Talk:Homeopathy/Archive 13

I'd like to point out that, after the first two paragraphs, I still haven't got the faintest clue what "homeopathy" means. Those paragraphs are also extremely badly written. --Larry Sanger 11:46, 4 November 2006 (CST)

Yes, I agree. I've trimmed this article down from a very long and wandering WP original, and done some re-ordering and reference tidying, but it's still an uncomfortable hybrid. Really needs a complete write-through.Gareth Leng 11:02, 7 November 2006 (CST)

Lead?

It's been suggested (not by me) that the new CZ style might incorprate a short and simple boxed message, and that for this article, that box might contain the text:

"Homeopathy is an Alternative Medicine system that tries to treat illnesses with tiny doses of the drugs that cause the same symptom as the illness. Homeopathy is based on the ideas of Samuel Hahnemann, a 19th century physician who observed that some contemporary medicines evoked symptoms similar to those of the illnesses for which they were prescribed. There is no clear evidence to support the efficacy of homeopathic remedies, and it is likely that the reported effects are placebo effects."

Keeping this here so we can see how it looks if and when style issues advanceGareth Leng 12:25, 9 November 2006 (CST)

That would make more sense. I have been trying to track down the CZ style guide/ideas with no luck. I have seen discussion here and there but nothing concrete. Am I missing something obvious? Chris Day (Talk) 12:31, 9 November 2006 (CST)

Comments by Nancy

Let's imagine that a perosn living in X city, Y country has been advised by a friend to see a homeopath for that problem with his health he is always complaining about. Knowing that CZ is edited by experts, he looks up Homeopathy. I don't think this article, as it stands, will serve him well.

Perhaps the introduction to the article would be less misleading if it described what the current practice of homeopathy is, rather than focused on a more historical definition of its roots. I realize that this is difficult. But it has been a hundred years, plus and minus, that medical practice was divided up into allopathy, osteopathy, homeopathy etc. Often times, I read that medicine, meaning conventional medicine or western medicine is allopathy and I object every time I do. Why? Well, I believe in evolution, but not that I, personally, descended from an ape. I believe my distant ancestors had the same ancestor as the apes. That’s different, you see. Similarly I am a physician but I am no allopath. The allopath was a distant “ancestor” of my teachers., and to infer – or outright state- that current medicine is actually allopathy is frankly ridiculous. If a person was advised to see an orthopedic surgeon and they looked up "allopath" what would they learn?

http://www.op.nysed.gov/06reg.htm according to this link, New York State does not license homeopaths. Yet very few licensed physicians are homeopaths. Meaning, most therapists in New York calling themselves homeopaths are not licensed healing arts professionals. Is there any geographic region where this is not the case? Who today actually is a homeopath? What is the actual practice of homeopathy in the world, currently?

It seems to me that current homeopathy, like most practicing healing arts, draws on the empiric success of the previous generation of clinicians. This is why much of medicine is medicine and actually not ‘human biology’, even though in an idealized sense it is based on human biology. On the level of treatments, it is misleading to suggest, for example, that the physician prescribes X drug because of its proven molecular interactions with the Y receptor. In selected cases, that may be true, but generally, it is not. Let’s face it, Doctor Jones almost never is drawing molecular diagrams when considering treatment.

I have only had contact with a couple of homeopaths, but it has been the same with them. They might have been taught, or read stuff written by, practitioners who were familiar with the original theories, but their practice draws on its own clinical traditions and they don’t puzzle over it for each treatment. More often, homeopathic remedies are delivered by alternative care healers who are not strictly homeopaths.

From my reading of history and medicine, it seems that in an era when mainstreams docs were heavily advocating harsh cathartics, emetics and purges for most illnesses, homeopaths gave out remedies that were mostly water and in fact, many patients did better than when forced to vomit, or repeatedly evacuate stool.

A good homeopathic remedy is a placebo, but placebo are particularly effective if combined with positive social interactions with the healer. Many modern medical treatments are essentially placebos and some excellent physicians are quite aware of this. There is a lot to say about placebos, perhaps in a different article that could be linked to this. Writing several articles at once that link (I did that with biology) can be helpful. Regards, Nancy Sculerati MD 07:55, 7 December 2006 (CST)

addendum - the above is not formulated in a manner that really addresses the article, and I'd like to do better. Specifically, the introduction should not imply that homeopathy is a recognized current branch of medicine, Itr is not true (unless I am wrong, and if so - please correct me- that the practice of homeopathy persited in medicine. Instead, others took it up. The historical view as written in the article does imply that homeopathy is a medical specialty, because it once was. It would be helpful to actually discuss who, currently, homeopaths are. This may differ by country. For example, in Germany, where you say homeopaths are licensed - what are the requirements? Exactly? How about UK? What are the regulations for practice? Then, since many practitioners in various fields use homeopathic potions, are these regulated by any country? How? I can tell you that years ago I had these silver/mercury dental fillings removed by a fabulous dentist, who replaced them with these perfectly molded porcelain ones that reconstructed the tooth. He was, in fact, the cousin of the head of the department I was training in. He always asked me if I'd like a little of his special medicine before starting. These were homeopathic remedies, each in a wonderfully shaped and colored bottle with a truly beautiful label. I was doing my fellowship at the Childrens Hospital of Pittsburgh at the time, and we both got a kick out of the fact that I really did want him to sprinkle the stuff on my tooth, and I'd spend some time picking out my favorite at each session. I know from some of my past patient's families that such remedies are available in the US over the counter and by various therapists. Nancy Sculerati MD 10:31, 7 December 2006 (CST)

Many thanks, just the type of radical advice needed. i've taken a sharp knife to it, spinning a lot into homeopathic proving and History of Homeopathy as a start, and done some reorderingGareth Leng 11:50, 8 December 2006 (CST)

Footnotes

The footnotes appear to be slightly out of sync, in the Intro at least:

The word 'homeopathy' was first used by the German physician Christian Friedrich Samuel Hahnemann (1755-1843). Hahnemann was an eminent physician and a prominent public health reformer. He believed that his new system was more humane and effective than the conventional medicine of his time[1], but it was greeted by the establishment with derision and contempt. Today, homeopathy is not an accepted part of conventional medicine, and its theories are not generally regarded as scientifically credible, but nevertheless it has more than 100,000 practitioners worldwide, and 500 million users.[2]

[2] supports sentences 2 and 3, but not sentence 4. I would edit, but don't want to mess it up further, as I don't know which subsequent citations need moving back, or whether one is missing. Thanks, Mike Emmans Dean 10:45, 6 February 2007 (CST)

WP flag

.. is set up for the following few lines of text

• Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious.
• Its strength lies in its evident effectiveness as it takes a holistic approach towards the sick individual through promotion of inner balance at mental emotional spiritual and physical levels.
• What this investigation has unearthed is appalling.
• Complementary Medicine - Therapies Homeopathy BBCs Complementary Medicine article on Homeopathy.

--AlekStos 14:56, 17 April 2007 (CDT)

AMA

Hi Dana, and welcome. I agree that you're right to say that the AMA is not antagonistic to homeopathy; but would not go so far as to suggest that this means that they believe that there is good evidence supporting its efficacy. I've left your text but reinserted a quote from their adopted policy, just to make this clear.Gareth Leng 11:46, 4 March 2008 (CST)

I may be wrong, but I think that it is very misleading to say that homeopathic manufacturers are regulated as drug companies. I think I'd be right in saying that homeopathic remedies do not need FDA approval for instanceGareth Leng 11:49, 4 March 2008 (CST)

I've restored the former text on the Lancet study, partly because your text did not summarise its conclusions but just directly criticised it, but more importantly because there were some major errors in your critique. Your text is in italics, my comments in bold: The researchers choose to only evaluate those studies that met certain criteria for “high quality” scientific investigations. No, this is a misunderstanding; they first did a global analysis of all trials and then a selection of high quality trials Of the original 110 trials, they found that 21 of the homeopathic studies fit this definition but only 9 of the conventional studies did so. The researchers did not provide any analysis of these high quality studies but instead chose to reduce these numbers to only those trials that had a large number of patients, claiming that these larger trials had less bias inherent in them. This wasn't a claim, nor does the issue of bias arise, it's merely an uncontroversial statement that larger trials have greater statistical power The researcher then compared 8 homeopathic trials with 6 conventional medical trials, even though these trials were no longer matched in any way. Well they weren't comparing the trials, so the point isn't relevant. They were comparing only the size of effect. Recall, the authors' premise was that if an effect is real, the size of the effect will not depend on the study size. If it is not real, then only small trials will show an effect, these being published because of the publication bias effect that maximises the likelihood that studies will be published when their effects are positive The final results of this small number of trials was that there was no significant difference between patients given a homeopathic medicine and those given a placebo. The authors claim that no further research on homeopathy is necessary, while advocates of homeopathy assert that almost all of the 8 homeopathic trials lacked external validity, that is, they used only a single homeopathic medicine given to every subject without the typical individualization of treatment that is commonly used in homeopathic practice. The last point is a fair point - if a treatment's efficacy depends critically on the ability of the practitioner to diagnose an appropriate treatment for an individual, then it becomes virtually impossible to test in a controlled way - and so there isn't much point in further research of that type at least.

I referenced rebuttals of the Lancet study and feel free to add to those. I wrote this section at some length because the study is unusual and notable for that reason, and also because it is so often misunderstood. What I tried to do was to explain what the study did - it's not our job either to endorse it or attack it; translating it to make it understandable (and it is a very complex paper) is however very much what we should be doing.

The bottom line is that we do not endorse or promote homeopathy, nor do we denigrate it. Gareth Leng 12:13, 4 March 2008 (CST)

It's important to avoid any suggestion that there is any acceptance of the theory behind homeopathy from any significant element of conventional medicine and science. There must be no confusion on that point. We needn't insist that the conventional science and medicine has got it right, but the general consensus of their views is clear, that the effects are those of the placebo effect. It is important to explain the theories and beliefs of homeopaths in a way that they would consider fair and accurate, but the representation of any scientific or medical views must be done in a way that they would consider fair and accurate too. Gareth Leng 03:49, 5 March 2008 (CST)

Gareth, it is a pleasure to discuss issues with you in a rational and non-emotional way. Thanx for improving upon my work, though you did edit out some important things (IMO). First, to clarify, companies who make homeopathic medicines ARE legally recognized and regulated by the FDA as "drug manufacturers." That is a fact. As for the Shang article, I re-inserted the reference to the concern that the homeopathic studies on which they based their conclusions lacked external validity. This does not mean that homeopathic research is not do-able. It simply means that there are only a limited number of conditions for which a single homeopathic medicine can be given effectively to everyone with a specific broadly defined disease. I am, however, confused why Shang and his team included only 1 trial testing Oscillococcinum in the TREATMENT of influenza, when the Cochrane Reports (2006) notes that there have been at least 3 large high quality trials. I am further confused why they completely ignored the allergy research by Reilly and team...and ignored the meta-analysis of Jacobs and team in the treatment of childhood diarrhea (instead, they included 1 of her 3 trials, even though the combined meta-analysis would have provided larger numbers). The bottomline is that Shang and team showed bad faith and bias in several design elements of their work that many reviewers have noted. Dana Ullman 08:07, 8 March 2008 (CST)

Fair enough, though I wouldn't use terms like bad faith and bias; they may have had good reasons - or there may be mistakes and shortcomings. I edited out "external validity" only because I felt this was a jargon term the meaning of which wasn't self evident. Maybe you can expand on that?Gareth Leng 05:43, 10 March 2008 (CDT)

This needs something

This sentence:

• Many homeopathic medicines sold in health food stores and pharmacies today are "low potencies," that is, at doses that do contain tiny amounts of the original medicine, while homeopathic medicines at potencies higher than about 24X, D24, or 12C (10^-24) contain no detectable ingredients apart from the diluent (water, alcohol or sugar). There is considerable scientific doubt about whether these doses can have any biological or therapeutic effect, but some scientists assert that homeopathic doses are compatible with biomedical experiences. .

From our statement above, it follows that remedies lower than 24X might have some plausible explanation in biomedical medicine, as they do contain a measurable amount of compound. Essentially, the first sentence seems to be talking about two different things (one plausible to skeptics, one not), while the second sentence seems to be lumping them into one - and it is unclear which one we are referencing. Is this intentional? --D. Matt Innis 19:49, 8 March 2008 (CST)

Good catch, Matt. I have made the correction in the article by adding "in low and high potencies." Please note that the reference to the Eskinazi article supports the evidence on the low potencies, while the other two references provide support for how high potency medicines fit within modern scientific foundations. Do you prefer if we separate out these references to the specific contention that supports, or is my grouping together OK? Dana Ullman 14:25, 9 March 2008 (CDT)

I am not a fan of inline references. I don't have access to the references, but I don't dispute that there isn't some sort of support out there for either contention. At this point, I'm really not as concerned about what others think of homeopathy as much as what homeopaths themselves are thinking. I haven't made my way through the entire article yet, so I'll let you keep going and jump in when I think I can help. --D. Matt Innis 19:08, 9 March 2008 (CDT)

Procedural aspect of reversion; no endorsement of content implied

In no way have I ever seen any convincing evidence that homeopathy has a rational foundation, although it is an excellent description of some classic principles of ritual magic (see The Golden Bough: A Study in Magic and Religion by Sir James George Frazer; online at http://www.bartleby.com/196/).

That being said, I am troubled by the procedural aspect here. Please correct me if I misunderstand, but my impression is that while complete reversion may be appropriate, a notice of intent to do so should be on the talk page, and the action taken by a Constable, possibly on the recommendation of a relevant Editor. This does not seem to have happened here.

Howard C. Berkowitz 12:36, 23 August 2008 (CDT)

Yeah, I suppose you're right. I'll revert it back to what was here earlier and then leave other people, more qualified than me, to do what they think is necessary. Personally, I don't think it should be allowed to stand as it is, though.... Hayford Peirce 12:42, 23 August 2008 (CDT)

Current content

From the introduction,

Tests of the efficacy of homeopathy have occasionally reported positive (where the principle of Homeopathy have been followed) as well as negative (where the principle of Homeopathy have not been followed) results, though the precise mechanism of action for its extremely small doses has not yet been verified and remains a stumbling block to its acceptance from mainstream medicine and science.

I'm trying to be fair here, and I'll freely admit a preference for molecular pharmacology. Nevertheless, from a purely statistical standpoint, I don't know how to interpret "tests...have occasionally reported".

If I understand some of the principles of homeopathy, they generally reject randomized clinical trials, and the associated statistical analysis, because homeopathy is individualized and trials on groups violate the principles. Is there, then, any way that the results of these tests can be expressed in statistical measures of confidence, etc.?

Howard C. Berkowitz 12:53, 23 August 2008 (CDT)

Revisions

I have taken a look at recent changes, and am sorry that I have felt it necessary to make significant revisions and delete many references. First, it is essential that this article does not appear, at any stage, to endorse the claims of homeopaths, while equally it should not denigrate homeopathic beliefs. This article should report those beliefs fairly and describe accurately and reasonably what homeopaths do. However, the article should not claim, or appear to assert, that homeopathy has a scientific validity or clinically attested efficacy that is not accepted by science or medicine. There is no need to labour the criticisms of homeopathy, they should be explained simply, clearly and concisely. Insofar as homeopaths reject the appropriateness of scientific scrutiny, that can be stated and explained.The article should clearly declare the skeptical view and the homeopathic view, ideally in a way that allows the reader to judge

The deletion of references is essential. On Citizendium, no article will be approved without editorial endorsement of the quality and appropriateness of the references; this large number of references in weak sources simply stretches demands on editorial scrutiny beyond acceptable limits. I've started by eliminating those references which prima facie would not meet my minimal criteria for noteworthiness. The others I will look at more closely before I consider removing them.

Gareth Leng 04:20, 25 August 2008 (CDT)

Absolutely. We need to push hard for scientific accuracy in these articles. I think that the article as it currently is could be improved by merging the 'skeptical view' and the 'scientific research' sections, since - as far as I can see - the skeptics are right, and we have thus got redundancy in the article. --Tom Morris 05:33, 25 August 2008 (CDT)

Gareth, or anyone---

I have a question about homeopathic clinical trials, or, if they exist in a form reasonably compatible with a double-blinded randomized clinical trial. Without having read the references, I have the impression that they are principally meta-analyses.

This is a question where I am trying to get information, rather than demonstrate a preconception. Does the homeopathic principle (if I understand it) that each patient's treatment must be individualized prevent the use of prospective randomized double-blind studies, because there cannot be a meaningful experimental arm if every patient receives a different set of drugs? I suppose this could be double-blinded if the homeopathic clinician does the appropriate diagnosis and treatment recommendations, sends the presciption (if that's the correct term) to the pharmacy, and the pharmacist breaks the seal on a sequential blinding record and fills the prescription either with the homeopathic preparations or placebo, and sends it back, blinded, to the clinicians?

Part of the reason I'm curious about this is a broader methodological problem than homeopathy. If genomic medicine becomes highly individualized, there may be a comparable blinding problem; the only way I see it working is the pharmacist, again, either prepares the genomically defined prescription or placebo, and sends it back to the clinician.

Am I missing something fundamental about the homeopathic clinical trials? Are any of the "high quality" trials prospective and double-blinded? For want of a better term, is there a recognized reference for "statistical design of homeopathic clinical trials" that is statistically respected? I keep thinking that if such doesn't exist, and genomic trials deal with more than one or two variables, the statistical problems will be comparable -- that is not meant as an endorsement or criticism of homeopathic trials; merely a thought pharmacogenomics and homeopathy might face similiar statistical challenges for prospective trials.

Again, this is a request for information to any qualified person that has gone through experimental designs in detail. Unfortunately, I'm in a fishing village several hours from the nearest medical library of quality, and I don't have a large journal budget.

Howard C. Berkowitz 05:47, 25 August 2008 (CDT)

This is a well phrased and apt question and you are right in that this is a much broader problem than homeopathy. Perhaps generally for clinical trials the issue is that while we know that genetic diversity and diverse disease aetiologies means that most treatments will have "responders and "non-responders", the design of "gold standard" trials is predicated on the assumption that a treatment is only useful if there is a high proportion of responders. Their power to detect subpopulations of responders is generally limited.

You are right that a rigorous double-blind trial could be performed for homeopathy in the way you describe, but would need a lot of organisation, and cooperation from many homeopaths. Interestingly some of the early homeopaths (including Hahnemann) were well aware of the need to exclude placebo effects, and proposed placebo controlled trials well before these became routine in medicine. Their proposed designs were naive by current standards, but for the time they were exceptional.Gareth Leng 12:03, 25 August 2008 (CDT)

Hi, I guess we need a discussion here. I provided 40 trials

*Colas H., Aubin M., Picard P., Lebecq J.C.. "Inhibition of lymphoblast transformation test (LTT) in phytohaemagglutinin (PHA) with Phytolacca americana in homeopathic dilution". Ann. Homéopat. Fr., 1975, 6: 1-11.

• Mansvelt J.D., van Amons E. "Inquiry into the limits of biological effects of chemical compounds in tissue culture. I. Low dose effects of mercury chloride". Z. Naturtorschung, 1975, 30: 643-649.
• Poitevin B., Aubin M., Royer J.F. "The effects of Belladonna and Ferrum phosphoricum on the chemoluminescence of human poly-morphonuclear neutrophils". Ann. Homéop. Fr., 1983, 3: 5-12.,
• Aubin M. "Effect of aconitum and veratrumon the isolated perfused heart of the common eel (Anguilla anguilla)". Comp. Biochem. Physiol., 1984, 776: 367-369.
• Aubin M. "Elements of homeopathic pharmacology". Homéopathie Franç., 1984, 72:231-235
• Wagner H., Jurcic K., Doenicke A., Rosenhuber E., Behrens N. "The effect of homeopathic preparations on the phagocyte activity of granulocytes. In vitro tests and double-blind controlled trials". Arzneim. Forsch./Drug Res., 1986, 36: 1424-1425.
• Poitevin B., Aubin M., Benveniste J. "Approach to quantitative analysis of the effect of Apis mellifica on the degranulation of human basophils cultivated in vitro". Innov. Tech. Biol. Med., 1986, 7: 64-68.
• Wagner H., Kreher B., Jurcic K. "In vitro stimulation of human granulocytes and

lymphocytes by pico- and femtogram quantities of cytostatic agents". Arzneim. Forsch./Drug Res., 1988, 38: 273-275.

• Poitevin B., Davenas E., Benveniste J. "In vitro immunologicaldegranulation of human basophilsis modulated by lung histamine and Apis mellifica". Brit. J. Clin. Pharmacol., 1988, 25: 439-444.
• Wagner H., Kreher B. "Cytotoxic agents as immunomodulators". Proceedings of the 3rd

GIRI meeting, Paris, 1989, 31-46.

• Boiron J., Belon P. "Contributions of fundamental research in homeopathy". Berl. J. Res. Hom., 1990, 1: 34-35.
• Bornoroni C. "Synergism of action between indoleacetic acid (IAA) and highly diluted

solutions of CaCO3 on the growth of oat coleoptiles". Berl. J. Res. Hom., 1991, 1 (4/5): 275-278.

• Boiron J., Abecassis J., Cotte J., Bernard A.M. "Study of the action of Hahnemannian dilutions of mercury chloride on the mitotic index in animal cell cultures.". Ann. Homéop.Fr., 1991, 23: 43-49.
• Bellavite P., Chirumbolo S., Lippi G., Andrioli G., Bonazzi L., Ferro I. "Dual effects of formylpeptides on the adhesion of endotoxin-primed human neutrophils". Cell. Biochem. Funct., 1993, 11: 231-239
• Chirumbolo S., Signorini A., Bianchi I., Lippi G., Bellavite P. "Effects of homeopathic preparations of organic acids and of minerals on the oxidative metabolism of human neutrophils". Br. Hom. J., 1993, 82: 227-244.
• Doutremepuich C., Lalanne M.C., Ramboer I., Sertillanges M.N., De Seze O.

"Platelets/endothelial cells interactions in presence of acetylsalicylic acid at ultra low dose". Omeomed 92 (C. Bornoroni, ed.), 1993, Editrice Compositori, Bologna: 109-115.

• Fougeray S., Moubry K., Vallot N., Bastide M. "Effect of high dilutions of epidermal growth factor (EGF) on in vitro proliferation of keratinocyte and fibroblast cell lines". Br. Hom. J.,

1993, 82: 124-125.

• Enbergs H., Arndt G. "Effects of different homeopathic potencies of Lachesis on lymphocyte cultures obtained from rabbit blood". Biol. Tier., 1993, 4.
• Gibson S.L., Gibson R.G. "The effect of homeopathic potencies of house dust mite on the migration of house-dust sensitive human leukocytes". Complement. Ther. Med., 1996, 4: 169-171.
• Kanui T.I., Enbergs H. "The effects of Nux vomica, Homaccord and Atropinum comp. on intestinal activity in vitro". Biol. Tier., 1996/1, 43-47
• Sainte-Laudy J., Belon P. "Application of flow cytometry to the analysis of the

immunosuppressive effect of histamine dilutions on human basophil action: effect of cimetidine". Inflamm. Res., 1997, 46:S27-S28.

• Chirumbolo S., Conforti A., Lussignoli S., Metelmann H. et Al. "Effects of Podophyllum peltatum compounds in various preparations and dilutions on human neutrophil functions in vitro". Br. Hom. J., 1997; 86-16.
• Harisch G., Dittmann J. "In vivo and in vitro studies on the efficiency of potentized and nonpotentized substances". BT, 1997, 2; 40-46.
• Harisch G., Dittmann J. "Experiments with the effects of Ubichinon-Injeel and strong

Ubichinon-Injeel on an acellular system". BM, 1997, 3; 99-104.

• Enbergs H. "Efficacy of the homeopathic drugs Suis and Arnica comp.-Heel® on

lymphocyte and phagocyte activity". BM, 1998, 1; 3-11.

• Harisch G., Dittmann J. "Influence of dilutions and potencies of cAMP on different enzymatic systems". BM, 1998, 2; 55-62.
• Harisch G., Dittmann J. "Studies of the principles of homeopathy; the change over from in vivo to in vitro experimental research". BM, 1998, 2; 55-62.
• Harisch G., Dittmann J. "Determination of the activity of acid phosphatase with cAMP at various potencies". BM, 1999, 1; 4-8.
• Gomez J.C. "Contribution to study of the efficacy of homeopathic potencies of phosphorus". BT, 1999, 2; 53-57.
• Harisch G., Dittmann J. "Determination of the activity of acid phosphatase in the presence of Ubichinon comp.". BM, 1999, 4; 188-194.
• Dittmann J., Kanapin H., Harisch G. "Biochemical efficacy of homeopathic and electronic preparations of D8 potassium cyanate". FKM, 1999, 6; 15-18.
• Palermo C., Filanti C., Poggi S., Manduca P. "Osteoporosis in vitro in rat tibia derived osteoblasts is promoted by the homeopathic preparation, FMS Calciumfluor". Cell Biol Int, 1999, 23(1): 31-40.
• Schmolz M. "Thin-layer chromatography (TLC)of homeopathic active constituents". BM, 1999, 5; 248-250.
• Datta S., Mallick P., Khuda Bukhsh A.R. "Efficacy of a potentised homeopathic drug in reducing cytotoxic effects produced by arsenic trioxide in mice". Complement Ther Med, 1999Jan; 7 (8): 62-75 (a).
• Datta S., Mallick P., Khuda Bukhsh A.R. Efficacy of a potentised homeopathic drug in reducing cytotoxic effects produced by arsenic trioxide in mice". Complement Ther Med, 1999 Sep; 7 (3): 156-63 (b).
• Heine H. "Non-cytotoxic antiviral action of a homeopathic drug". Ärzteitschrift

fürNeturheilverfahre, 2000; 41: 542-7.

• Kundu S.N., Mitra K., Khuda Bukhsh A.R. "Efficacy of a potentised homeopathic drug in reducing cytotoxic effects produced by arsenic trioxide in mice". Complement Ther Med, 2000 Sep; 1 (3): 157-65.
• Crocnan D., Greabu M., Olinescu R. "Stimulatory effect of some plant extracts used in homeopathy on the phagocytosis induced chemiluminescence of polymorphonuclear leukocytes". Rocz Akad Med Biochemist, 2000; 45: 246-254.
• Dittmann J., Harisch G. "Difference between the efficacy of single potencies and chords". BM, 2000, 1; 18-23.
• Dittmann J., Kanapin H., Harisch G. "Influence of some homeopathic drugs on the catalytic activity of uricase, acid phosphatase and thecytosol glutathion-S-transferase". BM, 2000, 3; 125-131
• Dittmann J., Kanapin H., Harisch G. "Influence of some homeopathic drugs on the catalytic activity of cAMP-dependent protein kinases". BM, 2000, 6; 289-296.
• Jonas W., Lin Y., Zortella F. "Neuroprotection from glutamatetoxicity with ultra-low dose glutamate". Neuroreport, 2001 Feb 92; 12 (2): 335-9.Talk:Homeopathy/Archive 13/Reflist that were deleted from the article. Was there something wrong with them?—Ramanand Jhingade 21:20, 26 August 2008 (CDT)

I wanted to get some interpretation of the statistical methodology, not just a list of references. Howard C. Berkowitz 21:24, 26 August 2008 (CDT)

Dear Howard,

Remedy selection in Homeopathy is highly individualized, e.g.a person who gets wet in the rain and catches cold immediately needs a different remedy from a person who gets wet in the rain everyday and catches cold only on the 5th or 6th day. The trials I mentioned take care of the individualization.—Ramanand Jhingade 21:44, 26 August 2008 (CDT)

I asked a specific question which will have to be considered in pharmacogenomics as well. Is it possible to have a randomized double blind trial in homeopathy? If so, how is it done? I would expect either a statistical explanation, or at least some references to generalized methodology. I already addressed, to Gareth, the question of the conflict between the randomized controlled trial and individual medicine. We agreed it is a problem, but possibly resolved.

I don't have access to these journals. Let me try the question again. A randomized double blind trial would consist of the homeopathic physician making a diagnosis, writing a prescription, and sending it to a compounder of the remedy. The compounder would have a set of sealed, numbered envelope. For the first patient, the compounder opens the envelope, which has a piece of paper saying "remedy" or "placebo", assuming there was no accepted therapy that made a placebo-controlled trial unethical. If the paper said "remedy", the bottle sent back to the homeopathic physician would contain exactly what he prescribed. If the paper said "placebo", the bottle would have water, or appropriately flavored liquid not containing the homeopathic remedy. The physician would administer what was in the bottle and chart the results. At the end of the trial, all charts would be collected, and it would be determined if there was a statistically significant difference between the remedy group and the placebo group.

Do any of these studies use a similar methodology? For simplicity, ignore the usual procedure, where a safety board, with access to both the clinical records and the record of which patients received the remedy, are monitoring and will intervene if either the treatment or placebo arm is significantly more or less helpful or dangerous.

This is the routine methodology when there is no recognized treatment. If there is a recognized treatment, then the best known treatment is used instead of placebo.

If it were for chronic disease, then a randomized double-blind crossover can be done. In that technique, when the compounder fills multiple prescriptions for the patient, one set will have remedy and the other will have placebo. The randomization states whether which set is given first, and possibly the number of doses at which the crossover is done. Howard C. Berkowitz 22:26, 26 August 2008 (CDT)

There have been placebo controlled studies of Homeopathy, which show that Homeopathy works (where the principles of Homeopathic remedy selection have been followed) - please look up the Net (there are too many to name here).—Ramanand Jhingade 22:02, 28 August 2008 (CDT)

Authoritative content in articles

"Look up on the net" is not an appropriate response to a question about content in an encyclopedia article. For an article on homeopathy to be considered authoritative, it needs to meet the same criteria as would an article on, for example, the statement that aromatase inhibitors are more effective in breast cancer than tamoxifen. It would be worth noting that the safety monitoring board stopped those randomized controlled trials because the benefit of the experimental treatment was so striking that it would have been unethical not to offer it to all trial participants.

For example, under diabetes mellitus, there is a summary of the finding of RCTs:

If dietary changes are not successful, medication is needed. A systematic review of randomized controlled trials found that metformin and second-generation sulfonylureas and are excellent choices.[53] Confirming the role of metformin, the initial choice of anti-diabetic drug has been compared in a randomized controlled trial which found "cumulative incidence of monotherapy failure at 5 years of 15% with rosiglitazone, 21% with metformin, and 34% with glyburide."[54] Rosiglitazone had more weight gain and edema.[54] Rosiglitazone may increase risk of death from cardiovascular causes.[55] Pioglitazone[56] and rosiglitazone may increase the risk of fractures.[57] Pioglitazone, an insulin sensitizer, may reduce atherosclerosis compared to sulfonylureas which are insulin secretagogues.[58]

,

That is the level of citation that I expect to see in an authoritative article. Ideally, I'd like to see more than percentages, such as measures of statistical significance, which would commonly be listed in a journal.

Given that some of the basic principles of homeopathy are at odds with basic chemistry, I'm afraid that for an article to treat homeopathy as a serious form of therapy, there has to be some explanations of why the law of similars should be exempt from the usual expectation that the mode of action of a new drug can be associated with at least some basis in molecular pharmacology.Howard C. Berkowitz 22:34, 28 August 2008 (CDT)

The effects of the remedies should be good enough to accept that it works. There are innumerable trials which show that Homeopathy works for so many problems/diseases. For some who feel that Homeopathic remedies are 'placebo', there is a Homeopathic remedy, "Nux Vomica", which in the 30th potency, taken thrice a day, can produce loose motions in anyone except the 'Constitutional' Nux Vomica Patient - this any one can try, to prove it works. Citizendium is the forum for the experts, so if you're a skeptic who has never tried Homeopathy, I think you should move over to Wikipedia (you can make whatever preposterous allegations there, because the expert Homeopaths are not allowed to post there).—Ramanand Jhingade 02:24, 30 August 2008 (CDT)

Preposterous allegations seem to be the domain of the homeopaths. Perhaps you can enlighten us on your other topics of interest: telepathy, past life regressions and remote viewing. Because those are all completely sane. --Tom Morris 03:49, 30 August 2008 (CDT)

The sad thing is that Gareth, who is certainly not principally an alternative medicine practitioners, indicated that he has seen homeopathic trials that did use some kind of randomized critical trial. I believe he said that those trials, as well as past convetional trials, might not meet the better developed statistical significance rules that are applied today, but I did not his comment as suggesting that such a trial was impossible for a treatment approach using individualization — not homeopathy necessarily, but what will obviously be needed in pharmacogenetics.

A good, productive discussion could start, and create something that is not precisely original research, but the type of expert synthesis that is part of the CZ, not WP, model. The article would not be about homeopathy specifically, but, an article — dare I say complementing? — the main randomized controlled trial for evaluating any inherently randomized trial.

I suggested one way of doing a double-blind trial of any individualized therapy, but apparently that was not considered worthy of consideration. 'Note to Dr. Jhingade: that last clause was very near the edge of what is considered unprofessional language for CZ discussions. May I observe that this discussion is getting rather emotional, as evidenced by comments such as

I think you should move over to Wikipedia (you can make whatever preposterous allegations there

are far more likely to be over the line , or anyone referring to anything as a "preposterous allegation."

I'm beginning to wonder if there needs to be a policy or two at CZ:

1. "Look it up on the Internet/Google" is never an appropriate response to a serious discussion question. That may already have been done, but the cited journal articles were not available online. One of the purposes of a wiki, as I see it, is to get, with calm interpretations, of material that might not be readily available.
2. For something to be considered for a Health Sciences or Healing Arts article, one with no substantial backup certainly can be an article defining and describing the function, but, to start suggesting something is efficacious, that minimal criteria of independent evaluation need to be available. That might not be a multicenter double blinded randomized crossover trial, but it has to have some statistical rigor. Unfortunately, I don't really see how a meaningful open-label trial could be done for any individualized form of therapy, which is not unique to homeopathy or picking on homeopathy.

As far as homeopathy specifically, I would suggest gently that the theory of similars, which runs rather counter to conventional chemistry, needs to be given some solid theory, or it's not a matter of skepticism &mdash. Accepting that a 30th potency has an effect requires throwing away molecular pharmacology.

I would also suggest that to discuss any alterntative therapy of anything, not just in the healing arts, proponents of the alternatives are not going to get very far if they insist on defining the terms of the discussion, such as "never use treat". To require someone who has not prejudged the alterative, but does believe a more conventional method is valid, demanding that they abandon their language and model in order to discuss it becomes more like a matter of religious faith than science. They are inherently different. I cannot argue that a given work is or is not divinely inspired; such a claim is not subject to testing and saying it is a matter of faith is no more unfair to say that mathematics cannot derive from untestable axioms. If the axioms are not credible, however, the discussion won't go much farther.

Howard C. Berkowitz 10:10, 30 August 2008 (CDT)

Ramanand Jhingade suggests that on Wikipedia, homeopaths are not given expert status (which is strange, since Wikipedia does not have any form of expert status). I think we have a problem here too. Articles on the Citizendium are supposed to represent fairly the scholarly consensus on topics, and debate around the topic. But there are disciplines like homeopathy where the failure of scientific tests and clinical trials to determine the efficacy of something lead to "alternative systems of expertise being setup". For the same reason I don't think that a biologist from the Institute for Creation Research should be given an expertise-based editorial role in articles in the Biology Workgroup, I don't think that alternative medicine practitioners should be able to do similarly in Health Sciences (and I'm not sure about Healing Arts - surely, stuff that works would become a Health Science, while stuff that doesn't work is still a Healing Art?). I think we need Editorial Council guidance here. I don't think the Citizendium should be a free-for-all for advocates of non-scientifically-supported ideas to run amuk. The Citizendium should be reality-based, not fantasy-based. --Tom Morris 10:28, 30 August 2008 (CDT)

Were I Emperor of the Universe, I wouldn't have separated healing arts and health science. "Complementary and alternative medicine" aren't an ideal term, but, if applied reasonably, it's perfectly possible to include things that are not easily measurable, such as religious services as part of comfort care. To take that as a neutral issue, however, there are some ethicist and HIPAA law controversy about the level of access that chaplains should have to Personal Health Information. Anecdotal, but I have watched the monitors on an ICU patient, and seen a positive change (although not permanent) in physiological status following each religious ritual. I don't see any way, however, for that to be rigorously tested, although there can be reasonable reporting, and also discussion of associated areas (e.g., a recent medical discussion question is what a physician, not of the patient's religion, is asked by patient or family to pray with them)?

I have no problem when I see something as complementary to mainstream methods. When, as in this case, there is strong argument that the proposed method is fundamentally superior and has a more accurate world-view, that has to be supported. While I don't consider the U.S. courts an ideal model of establishing knowledge, there has been a decent trend in recent years to expect that expert witnesses are testifying on principles generally accepted in a field. If the principles are not generally accepted, the expert bears the burden of proof. In this case, I expect that any therapy has appropriate statistical backing, and I've discussed how that is difficult in "individualized" methods (note that I did not say either "heal" or "treat"), but not impossible.

There's also, in anything dealing with health, the issue of when a practitioner goes outside the reasonable scope of his or her expertise. For example, there have been NIH multidisciplinary consensus panels showing that chiropractic may be the most effective approach to acute low back pain. I've worked with some chiropractors that try for a synthesis; the ones I know best have excellent relations and mutual referrals with internists and other specialists; some also have taken what they consider complementary training in physical therapy or exercise physiology. Anecdote not being the singular of data, I lost a inlaw and close friend because an individual chiropractor insisted all pain was within his scope of practice -- missed obvious visceral symptoms, as well as ignoring blood pressure, and the patient's aortic aneurysm had blown completely before anyone else looked at it. At the time, the surgical mortality for the particular repair was about 50%, but that's better than zero. One bad experience with a specialist in any discipline doesn't sour me on the discipline, although I am very careful with some (don't get me started on orthopedist and neurologist jokes--and I know both brilliant and idiotic specialists in both.)

Yes, I do think policy is involved here.

Howard C. Berkowitz 12:11, 30 August 2008 (CDT)

Just one point regarding the fantasy based vs reality based concept. While extreme views in any field should not be endorsed or given excessive space, I see no problem in presenting the view itself. It all comes down to balance.

With regard to the split of health sciences and healing arts, I think this makes sense to some degree. Obviously a topic can be in both workgroups, some will be restricted to one or the other. The area of health has a full spectrum of topics.

As for experts, we must consider that many biologists are religious. And even the ICR has biologists who would serve well as editors on citizendium biology articles. Most science does not touch on the religious science debate. For the areas where there might be a problem, evolution represents one such case, then the editors will have to duke it out. One would hope that within a representative group of editors an objective article could emerge. Chris Day 12:54, 30 August 2008 (CDT)

I'm sorry for ruffling feathers here. Please put yourselves in my shoes for a moment - Imagine you're a Homeopath who has healed not just yourself, but also thousands of others, wouldn't it be irritating to be told that you use placebo?—Ramanand Jhingade 21:06, 30 August 2008 (CDT)

It would be irritating, sure, and very understandably so. But how do you *know* that you healed them rather than the placebo effect? To you, this is real. To others, this is just one person's anecdotes, no more, no less. Hayford Peirce 22:30, 30 August 2008 (CDT)

Reality, as they say, is that thing which is still there regardless of whether you believe in it. It is not the job of authors on the Citizendium to help you maintain your fantasies, however many times you dilute them. --Tom Morris 04:53, 31 August 2008 (CDT)

I've healed people who had no faith in Homeopathy. I've also healed animals and babies who can't be influenced. I have reports/snaps of diseases/problems before and after. A lot of other Homeopaths also have reports of what they've done. I've also posted 40 studies above & I can post more if needed.—Ramanand Jhingade 22:38, 30 August 2008 (CDT)

Trying yet again

There is a term in current medicine, called VOMIT: Victim Of Modern Imaging Technologies. My colleagues in trauma use it most often, when they find someone operating because they see something in a CT scan that is not consistent with physical presentation and other laboratory studies. They also use it to describe situations where the surgeon does not operate on a patient, injured in an automobile accident, gives a history consistent with blunt abdominal trauma, has hematological tests consistent with loss of blood, presents physical signs indicative of something very wrong in his belly, but not showing any free fluid on ulrasound or CT.

The first thing that I need to see as reproducible is diagnosis, and I have yet to read a tightly written, clear, explanation of how a homeopath diagnoses, for patients with a certain class of symptoms, or "chief complaint". I expect the underlying model to be no more and no less than is considered best current practice for such things as chest pain of acute onset, or severe depression perhaps following an unsuccessful suicide attempt.

Sorry, if the answer is that a homeopath observes symptoms, and perhaps symptoms and not signs, and then tries to find a preparation that will reproduce them in low dose, and has no other model, we are not going to get any further. In those patients with acute chest pain, there are very real and different mechanisms than can produce apparently similar symptoms, and I am using symptom in a quite specific way. Symptoms alone are not adequate for deciding if pain is coming from myocardial ischemia secondary to 70 percent occlusion of two major coronary arteries, or Tietze's syndrome, or infectious pericarditis, each of which can have quite different objective signs, and require quite different treatment.

For the patients with coronary artery disease, there are emergency interventions, there are longer-term drug or surgical treatments, and there are indeed nutritional and behavioral changes that can help. Even within a given disorder, there will be different responses to the same interventions, which we are starting to understand, in some cases, on a genetic and biochemical basis.

So far, I hear no rigor in anything described. At least three times, I have either proposed a procedure for prospective statistical analysis of individualized treatments, or asked you explain how you would provide statistical evidence that your diagnosis and healing are correct, and have gotten no response of any substance. Your personal experience, or a generic "look it up on the Internet", may be acceptable in some contexts, but I believe it fair to say that subject matter experts here won't accept it as proof. Statistical experimental trials work in many disciplines, not only health -- I can describe how I would determine which of three different approaches to navigating a boat is most accurate, understanding that there will be some individual variations if human judgment supplements instrument readings. I can describe equivalent statistical approaches to a standardized approach to health diagnosis and treatment.

Not only I have said that pharmacogenetics will necessarily be individualized, but it still is subject to prospective clinical trials. Not all controlled clinical trials have a placebo arm; indeed, it would be considered unethical to use placebo controls when there is some standard treatment that can demonstrate some efficacy.

As long as you respond with anecdotes and announcements that our models are wrong, without giving models that are as logical, as long as you will not discuss detailed statistical evaluation, we aren't going to get anywhere -- and I suspect the Editorial Council may eventually decide that without such structured presentation, the material does not qualify for inclusion in Citizendium. I truly would be delighted to see solid evidence that an approach involving dancing widdershins around the chalice and athame during the full moon, and performing the Great Rite would assist a patient with a set of symptoms, but I may also recognize that is not subject to scientific proof. Howard C. Berkowitz 23:51, 30 August 2008 (CDT)

Homeopaths study the 'group of symptoms' a person suffers from, matches it with what is produced by a drug in it's crude form and gives that remedy in a potentised form (nano-pharmocology), to heal him/her. Homeopathic remedies reduce, modulate, and stimulate the reactivity of the three main biologic systems (nervous, immune and endocrine), to rebalance their physiological functioning, acting in both directions, (psychosomatic and somatopsychic). There will be more scientific evidence as Homeopathy becomes more and more popular - Homeopathy is already the most popular medical system after Allopathy (the ordinar, conventional medicine available in the medical stores).—Ramanand Jhingade 21:09, 31 August 2008 (CDT)

Notability of citations

Ramanand, you really need to heed the above post from Howard Berkowitz. We all acknowledge there is anecdotal evidence otherwise homeopathy would not be popular, but being popular is not that useful with regard to writing an accurate article with respect to academic standards.

Next, citing masses of studies that prove your point is also less than useful. I agree with Howard that these papers need to be analysed in context of "some interpretation of the statistical methodology". But also they need to looked at from the perspective of how well the papers are received. This is the reason that Gareth Leng deleted many of the references that you added to the article.

One homeopathic paper caught my eye recently, mainly as it was published in a good journal (Chest Journal).

Frass M, Dielacher C, Linkesch M, et al. (2005) Influence of potassium dichromate on tracheal secretions in critically ill patients. CHEST. 127(3):936-941.

When I first saw this paper I did a quick search using Web of Science and found that it had no citations. That is still the case today. I then looked at all the papers by M Frass in 2005 (a total of 15) and found that nine others of these had not been cited and the other five had twenty citations between them (now 28). The most cited had nine citations (now ten)

Schaumann N, Lorenz V, Schellongowski P, Staudinger T, Locker GJ, Burgmann H, Pikula B, Hofbauer R, Schuster E, Frass M: Evaluation of Seldinger technique emergency cricothyroidotomy versus standard cricothyroidotomy in 200 cadavers. Anesthesiology 102. 7-11.2005;

However, of those ten citations, two were correspondence to Anesthesiology criticising the paper and one a reply from Frass. Below is a flavor of the letters that appeared in Anesthesiology to criticise the paper.

Cricothyroidotomy: Do Not Compare Small Apples to Big Oranges

Anesthesiology - Volume 103(3), September 2005, p 667

Dulguerov, Pavel M.D., P.D.*; Gysin, Claudine M.D.

• Geneva University Hospital, Geneva, Switzerland. pavel.dulguerov@hcuge.ch

To the Editor:— ............ Finally, it is surprising that in a randomized study, the cadavers were significantly heavier and with larger necks in the surgical group. Stating that “the differences in weight and circumference of the neck were not clinically relevant” is either frivolous or represent a misunderstanding of the risk factors for this operation. In conclusion, this study, which seems exemplary at first glance, suffers from major methodologic flaws. Doubling of the failure rates should be an obvious reason to prefer a procedure, especially when a failure for cricothyroidotomy means a probable death for the patient. Overlooking these data and basing the conclusion on the duration of the procedure seems bewildering. Furthermore, these delays (time to tube insertion and time to first ventilation), although seeming objective, are somewhat subjective because they were performed by an unblinded and hopefully unbiased observer.

Surgical Cricothyroidotomy Technique

Anesthesiology - Volume 103(3), September 2005, pp 667-668

Richard J. Price, F.R.C.A.

Schaumann et al. are to be congratulated on their large and detailed study on cricothyroidotomy techniques.[1] However, the suggestion that their results favor the Seldinger technique as a method of inserting a surgical airway is misleading. The control technique used was inappropriate; the airways used were not comparable, and uncuffed narrow bore tubes may not be suitable as emergency airways. The clinical applicability of the study is therefore limited. The authors did not discuss these deficiencies in their article. ............

Surgical Cricothyroidotomy Technique

Anesthesiology - Volume 103(3), September 2005, p 668

Frass, Michael M.D.*; Schaumann, Nikolaus M.D.; Lorenz, Veit M.D.

• Medical University of Vienna, Vienna, Austria. michael.frass@meduniwien.ac.at

In Reply:— ....... We are concerned about the authors' use of the aggressive terms of “frivolous” and “misunderstanding.” Having performed more than 500 cricothyroidotomies in corpses ourselves, we are sure that a mean difference of 1.6 cm in neck circumference is not clinically relevant. If someone has performed more cricothyroidotomies in corpses, we are ready for discussion. ........ Again, we thank both readers for their valuable comments and helpful criticism. However, we cannot agree that the clinical applicability of our study is limited.

Michael Frass's next most popular publication from 2005 is:

Frass M, Schuster E, Muchitsch I, Duncan J, Gei W, Kozel G, Kastinger-Mayr C, Felleitner AE, Reiter C (2005) Bias in the trial and reporting of trials of homeopathy: A fundamental breakdown in peer review and standards? JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE 11 (5), 780-782.

It is editorial material and has been cited eight different times by Lionel Milgrom, an enthusiastic advocate of homeopathy who writes many letters to the editor and editorials on the topic (hence eight citations and counting).

What needs to be considered here is that not all papers, even those published in high impact journals, are notable. Of those that are notable, it could be due to the breakthrough science or for its notoriety (i.e. bad science). Frass, who has a prolific publication record, does not appear to attract much attention from his peers. And the little he does get appears to be from critical letters to the editor. To have most of your papers with zero citations would suggest his research is not particularly notable in his own field. Articles such as this one in the Chest Journal seem interesting and notable but, on closer inspection, they are often not as notable as they first appear.

Similar rigor needs to be applied to all papers for them to be useful source material for citizendium, or any encyclopedia. Chris Day 11:19, 31 August 2008 (CDT)