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Controversial addition needs discussion: "Mainstream"?

A few edits are moved here for discussion:

• The Associated Press has cited alternative medicine as having become "became more mainstream than ever" since the beginning of the millennium. Well known alt-med advocates support this view."

1. First, this was added directly to the lead, which isn't usually proper. It should have been added to the appropriate section in the body, and if significant enough, then mentioned briefly in the lead.
2. Second, the presentation leaves something to be desired. The first comment is just a statement by someone. The second is a commentary article by some of the most well known promoters of woo woo around. Of course they will say that. That's how they make their money. Some of them sell products, and this is a sales pitch.
   But, that really doesn't make any difference. What they say is a "duh" statement, but might be allowable if attributed and framed properly. It sounds like their sales pitch is being presented as undisputed fact, which is far from the truth. It is their highly disputed opinion that flies in the face of other statements to the contrary we have already cited. The conflict needs to be made clear.
   Becoming "mainstream" is also being used in different ways here. This addition blends references to use by the public (IOW claimed acceptance by the public) with controversial and disputed claims of scientific proofs (IOW claimed acceptance by mainstream science and medicine) claimed by promoters. They are misusing the "evidence" to support their sales and POV. It's just their opinion.
3. Third, their statement "The evidence is mounting that diet and lifestyle are the best cures for our worst afflictions." is another devious statement, as those aren't even alternative medicine, but are proven by mainstream evidence and supported by the mainstream. This is an example of something that when proven, becomes mainstream. If something is unproven, it's still "alternative".
4. Fourth, the juxtaposition of the refs is a synthesis designed to promote an editorial POV. That's not allowed here.

If this material is to be used at all, it needs to be done in the right place, and then framed and attributed properly. -- Brangifer (talk) 07:28, 23 December 2009 (UTC)

Checking down the history of this article, one could perhaps be forgiven for thinking that you see all pro-alt. med. material as controversial. As such, as a means of demonstrating that anybody thinking this is mistaken, perhaps you would state where you think the "right place" is, and what particular wording would meet with your agreement? Otherwise, one could equally be forgiven for thinking that your purpose is simply to kick such material into the long grass, as it were.Vitaminman (talk) 10:44, 23 December 2009 (UTC)

Try AGF. Pro altmed material is definitely legitimate content here, but since this is a fringe topic, certain policies and guidelines are especially relevant, such as MEDRS, FRINGE, and weight. The impression that the sales pitches of prominent advocates is somehow equal to mainstream acceptance isn't legitimate content. Things need to be attributed properly so readers can see things for what they are, and that those sales pitches are disputed by the mainstream community, even if the public is glibly ignorant of the issues and is easily fooled.

There are several spots where the two sources might be useful:

• Alternative_medicine#Relation_to_evidence-based_medicine for the contrast between the views of these proponents and the views of mainstream medicine who are skeptical.

• Alternative_medicine#Public_use_in_the_US or Alternative_medicine#Appeal_of_alternative_medicine for the public acceptance of alt med.

Give it a try here and let's see what works. -- Brangifer (talk) 15:27, 23 December 2009 (UTC)

Nice to see that you're not letting the Christmas spirit neutralise your POV. Of your suggested spots, I think that Alternative_medicine#Appeal_of_alternative_medicine would fit best. A redraft follows below. Should it not meet with your agreement, I trust that rather than simply criticizing it (kicking it into the long grass), you will instead work with me by proposing an alternative wording that would meet with your agreement. Season's greetings.

• Jocelyn Noveck, a national writer for the Associated Press, has cited alternative medicine as having become "became more mainstream than ever" since the beginning of the millennium. Well known alt-med advocates Deepak Chopra, Dean Ornish, Rustum Roy and Andrew Weil, writing in the Wall Street Journal, have expressed similar views." Vitaminman (talk) 14:13, 24 December 2009 (UTC)

While we're on, here are some more WP:RS references on the alt. med./mainstream theme: CBS News Channel 4 News, UK Star Tribune, Minneapolis - St. Paul, Minnesota Washington Post Vitaminman (talk) 14:41, 24 December 2009 (UTC)

BullRangifer, try as I might to AGF, thus far it seems my analysis that you are only interested in kicking this issue into the long grass is spot on. You can of course prove me wrong, which would be most welcome. Two paragraphs above you will find my proposed redraft of the "mainstream" wording. Should it not meet with your agreement, I look forward reading your proposed text for an alternative wording. Vitaminman (talk) 11:09, 2 January 2010 (UTC)

This editor does not seem to understand wikipedia when s/he calls CAM a fringe topic. CAM is widely used in Europe, and of course Chinese herbal medicine, acupuncture, etc., is err, widely used in China. Even homeopathic practice is widely used in Europe. This discussion so far is an excellent example of what I've run into in some of my edits. The wikipedia guidelines are well written and meant to be, and are, helpful. But every one of them can be used to split hairs and wear a person down to the point that they just give up. And this is most true when one editor is very experienced and the other is not (like me).Gandydancer (talk) 11:55, 2 January 2010 (UTC)

As a newbie here, it's a bit audacious to say I don't understand Misplaced Pages, but then again, even among experienced editors, who really understands it completely? It's far too complex! Anyway, your issue with the word "fringe" actually happens to be with the special way we use the term here. It refers to its relation to mainstream, evidence-based medicine, not to its popularity with the public. We have dealt with it so much here that we even have a "fringe theories guideline", and an ArbCom ruling on how we should deal with pseudoscience, which covers many forms of alternative medicine. You should read them so you can avoid the innocent creation of disruption here. Note that persistence in activities that create disruption, even if done out of ignorance, can call down the wrath of many Wikipedians and admins, leading to you getting blocked. That can be avoided if you read the sources provided to you. I wish you luck. You're always welcome to come to my talk page and discuss things with me. -- Brangifer (talk) 21:30, 2 January 2010 (UTC)

Need for a new section or subsection on "mainstreamness"

The issue introduced above reveals that the matter may deserve its own section or subsection in the article or the combination of some existing sections:

• Contemporary use of alternative medicine

• Appeal of alternative medicine

Something like "Appeal and popularity" might be good. There we can deal with the "mainstream" angle, as I have detailed above. It's a complex issue, with wide diversity depending on what POV is being quoted, and what part of the world is involved. There is no desire to "kick this into the long grass". It's just too complex an issue to deal with by the simple addition of one or two sources. If we deal with the formatting issues (sections) first, we can give the topic much better coverage, rather than giving it less coverage. I'm just proposing that we do this matter justice, rather than using a piecemeal approach. All angles need to be mentioned. Alt med is obviously part of the mainstream in some countries (notably India), while it is used more widely (though still a signifant minority position) in some European countries, than in the USA. -- Brangifer (talk) 21:30, 2 January 2010 (UTC)

Hang on, what about your own proposal, above, that we "Give it a try here and let's see what works"? Until you actually respond with a suggested rewording, you are indeed kicking this issue into the long grass by virtue of the fact that you have: a) criticized my initial wording, b) removed it from the article, c) suggested that we work on it here, then d) (most crucially of all) failed to suggest any alternative. According to most people's understanding of the term, this is indeed what is termed "kicking it into the long grass".. Vitaminman (talk) 23:16, 2 January 2010 (UTC)

I'm sorry if I've gotten tangled up in conversations with Severina123 elsewhere and Gandydancer here. That may have derailed things, but it's also impressed upon me the need to do this right. Your repetition of "... long grass" is not an AGF. Stop and read what I've written and you'll see that I'm actually aiming for better coverage than the piecemeal approach we were heading for. We're actually in agreement that the matter needs coverage. Right now I happen to be juggling some other issues on the phone in the middle of the night here. Airlines are horrible to deal with! -- Brangifer (talk) 00:37, 3 January 2010 (UTC)

Still fishing around in the long grass here, and feeling that this issue is being ignored. Nevertheless, setting my doubts aside, here is a short excerpt from a New York Times article which states that alt. med. "is becoming more mainstream every day":

So-called complementary and alternative medicine — or CAM, as it is known by practitioners and adherents — is becoming more mainstream every day. In 2007, more than one in three adults and nearly one in eight children, according to a federal study sponsored by the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health, used some form of CAM — from self-prescribed nutritional substitutes to repeat visits to alternative health care practitioners. So commonplace are the alternative providers that chiropractors and acupuncturists, for example, are now licensed by most states. At the same time, many traditional medical doctors, recognizing patients’ demand for alternative therapies, have signed up for training in alternative therapies or added alternative professionals to their staffs.

Along with the other refs that I cited earlier (i.e. Associated Press; Wall Street Journal; CBS News Channel 4 News, UK Star Tribune, Minneapolis - St. Paul, Minnesota Washington Post) we now have more than enough refs to put together a decent paragraph on this.

Brangifer, under the "Controversial addition needs discussion: "Mainstream"?" heading, above, you stated: "Give it a try here and let's see what works." I did give it a try and said that should it not meet with your agreement, I looked forward reading your proposed text for an alternative wording. Sadly, however (some might say "predictably"), you never came back with any alternative proposal. As such, until such time as you do, my conclusion that you are more interested in kicking this issue into the long grass is, sadly and depressingly, right on the money. Vitaminman (talk) 21:26, 8 January 2010 (UTC)

I'm not stopping you. You have collected some sources, so give it a try here. See what kind of a paragraph you can make with them. You treat me as if I'm opposed to the idea. Nothing could be further from the truth. -- Brangifer (talk) 08:00, 9 January 2010 (UTC)

Please stop playing games with me Brangifer. You know very well that I have already given it a try here, at 14:13 on 24 December 2009. (In fact, that was actually my second "try"). Nevertheless, to show good faith, here it is again. Should it not meet with your agreement, I look forward reading your proposed text for an alternative wording (rather than yet another dismissive kick into the long grass):

Jocelyn Noveck, a national writer for the Associated Press, has cited alternative medicine as having become "became more mainstream than ever" since the beginning of the millennium. Well known alt-med advocates Deepak Chopra, Dean Ornish, Rustum Roy and Andrew Weil, writing in the Wall Street Journal, have expressed similar views." Vitaminman (talk) 09:48, 9 January 2010 (UTC)

As an alternative (pun intended), here is a proposal that utilises all seven of the sources:

== Alternative medicine as mainstream ==

Some evidence suggests that alternative medicine is becoming more mainstream.

In the United States, for example, according to a federal study sponsored by the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health, more than one in three adults and nearly one in eight children used some form of alternative medicine in 2007, such as self-prescribed nutritional substitutes to repeat visits to alternative health care practitioners. Chiropractors and acupuncturists are now licensed by most states in the U.S., whilst many traditional medical doctors have signed up for training in alternative therapies or added alternative professionals to their staffs. Similarly, over 40 U.S. medical schools now require students to learn about alternative therapies, whilst a 2006 survey of nearly 1,400 U.S. hospitals showed that more than one in four now offer therapies such as acupuncture, homeopathy, and massage therapy.

In Europe, a 2007 report by market analyst Mintel stated that herbal and homeopathic remedies are becoming mainstream in the United Kingdom, with echinacea and green tea-based treatments among the most popular remedies.

Jocelyn Noveck, a national writer for the Associated Press, has cited alternative medicine as having become "became more mainstream than ever" since the beginning of the millennium. Well known alt-med advocates Deepak Chopra, Dean Ornish, Rustum Roy and Andrew Weil, writing in the Wall Street Journal, have expressed a similar view, adding that “Integrative medicine approaches such as plant-based diets, yoga, meditation and psychosocial support may stop or even reverse the progression of coronary heart disease, diabetes, hypertension, prostate cancer, obesity, hypercholesterolemia and other chronic conditions.” Vitaminman (talk) 14:48, 9 January 2010 (UTC)

This is what I've been calling for. Now you're using more sources, which makes for a better section. You keep asking me to do this, but it is YOUR duty to provide it, and that's what I've been asking for, so your gross baiting insults and assumptions of bad faith are very misplaced. You've misunderstood your task and my expectations. Your first try was good, but not good enough. If I had been trying to kick this into the long grass, I would have rebuffed you rather than encouraged you. Would someone who was opposing you have done that? Hardly! Now the subject is covered much better. I'm not saying it's perfect, but at least more justice is done to the subject. I expect an apology. -- Brangifer (talk) 01:11, 10 January 2010 (UTC)

Let's stick to the issue at hand. My frustration comes from the fact that you have not made so much as one attempt to edit my efforts into something that would meet with your agreement. This remains the case. In fact, this time you provide even less to go on as you don't give any indication whatsoever as to what anybody needs to do to the text in order for it to be acceptable to you. Until such time as you actually do some editing, rather than simply criticizing, I'm sorry, but I have to stand by what I've said. I can't guess what would be acceptable to you, so you have to help me by editing with me. Vitaminman (talk) 09:51, 10 January 2010 (UTC)

Following the continued absence of any participatory help from BullRangifer, I've been working on a further enhancement to my previous text. Unless anybody has any serious objections, I propose that it is now worthy of being added to the article:

== Alternative medicine as mainstream ==

Some evidence suggests that alternative medicine is becoming more mainstream.

In the United States, for example, according to a federal study sponsored by the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health, more than one in three adults and nearly one in eight children used some form of alternative medicine in 2007, such as self-prescribed nutritional substitutes to repeat visits to alternative health care practitioners. Chiropractors and acupuncturists are now licensed by most states in the U.S., whilst many traditional medical doctors have signed up for training in alternative therapies or added alternative professionals to their staffs. Similarly, over 40 U.S. medical schools now require students to learn about alternative therapies, whilst a 2006 survey of nearly 1,400 U.S. hospitals showed that more than one in four now offer therapies such as acupuncture, homeopathy, and massage therapy.

Americans spent about $33.9 billion on alternative medicine in 2007, accounting for about 11.2% of the public's total out-of-pocket health expenditures.

In Europe, a 2007 report by market analyst Mintel stated that herbal and homeopathic remedies are becoming mainstream in the United Kingdom, with echinacea and green tea-based treatments among the most popular remedies.

Jocelyn Noveck, a national writer for the Associated Press, has cited alternative medicine as having become "became more mainstream than ever" since the beginning of the millennium. Well known alt-med advocates Deepak Chopra, Dean Ornish, Rustum Roy and Andrew Weil, writing in the Wall Street Journal, have expressed a similar view, adding that “Integrative medicine approaches such as plant-based diets, yoga, meditation and psychosocial support may stop or even reverse the progression of coronary heart disease, diabetes, hypertension, prostate cancer, obesity, hypercholesterolemia and other chronic conditions.”

Some experts are calling for tighter regulation, saying that because of how many people are using alternative medicine it's important to have some kind of surveillance system in place. Some critics charge that Government actions and powerful interest groups have left consumers vulnerable to flawed products and misleading marketing, and that dietary supplements do not have to be proved safe or effective before they can be sold. Vitaminman (talk) 21:09, 14 January 2010 (UTC)

(← outdent) Might be a hint of original synthesis of the source material, would you not agree? Covering a topic encyclopedically is not a matter of finding a source and considering hm, how can I shoe-horn this into the article, or finding an idea and considering hm, what sources can I find that support this, but rather it is a matter of considering the whole topic from all points of view to see how the experts themselves have synthesized the literature. - 2/0 (cont.) 03:11, 15 January 2010 (UTC)

No, actually, I would not agree with your analysis at all. We now have WP:RS material from CBS News, the Washington Post, the Wall Street Journal, CNN, the New York Times, the Los Angeles Times, the Associated Press and others, all of which describe – over a period of ten years – alternative medicine as having become mainstream. I'm not trying to shoe-horn anything into the article, but I would prefer it if, rather than simply kicking this issue into the long grass, the critics here would actually help by editing the material into something that would meet with their approval. Criticism is fine, of course. But when it is not accompanied by any apparent willingness to provide positive input and assistance, it's not difficult to see why Misplaced Pages is losing editors in droves. Are you willing to help, or are you simply aiming for the long grass? Vitaminman (talk) 09:31, 15 January 2010 (UTC)

Just passing through, but thought that I'd make an observation. You should be very careful when you use "mainstream" like this. Some people might misread this as suggesting that alternative medicine is being adopted by the public on objective, evidence-based grounds. Which would, of course, be incorrect. Instead, I'd suggest spelling out exactly what is meant by "mainstream" (i.e. even if a RS makes this statement, it should be clear what they're referring to). For instance, "Some evidence suggests that alternative medicine is becoming more commonly used by the general public". --PLUMBAGO 10:31, 15 January 2010 (UTC)

Thanks for that. Keeping the 'Alternative medicine as mainstream' title, and making "Some evidence suggests that alternative medicine is becoming more commonly used by the general public" the first sentence, would certainly meet with my support. Vitaminman (talk) 20:33, 19 January 2010 (UTC)

This article is biased

This article is biased but don't expect to make any changes, it's a waste of time. At least that has been my experience. For example, the Cochrane group reports that a survey of physicians found that 50% prescribe CAM treatments to their patients and yet the intro to this article uses one journal article to state, "The claims made by alternative medicine practitioners are generally not accepted by the medical community because evidence-based assessment of safety and efficacy is either not available or has not been performed for many of these practices".Gandydancer (talk) 21:17, 30 December 2009 (UTC)

well, that would be a fairly dramatic inconsistency, if true. how do you suggest we address it? --Ludwigs2 23:25, 30 December 2009 (UTC)

Sorry, which Cochrane source indicates that 50% of physicians prescribe CAM? I'm not finding it - could you provide a link? In any case, those statements are not mutually exclusive, in part because of the vagueness of the term "CAM". It's entirely possible that a physician has referred patients to a chiropractor for back pain on occasion, but simultaneously holds a low opinion of the sorts of exaggerated or unscientific claims with which many alternative medicines are marketed. I may even know some physicians like that. MastCell  00:15, 31 December 2009 (UTC)

Totally agree about the article being biased. For example, there are plenty of WP:RS articles and reports showing that Alt. Med. is becoming mainstream. EG: Associated Press; Wall Street Journal; CBS News Channel 4 News, UK Star Tribune, Minneapolis - St. Paul, Minnesota Washington Post. Predictably, however, it would appear that the "usual suspects" are doing everything they can to delay/prevent this material from being added.Vitaminman (talk) 11:34, 31 December 2009 (UTC)

I think you should AGF. It's a rather complicated issue. Just because a source calls it mainstream doesn't mean it is. This matter isn't simple because of various factors:

1. Well-known proponents often use the term "mainstream" as part of their propaganda and sales technique.

2. The term "CAM" is used ambiguously and with different definitions.

3. The percentage of licensed physicians who use CAM varies greatly from country to country.

4. In some countries there is very little access to evidence-based medical care, and both CAM and traditional medicine compose the greatest percentage of available options.

5. In some countries CAM practitioners are licensed as regular physicians, for example in India, where Ayurveda and homeopathic practitioners are often licensed as physicians.

6. The difference between what the scientific/skeptical community consider "mainstream" and what the public acceptance/use determines to be "mainstream" are very different, so it depends on which angle the quote is coming from.

7. It has, is, and can be/been (depending on where and when) the case that the public uses nonsensical methods to such a degree that CAM can be called "mainstream", while the scientific community throws up its hands in despair at the ignorance and gullibility of the public, because medicine and science don't think those methods are "mainstream" to them. They still consider them unproven and disproven. Don't underestimate the power of quacks and marketers of weird things to fool the public. Gullibility is the nature of our race, and critical thinking/skepticism is somewhat rare in those without a scientific education, and even then such an education is no guarantee for common sense.

If we could somehow find and use RS to convey the wide diversity and complex nature of the use of the term "mainstream", we'd be doing readers a great service, but using RS that happen to use the term "mainstream" as a trump card won't do, because no one source conveys the real truth of the matter. No, AGF and let's work on developing the subject. I certainly have no objections to doing so. -- Brangifer (talk) 15:37, 31 December 2009 (UTC)

Please see the last two additions as an example of how easy it is to bias this article. I knew when I read that latest addition something was odd. Alternative/Complementary medicine is very common and generally very beneficial for cancer patients. I just couldn't imagine that it could actually be harmful, and it turned out I was right.

Yesterday I took some time and looked at many of the references for this article and sometimes found that only the negative part of the ref would be used. I also found that one article by one person was allowed to be used to speak as though it were the voice of oposition to CAM as a whole. I mentioned that many docs prescribe CAM and I found three refs for that right here - the one Cochrane I mentioned and two others that said 60% prescribe CAM.

I am not suggesting that we should not include a strong criticism section. But see this article from The Journal of Clinical Oncology and notice how differently it reads than this one: http://jco.ascopubs.org/cgi/content/full/17/suppl_1/44 Also, note that it says that only 2% of people use alternative practices rather than seek mainstream care for illness. To read this article you'd almost think that it was the 98% seeking dangerous, worthless, and even harmful treatments rather than as a complement to mainstream medicine, and Misplaced Pages is needed to save them from the quacks.

Now as for MastCell's statement about wild claims from CAM therapists, that really is not a fact at all. MastCell seems to be making the mistake of "guilty by association". Every profession has its share of quacks, including mainstream medicine. Most CAM practicianers do not make wild claims about curing anything. They do their thing and the proof of the pudding will be in the eating, so as to speak. Considering that such a large percentage of the population uses alternative/complementary medicine, some people must be finding some benefit. Gandydancer (talk) 04:14, 1 January 2010 (UTC)

I'm sorry, you keep citing percentages from Cochrane and other sources, but I'm not finding these refs. Could you please link them when you cite percentages from them? Thanks.

The one reference you did cite, Cassileth 1999, reinforces several points under discussion:

• The cited prevalence of alt-med usage varies widely, from <10% to 50%, because of the vagueness and varying definitions of "complementary" and "alternative" medicine (This broad range, with its apparent discrepancies, is attributable to variable understandings and definitions of CAM. Often CAM is not defined in surveys, or it is defined so broadly as to include lifestyle activities such as weight loss efforts, exercise, church attendance, and support activities (such as group counseling), which results in overblown figures for CAM use.)
• Alternative (cancer) therapies are "potentially harmful, either directly through biologic activity or indirectly when patients postpone mainstream care."
• The deregulation of the U.S. herbal/supplement industry in 1994 through DSHEA (written by supplement-industry lobbyists) was a key factor in the growth of alternative medicine in the 1990s.
• Quackery is a widespread problem given the free-for-all manner in which alternative medicine is marketed (Information about CAM varies widely in its accuracy... Misinformation about health issues abounds. In 1999, the United States Federal Trade Commission (FTC) announced that it had identified hundreds of web sites selling bogus cures for cancer and other serious illnesses among the estimated total of approximately 17,000 health-related web sites.)
• "Many mainstream scientists are displeased with the integration of CAM into mainstream medicine and are particularly unhappy about the existence of a separate NIH research entity for alternative medicine. Vigorous opposition to parts of CAM as 'pseudo science' based on 'absurd beliefs' has been voiced. The deviation from basic scientific principles, which is implicit in homeopathy and therapeutic touch, for example, is decried. The very existence of CCAM as an entity apart from existing NIH research institutes, many claim, supports a separate, inferior level of research and an antiscience bias." Hey, there's a cite for that pesky issue about mainstream disapproval of alternative medicine claims!
• As far as "finding some benefit", the article states: Although there is no evidence that these treatments impede the progression of malignant diseases, they remain popular and are used by large numbers of patients. (emphasis mine)

Thanks for citing this particular source - I think this is useful. I look forward to additional citations along these lines. MastCell  04:58, 1 January 2010 (UTC)

Need for new section on evidence basis

We currently have some good content regarding the evidence basis for alternative medicine, but it's spread over several sections. These have been touched on in the edits of the last few days. We should start a new section and collect it in one place. In some cases this would mean copying it (rather than removing it) from its current location, since it is an integral part of the whole fabric of an existing section, but in some cases a rewording of sections would allow us to use content in the new section. The new section should document the diverse and conflicting POV over whether and to what degree there is a good evidence basis for alternative medicine in general and with specific techniques, although we shouldn't get too detailed about individual techniques, but refer to their articles.

I suggest that the safest and least disruptive approach would be to copy the relevant material into a list here (the order is unimportant at first), then combine it using good prose into a trial version here where we can work on it. When we have a consensus version, it can be included. Once that is done, we can work on getting rid of unnecessary duplication in other sections.

This is important because this is one of the biggest points of contention between the mainstream medical community and believers in alternative medicine. The claims made are directly contradictory to each other creating much confusion in the minds of the public, even if there is much less contention over the matter within the scientific community. These facts can be made clear by using references to scientific research, to notable opinions, and to news coverage of the issue. We already have enough in the article, but we could add even more, since the sources do exist. The section should make it clear what the differing sides think about the matter and should use attribution properly.

What think ye? -- Brangifer (talk) 15:18, 1 January 2010 (UTC)

Seems like a very good idea to me. Gandydancer (talk) 03:42, 2 January 2010 (UTC)

revising lead paragraph

I do not feel that it is correct to open the article with a statement by a person who, as far as I can tell, is not qualified to make a judgment on CAM. If someone has more information on Dr. Davis, I'd like to see it, since when I google him I come up with next to nothing. On the other hand, the well known Cochran group says something quite different to define CAM:

What are considered complementary or alternative practices in one country may be considered conventional medical practices in another. Therefore, our definition is broad and general: complementary medicine includes all such practices and ideas which are outside the domain of conventional medicine in several countries and defined by its users as preventing or treating illness, or promoting health and well-being. These practices complement mainstream medicine by 1) contributing to a common whole, 2) satisfying a demand not met by conventional practices, and 3) diversifying the conceptual framework of medicine."

Furthermore, if one were to use the statement, "that which has not been shown consistently to be effective" one would need to include some mainstream drugs, antidepressants, for just one example. Thoughts? Gandydancer (talk) 15:36, 24 January 2010 (UTC)

I also have a problem with this in the opening section:

Because alternative techniques tend to lack evidence, some have advocated defining it as non-evidence based medicine, or not medicine at all. Some researchers state that the evidence-based approach to defining CAM is problematic because some CAM is tested, and research suggests that many mainstream medical techniques lack solid evidence.

For one thing, it uses the word "some" twice. The reference is several pages from a book that is not noteworty written by an author who is not either. Plus, I really can't figure out what this editor was trying to say. Can you? Thoughts? Gandydancer (talk) 22:36, 24 January 2010 (UTC)

wow, it's been a while since I read the intro all the way through. that second paragraph is awfully POV-pushy. I'll revise. you can feel free to recise it as well, you know. be bold when you see problems. --Ludwigs2 00:23, 25 January 2010 (UTC)

Gandydancer, you're throwing our "not noteworthy" quite a bit. By whose definition? Are you engaged in whitewashing by removing critical POV? If they're sourced properly, then your personal opinion needs to be weighed against the opinions of lots of other editors before you start deleting sourced material. That's normally considered vandalism. You have been bold and removed material. That it was sourced is problematic, so you shouldn't have done it. But since you were reverted (twice!) and stil persisted, that's a violation of the WP:BRD cycle. It only has one cycle. You should have immediately, right after the first restoration, started this discussion. It's good you're doing it now and we might we get somewhere with this.

Ludwigs, I reverted one of your deletions as we don't delete POV here, especially when properly sourced. If the wording could be made better, as well it might, then let's discuss it here first.

As you know, this article has been a war zone many times and we need to avoid returning to those days. It can certainly be improved, so suggestions are always welcome. I'm not saying that your objections might not have legitimacy. I'm just saying that we should discuss it first. -- Brangifer (talk) 05:15, 25 January 2010 (UTC)

It is important to note that you're editing the lead, which is based on content in the body of the article. The body should be altered before making changes to the lead. Some of the aspects you're dealing with are a reflection of content here: Alternative_Medicine#Relation_to_evidence-based_medicine. Note that there isn't total agreement on definitions, which is why there is internally inconsistent and conflicting content, which is a good thing....the article reflects the real world. Things are evolving and the article will reflect it. -- Brangifer (talk) 05:27, 25 January 2010 (UTC)

I know about evidence-based research - it is a minority position (fairly small minority, at that) that was invented as a semi-skeptical attempt to redefine CAM and alternative medicine. It is not fully developed, and not generally accepted, and Its presence in the article is well out of proportion to its acceptance by the scholarly/medical world. It may grow over time, but that is irrelevant per WP:SPECULATION. further, my revisions eliminated some obvious misstatements - for instance, this phrase - "The claims made by alternative medicine practitioners are generally not accepted by the medical community because evidence-based assessment of safety and efficacy..." is entirely incorrect, for the following reasons:

• alternative medicine practitioners do not make claims, they have practices
• many classically defined Alt med practices are accepted by the medical community (it's only under EB assumptions that that becomes tautologically impossible)
• 'evidence-based' assessments are not standard scientific language, and many conventional medicines would fail by those standards anyway, so that phrase is almost entirely misleading

I hadn't really wanted to get into major edits right now (because I have other things to do) but if you insist I can go and edit that section with an eye to wP:undue to justify attempts to balance the lead. right now, though, I'm just going to reinstate the changes that I made - please read them this time before you revert, because it really is an improvement to the article. --Ludwigs2 05:56, 25 January 2010 (UTC)

You're not listening. We need to avoid edit warring here again. Discuss such changes first. I'm reverting and will take this further if necessary. Discussion is the way to do this. Some of your statements are flat out contradicted by the sources being quoted. You're removing sourced information. Just because you don't agree is no reason to remove it. -- Brangifer (talk) 06:56, 25 January 2010 (UTC)

I'm always amazed when people say 'don't edit war' right before they begin edit warring on their own. look, I have discussed the edit I made, just above - you've reverted (twice now) without addressing my edits in any meaningful way, or even (I suspect) reading what I wrote. what's up with that? I'll AGF this and give you a chance to explain why you're so upset about relatively minor changes, and why you think my explanations above don't work, but if you don't engage in proper discussion I will have no choice but to revert it again. ok? so, ball's in your court - explain what's wrong with the edits I made. --Ludwigs2 07:22, 25 January 2010 (UTC)

I'll add that in your haste to revert my changes you also removed some changes I made to templates at other places in the body. I will consider it a sign of good faith if you go back and restore the non-intro changes that I made to the article. --Ludwigs2 07:33, 25 January 2010 (UTC)

I have reinstated your tag. Better to tag and discuss, rather than make non-consensus changes. That's my concern. The changes that initiated this section and the following changes weren't consensus changes and should be discussed first. That's why I reverted back to the "status quo". Not that status quo is always good, it just needs to be discussed. I had read your arguments above and found them to be plainly false or misleading opinions that didn't justify making changes to sourced material. Alternative medicine practitioners and advocates DO make claims, often radical lies, in order to promote their businesses and ideas. Those claims are often very dangerous. Some, not "many" classically defined Alt med practices, are accepted by a few in the medical community, even though they still lack convincing evidence. OTOH, if you're referring to some method that has long-since proven itself beyond doubt with good research, then of course it's accepted and should no longer be termed "alternative". It has made the transition. That used to happen more often, less so now, and even less so in the future. Currently very few of the methods that are classified as alternative have a chance of ever becoming proven, as they have been investigated and found wanting. That's why the skeptical definition applies even more so now than before: "unproven and disproven". Many have been disproven. The question of whether conventional medicines would fail testing is always relevant, and that's what the process of EBM does, it weeds out the wheat from the chaff. Such methods are then discarded, sometimes grudgingly, but it happens. They then often are continued by quack MDs who also promote alternative medicine. Chelation therapy for non-indicated and off-label uses are an example.

Note that some of your rewordings changed the meaning and left out wordings that were sourced to very notable individuals. That's why you need to copy the original wording (before this mess) with the references to this talk page and let's work on them here. You're smart and you may well have a better way of wording this stuff. I'm very willing to work with you in this process, but do it here, not in the article. It needs to remain stable. -- Brangifer (talk) 15:17, 25 January 2010 (UTC)

Let me address your points in order, because they really have no basis in fact:

1. 'Consensus' and 'status quo' are not synonymous. Consensus is an agreement that content actually reflects the real world, which we clearly do not have.
2. "Alternative medicine practitioners and advocates DO make claims, often radical lies, in order to promote their businesses and ideas." Some AM practitioners do this. So do some mainstream medical (MM) practitioners. There are charlatans on both sides of the fence here. Most AM and MM people, however, don't make overt claims, they simply do what they believe is best for your health. When an acupuncturist tells you that he wants to needle a particular meridian he is not 'lying' to you (e.g. telling you something he believes is false, and he is not making a 'claim'; he's simply following a practice. You personally may not think that practice has merits (that's fine), but that is a different matter.
3. Your next three statements come straight out of the Evidence-Based medicine POV - while showing a certain amount of common sense, they are not the current common understanding on AM in the medical world, and shouldn't be presented as such. I can't be clearer about this - you cannot write the article from the perspective of a minor skeptical theory within conventional medicine. .

Believe me, I understand where you're coming from politically, but this is wikipedia, not politics. You can't allow your personal beliefs to influence your editing of the page. --Ludwigs2 17:05, 25 January 2010 (UTC)

I took the liberty of punctuating and capitalizing the right spots in your message so I could understand it better. The meaning isn't affected at all. I'll reply by the numbers:

1. Of course they're not synonymous. My point is that controversial changes should be discussed first. That's all.
2. I'm not implying that all make claims or that they're lying. Some make claims. Some lie. Most believe in what they're doing, so even if their statements aren't true, they're not lying. It's all a matter of motives. No disagreement there. My beliefs about their practices isn't the point here. It's neither here nor there. I was just responding to your statement above: "alternative medicine practitioners do not make claims, they have practices." I don't claim that all of them make loud claims, but the very fact that they are practicing involves them making claims to their patients and customers. Other practitioners and advocates are very vocal in their advertising. Gary Null, Tim Bolen, Andrew Weil and Joseph Mercola are some examples. Note that I'm not opposing the inclusion of opinions they hold when properly sourced. You seem to be denying that the opinions of those who hold the opposite POV should be suppressed or denigrated in this article. That's a violation of FRINGE, WEIGHT, and NPOV. The mainstream POV gets the most weight, and skeptics are the ones who support that POV. It seems to me that you're pulling in the opposite direction and trying to diminish such content here.
3. I'm not saying the article should be written from the POV of skeptics, but it should include the POV of skeptics, and you seem to be trying to diminish that content. The article shouldn't be written from the POV of believers in alternative medicine either, but it should definitely include it.

No, unlike you, I'm not trying to diminish that POV at all. You accuse me of allowing my POV to influence my editing. If that's true, then we're certainly even, but it's not that simple. We each have our own POV, POV that exist in the real world, and that's perfectly fine. We just need to make sure that each other's POV is represented using good sources. Both should be in the article. I'm not denying you that right. Why are you denying me that right, as required by NPOV? -- Brangifer (talk) 02:18, 26 January 2010 (UTC)

ok, one good cheap POV shot deserves another, so lets let that slide and drop it, because we both no its not particularly true. back to points.

1. good enough - however, I don't really see anything controversial in these changes, and I'm not sure why you're objecting
2. the current line in the article implies 'very clearly that all alt med practitioners are making claims when in fact you just said that they don't all do that. so why did you revert my edit that changed that line? to your other points:
   • "the very fact that they are practicing involves them making claims to their patients and customers" - this is true of all medical practitioners, Alt or Mainstream. if you go into your doctors office, he will make claims about the various treatments that you might get.
   • "You seem to be denying that the opinions of those who hold the opposite POV should be suppressed or denigrated in this article." - that's an idiotic statement. I did not remove any of any skeptic talk, I just balanced it. Evidence-based medicine is still a relatively small and minor POV, and does not reflect the opinions of Alt med practitioneres or mainstream medicine
3. again, same point - I didn't remove anything from the lead - did you even read what I wrote

Stop arguing without information - READ the changes I made and tell me how any of what you're complaining about above applies to what I did. --Ludwigs2 02:34, 26 January 2010 (UTC)

QUOTE FROM BRANGIFER:

• Gandydancer, you're throwing our "not noteworthy" quite a bit. By whose definition? Are you engaged in whitewashing by removing critical POV? If they're sourced properly, then your personal opinion needs to be weighed against the opinions of lots of other editors before you start deleting sourced material. That's normally considered vandalism. You have been bold and removed material. That it was sourced is problematic, so you shouldn't have done it. But since you were reverted (twice!) and stil persisted, that's a violation of the WP:BRD cycle. It only has one cycle. You should have immediately, right after the first restoration, started this discussion. It's good you're doing it now and we might we get somewhere with this.

Here is what I removed: ...or "that which has not been shown consistently to be effective.", and it is from the opening sentence of the article, and it is a quote of an MD that nobody's ever heard of from a book that nobody's ever heard of either. When I said he is not noteworthy, I am NOT using my own definition, I am using the Misplaced Pages definition. Compare that statement to the balanced Cochrane definition. Are we, in the opening sentence of this article, going to use the statement of an unheard of person/book or a Cochrane review? If Brangifer can find a guideline that suggests this, I'd like to see it. Not that you'd need to check the guidelines as it's only common sense. Furthermore, as I said, to suggest that the definition "everything that has not been shown to be consistently effective" would have to include medications used in mainstream medicine as well. For instance recent studies have shown that antidepressants are effective for severe depression but not effective for mild depression--interestingly, it has been found that St. John's wort HAS been found to be effective for mild depression, but not severe depression. I am tempted to get into a discussion about accusations of vandalism and the suggestion made so frequently that editors to this article are creating editing wars, but I will not further stir the pot for now. Gandydancer (talk) 12:09, 26 January 2010 (UTC)

Gandydancer, notability is not a requirement for inclusion of references, only for the creation of articles. The subject of an article must be notable, but the content can be from V & RS, including unnotable ones. There are numerous definitions of alternative medicine, some of them conflicting, and we are including some of them from various sides of the debate. That's what NPOV requires. If this article were to make it seem like there are clearcut definitions and that there are only two sides to the debate, it would be misleading, because that's not the way it really is in the real world. -- Brangifer (talk) 14:53, 26 January 2010 (UTC)

As I look at the recent (and deep) edit history, and this particular section of the discussion, it seems to me that the problem has mainly to do with failing to recognize that the term is a matter of dispute: whether it designates something that can be defined (except by lists and by exclusion from institutionally sanctioned practices), and then only secondarily whether anything coherent can be said about the things it gets attached to. It seems to me that the article needs to talk about medical practice, science, and what counts as either of those things, but it can’t go there without acknowledging that this term is an operator in a semantic contest. I have redrafted the intro to recognize the opposed points of view, to include recognition that there are perspectives on the term from the medical establishment, from those who identify as part of a CAM movement or community, from those who work with language, folklore, the sociology and history of ideas. DavidOaks (talk) 15:43, 26 January 2010 (UTC)

David, I hate to say it, but your rewrite messed up some extremely sensitive wordings. The history of this article has been characterized by some long and fierce edit wars, with ArbCom cases, blocks and bans, ArbCom sanctions, lockdown protections of the article, and numerous editors on various sides of the debates finally arriving at a finely balanced consensus lead. That has now been seriously disturbed, violating the rules for how a lead must be written, and also messing up the reason for certain redirects. Note that this article is the result of merges of several former articles (Complementary and alternative medicine, and Complementary medicine). The conditions for merging those articles here are violated by removing the content that came from them and which was in the lead. That's a contractual violation of agreements made at the time, and that must be fixed. If you'll go back, you'll see that the lead had those article titles in bold. That is only allowed because of the redirects from those former articles. That content must be restored to the lead.

Only someone who has lived through all these elements of the article's history would know these things and why the lead shouldn't have been disturbed without very careful discussions and consensus of each word and phrase first. You are excused because you didn't know all of this, so please don't take offense because I'm reverting it all back to its original state. That's the only way to get back to the condition that existed as a result of all those complicated events and agreements.

A peeve is also that our MoS isn't followed in the formatting around the refs. The spacings are all screwed up now. Basically it should be restored to its previous state and only consensus edits should be made to it. This edit warring is what I've tried to warn about, but unsuccessfully. Some have insisted on editing the article while discussions were ongoing. That's totally wrong. Never make an edit that you know might be contested while discussions are still ongoing. Only revert back to the previous stable version. Then, only after consensus is very clear, should it be altered in any manner. Edit wars suck! -- Brangifer (talk) 07:02, 28 January 2010 (UTC)

OK, one approach would be to revert to what it was immediately before my change, and imbed a hidden comment warning future editors of the situation -- that the lead was highly contentious, is fine-tuned, and should not be altered without consensus. DavidOaks (talk) 12:33, 28 January 2010 (UTC)

Thanks, and I feel you have made a very good start. I do have a problem with this statement: "...the practices so designated have little in common except their lack of conventional scientific basis." Just to take one example of many: green tea. See this page please: http://www.sciencedaily.com/search/?type=news&keyword=green+tea&section=health&filename=&period=1825&sort=relevance I could give many other examples.Gandydancer (talk) 16:07, 26 January 2010 (UTC)

If "having a problem with it" means "people will disagree," I think that's what we've got to include. It's a fairly harsh statement rhetorically, but the writer's a professor of biostatistics, the book's a recent offering from one of the most prestigious university presses -- it represents a significant opinion. DavidOaks (talk)

David - not bad (a few redundancies I'll remove in a bit), but you missed the main point of contention, which is the myopic focus in 'evidence-based medicine' in the second paragraph. I have no problem with EBM (well, except that it is thin and has some obvious flaws of logic) but it is not the proper lens through which to view Alt Med because it is not the conventional view either in medical science or alternative medicine. If you want to address that, I'd apprciate it. --Ludwigs2 16:13, 26 January 2010 (UTC)

Well, I don't share the conviction, put forward here in a number of forms, that "evidence based medicine" is a minority view. I freely admit I haven't done any systematic study, but I spend an awful lot of time with medical educators, and I get the strong impression that it's among the dominant curricular paradigms. I think at the very least we need to get a handle on its status before we make rhetorical decisions based on its being a minority view. It could well be that EBM is another term that has a different meaning for you than for me (I gather it is simply normative scientific rigor, but specifically applied to the administrative healthcare environment we currently have)DavidOaks (talk) 16:31, 26 January 2010 (UTC)

Brangifer, however you are opening the article using an unknown person/book. You are using that reference to override the Cochrane review:

"What are considered complementary or alternative practices in one country may be considered conventional medical practices in another. Therefore, our definition is broad and general: complementary medicine includes all such practices and ideas which are outside the domain of conventional medicine in several countries and defined by its users as preventing or treating illness, or promoting health and well-being. These practices complement mainstream medicine by 1) contributing to a common whole, 2) satisfying a demand not met by conventional practices, and 3) diversifying the conceptual framework of medicine."

If I were to go to a wikipedia article and add a statement to refute a Cochrane review with some opinion by some MD that nobody had ever heard of, how long do you think my edit would last? Obviously, not very long. Why would you think it would be different with this article? You seem to forget again and again that your POV about CAM is not shared by thousands of others. Not mine, my well-educated friends, and not thousands of people including health care professionals in the US and elsewhere.Gandydancer (talk) 16:32, 26 January 2010 (UTC)

Gandy, that reference never "overrode" or "refuted" Cochrane. It was just one of varous conflicting definitions we included to show that there isn't unity on the subject. Cochrane isn't the only or final word. The disunity of definitions must be preserved. That's the way it is in the real world. -- Brangifer (talk) 07:02, 28 January 2010 (UTC)

Sorry, I missed that... Who said that EBM is a minority view?Gandydancer (talk) 16:39, 26 January 2010 (UTC)

My earlier link does not seem to work. Try this as an example of one of the many "scientific" studies that have been done: http://www.sciencedaily.com/releases/2008/07/080702080624.htm Gandydancer (talk) 16:53, 26 January 2010 (UTC)

wow - can we keep the indents sane, please?

I said EBM was a minority view. I recognize that the idea that medicine should be based on scientific evidence is both widespread and mainstream - I have no problem with that. but the actual, explicit tenets of the thing called Evidence-Based Medicine (as proposed by people like the Cochran Collaboration) are not widely accepted, and suffer from some inherent flaws. You'll notice that all I did in my previous revisions was separate scientific medicine (which is widely accepted) from evidence-based medicine (which is one minor viewpoint about scientific medicine). I don't have a problem with giving scientific medicine it's due - I do have a problem with editors who seems to want to advance the Cochrane group to a much higher level of prominence than they actually occupy. can you all see that distinction? --Ludwigs2 16:57, 26 January 2010 (UTC)

That's a pretty radical view I've never heard before. Unless I'm totally misunderstanding you, it reeks of ignorance of mainstream medicine. It sounds like your own opinion which isn't echoed anywhere in the medical or scientific establishment. EBM is the prevailing paradigm. That doesn't mean it's finished being applied to every method in use in mainstream medicine, or that it's all taken effect yet, which might be what you're referring to. If so, no denial there. It's a movement and way of thought, a method for using the scientific method to sift the chaff from the wheat. It has nothing to do with skeptics and certainly wasn't invented by quackbusters. Keep in mind that the scientific method is the basic application of skeptical principles to how one approaches claims. In that sense there is a total alignment with skeptical thinking. Skeptical thinking in medical matters is aligned with mainstream scientific principles, and is even echoed in Misplaced Pages's polices of V & RS. A Misplaced Pages editor says "show me the proof/references", and a skeptic says "show me the evidence".

EBM is mainstream thought. It is used by ordinary scientists in their efforts to determine what really works among the methods that are already incorporated and being used. They can thus eliminate methods that have been favorites, but which actually don't work as thought. Skeptics also use the concept in their attempts to prevent unproven alternative methods from being blindly accepted by scientists who don't know what they're really dealing with. They can easily be fooled by first appearances. They want alternative methods to be subjected to the same types of rigorous research demanded of other methods before being accepted. No, EBM is mainstream, skeptics are also mainstream, and the EBM paradigm works fine within the laboratory and out on the frontlines of quackbusting. -- Brangifer (talk) 21:02, 26 January 2010 (UTC)

first point: let me be clear - I don't generally use the word sceptic as an epithet (as you seem to be implying here). I lean that way sometimes, but only when I see someone abusing proper skepticism in order to advance a belief.

Second, as far as I can tell you are failing to distinguish between the normal scientific reliance on evidence of certain types, and the philosophical position named 'evidence-based medicine'. I have no qualms with the first, but the second (currently) is a philosophically underdeveloped minority position with pretensions of universality (as all good philosophical positions must have). If you want to talk about the kind of scientific evidence that medicine relies on, you will find no objection from me. if you want to talk about 'evidence-based medicine' then you'll need to frame it appropriately as a philosophical perspective. if you want to continue to confuse the two then we have a problem, because I can only see that as (a) an odd misuse of language or (b) an effort to advance a position beyond its prominence. --Ludwigs2 21:21, 26 January 2010 (UTC)

Sorry about the indent - someone else posted while I was working on my post. Ludwigs, while I do agree with you, I do not believe that here and now is the place/time for you to push that point of view. I have even looked at the Cochrane page and thought of adding criticisms, but I am not really qualified to do that. I have a friend who teaches stats and she is critical of that type of review and feels that evidense based studies should have their place as well. She was referring to mainstream meds not alt. med., but it is even more true with alt. med. I feel it would be great if you would write a paragraph in the article if you can find references, however I strongly feel that we must accept that rightly or wrongly, we need to accept that it is the Golden Rule at wikipedia. At least, that has been my experience when trying to edit. BTW, where are you getting your information when saying that Cochrane type reviews, etc., are not widely accepted? I thought it was just me... Gandydancer (talk) 17:25, 26 January 2010 (UTC)

it's a lack of evidence, really: Cochrane is not cited outside of skeptical journals, and I've never seen EBM mentioned in a mainstream medical journal (not that I read all that many of them). it may be that the EBM label will become the norm in a decade or so. but if it does, it will be in a different substantive form than it's in now - the current version, as has been noted, doesn't effectively distinguish between accepted and unaccepted forms of medicine. For the moment (as far as I can tell) it's just a neologism that was invented by concerned skeptics as a way of forestalling what they saw as a dangerous trend in the populace towards non-mainstream medical perspectives.

Again a very radical and seemingly ignorant view. Cochrane is used by scientists in their literature searching work and EBM comes from and is discussed in mainstream journals all the time. Very strange views I've never heard before. Pure OR. -- Brangifer (talk) 21:09, 26 January 2010 (UTC)

this would be the time for you to (a) stop insulting me, and (b) start producing some evidence that demonstrates that what you say is true. insults are unproductive, and if you continue I'll ask an administrator to intervene. do we understand each other? --Ludwigs2 21:26, 26 January 2010 (UTC)

I'm not pushing a point of view - one can't push NPOV. read this diff which branfiger is so up in arms about and tell me what it is he actually is up in arms about. it seems like a wholly innocuous improvement to me. --Ludwigs2 17:42, 26 January 2010 (UTC)

OK, back to work... This sentence: The category is difficult to define, in part because of the wide spectrum of beliefs and practices which may be so designated, , the lack of agreement as to what constitutes a “successful treatment outcome” as well as the fact that the practices so designated have little in common except their lack of conventional scientific basis .

I would like to change it to read like this: The category is difficult to define, in part because of the wide spectrum of beliefs and practices which may be so designated, , the lack of agreement as to what constitutes a “successful treatment outcome” as well as the fact that critics argue that the practices so designated have little in common except their lack of conventional scientific basis .

I would like this change because, as I have said, many CAM treatments have been "scientifically" studied. Here, for example, is a PubMed zink study: http://www.ncbi.nlm.nih.gov/pubmed/18045283?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=14 And here is what the Mayo Clinic has to say about CAM - surely you'd think that if they claim that studies have been done, one could trust that they are correct: http://www.mayoclinic.com/health/alternative-medicine/PN00001 Also note on p.2 they explain why so few CAM studies have been done. I really do just find it amazing that anything to do with CAM in wikipedia seems to cause all hell to break loose. It is being taught to nursing students, med students, and used to compliment mainline medical care extensivly. Gandydancer (talk) 19:26, 26 January 2010 (UTC)

Identifying the perspective in note 4 as coming from a critic seems quite reasonable and improves neutrality. Now, entirely separate question: treatments that have had extensive scietific testing and are taught in mainstream medical institutions -- how are they then CAM? This is the definitional problem that -- as it seems to me -- we keep barking our shins on. DavidOaks (talk) 20:07, 26 January 2010 (UTC)

(e/c) wow - took me a while to find the change there. I see what you're getting at, but I think adding that one word is problematic, since it open the question of what a 'critic' is). really more of a bandaid than a cure. I think it would be better if we went withe a broader rewrite like so:

The category is difficult to define: it is a 'catch-all' label for a wide spectrum of beliefs and practices which have little in common except that they are not derived from the methodology of conventional scientific medicine. They may differ in their assumptions from conventional medicine and from each other, and may even have significant differences in what they consider valid evidence or successful treatment outcomes.

what do you think? --Ludwigs2 20:13, 26 January 2010 (UTC)

@ David - you're speaking from the perspective of EBM. in colleges that teach such things (to my knowledge), courses are usually offered explicitly under the CAM or AltMed label: they are neither treated as mainstream medicine nor reviled as unworkable - it's a purely pragmatic approach to the topic. --Ludwigs2 20:18, 26 January 2010 (UTC)

I think part of the problem is the equivacation of mainstream with "scientifically proven" medicine. A lot of mainstream medicine is not based on scientifically proven medicine - take off-label use of drugs. This is legal, and an accepted part of "mainstream' medicine, up to the discretion of the physician. To restate what is on Misplaced Pages on Off-label use

Up to one-fifth of all drugs are prescribed off label and amongst psychiatric drugs, off-label use rises to 31% (Radley, et al. 2006). New drugs are often not tested for safety and efficacy specifically in children. Therefore, it is believed that 50-75% of all medications prescribed by pediatricians in the U.S. are for off-label indications.Some drugs are used more frequently off label than for their original, FDA-approved indications. A 1991 study by the U.S. General Accounting Office found that one-third of all drug administrations to cancer patients were off label, and more than half of cancer patients received at least one drug for an off-label indication. A 1997 survey of 200 cancer doctors by the American Enterprise Institute and the American Cancer Society found that 60% of them prescribed drugs off label.. Frequently, the standard of care for a particular type or stage of cancer involves the off-label use of one or more drugs. An example is the use of tricyclic antidepressants to treat neuropathic pain. This old class of antidepressants is now rarely used for clinical depression due to side effects, but the tricyclics are often effective for treating pain.

. And, even for those "proven" medicines, clinical trials can prove that something works X% of the time - that can be anywhere from close to 100% (NNT=1) to 1% (NNT>99), which means that some mainstream medicine is administered, even when it is known that it won't work for a good percentage of the people that it is prescribed to, in hopes that it will help a few. The reason might be that there is not anything else, or that the doctor might feel that this patient might be a good candidate for this based on the physician's personal experience with using that drug. Scientifically proven methods/medicine is only a part of Mainstream medicine, not the whole. stmrlbs|talk 05:01, 27 January 2010 (UTC)

This is what I was trying to capture in the derived from language, above. off-label drug use has not been tested for efficacy, but the drugs have been developed under a western-scientific testing paradigm, so there is at least the marginal assumption that they've been tested for safety in that model. So, there is no more evidence that the off-label use of a drug works than there is that a traditional herbal medication works; it's just that the traditional herbal medicine hasn't been derived from the same model. --Ludwigs2 06:09, 27 January 2010 (UTC)

People have no idea how poorly some of the drugs on the market have been tested and how little they are aware of the results. See this report on a sleep med for instance:

Rozerem (ramelteon), for example, was approved in 2005 for chronic insomnia and was aggressively promoted to consumers. No efficacy data were provided in the label.4 The phase 3 sleep-laboratory studies that were included in the FDA’s medical review show that Rozerem reduced the time required for patients to fall asleep (as measured by polysomnography) by 14 minutes among younger adults and by 7 minutes among older adults (see box on Rozerem data). However, there were no subjective improvements in total sleep time, sleep quality, or the time it took to fall asleep. Two phase 3 outpatient trials confirmed that people didn’t notice much benefit from Rozerem. In a trial involving younger adults, Rozerem had no effect on any subjective sleep outcome; in one involving older adults, the drug reduced reported time to fall asleep by 7 minutes but did not reduce the proportion of cases meeting the definition of insomnia (taking more than 30 minutes to fall asleep). Nor did it improve any of the secondary outcomes: falling back asleep, number of awakenings, total sleep time, or sleep quality.

http://healthcarereform.nejm.org/?p=2126&query=home Gandydancer (talk) 14:53, 27 January 2010 (UTC)

Again, back to the wording about the "fact" that CAMs have not been scientifically tested, see this Cochrane review of St. John's wort: http://www.cochrane.org/reviews/en/ab000448.html

Is there an agreement that I may change the wording as I suggested above? Gandydancer (talk) 15:15, 27 January 2010 (UTC)

sorry, this thread has gotten awfully sidetracked. can you create a new 'proposed revisions' section and restate the change you want to make? I've lost it in the mess above. --Ludwigs2 16:16, 27 January 2010 (UTC)

I agree we need a new start, however for now I will just paste it here:

This sentence: The category is difficult to define, in part because of the wide spectrum of beliefs and practices which may be so designated, , the lack of agreement as to what constitutes a “successful treatment outcome” as well as the fact that the practices so designated have little in common except their lack of conventional scientific basis .

I would like to change it to read like this: The category is difficult to define, in part because of the wide spectrum of beliefs and practices which may be so designated, , the lack of agreement as to what constitutes a “successful treatment outcome” as well as the fact that critics argue that the practices so designated have little in common except their lack of conventional scientific basis .

This should be a good way to keep NPOV because the Snake Oil book, while I do not agree with it, is extremely against all CAM and has been widely read and is familiar to most people (unlike the Davis book that I have argued against). Gandydancer (talk) 16:43, 27 January 2010 (UTC)

I don't have any objection to the addition of the word 'critic', but I don't think the revision really gets at the issue. as I said, I think we need a more extensive revision. it's a start, though. --Ludwigs2 19:04, 27 January 2010 (UTC)

revising lead paragraph, cont'd

(If only because we NEED a new section). Now, while observing WP:AGF, I have to say that I see some partisanship here (no one needs to read the page to know that; simply noting the number of archived discussions is sufficient). I also see a certain pattern of repeated claims and positionings that need to be addressed.

First, the treatment of resistance to CAM as coming from EBM, which in turn is treated as a minority position (therefore easily ignored) but also equated with institutional and conventional medicine (so that being able to ignore EBM defuses virtually any critique of CAM). Sources must be brought forward identifying EBM as identical with institutional medcine, and/or a minority opinion in medical education (it kind of has to be one or the other, and my distrust is awakened by the way it seems to keep switching), or these positions must be abandoned. I have not yet gone source-hunting myself, but some informal offline polling tells me that EBM is taken as a current buzzword for the fairly recent implementation of scientific principles to the actual delivery of healthcare and healthcare decision making as well as has long been the case with questions of individual therapeutic benefit, and it is regarded as entirely mainstream. When CAM is criticized for failure to meet standards of saftey and effectiveness, it is not under attack by philosophical EBM.

Second, the claims about sources being notable or "heard-of" by "everybody" or the reverse. I'm not sure how one sustains a claim that nobody had ever heard of a given thing. See WP:Google for the essential wrongheadedness of the approach. Notability is not a requirement for WP:RS; pertinence is. When the topic embraces folk medicine, a folklorist who has written about the differences between folk medicine and other practices is pertinent. When the topic is language, a comedian who focuses on the use of language in the subject of alternative medicine is pertinent.

Third: definitions (this is the big one)

• CAM seems not to be definable except in "practical" terms (which seems to mean a list whose logic no one can explain, and whose contents none can characterize)

• Institutional medicine seems not to be definable, since there are claims that some of its science has contained error, its permissive attitude towards off-label use of approved drugs counts as CAM (?), and some CAM procedures get rigorous scientific testing (and yet remain CAM?).

The first thing has to do with the nature of the subject. The next two seem to me claims that must be made explicit and then supported with WP:RS, or must be abandoned. This blurring of lines has the effect of undermining the authority of scientific, institutional medicine while simultaneously raising the dignity of CAM. If that's the case, the necessary and inevitable conclusion is that the entire matter is political, ideological and linguistic, without scientific content of any kind: there is no meaningful distinction between CAM and any other medical theory or practice. Again, that being decided, the article needs a complete reboot, and really has to be exclusively about language. DavidOaks (talk) 19:50, 27 January 2010 (UTC)

I honestly think that there's a lot of 'mountains from molehills' reasoning going on here. the way I see it:

• Alt Med/Cam are not difficult to define: they are medical practices that are not derived from conventional (western/scientific) medical science. If you want to be really specific, AltMed/Cam is any healing practice that is not explicitly recognized by medical associations such as the AMA.
  • the definition has nothing to do with efficacy or safety, though there are any number of editors who want to make that association. The best one can say is that CAM practices are not tested for efficacy and safety under the same paradigms as institution-approved practices.
• no one is arguing that conventional medicine is not based on scientific evidence. all I am arguing is that the particular label 'Evidence-based medicine' refers to a particular philosophical attempt to re-conceptualize the difference between 'mainstream' and 'alternative' medicine. In practice, this is probably an approximation of what most doctors/researchers do - they evaluate treatments based on evidence of efficacy and safety. I think you're right about it being a buzzword - most doctors/researchers do not think of it in terms of EBM, they think of it in terms of normal scientific practice. we cannot elevate the philosophical perspective to undue prominence by insisting on using the term any more than we can deny to prominence of normal scientific practice.
  • remember, EBM was created as a response to altmed/CAM, not the other way around.
• I don't particularly want to 'raise the dignity of CAM' (whatever you meant by that phrase); nor do I want to disparage CAM as something less-than. Misplaced Pages is not the place to argue whether CAM does or doesn't work.

I personally think that everyone should get away from (a) any tendency they feel to push one or another side of this debate, and (b) any tendency they feel to accuse others of doing that. We're ot going to get an NPOV article any other way than that. --Ludwigs2 20:29, 27 January 2010 (UTC)

Second, the claims about sources being notable or "heard-of" by "everybody" or the reverse. I'm not sure how one sustains a claim that nobody had ever heard of a given thing. See WP:Google for the essential wrongheadedness of the approach. Notability is not a requirement for WP:RS; pertinence is. When the topic embraces folk medicine, a folklorist who has written about the differences between folk medicine and other practices is pertinent. When the topic is language, a comedian who focuses on the use of language in the subject of alternative medicine is pertinent.

So you are telling me that I am not correct and that I do not understand wikipedia quidelines, when I suggest that a well-recognized auther/book that discusses all aspects of CAM is better than an unknown author/book that discusses one aspect of CAM, folk medicine? You actually feel that they are on equal footing for the opening sentences of this article?? If this discussion is going to move away from an honest effort to come up with wording that is satisfactory to all, I shall lose interest in a hurry. Gandydancer (talk) 02:40, 28 January 2010 (UTC)

Gandy, as a newbie here, I'll excuse you. The more one learns about NPOV, the more one realizes that an NPOV article contains content that will grate on the sensitivities of pretty much everyone on either side of the debates. That is a requirement -- that we include content that reflects the debates and disunity of the subject. It's not our business to pick and choose one statement or quote we feel summarizes the subject. That can't be done satisfactorily to everyone. We must pick several of the best/worst and strongest examples of each POV, IOW what is "best" for one side will be considered "worst" by the other, and that content must coexist within the same article and in the lead. Deletionism of opposing POV is a serious violation of NPOV. -- Brangifer (talk) 07:20, 28 January 2010 (UTC)

I'm telling you that your insistence on comparing them is inappropriate. They speak to entirely different aspects of the issue. Beyond the act of comparing them, in terms of your method of comparing them, yes, it's outside of wikiguidelines. Still trying to work out the methodology behind these repeated determinations -- "unknown" "nobody ever heard of." Whether a thing is familiar to a given editor is not a useful standard. See WP:Notability DavidOaks (talk) 04:03, 28 January 2010 (UTC)

BUllRangifer, Please read my posts before you are ready to be so kind as to excuse me for my lack of experience which has led to a serious violation of NPOV. If you had read my posts you would know that I DID want to site the most notable "authority" who has come out against CAM rather than some obscure MD writing about folk medicine. Gandydancer (talk) 10:19, 28 January 2010 (UTC)

DavidOaks, It is beyond me why you continue to insist that it would be as appropriate to open the article with a quote from an unknown MD writing for a state's folklore site (or whatever it was...) as compared to a well-known book, the Snake Oil book. Though frankly, I question your judgement anyway, since you are the person that reverted Vsmith's delete of the inclusion of a comedian's take on CAM in this article, as though a medical article is appropriate for that! Gandydancer (talk) 11:37, 28 January 2010 (UTC)

Please note -- the source to which you refer hasn't been part of the article for quite some time. In fact, I was the one who removed it. The conversation here is about wikiprinciples, not the particular source. I am correcting your tendency to make wide-ranging judments about what is obscure, what is relevant, without explaining your means for arriving at those judgments, without securing consensus. This is bad practice, and it's consistent. DavidOaks (talk) 12:14, 28 January 2010 (UTC)

I know you removed it. In fact, you are the person that added the Snake Oil ref, which I feel is excellent. And, as for the Davis ref not being here for quite some time, it is the fact that I removed it on the 24th with the statement "Dr. Davis is not noteworthy or qualified to make this statement" and I further stated that it was not appropriate to open the article with a statement made by an unknown ("expert"), that has started this controversy in the first place. Why you would suggest that I need to be corrected because this constitutes "your tendency to make wide-ranging judments about what is obscure, what is relevant, without explaining your means for arriving at those judgments, without securing consensus. This is bad practice and its consistent". Yes, I have consistently said that. I have not wavered. I have NOT said that there is no place in the article for Dr. Davis. If folk med is discussed later in the article, he may work in just fine. Or if this article was titled "Folk Medicine", it may work very well in the lead paragraph. But you DO NOT open this article, the first line in fact, with an unknown MD who wrote about folk medicine for a state's folklore page. And why I need to defend this over and over is beyond me. Gandydancer (talk) 14:21, 28 January 2010 (UTC)

(outdent) You need to defend it because you haven't. You have finally gotten around to stating that you think the reference is not relevant -- that's good. You have not explained WHY you think that the views of a folklorist, writing on folk medicine, are irrelevant to a topic closely related to folk medicine, and that would be your next step. You also repeatedly make determinations of prominence without accounting for how you arrived at them. If there's a wikipolicy for nobody-ever-heard-of-ness, let's have it. Otherwise, try this example: I personally think that health care reform has nothing to do with political philosophies; I think that's a smokescreen to conceal another set of motivations. Health care reform should be about medicine. Moreover, I have never heard of Alan Reynolds. He should not be in the lead of an article on health care reform. He certainly does not belong in the same prominence with writers appearing in medical journals, espcially those whom everybody has heard of: Gerard F. Anderson, Uwe E. Reinhardt, Peter S. Hussey and Varduhi Petrosyan. So because I have determined that Reynolds is obscure, irrelevant, he has to go. Now, should I just delete him? Do you think I'm going to get consensus over there? Or will I find myself reverting, being reverted, and saying "why I have to defend this is beyond me!" (of course I will do nothing so WP:Pointy.) Now, my own view is that the lead should give a sense of the things that are generally meant by CAM, but should be very clear by the end of that first paragraph that it's open to debate whether the term really has a clear meaning, or is primarily a cluster of connotations. I submit that proposal for consensus, which is what you should have done. More: I think that the views of a folklorist, writing on the relation of folk medicine to institutional medicine, are relevant to an article on the relation of CAM (which partially subsumes folk medicine) to instituional medicine. I am explaining what I propose and how I reasoned my way there. This is what you need to do, as a matter of habit. WP:Be Bold is a policy, but the situation here calls for it to be tempered by WP:Consensus, and that's what we're trying to do. If you wish to argue that Minchin's linguistic insights are irrelevant, you must say so, and see whether there's substantial agreement. If you think that nobody's ever heard of him or he's obscure, then you need to help us understand how that determination is made. Does it just mean that you've never heard of him? See, I had never heard of him before joining this discussion. But I think he has framed something significant, done so in memorable form, and as a public thinker about language, has the authority to do so. If you disagree, say why. If you simply feel that he has no standing to make comments on semantics, either because he specifically suffers from some defect, or because comedians in general are barred from relevance, generally or only on this subject, then you must say so. This article is highly contested ground, so there's more than the usual requirement to explain oneself. Myself, I think Minchin's formulation of the linguistic problem is more elegant and apt, and I think a comedian has some standing as a social critic, and I think that social criticism is properly part of the lead for this concept. Those too are things we can and should get consensus on. DavidOaks (talk) 15:16, 28 January 2010 (UTC)

You need to defend it because you haven't What??? It was the very first thing I did. I said: "I do not feel that it is correct to open the article with a statement by a person who, as far as I can tell, is not qualified to make a judgment on CAM. If someone has more information on Dr. Davis, I'd like to see it, since when I google him I come up with next to nothing." I clearly say here he is not qualified as far as I can tell (he wrote an article about folk medicine) and he is not notable. Gandydancer (talk) 15:59, 28 January 2010 (UTC)

Hmm, maybe we have different ideas of what "defend" means. For me, it has to do with explaining reasons, rather than asserting views. Your errors are several. You first fail to show why notability is relevant. There is no wikipolicy that requires notability as part of the WP:RS. Then your "proof" of non-notability depends on googling. You were directed to look at WP:Google in order to discover the inappropriateness of that approach. You were invited multiple times to clarify your position on the relevance of a folklorist's view on the distinction between scientific and CAM based on that writer's distinction between scietific and folk medicine, with an explicit link between folk medicine and CAM. As far as I can see, you haven't done it. And you needn't bother, because it's really beside the point, as the discussion has moved beyond that particular question. But I am willing to take this time with you, because you seem eager to contribute, but also need to come a little further in understanding how consensus works. I myself now think the lead will be strengthened by sticking to the medical sources Bullrangifer lists, not because defining CAM is out of the range of someone who has written about folk medicine, not because only medical people should be allowed to speak about the meaning of the term (I actually think a linguist or a philosopher of science is the most well-suited professionally) but for the more purely rhetorical reason that figuring out that relevance is really hard for some people, or at least it sets up a speedbump and just generally invites nonproductive arguments. Now, go down to that section and respond to the merits of those proposals. DavidOaks (talk) 17:40, 28 January 2010 (UTC)

reversions and consensus

we are in the middle of discussing productive changes to the page. reversions are counter-productive. please use this space to explain why these changes ou keep reverting cannot be made. --Ludwigs2 07:34, 28 January 2010 (UTC)

The key word is "discussing". Discussion is good, but making changes without consensus is counterproductive. Be patient. Making changes to the lead is always a sensitive issue because changes there are supposed to reflect changes to the actual content of the article. Yes, wordings in the lead can be written awkwardly or poorly and can be improved, but substantive changes need a very solid consensus based on changes in the body of the article.

Have you noticed the references section at the bottom of this talk page? It's there for a reason. It's there so that editors can copy (NOT edit) questioned content from the article and together with editors who hold opposing POV work on revising it here. Only after there is a consensus does the new version get used to replace the old version. That's what's known as collaborative editing. It takes a lot of good faith and the ability to write for the opponent. While that may grate on one's nerves, at least enable it.

My major objection to this latest debacle has been regarding process rather than content. When consensus gets violated, all hell breaks loose. We need to avoid edit wars. This article has been quite stable for some time until a newbie came along and boldly removed content they didn't like. It was restored and they did it again. That started an edit war and I rebooted the situation so we can start collaborative editing. I'm perfectly willing to discuss changes, but do it here, not by making controversial edits. -- Brangifer (talk) 15:15, 28 January 2010 (UTC)

Oh, cut it out. When I made my edit and it was reversed with the comment "where have you discussed this on the talk page", I immediately started a talk page discussion. I did not revert the edit, and in fact have not made a single edit since that time. Gandydancer (talk) 17:01, 28 January 2010 (UTC)

Brangifer: I'm sorry that you object to the process we've been using, but I don't honestly care. I suggest that you stop reverting, stop explaining why we can't make changes to the page, and start discussing the changes we are trying to make. the first two are non-productive; the second might get us somewhere. I've made multiple comments on this talk page that you have not yet addressed; do you want to start with those? --Ludwigs2 18:15, 28 January 2010 (UTC)

Reboot and proceed

Minchin quote

One objection has been to the inclusion of Tim Minchin's quote. While a comedian's comment is perfectly appropriate as a documented opinion within a medical article, it really doesn't add anything that isn't already said by more authoritative sources in the article. It therefore seems superfluous.

Now, instead of deleting it, let's discuss my proposal to delete it. When we are agreed on what to do, then we can do it or not do it. I'm adding it here so we know exactly what we're talking about -- Brangifer (talk) 15:15, 28 January 2010 (UTC)

"Australian comedian Tim Minchin, in his nine minute beat poem "Storm", states that alternative medicine is medicine that "has either not been proved to work, or been proved not to work." He goes on to ask "You know what they call 'alternative medicine' that’s been proved to work? Medicine.”

My view is that it should stay, at the end of the lead par, as a succinct expression of the key question as to whether there is a an objectively identifiable body of things we can point to and say "CAM," or whether the term is mainly a rhetorical operator, a cluster of associations, connotations. DavidOaks (talk) 15:23, 28 January 2010 (UTC)

May I suggest that you all take a look here for quotes by even more authoritative persons which make the same point?:

• Alternative medicine critics

Brangifer (talk) 15:33, 28 January 2010 (UTC)

• This quote is inaccurate and superfluous. I'm more than happy to see it go. leading off a serious encyclopedic article with a quote by a comedian is pointy at best; it smacks of an attempt to ridicule the subject matter. leading with any skeptical comment would produce an unnecessary POV - the lead should start of with a simple, neutral description of the subject matter, and prominent critical opinions should be saved at least until the subject itself is properly defined and lain out (I'd say third paragraph). --Ludwigs2 18:21, 28 January 2010 (UTC)

Davis quote

We may be able to find a different author to a quote that substantially says the same thing. Let's try that and and see if we can agree on an alternative. -- Brangifer (talk) 15:42, 28 January 2010 (UTC)

Yes, I think this statement about alternative medicine in the lead being from a Professor of English is not an appropriate source. stmrlbs|talk 16:01, 28 January 2010 (UTC)

OK, now is that because you think that folklorists have nothing to say on the subject of the definition of or the claims made for folk medicine? I'm asking on wikiprinciple, and kinda puzzled/amused by the readiness to assert, the reluctance to explain. Myself, I think the lead needs a strong statement of skepticism, and it would be better coming from a physician. Bullrangifer has given us a lot of them. Here are some that I think would work best in the opening paragraph. Angell and Happle are physicians (good cred) and speak to the operational distinctions. Novella is also a physician. Some would say that gives him cred when he is talking about language, but I was just talking to a linguist, who never heard of him (LOL). Carroll has pretty good phrasing, IMHOP. DavidOaks (talk) 16:15, 28 January 2010 (UTC)

• Marcia Angell, an American physician, author, and the first woman to serve as editor-in-chief of the New England Journal of Medicine (NEJM).

• "What most sets alternative medicine apart . . . is that it has not been scientifically tested and its advocates largely deny the need for such testing. By testing, we mean the marshaling of rigorous evidence of safety and efficacy, as required by the Food and Drug Administration (FDA) for the approval of drugs and by the best peer-reviewed medical journals for the publication of research reports. Of course, many treatments used in conventional medicine have not been rigorously tested, either, but the scientific community generally acknowledges that this is a failing that needs to be remedied. Many advocates of alternative medicine, in contrast, believe the scientific method is simply not applicable to their remedies. . . ."

• Robert Todd Carroll, philosopher. Author of The Skeptic's Dictionary book and website.

• "A health or medical practice is called "alternative" if it is based on untested, untraditional, or unscientific principles, methods, treatments, or knowledge. "Alternative" medicine is often based upon metaphysical beliefs and is frequently anti-scientific. Because truly "alternative" medical practices would be ones that are known to be equally or nearly equally effective, most "alternative" medical practices are not truly "alternative," but quackery. If the "alternative" health practice is offered along with conventional medicine, it is referred to as "complementary" medicine."

• "Complementary medicine is another expression for "alternative" medicine, though the two are often linked as complementary and alternative medicine and referred to as CAM. The term 'complementary' seems to have been introduced by the purveyors of quackery in an attempt to produce the bias that untested or discredited treatments should be used along with conventional medical treatments. There really is no such thing as "alternative" medicine; if it's medicine, it's medicine. 'Alternative medicine' is a deceptive term that tries to create the illusion that a discredited or untested treatment is truly an alternative to an established treatment in conventional medicine. By adding 'complementary medicine' to the repertoire of misleading terms, the purveyors of quackery have improved on the illusion that their remedies somehow enhance or improve the effects of standard conventional treatments.

• Rudolf Happle, German dermatologist.

• "When deliberating on the essence of alternative medicine we should simultaneously reflect on the intellectual and moral basis of regular medicine. . . . (1) alternative and regular medicine are speaking different languages; (2) alternative medicine is not unconventional medicine; (3) the paradigm of regular medicine is rational thinking; (4) the paradigm of alternative medicine is irrational thinking; (5) the present popularity of alternative medicine can be explained by romanticism; (6) some concepts of alternative medicine are falsifiable and others are not; (7) alternative medicine and evidence-based medicine are mutually exclusive; (8) the placebo effect is an important factor in regular medicine and the exclusive therapeutic principle of alternative medicine; (9) regular and alternative medicine have different aims: coming of age vs faithfulness; (10) alternative medicine is not always safe; (11) alternative medicine is not economic; and (12) alternative medicine will always exist. The fact that alternative methods are presently an integral part of medicine as taught at German universities, as well as of the physician's fee schedule, represents a collective aberration of mind that hopefully will last for only a short time."

• Steven Novella, neurologist. Founder of the New England Skeptical Society and host of The Skeptics' Guide to the Universe podcast.

• "The fundamental intellectual flaw of “CAM” as a concept is that it is made to include modalities that are extremely diverse, even mutually contradictory, under one umbrella. Very deliberately modalities which are scientific and mainstream, like the proper use of nutrition, are often included under the CAM umbrella by proponents in order to make it seem like CAM is a bigger phenomenon than it actually is, and as a wedge to open the door for the more pseudoscientific modalities."

• "The dichotomy between alternative and conventional medicine is artificial and confusing. It should be given up. "Medicine is what works," the best methods known should be used. Any kind of medicine which adheres to this maxim is to be taken serious."

Well, many of these definitions are explicitly skeptical (e.g., people trying to define AltMed/CAM in terms of the fact that it doesn't work rather than in terms of the pragmatics (they originate in modalities outside modern scientific medicine). aren't their any neutral (non-skeptic, non-advocate) definitions out there? --Ludwigs2 18:31, 28 January 2010 (UTC)

References

Please keep this section at the bottom. TO ADD A NEW SECTION, just click the EDIT link at the right and add the new section ABOVE this one. Then copy the heading into the edit summary box.

1. 50 things that changed our lives in the aughts. Associated Press. Published 22 December 2009. Accessed 22 December 2009.
2. 'Alternative' Medicine Is Mainstream Wall Street Journal. Published January 9, 2009. Accessed 22 December 2009.
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4. 'Alternative' Medicine Is Mainstream Wall Street Journal. Published January 9, 2009. Accessed 22 December 2009.
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28. 'Alternative' Medicine Is Mainstream Wall Street Journal. Published January 9, 2009. Accessed 9 January, 2010.
29. New York Times. Published September 28, 2004. Accessed 14 January, 2010.
30. Alternative medicine meets mainstream hospitals USA Today. Published June 8, 2009. Accessed 14 January, 2010.
31. http://archinte.ama-assn.org/cgi/content/full/166/9/1021
32. http://www.npr.org/templates/story/story.php?storyId=95985619
33. "Why is off-label use of drugs so common in cancer treatment?". National Cancer Institute. Retrieved 2009-07-12.
34. Cite error: The named reference Angell was invoked but never defined (see the help page).
35. Robert Todd Carroll. "alternative" health practice. Skeptic's Dictionary
36. Robert Todd Carroll. Complementary medicine. Skeptic's Dictionary
37. Happle R. "The essence of alternative medicine: A dermatologist's view from Germany." Archives of Dermatology 134:1455-1460, 1998.
38. Steven Novella. National Health Interview Survey 2007 - CAM Use by Adults. Science-Based Medicine
39. Steven Novella. Alternative Medicine: a skeptical look Capital District Humanist Society

POV Intro tag

Can this tag please be justified, concisely, with specific points? Otherwise it will likely be removed. Thanks, Verbal chat

thanks, yes. I placed it there because there is an broad failure of discussion on the following two points I have raised above:

• there is an excess emphasis on the the philosophical position of 'Evidence-Based medicine', as opposed to a more neutral reference to scientific medical practices. Misplaced Pages is not the correct venue to campaign for a particular philosophical viewpoint. I think EBM is prominent enough to get mention in the lead, but I don't think the medical position in its entirety should be cast as being derived from EBM (particularly since EBM was specifically invented as a means to redefine medical perspectives towards AltMed).
• The intro leads with critical commentary. It should lead with a neutral description of the topic - i.e., one that does not attempt to call into question the safety or efficacy of AltMed in bulk or as a matter of definition. critical perspectives should be added later in the intro to balance out any perception that AltMed has broad medical acceptance, but this is an article about Alt Med, not against alt med, and shouldn't give the appearance of being the latter.

--Ludwigs2 19:23, 28 January 2010 (UTC)

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