pain. Menolascino et al (1988), pp 137 & 140-144, cites 14 "megavitamin therapies" in mainstream medicine for amino acid metabolic disorders, before he drills down to his questions & criticisms of Orthomolecular psychiatry. Further Menolascino states, This limitation of described cases is not a true reflection of all the disorders in a population which are potentially treatable with specific vitamins. For example, only recently have some disorders of carbohydrate and lipid metabolism been found to respond to large dosages of specific cofactors/vitamins. (e.g. The lipid disorder, Abetalipoproteinemia, typically requires 6000-25,000 iu vitamin E per day along with more A, D, K). Malabsorption syndromes are also acknowledged to require supplementation & megavitamin therapies for various forms of gastrointestinal problems.--TheNautilus (talk) 20:30, 6 April 2008 (UTC)

Rather than endlessly restating your own point of view and arguing with the conclusions of the sources, you would do better to find some general reviews of orthomolecular medicine in reliable sources, or positive statements about this form of alternative medicine by prominent medical orgaisations. Your personal opinions and arguments are not relevant and cannot be included. Tim Vickers (talk) 21:17, 6 April 2008 (UTC)

Wrong again. These points cite WP:V failures, of your nominally RS sources, when flawed sources have to yield (or modify) to facts. I've summarized and referenced a large amount of material, including whole books. Including the Cassileth/Aaronson cant - "no evidence megavitamins... effective in treating any disease", a major, prejudicial statement stated absolutely that is just flat ass wrong by a dozen+ of *mainstream* megavitamin examples and overweight the lede with petty (short, POV), OR fabricated, or obsolete references.--TheNautilus (talk) 22:03, 6 April 2008 (UTC)

break

Can you summarize briefly and specifically here what you think of as the problem with TimVickers's sources? Antelan 02:50, 7 April 2008 (UTC)

Thanks, Antelan. I think that I have pretty well shown that three of the references are brief, have POV & WP:V problems, and / or are obsolete with respect to *current* medical science (with substantial references & background). A preliminary table has been started to summarize references in the lede. Although the Canadian Pediatrics (1990) paper is dated, largely rebuttable by subsequent mainstream positions (e.g Canadian Pediatrics (2007) vitamin D RDA 200-400iu -> 1000-4000iu, which equaled or exceeded previous orthomolecular recommendations of the 80s & 90s) or orthomed science points on "then conventional" clear flaws, it is a substantial paper that reasonably establishes a (rebuttable) mainstream pov ca 1990 without the vitriol, exaggerated degree of misrepresentation & error, and defamatory language of the three I've discussed so far, above (Jukes(1990); Jarvis (1983); Aaronson (2006) ).

We need to figure out fair use viewing on the Menolascino et al (1988) article. That is actually the most informed orthomed criticism that I have seen. Encyclopedic summary is the proper way to go, quotes and balancing discussions in the main body. e.g. Lede: "The ACS and AMA dontlikeit and historically have criticized it, some critics with vitriol and great deprecation." Otherwise the lede and the article are being hijacked and poisoned with prejudicial words and phrases of its most bitter, least accurate, often least qualified enemies, and even other personal disputes like Jukes' running toward defamation on Pauling, WP:OR putatively sideswiping OMM.--TheNautilus (talk) 09:25, 7 April 2008 (UTC)

OK, thanks for the summary, TheNautilus. I'm going to restate it from my own understanding so that you can let me know if I got something wrong: The sources in question do not actually address modern orthomolecular medicine. They address a previous version that is no longer practiced. I am having trouble understanding if you mean that (1) the mainstream or (2) the orthomolecular positions described in those references are outdated. (I'm ignoring for now the WP:V and POV concerns because those don't generally apply to sources, although those can inform the structure and the weight given to that material in the article itself.) Antelan 20:28, 7 April 2008 (UTC)

Both have changed. Orthomed oral regimens frontload much higher on the first hour or two to reach bowel tolerance sooner (may first notice substantial drying up in ~1/2 hour, the antihistamine effect earlier even Barrett mentions as "possible benefit", then approach slower to bowel tolerance). Although the orthomed crowd will tell you vitamin suppresses colds pretty well (this is at higher frequency & dose than any conventional controlled test), vitamin D & immune resistance is the other big thing here in the north. The mainstream has changed because the realization the Pauling was right about researchers generally were not analyzing & reporting their positive experimental results correctly e.g. Hemila (2006) and that NIH is publishing yearly in CMAJ or PNAS on IV vitamin C & cancer. Since 2000, papers or some acceptance on mega E for alzheimer's, the *big* vitamin D change, alpha lipoic acid for diabetes, fish oil for CVD, coQ10 for cardiomyopathy, thiamine losses of diabetics, Hemila on vitamin C & respiratory disease, IV vitamin C for cancer trmt (still need that adjuvant), more recognition of mixed arthritis formulas (higher dose MSM, glucosamine, chondroitin combos), mixed/other carotenoids like lycopene etc, seem to show a change is taking place in pharmacology & the mainstream acceptance.

To answer your question, the mainstream is starting to recognize that the C questions were never remotely tested, analyzed, or reported accurately, much less answered at all, and that significant pausibility exists. This applies as well for other (big) nutrients that are therapeutically useful.--TheNautilus (talk) 10:39, 8 April 2008 (UTC)

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As I understand it, TheNautilus' problem is that the source (a widely used, highly valued reference work for oncologists) disagrees with his convictions about OMM.

TheNautilus, I assure you that, even if every single word you say here is true, WP:RS does not actually require that the source get any of its facts right. The Chicago Tribune is still a reliable source, despite one of the most famous errors in the history of newsprint. WP:RS is about the source itself, not what the source says in any given case. If you can make a case for standard reference works being "unreliable" in general, or for this book not being a standard reference work, then let's hear it. Otherwise, you need to quit complaining about this source qua source. WhatamIdoing (talk) 05:32, 7 April 2008 (UTC)

The application of WP:V to problematic WP:RS sources in technically related articles, which this is, along with NPOV and WEIGHT require some work to avoid inaccurate and misleading statements. Proper use and interplay of policies yield accuracy, scientific priority and fairness. Basically it is non-encyclopedic to be repeating fundamental & factual errors & misrepresentations that do show the unfamiliarity, or bias, of authors outside their expertise. Then the material needs to summarized, not quoted at length or unbalanced. Unbalanced quotes and attack style statements are not good practice in the lede, rather roughly describing the totality rather than just repeating some (prominent) biased individual or groups where WP:V technical error or misrepresentation of facts, especially mainstream recognized ones, are involved. I think that we may be starting to surface the issues interaction on POV, currency, & technical accuracy to begin to resolve the disputes if some editors will focus on these technical discussions and not just assume QW-based prose reflect current or mainstream science.--TheNautilus (talk) 09:25, 7 April 2008 (UTC)

The issue isn't whether or not "reliable sources" one may not like are quoted, but rather if they are claimed to be authorative, and whether reliable countervailing voices are silenced. --Alterrabe (talk) 19:54, 7 April 2008 (UTC)

Yes, as the "quackery" and "faddism" views are notable views in the scientific and medical literature, then we need to note that these views exist and cite the literature that puts these views forwards. Our personal views on the accuracy of these views is not relevant to that fact that these views exist. Tim Vickers (talk) 19:58, 7 April 2008 (UTC)

I have never been against putting vitriolic condemnations of orthomolecular medicine into the lead. It was I, in fact who described OMM as a "controversial" branch of medicine. But if we put such vitriol into the lead, I think it's only fair to include that some of the organizations that condemn OMM, such as the AMA, have a very dubious history themselves, having promoted smoking at a time when smoking was controversial. This way, and only this way, would the first time reader know right from the start that this is a controversial topic, and that they may have to think for themselves.--Alterrabe (talk) 20:25, 7 April 2008 (UTC)

A concise, current, accurate balanced lede summarizing high quality references (e.g a calm, authoritative 15 page paper written to the subject, without ambiguous non-technical epithets) is best. So far all I is see are obsolete statements, old innuendos and misrepresentations falsely presented in an authoritative voice. The 3rd paragraph continues to violate NPOV, WP:V in the current factual sense, UNDUE weight, and *promotes* a false light with a defamatory POV.--TheNautilus (talk) 22:01, 7 April 2008 (UTC)

I would respectfully disagree. Orthomolecular medicine is so controversial that including epithets, and questioning the seriosness of those who truck in such epithets, in the lede, would contribute to our efforts to enlighten our readers. Not referencing them, or referencing them, without questioning them, would suggest that this is a topic often discussed dispassionately, or that the criticisms themselves don't merit criticisms to the unenlightened reader.--Alterrabe (talk) 22:39, 7 April 2008 (UTC)

When you say "WP:V in the current factual sense" it is very clear that you don't understand this policy. Please read it again. especially the first sentence - "The threshold for inclusion in Misplaced Pages is verifiability, not truth." Arguments over if that something is true or accurate is completely irrelevant to if it is verifiable. Tim Vickers (talk) 22:31, 7 April 2008 (UTC)

Tim, you are clearly misstating policies and their application. From WP:V Reliable sources: ...As a rule of thumb, the greater the degree of scrutiny involved in checking facts, analyzing legal issues, and scrutinizing the evidence and arguments of a particular work, the more reliable it is. The three sources, mere partisan or non authoritative blurbs, Jarvis(83), Jukes(90), Aaronson(2006) that I have analyzed fall far short on these three conditions: checking facts, when they contain (multiple) false (and misleading) statements; analyzing issues - there's no analysis or length in a quick bash; and have clear deficiencies in evidence and arguments; hence a less or unreliable source. You are attempting to confuse an WP:RS masthead with flawed text and literal print as WP:V with the preceeding actuality of RS and WP:V, where facts must prevail in precedence to have coherence in techncial matters. I am open to acknowledging controversy & status, past and present. You are short circuiting this with weak references, weak WP:RS, weak because of the source text and subsequent findings, not the publication.

Verification of factuality, not merely verification of printing.--TheNautilus (talk) 07:57, 8 April 2008 (UTC)

Ah...the Misplaced Pages:TRUTH. Jefffire (talk) 08:07, 8 April 2008 (UTC)

Now I have directly cited the policies, WP:RS on substance. I have cited hard references for the current facts and situation. The two sources, OlsonJukes(1990)amplifying fabricating Jukes' "words", Jarvis (1983) are simply old, tiny, loosely stated, individual political opinions being given UNDUE weight, obsolete on the vitamin C question, the underlying issue in those two sources, with no scientific substance and only minor historical merit to greatly mispresent the current status of the vitamin C questions, much less all orthomed.

Goodwin (1998, Arch Int Med): "Pauling...respiratory disease...idea is now a respectable hypothesis, but 20 years ago it was quackery." (Cochrane Collection author) Hemila (2006), shows Chalmers and all misanalyzed the positive data on doses much lower than orthomed (zero data on orthomed), and vitamin C appears to work with small statistical benefits at small fractions of Pauling's recomnmendation. Aaronson's (2006) statements, contradicted by real examples (and better informed doctors), simply suggest he doesn't know what he is talking about, a good reason to keep it short at three paragraphs, a trivial "reference" on a subject. This article and the lede on a technical subject are being overloaded & sabotaged with obsolete and erroneous POV in large quantity. Plase re-read NPOV: especially Undue Weight, Fairness of tone, and Balance.--TheNautilus (talk) 10:09, 8 April 2008 (UTC)

And what is the truth? is the issue isn't it? Is it what x said, or what y said. Frankly, it doesn't matter. Verify that x said z about orthomolecular medicine and it can go in. Verify that y said a about orthomoleculal medicine and it can go in. Declaring that x's statement is wrong because y said so is PoV. Of course, all that depends on the subject of x and y's discourse being about orthomolecular medicine. If they don't explicately say so, then it's OR to claim that it is. I mention this because I've started to go over some of the references, and some seem to not mention OM at all. Jefffire (talk) 10:21, 8 April 2008 (UTC)

Many of the article's references & authors are quoted, directly acknowledged as, and/or referenced by other orthomolecular publications, OM authors and orthomolecular related articles as well as reflecting upon elementary orthomolecular positions & principles.--TheNautilus (talk) 00:33, 9 April 2008 (UTC)

You may very well think that, we cannot possible comment. It's OR. Jefffire (talk) 09:14, 9 April 2008 (UTC)

No, orthomolecular acknowledged references are primary & secondary sources that provide additional material actually used in orthomolecular research, analysis & recommendations from a common body of literature.--TheNautilus (talk) 20:51, 9 April 2008 (UTC)

See Talk:Orthomolecular_medicine#off_topic_link_removal for discussion of the jargon, synonymous terms include "megavitamin therapy" and "vitamin therapy". TheNautilus insists on a very prominent use of the term "orthomolecular medicine" in critical sources, but is happy to include any clinical study that used a nutrient if it is supportive of his ideas, even if "orthomolecular medicine" is never mentioned. Tim Vickers (talk) 13:58, 8 April 2008 (UTC)

These terms are not synonymous, rather they overlap and context is important.--TheNautilus (talk) 20:51, 9 April 2008 (UTC)

Although it may sound baffling, there is some method to this. In Abram Hoffer's online writing about the orthomolecular treatment of cancer, he has some therapies which he calls "orthomolecular" and insists they be part of a regimen, and then many others that he essentially adds as optional adjuncts that probably are useful. It would be unfair to use the adjuncts to discredit the "blue-chip" orthomolecular therapies that Hoffer, Pfeiffer, and Pauling endorsed, but I suppose that we ought to make it clear when the adjunct therapies are not 100% orthomolecular. There is a lot of overlap, and the only way to avoid frustration is to be very precise.--Alterrabe (talk) 17:56, 8 April 2008 (UTC)

Those "imputed" references referred to, many/most of which I didn't add, are usually based on test & data that were generally recognized as substantially orthomolecular in nature, mostly from the lower dose optimum nutrition side, don't have "hot button" non-orthomolecular errors ( e.g. wrong molecules from "K3" to excess iron for the population subgroup or wrong quantity for specified use) and usually are claimed, used, referenced, discussed, and/or written by explicit orthomolecular sources and authors.

The three "references" ( Jukes/Olson, Jarvis, Aaronson, short, spurious opinion non-encyclopedic blurbs really) that I am objecting to, are insubstantial & highly flawed:

(1) two are relatively old for "current opinion" (1983, 1990), given important changes in published science, later references specifically and more authoritatively refuting them, the public, and the marketplace;

(2) all three blurbs are not reliable sources in the sense of RS objective criteria (e.g. (i) only ~12 lines of (sometimes vaguely) OMM related material instead of a paper with 15 focused pages; (ii) an evidence based, logically presented opinion; (iii) multiple serious errors or misrepresentations, failing WP:V for fact checking);

(3) they are being given undue weight to advance a bitterly partisan position often associated with groups whose broadly distrbuted opinions are recognized as unreliable sources at WP, from groups increasingly generally recognized as sources of (systematic) bias in legal, scholarly and scientific venues.

(4) the orthomolecular connections are indirect OR or highly specific instead of general OMM coverage (e.g. Jukes: attacking LP himself (not OMM per se), defending an obsolete RDA and incidentally, prodding LP on low range vitamin C but mostly including the Jukes' sub orthomed based dose-frequency opinions, off by 1 or more orders of magnitude in either the therapeutic or prevention categories of single OMM components. An irrelevant opinion by most scientific & academic measures.

(5) critics are seldom even talking about/using the same nutrient forms, and never(?) the current complete regimens, making them "more" irrelevant.--TheNautilus (talk) 23:26, 8 April 2008 (UTC)

Table of (possible) Lede references

see Help:Table

• As a note on Menolascino, et al, on-line access to Child Psychiatry & Human Development starts at 1993 and my university only has print holdings from 1997. Anyway, weren't you complaining above about references from the 1980s being too old? Why is this one different, or have you changed your mind? Tim Vickers (talk) 23:11, 9 April 2008 (UTC)

You've misunderstood the principles & fundamental statements. I said old, vitriolic (extreme) opinions, that are unsupported within the relatively few relevant lines in their papers (or Olson's misattributed editorial that you quoted as Jukes') for support, that certainly aren't current for mainstream medical science. Where time has proven them wrong for making a number of rabidly conclusory judgments (niacin for HDL₂, triglycerides, & ApoB; vitamin Bs' uses developing, C is an active issue, megavitamin D is happening in Canada, E has evidence in claudification & Alzheimers, K₂ in cancer & osteoporosis, lipoic acid in diabetes, not to mention the long known megavitamin treatments for disorders of metabolism and maladsorption). Menolascino analyzed, presented readers with balanced work, references and facts to state his criticisms in ~600 lines (lots of supporting info & references). Older solid work? - most people, if they (can) do any physics, still use Newton's version, 300 years later. Although some of Menolascino's points are uncomfortable, they are still far more relevant, focused, knowledgeable & balanced than any other critique that I have seen here, not just cheap, internally unsupported (or even back then knowably wrong) shots under a "WP:RS" masthead.

Also another item that has been misunderstood or ignored several times, is that although I think some of these references are utter c---, I am more amenable to working balance issues in the body. Such low quality, obsolete opinion based references in a prominent & conclusory manner, appear to unencyclopic and violate NPOV in presentation, with undue weight and lack of currency among others.

I have a copy of Menolascino but need a current fair use policy (e.g. limited time, words).--TheNautilus (talk) 01:31, 10 April 2008 (UTC)

Lead as a summary

I don't find a statement in the main text about OMM being called quackery by its critics. Obviously it was, and indeed is, in some circles, but if it's not important enough to include in the body of the article, then it doesn't belong in the lead. WhatamIdoing (talk) 05:13, 7 April 2008 (UTC)

I'm sure that was there before, I've replaced it in the criticism section. Tim Vickers (talk) 16:00, 7 April 2008 (UTC)

We also failed to summarise the Prevalence section, I've added some of this data to the lead. Tim Vickers (talk) 16:27, 7 April 2008 (UTC)

POV problem at daughter article

The article Megavitamin therapy is ridiculously POV, and appears to have been written by an advocate of this concept. Tim Vickers (talk) 18:22, 7 April 2008 (UTC)

We need to finish here. You are still running around touting misattributed statements, such as that slap shot activist editorial (read ARN 1990 Preface's whole editorial, promoting Jukes' kind of polemics, not even accurately rendering Jukes' statements) of a faction that time has demonstrated, in the mainstream, were not only wrong relative to orthomolecular recommendations, but demonstrably detrimental to public health. At least in my state and Canada, spreading their dangerous "VDD" (vitamin D deficiency) promoting nonsense, as well as the other obsolete or blatant errors on A, B, C, D, E....--TheNautilus (talk) 21:35, 7 April 2008 (UTC)

I'm sorry, but if you want to attack the entire medical profession as idiots, then per WP:REDFLAG, which specifically mentions medicine, you will need superior sources. Shoemaker's Holiday (talk) 23:40, 7 April 2008 (UTC)

My answer, above, to Tim has little to do with the medical profession per se, rather it is about old (e.g. circa WWII profs, students & their "allies") nutritionist factions that are literally dying off, but leave a bitter legacy that is only slowly emerging from a dark age in preventive & therapeutic research with natural or bioequivalent compounds. The results that I refer to come from current millenium medical recommendations, research and papers, some even earlier. Some compounds were even previously acknowledged in a backhanded way by one of Pauling's biggest antagonists, Herbert. The nature of your answer suggests you might want to read these discussions, the archives, and the current nutritional & medical science literature more closely.--TheNautilus (talk) 04:01, 8 April 2008 (UTC)

"slowly emerging from a dark age" - no wonder these articles have so many problems. Shot info (talk) 06:32, 10 April 2008 (UTC)

With the belated recognition of many nutrient based therapies in the past ten years, that one is already in the rear view mirror, ca 1948 - 1998.--TheNautilus (talk) 07:58, 10 April 2008 (UTC)

Great review

Is there a metabolic basis for dietary supplementation?. Unfortunately, as is normal in modern reviews that don't address alternative medicine, "orthomolecular medicine" is not mentioned. It would probably be OR to include this, although it discusses exactly the topic of this article. Tim Vickers (talk) 18:35, 10 April 2008 (UTC)

That is an interesting article, Tim. Although it studiously avoids the "O" & "M" words, despite discussing similar concepts at length, perhaps it provides some transition for conventional opinion without any "hot button" words. I might point out that in Figure 2, Risk of deficiency vs Intake, on vitamin RDA, optimum dose, upper safe limit and toxicity, that the graph would likely represent a logarithmic scale on the x-axis of dosage (1, 10, 100 grams/day...) where positive human experience with increasing vitamin C doses covers over 6 orders of magnitude and individual's benefit-opimum-tox curve may vary substantially with time & conditions, such as any stresses and illness. The orthomolecular crowd may also express concerns about the (non)ideal shape & skewness of the curves, perhaps especially the tail. Also the curve's labelled RDA, optimum and inflection pts, allow consideration of the definitional "deficiencies" hobgoblin: (1) deficiency relative the individual's optimum point, (2) subclinically deficient relative to some population average, (3) clinically deficient by some measure, or (4) even "classic" deficiency sysptoms including death. Offhand, I am not sure how to address this article here, myself.--TheNautilus (talk) 07:52, 11 April 2008 (UTC)

The values on the X-axis depends on the substance in question, with the window between beneficial intake and toxicity in selenium, for example, being quite narrow. Tim Vickers (talk) 15:42, 11 April 2008 (UTC)

The width of the "selenium window" also greatly depends on body stores, disease, and the Se form. e.g. inorganic -ite, -ate not so wide vs some organic forms that are much better tolerated and may be more effective too. The "true" orthomolecular Se form is considered to be not yet identified.--TheNautilus (talk) 11:50, 23 April 2008 (UTC)

False light

Just FYI: you can't make a "false light" or "defamation" charge stick against an idea. Privacy rights (and freedom from false light representations is indeed a privacy right) only attain to persons. WhatamIdoing (talk) 04:18, 11 April 2008 (UTC)

I have adjusted the table entry for greater precision.--TheNautilus (talk) 07:52, 11 April 2008 (UTC)

Not really. Saying that something is a "slur that promotes defamatory statements" (to slightly paraphrase) still makes a claim of defamation against the idea of megavitamin therapy. You can defame a person or an organization; you cannot defame an idea.

Try "criticize", "denounce," "disparage" or "attack" instead. I doubt anyone would disagree with summarizing that link as "an editorial that strongly disparages megavitamin therapy as quackery". WhatamIdoing (talk) 18:54, 11 April 2008 (UTC)

The nature of the lead assertion is at the point of incivility, it certainly is not NPOV, balanced, weighted, technically current or scientifically accurate as a summary. My point is an erroneous POV emanting from known unreliable sources, that are at least obsolete, has a history of fueling (expensive, losing) real world persecutions, including defamation, while drowning out more technically accurate and balanced accounts. This poisonous POV is being used *here*, at Misplaced Pages, to advance extreme positions & innuendos that are simply WP:V false. These old opinion pieces engage in personal and professional attacks, that were identifiable as without genuine foundation even then. Mainstream authorities of today's science and medicine have taken notice, however low key, finding scientific merit in statements previously dismissed most uncivilly without any consideration, much less according to scientific methodology. Rather than summarize and balance that there have been vitriolic critics whose views were once accorded weight far beyond their technical foundation, successive statements focus on the extreme view and accentuate, add or exaggerate the obsolete negative. Jukes vitriol -> Olson's added opinion (flames) -> Misplaced Pages's lead focuses on the small extreme rather than summarize and generalize. The Lead should be general summary e.g "there have been mainstream, and extreme vitriolic, critics" rather than the KKK-like whirlwind of rising epithets, poisoning the reader in the Lead, presented as if they were current or authoritative.--TheNautilus (talk) 11:13, 23 April 2008 (UTC)

Also phrases such as "ind'l stmt, anti-MV boosterism" are incomprehensible and close to gibberish. People will not respond to statements they cannot understand. Tim Vickers (talk) 19:54, 11 April 2008 (UTC)

One thing that I will note is that often new, almost alien concepts and terminology, can be difficult to understand, sound like gibberish, difficult to grasp or even remember. Here I wrestle with several sets of jargon (Wiki, conventional, CAM, and orthomed) that are important to condense concepts and material into retainable or decipherable chunks that can be be scanned at all. It's a long story. Hoffer himself noted that cleaning up after these kind of broadsides: ...your latest account of megavitamin therapy ...1975. I am sure that you realize it is impossible for any person to mop up the continual errors which are put out--TheNautilus (talk) 11:13, 23 April 2008 (UTC)

The sentence you object to is "Other critics have classed orthomolecular medicine as food faddism or quackery." What part of this sentence do you believe is factually untrue? Do you believe that no critics, however misguided they might be, have ever made such a claim? WhatamIdoing (talk) 01:09, 24 April 2008 (UTC)

The allegations themselves are based on gross misrepresentations & appear malicious in nature to those knowledgeable about the underlying facts. These are extreme, hurtful, uncivil opinions being presented as if they were authoritative. They certainly are not NPOV, BALANCED summary. That there are vitriolic critics is notable. Perhaps like the KKK on ethnic groups, their words of malice & attack are not suitable lead material. If this is the Misplaced Pages standard of editing, there are a lot of medicine and pharmaceutical articles leads that we should probably quote NY Times, NEJM, JAMA, etc about "scams", "fraud", cooked and crooked science.--TheNautilus (talk) 11:38, 24 April 2008 (UTC)

That's what I thought your concern was. You seem to have fallen into the logical fallacy of assuming that because we state a bare fact, that we support or approve of the bare fact. PLAIN FACT: Other critics used these words to describe this concept. NOTE: That's all we're saying. It doesn't say "Other critics used these words, and we think they're right" -- just "Other critics used these words."

And I assure you that there are many articles in which the words scam, fraud, etc., feature in the lead, to the disgust of supporters. See Homeopathy, for example, which is labeled as "scientifically implausible", "diametrically opposed to modern pharmaceutical knowledge", "regarded as pseudoscience", "quackery" and so more -- in the lead. Ozone therapy's second sentence names critical claims that it "is nonscientific and has no proven benefits." The bio for researcher Hwang Woo-Suk discusses "various lies and frauds". OMM's lead is by no means unusual in this respect. WhatamIdoing (talk) 15:37, 24 April 2008 (UTC)

"SYNTH"

Jefffire's edits seem to frequently call things he doesn't like, "SYNTH". We would disagree as to the use of "source based research", explicitly cited by J Wales himself. Without it, we'll never get remotely current or accurate articles. The "nutritional medicine" formulation is closer to the commentaries' broad scattered criticism of nutrition or to the periphery (or actual outside) of orthomolecular therapy regimes, just barely mentioning "ortho-" anything. Making a categorical assignment of all the criticism to orthomed in general has the SYNTH problem. Let's focus on improving the sentence, please.--TheNautilus (talk) 12:03, 23 April 2008 (UTC)

Nutrition is not synonymous with Orthomolecular medicine. Your choice of wording implied that it was. One cannot attribute anything to do with nutrition as being orthmoecular. If the article makes direct references to OM, then we might have something useful to work with. Jefffire (talk) 12:11, 23 April 2008 (UTC)

The sentence overstates its source base on "orthomolecular" content, that's the original SYNTH problem.--TheNautilus (talk) 12:14, 23 April 2008 (UTC)

Could you elaborate, please? If critical material is WP:SYNTH I'll look into it too. Jefffire (talk) 12:25, 23 April 2008 (UTC)

Jarvis (1983) just barely touches OM with 2 "ortho-" anything words in 17 pages, quotes linked above. Jukes (1990) attacks vitamin C with misplaced proximity to "Quack Remedies in Cancer" being the crime, where Jukes never mentions vitamin C & cancer, just vitamin C & colds with Pauling. Jukes' nutritional autobiography and (misrepresented) attack on Pauling nevers says "ortho-" anything in 23 pages, Jukes *briefly* criticizes "megavitamins" (and Congress, Pauling, Roger J. Williams, NHF, Prevention magazine...) on a failed FDA attempt to regulate vitamins over 150% of RDA in one paragraph (FDA went down in flames, 81 to 10), all in one paragraph. Jukes finishes the "Megavitamin" section with two paragraphs criticizing organic foods being pesticide-, hormone-, artificial fertilizer- free. Megavitamin, huh?

Then AJR editor, Robert Olson, starts bashing everything in sight as quackery, sort of "hey everybody, sic 'em like Jukes, sic 'em, sic 'em." All personal opinion, no technical back up, references, nada. Just pure attack. Not even one use of "ortho-" anything, just one (ab)use of ambiguous "megavitamin therapy". Misrepresented megavitamin use - the big negative examples were never orthomolecular in nature e.g. synthetic menadione (once called K₃) used by *mainstream doctors* in larger amounts on newborns (up to 50 mg documented) than orthomolecular amounts of the safe human forms of vitamin K₂ used successfully on liver metastases in Japan for terminal adults. Or even now pharmaceutical isotretinoin, a scarce interconversion form of vitamin A, used too frequently (6x?) on young females that can create severe defects or coerced abortions even several years after drug cessation. Yeah, there may be big "megavitamin" examples of quackery alright, they are just not orthomolecular.--TheNautilus (talk) 13:31, 23 April 2008 (UTC)

It's probably within the realms of reason to include criticisms aimed at the founder and megavitimins since they appear to be strongly associated with the subject. There's a lot of detail in your post above, so could we take it one at a time? Which do you think is the biggest problem at the moment? Jefffire (talk) 13:39, 23 April 2008 (UTC)

Beyond the textual summary's inaccuracy and sources' minimal coverage, these are extremist critics being given undue weight, without balance or NPOV, as well as being without a relevant scientific base or technical development on the subject. Criticism based on megavitamins should reflect clear orthomolecular examples. The supposed "bad" megadose examples that are typically presented either were fundamentally non-orthomolecular in nature or involved (long) known contraindications.

Jarvis, founder of an "activist" group that virtually sued itself into oblivion being also legally wrong too many times, has no research in the area. Jukes, a "gifted polemicist", sore at being gently needled by Pauling for being a critic with no research on high dose vitamins & C after several decades of missing opportunities, appears to deliberately create an innuendo against Pauling by selective truncation of the radio transcript - pretty non-encyclopedic for orthmed by any standard.

Deja vu. To further demonstrate what I mean about "extreme", let's listen to *the mainstream* in Science, about Robert Olson and the NAS decison to not release an RDA recommendation to drop from 45 mg to 40 mg per day for vitamin C (now 75-90 mg/day, recommended for 200 mg/day by Levine et al at NIH). Olson supported a food only RDA proposal dropping to 40 mg/day vitamin C. Robert Olson was neither a part of the panel nor party to the review process. His letter contains unverified assertions about NRC's decision, selective citations, faulty characterization of the review process, and unjustified attacks on members of the Food and Nutrition Board. - Frank Press, Office of the Chairman, National Research Council, National Academy of Science.

Ultimately, these avowed enemies of "more than minimalist nutrition" are being used to perpetuate gross misrepresentations and misconceptions about orthomolecular medicine here at Misplaced Pages with weak, highly biased sources from extreme, baseless statements with *no* relevant data. Although "FF-Q" discussion in the body can be balanced and summarized, the current Lead is POV, unbalanced(-able) and frankly, uncivil, as well as false (currently experimental with plausiblity and gaining positive medical evidence) and not a summary, just a transparent attack given UNDUE WIEGHT and authority.--TheNautilus (talk) 11:15, 24 April 2008 (UTC)

Dated reference in lead used for current consensus statement.

Concerning the claim: "The current scientific and medical consensus is that the major claims of disease treatment by advocates of orthomolecular medicine are unsubstantiated by the available evidence."

Already dated reference 10 published in 1990, cited studies that were published in the 1970s and 1980s to substantiate their position, It would seem to be misleading to use it to represent current scientific and medical consensus. Ward20 (talk) 20:29, 13 May 2008 (UTC)

The other two references are from 2003 and 1997. Tim Vickers (talk) 21:44, 13 May 2008 (UTC)

Yes, I agree that those two references support the claim of current, but a 1990 viewpoint based on data from the 70s and 80s should not represent current scientific and medical consensus. If the other sources are strong enough to support the content then reference 10 is redundant and can stay or go. If references 9 and 11 will not support the content on their own, then a new reference might be found or the sentence reworded. Ward20 (talk) 23:27, 13 May 2008 (UTC)

Ward20, I think that the combination of references is okay (not ideal, but okay) here, but perhaps you would prefer to have it say "The longstanding scientific and medical consensus..." instead? WhatamIdoing (talk) 19:45, 19 May 2008 (UTC)

Yes, I believe the above wording would be more accurate to the sources used, although I have some other suggestions about these references and paragraph to try to improve it.

The source (9) Cancer Medicine Megavitamin and Orthomolecular Therapy section seems to be written by two PhD's, and as far as I can tell their primary view states, "There is no evidence that megavitamin or orthomolecular therapy is effective in treating any disease." This is contradicted by sources (10) and (11) and other studies cited in the article. I don't view that source supporting "the consensus of the scientific and medical community" very well.

Source (10) Megavitamin and megamineral therapy in childhood which I believe the most dated source, seems less negative about megavitamin and mineral therapy than source (9) saying, "Vitamins and minerals in large doses are used as primary therapy for certain medical conditions." and "A number of disease states necessitate the use of vitamins and minerals in doses exceeding the recommended nutrient intake... diseases of the liver, kidney and bone... Large doses of vitamin D, ...rickets... high doses of vitamin A analogues... acne... The rationale for use in several other conditions, however, is not as well established." Then they discuss studies that conclude there is a lack of efficacy for many conditions advocated for megavitamin and megamineral therapy. In the recommendation section they urge caution concerning the health hazards and substitution of unproven megavitamin regimens for proven safe and efficacious treatments.

Source (11) Orthomolecular Medicine by the American Cancer Society states, "Available scientific evidence does not support use of orthomolecular therapy for most of the conditions for which it is promoted. However, vitamins, minerals, and other supplements have been and continue to be studied to see if they can help or prevent many types of illness. While some supplements have been shown to help certain conditions, a few have unexpectedly proven to be harmful."

Suggestion to change the paragraph to bring more balance in the lead:

• The American Cancer Society states that current scientific evidence does not substantiate most uses of orthomolecular therapy for which it is promoted. Certain conditions have been helped by some supplements, while a few nutritional therapies have proven harmful. The American Medical Association stated in 1997 that "much of the dietary intervention stressed by alternative healers is prudent and reasonable", but described as a "myth" the idea that "most diseases are caused by faulty diets and can be prevented by nutritional interventions". Other medical literature has been very critical of orthomolecular medicine.

I changed the last sentence because it seems to be cherry picking in order to get pejorative phrases into the lead. I think the prior wording gives the pejorative phrases too much weight. This change would bring more balance to the lead, and then the primary source positive studies in the last paragraph could be moved out of the lead into a section that specifically talks about those. It would seem to me that better balance in the lead similar to this would be more encyclopedic than (perhaps overly) harsh criticism which is then followed by positive studies. Ward20 (talk) 02:01, 20 May 2008 (UTC)

And the longstanding wording per WhatamIdoing suggested, along with source (10)'s pro and con statements could be added. I still wish the paper was more recent though. Ward20 (talk) 02:35, 20 May 2008 (UTC)

Lead Redux

I was in the middle of editing the lead when Ward20 changed it. Here's what my edit looked like:

However, recent science has begun to substantiate some of the claims of orthomolecular medicine, finding that nutritional deficiencies may play a greater role than previously thought in mental illnesses and criminal behavior. A recent review of case studies found three cancer patients whose only significant treatment was intravenous vitamin C survived much longer than expected. These results are far from conclusive as there are other possible explanations, including the conventional treatments which two of the three underwent, but further clinical trials are in motion.

I don't know if we really need to explicitly describe studies in the intro section, especially when the studies are open-access. Note that the vitamin C case study explicitly says "3 cases of patients with usually progressive malignant disease who received intravenous vitamin C therapy as their only significant cancer therapy". Thus broadly claiming that these patients' had conventional and alternative treatments is misleading. Spending time on this study makes sense given that "vitamin C cures cancer" was a major part of this discipline. Also, I may raise a RfC on the "quackery" bit, although I don't suppose it matters that much. Its ad hominem attacks don't mean anything analytic readers, but most people aren't that analytic. Still, I don't think it belongs in the opening -- the "mainstream consensus" bit covers that side much less crassly. Impin | {talk - contribs} 23:45, 13 May 2008 (UTC)

I can see the point. The amount of detail is certainly a matter for discussion. I do believe the phrases, "science has begun to substantiate" and "nutritional deficiencies may play a greater role" may be slightly synth, in that the citations talk mostly about benefits of treating nutritional deficiencies and not about substantiation of Orthomolecular medicine or the perception of nutritional deficiencies. The two papers that discuss the cancer studies cases do say that other alternative treatments besides C were used and it would be difficult to say which are important. I agree with the point that only 2 of the three patients had limited conventional treatments along with the alternative treatments. Ward20 (talk) 01:13, 14 May 2008 (UTC)

Orthomolecular medicine is about treating nutritional deficiencies. I don't see how this is synth. Impin | {talk - contribs} 18:51, 14 May 2008 (UTC)

Perhaps WP:OR is a better term because those two opinions do not appear to be stated in the citations. Ward20 (talk) 05:48, 17 May 2008 (UTC)

Using vitamins to treat diseases is what OM is about. I don't see how you're making these claims.

For the last RfC see above. To be perfectly honest, a historical account of three people over ten years who received a mix of many different treatments is not something I would have added to the lead. Furthermore describing this as Recent evidence even suggests that vitamin C delivered intravenously can shrink tumors. is unsupported by the data. Tim Vickers (talk) 15:50, 14 May 2008 (UTC)

Furthermore saying that vitamin C was their "only significant treatment" when all these people received either radiation therapy or surgery is equally misleading. Tim Vickers (talk) 15:56, 14 May 2008 (UTC)

That RfC was not focused on your quackery addition at all -- both were in the two choices. Many people said they disliked both. First, this is a study highly pertinent to this topic which is mainstream generating attention; it definitely belongs in the lead. As far as saying "only significant" treatment -- that's a quote from the paper; it's not our job to contradict researchers, no matter what our qualifications are. One of these people received no radiation or surgery. So stating that they all received some conventional treatment is patently false, beyond misleading. False statements do not belong in this encyclopedia. Impin | {talk - contribs} 18:51, 14 May 2008 (UTC)

Case 1 received nephrectomy, case 2 received transurethral resection and case 3 received radiation. As the authors note in the discussion "The cases reported here do not prove that vitamin C induced the favourable outcomes observed." I do appreciate your eagerness to improve the article, but please try to read the sources carefully. Tim Vickers (talk) 19:00, 14 May 2008 (UTC)

Sorry, I missed the nephrectomy statement on case 1. Ward20 (talk) 05:48, 17 May 2008 (UTC)

No, the conventional therapy is not very prominently presented in this paper, for some reason. Tim Vickers (talk) 15:09, 17 May 2008 (UTC)

Your observation and wording, very astute. Ward20 (talk) 05:29, 18 May 2008 (UTC)

The paper clearly says that the only significant therapy for these 3 was the vitamin C therapy. Leaving that out and putting the conventional therapies on the same level distorts the paper. I'm no specialist, but I got the impression that the chance of the conventional therapies working was very remote. I'll have to re-read it, but I recall hearing that the chance of recovery with only the conventional therapies was somewhere around 1% for at least 1 of the patients. Impin | {talk - contribs} 18:02, 20 May 2008 (UTC)

So if you treat 1,000 people with a therapy that works 1% of the time, you would expect it to work in 10 cases. Here we have 3 cases where the people were treated and had a small chance of getting better, and did they get better. What a case-report study like this can't tell you is if there are 997 cases where people treated in the same way did not get better. This is why people do clinical trials and why the authors of the study say that it doesn't prove anything. Tim Vickers (talk) 18:15, 20 May 2008 (UTC)

True. My proposed intro says that "these results are far from conclusive". That doesn't take away from the fact that the conventional treatments were considered minor by the researchers, which is not in the intro. Ultimately, I didn't put the vitamin C study in the lead; I think it belongs in the lead only because the vitamin C cures cancer is such a well-known claim of OM. Impin | {talk - contribs} 18:21, 20 May 2008 (UTC)

Instead of using an inconclusive report on 3 people who were treated with a complex mix of alternative and conventional therapies, what about using a recent review on the topic of vitamin C as a cancer therapy? Examples could be this meta-analysis or this review in an alternative medicine journal. Tim Vickers (talk) 18:34, 20 May 2008 (UTC)

poor relevance (OR), obsolete reference, 1990 CMAJ

The 1990 CMAJ Canadian Pediatrics Society paper is obsolete and has been demonstrated to be in dangerous error for Canadian children in some cases (e.g. vitamin D in the high north), much less much about orthomolecular medicine. Hoffer's books on OMM deprecate the use of "megavitamin" and "megavitamin" is not synonymous with "orthomolecular", especially when "conventional" types are hunting for disparaging text with just plain old overdosages. Using the 1990 CMAJ article confabulates a connection between OMM and some large ("mega")dosage examples that are not any therapy, and especially are not the same as orthomolecular megavitamin therapies. As for the CMAJ quote in the lead: "For certain nutrients or people toxic effects may occur at much lower levels." Well, duh, see RJ WIlliams, Biochemical Individuality, 1956. This quote misleads. OMM has a much better track record identifying this than conventional MD / RD recommendations, recommending nutrient better forms and recognizing individual conditions and contraindications to individualize any dose (e.g. see niacin comments below). Vitamin A and carotenes are an area great inidividualization because of the chemical (alcohol, statins) & oxidative stress (smoking, lack of vit C) and liver disease populations that also need careful handling and monitoring. In these latter cases, OMM would talk about vitamins B's, C, K, E, Se, Q10, alpha lipoic acid, N acetylcysteine, sAME, silymarin, phosphatidylcholine (lecithin) for liver support as well as individual dosing of vitamin A and/or mixed carotenoids.

As for OMM oversupplementation with iron, vitamin D and calcium, how insulting. CMAJ 1990 et al simply missed the pediatric vitamin D requirements by a factor of 5-10, at least, according to *current* medical schools' research. Iron has been a watchword of caution in orthomed-natural circles for a long time (so long I am not sure, but before the 1980s), long before conventionals caught on in the 1990s. OMM types have been concerned about magnesium - calcium ratios for a long time too, some OMM groups being very negative about current willy nilly calcium supplements without magnesium.

Niacin hepatotoxicity is grossly overstated and not relevant to OMM recommendations, pure niacin doesn't have these problems outside the most liver compromised, -ing, pre-existing conditions (see Parsons, WB (1961 a). Archives of Internal Medicine 107, 639-652 & Parsons, WB (1961 b). Archives of Internal Medicine 107, 653-667; and the Coronary Drug Project, 1966-1974); the old sllooowwww release non-orthomolecular forms were problematic. Journal papers claiming problems (e.g. JAMA 1994) include gross malpractice using triple-sized dosages (e.g. 1500 mg bid instead of 500 mg tid) of the slow release form on unacclimated patients - long known gross overdosages, greatly over *any* hard ceiling at 750 or 1000 mg on such slow release niacin.

Multigram gram doses of B6 are not modern OMM treatments (1950s, before Pauling's definition), especially by itself and without other vitamins and minerals. Using the Table 1 in CMAJ 1990 with cobalt, fluoride, iron and copper toxicity, again how misleadingly insulting, like Al Capone accusing someone's tea totaling virgin aunt of impropriety. I haven't noticed OMM advocate fluoride or cobalt chloride as implied using CMAJ (1990), and OMM is much more cautious about iron and copper supplementation than most conventional recommendations or multivitamins have been.

Using the 1990 CMAJ article is pretty much inaccurate OR about orthomolecular medicine to support a POV and perpetuates several misunderstandings of orthomolecular medicine in relation to random megadose accidents and megavitamin therapies.--TheNautilus (talk) 14:32, 20 May 2008 (UTC)

Source selection

There are three studies mentioned in the last paragraph of the lead that deal with the effects on particular conditions of nutritional supplements, rather than discussing OM or megavitamin therapy in general. What was the reason that these studies in particular were chosen from the thousands of other studies that have been done over the years? Why also are we quoting these primary sources describing specific pieces of research, rather than secondary sources such as reviews or textbooks? Tim Vickers (talk) 16:01, 20 May 2008 (UTC)

OM medicine simply is the use of vitamins to treat diseases. It overlaps with mainstream nutrition. And what do you mean? There are three main topics cited. 'The first is a 2008 review -- it literally is a review. Look at it. The second is a fairly straightforward study; there's no harm in it. And the third touches on one of the primary topics of OM, vitamin C for cancer. The rule for secondary sources is designed to avoid using extremely technical papers, which other WP users can't understand. Read WP:PSTS. I'll quote it for you just to make sure: "Primary sources that have been published by a reliable source may be used in Misplaced Pages, but only with care, because it is easy to misuse them. For that reason, anyone—without specialist knowledge—who reads the primary source should be able to verify that the Misplaced Pages passage agrees with the primary source." None of these papers are highly technical, and we aren't making any controversial interpretations -- we're describing them in a straightforward manner. Also, the vitamin C study is cited by two secondary source which agrees with our interpretation -- a newspaper and an editorial in the journal. Impin | {talk - contribs} 16:39, 20 May 2008 (UTC)

So what was the reason for the selection of these three particular publications? Tim Vickers (talk) 16:47, 20 May 2008 (UTC)

1. Cite error: The named reference ACS was invoked but never defined (see the help page).
2. Report 12 of the Council on Scientific Affairs: Alternative medicine American Medical Association June 1997, Accessed 21 March 2008
3. Jarvis WT (1983). "Food faddism, cultism, and quackery". Annu. Rev. Nutr. 3: 35–52. doi:10.1146/annurev.nu.03.070183.000343. PMID 6315036.
4. Jukes, T.H. (1990). "Nutrition Science from Vitamins to Molecular Biology". Annual Review of Nutrition. 10 (1): 1–20. doi:10.1146/annurev.nu.10.070190.000245. A short summary is in the journal's preface.
5. Braganza, S.F. (2005). "Fad Therapies". Pediatrics in Review. 26 (10): 371–376. doi:10.1542/pir.26-10-371. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
6. Lakhan SE, Vieira KF (2008). Nutritional therapies for mental disorders. Nutr J 7: 2. doi:10.1186/1475-2891-7-2. PMID 18208598.
7. Gesch CB et al, Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners. Randomised, placebo-controlled trial., Br J Psych, 2002, Vol. 181, pp. 22-28 2002
8. Padayatty SJ, Riordan HD, Hewitt SM, Katz A, Hoffer LJ, Levine M (2006). "Intravenously administered vitamin C as cancer therapy: three cases". CMAJ. 174 (7): 937–42. doi:10.1503/cmaj.050346. PMID 16567755. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
9. Assouline S, Miller WH (2006). "High-dose vitamin C therapy: renewed hope or false promise?". CMAJ. 174 (7): 956–7. doi:10.1503/cmaj.060228. PMID 16567756. {{cite journal}}: Unknown parameter |month= ignored (help)
10. http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/research-backs-theory-that-vitamin-c-shrinks-tumours-471757.html

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