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Cloudbuster: Keep or redirect and merge?

The 2nd Articles for deletion discussion for Cloudbuster closed as "keep," with the note that "any merge/redirect discussions should take place at the relevant talk pages". However, the article was immediately merged and redirected into Orgone energy. The editor who participated in the discussion and then performed the merge believes that the merge/redirect is supported by consensus. I am posting this notice to the talk page of each of the editors who participated in the discussion, including the nominator, to ensure that this is the case. -- Shunpiker (talk) 18:11, 20 March 2009 (UTC)

Misplaced Pages:Articles_for_deletion/List_of_common_misconceptions_(2nd_nomination)

In your comment to this AFD, you said: "the sourced information is fine, but there is no encyclopedic reason to organize it like this." This doesn't stroke with your delete vote. If the organization is a problem then why aren't you suggesting a renaming or something other than deletion? - Mgm| 23:53, 23 March 2009 (UTC)

You are correct - updating to merge to relevant articles. - Eldereft (cont.) 23:58, 23 March 2009 (UTC)

Thank you for keeping an open mind! Sincerely, --A Nobody 02:37, 24 March 2009 (UTC)

Overdue Star time

		The Barnstar of Integrity
		For exemplifying both collegiality and scientific rigour over a sustained period of editing, and applying these virtues to solving knotty problems, e.g. the much-needed title change at List of topics characterized as pseudoscience (discussion) and major improvements to several entries there. all the best, Middle 8 (talk) 22:56, 25 March 2009 (UTC)

• Huzzah! Seconded. MastCell  23:09, 25 March 2009 (UTC)

• • Huzzah! Thir ... er, I mean - thank you. The both of you are good 'uns. Now I feel all warm and full of organs inside. - Eldereft (cont.) 23:37, 25 March 2009 (UTC)

Naturopathy

Heh, don't worry, it happens. =) I just got a bit worried because, well, you know, willow bark, say, will relieve pain - there's no doubt that pharmocological compounds exist in herbs, but herbalists seem very willing to make claims well above what there's justification for, and the natural variation is much higher than is ideal: It's more dangerous to use foxglove than digitoxin, because you don't know how much digitoxin is in any particular foxglove. Shoemaker's Holiday (talk) 10:57, 26 March 2009 (UTC)

Very true; that's a big problem with herbs. Sometimes, though, folk medicine, as with the use of cultigens, optimizes effects by mixing up multiple ingredients. Opium, for example, includes compounds that are respiratory stimulants, countering the depressive effects of morphine, so it's an effective analgesic that is less likely to kill you. TCM herbalists use a lot of licorice, which induces liver enzymes, thereby allowing the quicker metabolism of other ingredients that one might not want sticking around. Very careful attention should be paid to longstanding folk usages, imo. (And while I think researchers don't always take this stuff into account, I personally would never let a naturopath dose me with anything other than a sugar pill and some happy vibes.) --Middle 8 (talk) 06:13, 27 March 2009 (UTC)

Sure, I think the effect of congeners in an herbal substance is pretty well-recognized. To take a different example, it has been suggested that dronabinol is less effective and more toxic than inhaled marijuana as a treatment for nausea and anorexia. The assumption would be that other compounds in marijuana besides THC have modulating effects. But the fundamental problem with all herbal remedies, which you mention, is standardization. Even in a best-case scenario, dosing herbal products is a shot in the dark. And since the passage of DSHEA, the US at least is in a worst-case scenario in terms of purity of herbal supplements. Anyhow, never underestimate the effectiveness of a sugar pill and happy vibes; the objective response rate to placebo in some studies is 60% or higher. MastCell  18:43, 27 March 2009 (UTC)

60%? Damn...

On standardization: I like the idea of regulating herbs as an entirely new category, "in between" drugs and foods. Relatively non-toxic herbs (such as cannabis) probably wouldn't need too much in the way of standardization, apart from truth in labelling (e.g., "guaranteed not to have any Labrador in it"). --Middle 8 (talk) 08:22, 30 March 2009 (UTC)

Actually, cannabis is probably de facto regulated to a much higher standard than dietary supplements. If an entrepreneur consistently markets cannabis which is adulterated or deficient in active ingredient, he or she is quite likely to suffer serious professional and personal repercussions.

On the other hand, if you sell a dietary supplement which happens to be entirely devoid of the labeled ingredient, or packed full of lead and cinnabar, or lethal (cf. ephedra, aristolochia), or (best of all) adulterated with those evil but effective pharmaceuticals that your ads rail against, you'll probably retire to the Bahamas with a fleet of jet-skis. Huzzah for "health freedom". MastCell  20:57, 30 March 2009 (UTC)

That's true, although I'd argue that there is similar de facto regulation (of safety, not so much efficacy) with herbs/supplements sold by large outfits (groceries, drugstores) in the US. Those companies are big enough to get sued and pay judgments if they're found to be selling nasty stuff. (As for stuff imported from, e.g., China, I won't go near it, except for reputable companies with third-party oversight.) And again, the fatalities from ephedra, aristolochia and kava were all instances of greedy, too-clever-by-half manufacturers ignoring longstanding traditional herbal standards. Even so, the number of people who reportedly suffered liver toxicity from ill-prepared kava was about one order of magnitude less than the number of people who die each year from acetaminophen. Freedom involves risk. Agree the DSHEA is too lax, but I fear they'll err too far toward strictness if/when they rewrite it. regards, Middle 8 (talk) 14:18, 31 March 2009 (UTC)

Well, yeah, plenty of people die from acetaminophen or aspirin. But the point is that if you take a 650 mg tablet of acetaminophen, you know that you're ingesting 650 mg of acetaminophen. If you take something labeled as containing 100 mg of herb X, you have no idea if contains any X, or a tenfold overdose of X, or X adulterated with lead and mercury, or X adulterated with prescription drugs to make the herb actually work, etc. People don't die from using acetaminophen in the manner directed on the bottle (most deaths are suicides). On the other hand, people can and do die from taking ephedra or aristolochia exactly as specified on the bottle. That's a pretty major difference. Leaving matters of safety, quality, and purity to the free market is a recipe for disaster. Freedom involves risk, sure - but there's a difference between making an informed decision about your health and playing Russian roulette. MastCell  19:38, 31 March 2009 (UTC)

(de-indent) Gotta object to that analogy. Broad-brush use of terms like "Russian roulette" is about as helpful as abstinence-only sex education or the This Is Your Brain on Drugs campaign. People who have tried marijuana know what the effects are, and they know that anti-drug hysteria is bullshit. Same deal with (many) herbs. Just because we don't know the exact chemical profile of an herb doesn't mean that there is a realistic risk of it containing something lethal. ("Don't shoot up that reefer, you could DIE from it!")

Sure, some products are adulterated, but we do know that people who take herbs made by reputable suppliers aren't dropping dead at the Russian-roulette ratio of one in six, or one in six hundred. Many are quite pleased with the results, in fact, which is a large reason why the "health freedom" movement is popular: consumers don't blindly follow shady herb manufacturers, any more than they uncritically swallow everything doctors or politicians tell them. Depending on the herb, it may suffice to grow, harvest and prepare it consistently, without further standardization. (I don't mean to suggest that we should fail to try to understand each and every herb at as granular a level as possible, but while we pursue that gargantuan and funding-poor task, consumers should be able to choose, and to do so with a realistic and non-hysterical picture of the evidence. It's much, much better to tell a patient using herbs about known herb-drug interactions than to tell them to "just say no", because some will just do it anyway.)

Re acetaminophen, I understand your point, but there are also concerns about its overuse in OTC products, where it's "hidden" in the fine print. And how many RCT's are there for combinations of more than three compounds? Many elderly patients are on four, five, six prescription drugs or more. They, abetted by their doctors, are also playing a game of chance. They are well outside the realm of reliable data on safety, not to mention efficacy. But I wouldn't quite call what they are doing Russian roulette either. Regulation and education are difficult precisely because consumers, healthcare providers and supplier exhibit a full spectrum of behavior, from Darwin award winners and opportunistic shysters all the way to highly educated individuals who are able to use herbs to make a positive difference in their own and others' health. regards, Middle 8 (talk) 16:01, 3 April 2009 (UTC)

• If you buy your herbs from a major manufacturer, my guess is that there's that not much of a greater chance of adulteration than there is with regular pharmaceuticals. And their active ingredients probably do stay in a manageable ranges, although there's admittedly differences. I use kava a few times a month, and my kava specifies its kavalactones. Let's not forget that in 2004 the Brits shut down Chiron , which the FDA didn't inspect even after it admitted to contamination. The vast majority of drugs now are made overseas; one NEJM editorial discussing the recent heparin contamination says "it would take the FDA more than 13 years to inspect all foreign plants exporting prescription drugs to the United States and 27 years to inspect all foreign plants exporting medical devices". And really, the deaths from ephedra are less shocking than the deaths resulting from mainstream therapies such as Vioxx (quadruple your rate of heart attack for the possibility of less gastrointestinal problems?) or hormone replacement therapy. What's most shocking about these is how they got past regulation, which suggests there's more things out there that haven't been decently tested, or have been decently tested, shown to cause major adverse effects, but passed regulation through outright denial of the facts and negligent peer review. II | (t - c) 17:01, 3 April 2009 (UTC)
  • I agree with most of what you're both saying. Certainly the current requirements for FDA approval, in which a drug can be tested against placebo (rather than against other active, approved therapies) in a small number of otherwise healthy patients, is suboptimal. Most patients in the real world take multiple medications, and most don't fit the profile of the young, healthy Phase I trial volunteer. I'm not really defending the current system of pharmaceutical approval, as I think virtually every thinking person agrees that it's unsatisfactory.

    If you buy and use marijuana from a dealer, then realistically you're aware of and accepting the risk that it might be adulterated. People intuitively understand this. On the other hand, when you buy a supplement in a bottle at the health food store, with a label indicating supposed ingredients, purity, dosage, etc, most people assume that the product they are buying and ingesting is in some way regulated. Studies and surveys have repeatedly found that people are remarkably ignorant about the lack of regulation of herbal supplements (cf. , , PMID 11268222). So the idea that people have made a conscious decision to accept less regulation isn't really borne out - in fact, they just don't understand the extent to which DSHEA deregulated the industry. That's a function of both the way laws are made (in this case, drafted largely by representatives of the supplement industry and promoted with a misleading PR campaign), and of the ignorance and lack of curiosity of the American public.

    II correctly mentions that adulteration of prescription drugs is an increasingly recognized problem (the heparin case probably being the tip of the iceberg). The FDA suffers from underfunding and a variety of other institutional problems - it can't effectively enforce existing regulations. It's a bit slick to cite the NEJM editorial, since it actually reinforces my point - the free market can't be relied upon to produce safe, effective drugs/herbs/etc. The sentence you elided actually says: "At current funding levels, it would take the FDA more than 13 years to inspect all foreign plants exporting prescription drugs to the United States and 27 years to inspect all foreign plants exporting medical devices." The point is that the FDA needs more logistical support to enforce existing regulations, not that the task is impossible a priori.

    It's almost a knee-jerk response, when DSHEA or its principles are questioned, to point to prescription-drug safety. But it's not a convincing argument, at least not to me. Prescription drugs need to be safer - from their preclinical testing, to their manufacture, to post-marketing surveillance. At the same time, supplements need to be better regulated. You asked whether I thought ephedra was "worse" than Vioxx. The answer is yes. Vioxx was a failure of critical thinking - the data were out there. I know, because I had professional discussions at the time about whether the supposed "cardioprotective" effect of naproxen was sufficient to account for the difference in cardiovascular events, and about whether the magnitude of the GI benefit was large enough to justify prescribing an expensive drug over cheaper generics in the face of possible safety concerns. Ephedra is a different story. No amount of critical thinking would have solved that problem. DSHEA was written in such a way that the FDA literally had to wait for a sufficient number of bodies to pile up before they could legally take action (and even then, they had to overcome resistance from the usual suspects). If Steve Bechler hadn't died, ephedra would probably still be legal and people would still be dying while Metabolife fought off the FDA in court and painted them as jackbooted thugs trying to take away our freedom.

    The answer is that regulation is necessary. In the case of prescription drugs, regulation needs to be beefed up and regulatory agencies adequately funded. In the case of herbs and supplements, there's a longer way to go - first, we have to recognize the need for some degree of regulation, and we're not there yet. The sad reality is that a certain number of high-profile incidents are necessary to generate the political will to act. It's a matter of phrasing. If you ask people: "Do you think the government should have to right to take away your supplements?" people will answer, "Hell no!" On the other hand, if you ask: "Should the government make sure that supplements are reasonably safe, don't contain lead, and actually contain the labeled ingredients?" Then people will say "Of course - doesn't the government already do that?" MastCell  18:13, 3 April 2009 (UTC)

As I've mentioned (not to sound snarky), we're in agreement that most consumers want their supplements regulated for purity (randomly pulling some off the shelves for a test, randomly inspecting manufacturers). As far as increased regulation, sure, the FDA should be better funded. But money doesn't make an agency ethical. Government agencies are only as effective as their head bureaucrats; money isn't a magic cure-all, and it has a significant opportunity cost. In fact, in the Vioxx case FDA scientists were well aware that it was dangerous, and one of the reviewers wrote in 2001 that, assuming Merck was right about naproxen's cardioprotective effects, then naproxen would be the obviously superior choice (the article in on the FDA website). The FDA scientists were highly skeptical that naproxen was cardioprotective, however. The FDA was well aware of how biased the NEJM article was, as well, although when Woodcock was asked why they didn't say anything by John Abramson and Angell in 2002, Woodcock just shrugged and said "I don't know" (source:Overdo$ed America). Astonishingly, a WSJ article in 2008 said she might be made drug director for life and she remains in the position today. Capitalism rewards the faithful. II | (t - c) 23:42, 3 April 2009 (UTC)

I don't make a habit of defending the FDA, because they've made a lot of bad decisions over the years. On the other hand, they're an overly convenient target for opportunistic criticism (and yes, I know the author of that NEJM editorial is on the board of PhRMA). I also don't make a habit of defending Janet Woodcock - not since she allegedly held up OTC approval of emergency contraception over a fear that it would "take on an 'urban legend' status that would lead adolescents to form sex-based cults centered around the use of Plan B." (, , , ).

Right now the FDA is being asked to do the impossible - it's blamed for both being overly restrictive and overly permissive, often by the same people, and it's underfunded and underpowered even for a more modest mandate. Leadership has been noticeably absent. Morale might be expected to be low. I'm hopeful things will improve, but with them taking on tobacco regulation as well, they may continue to be spread too thin.

Regarding the influence of money and industry on medical science, I think we're seeing a real change in what's acceptable (or maybe it's just a pendulum swing). Between Grassley's hearings and the proposed Sunshine Act, I think things are moving in a positive direction. MastCell  19:42, 7 April 2009 (UTC)

Indeed, decent leadership has been absent. And when scientists who try to their job are ignored and marginalized, as in the Relenza case (an interview) and Rezulin case you might expect morale to be low. In 2004 20-year FDA veteran Graham described the FDA as a "a climate of fear, retaliation and intimidation". Wood makes an interesting point: "80% of the FDA's computer servers are more than 5 years old; critical clinical trial records are stored on paper in warehouses, largely inaccessible for analysis; and the information technology budget is about 40% of that for the Centers for Disease Control and Prevention". I'm not convinced that all these problems are necessarily due to budget problems; it's a general leadership problem. Even 5-year old servers can handle electronic records. By the way, I haven't really been able to find support for the FDA aside from PhRMA, the Cato Institute, and a few economists &nash; none of which I have much regard for. Anyway, federal agencies are going to reflect the biases of the administration. They are highly political. This is evident in the SEC's handling of the financial crisis, the FDA's handling of drugs, and also, for example, in Germany's recent banning of GM corn. II | (t - c) 16:56, 17 April 2009 (UTC)

AfD for Sheree Silver

Misplaced Pages:Articles_for_deletion/Sheree_Silver_(2nd_nomination). Please be informed. – Shannon Rose (talk) 19:44, 31 March 2009 (UTC)

Removal of Biopyschiatry

Hi, I am curious as to why you removed it from list of topics characterized as pseudoscience. It was never in dispute, and it was brought up by middle8 from an article in CSICOP. Unomi (talk) 21:21, 1 April 2009 (UTC)

General practitioner

Can you please explian why my "edit" was deleted. Thanks.

Steve Herbets, M.D.

Thanks. 74.10.7.238 (talk) 21:44, 21 April 2009 (UTC)

Talk:General practitioner#American Academy of General Physician. Please keep conversations on the topic of how best to improve the associated article there. You may also wish to consider the benefits of registering an account. - Eldereft (cont.) 21:49, 21 April 2009 (UTC)