Talk:Alternative medicine: Difference between revisions

Studying Complementary and Alternative Therapies - JAMA

Another interesting article:

• Studying Complementary and Alternative Therapies. By Paul A. Offit, MD, May 2, 2012, JAMA. 2012;307(17):1803-1804. doi:10.1001/jama.2012.518

Brangifer (talk) 03:49, 23 May 2012 (UTC)

A "Viewpoint", yes, but not an especially interesting, or even original, one. Vitaminman (talk) 08:42, 25 May 2012 (UTC)

Clinical outcomes for cancer patients using complementary and alternative medicine - Altern Ther Health Med.

Another interesting article:

• Clinical outcomes for cancer patients using complementary and alternative medicine. Chan A, Lin TH, Shih V, Ching TH, Chiang J. Altern Ther Health Med. 2012 Jan-Feb;18(1):12-7.

Vitaminman (talk) 20:41, 24 May 2012 (UTC)

Yes, published in the prestigious Alternative Therapies In Health And Medicine journal...JoelWhy (talk) 20:44, 24 May 2012 (UTC)

Although the authors state in the abstract that CAM use "provided an absolute reduction of infection episodes", what they really mean is that CAM use was associated with a lower infection risk. Obviously, you can't seriously consider assigning causality on the basis of a retrospective cohort study which made no apparent attempt to control for possible confounding variables.

It's difficult to comment further without the full text, which I'll have to dig up, but the abstract raises some interesting questions. For example, if patients using CAM died more quickly, they would likely have a lower infection rate - because once you die, you can't get any more infections. I'm ordinarily willing to give authors the benefit of the doubt that they've handled these sorts of competing risks appropriately, but my experience with the alt-med literature has led me not to assume anything of the sort, particularly as the authors rather surprisingly failed to comment on survival or overall mortality in the cohort in the abstract. MastCell ^Talk 23:53, 24 May 2012 (UTC)

(Also commenting without looking at the specifics) I find it odd that they are commenting on antibiotics use and infections, as opposed to say, cancer mortality, all-cause mortality or some other endpoint that's more relevant. Smells like one of those statistical fishing expeditions where they analyze 50 variables and (shockingly) find two or three are "statistically significant"... Yobol (talk) 00:15, 25 May 2012 (UTC)

I haven't read the actual study (only the abstract is available for free, AFAIK.) However, based on the information provided, no definition of CAM is given. Some of these studies classify things like diet and exercise as CAM. So, if you study how people who (a) improved their diet, (b) increased the amount of exercise, and (c) began to drink magic water, and then they do better than those who made no such changes, these researchers conclude that the magic water must have worked. Brilliant!JoelWhy (talk) 12:33, 25 May 2012 (UTC)

Based on the abstract and the first few paragraphs (free preview of the first page only at [1]), it's almost certainly a statistical fishing expedition: "The authors collected data on clinical characteristics for each patient and assessed the differences between each characteristic at baseline...and at 6 months after baseline measurement." In other words, in this retrospective study they took all 357 case files, compared every measure that was reported in each, and kept plugging away until they found a spurious statistical 'significance' on one of the metrics. They then went further and performed a 'subgroup analysis' on the one measure where they had spurious significance in order to show a more dramatic benefit for the metastatic disease subgroup; even if you randomly divide a group that has a marginal effect in it, you're likely to end up with one subgroup showing a larger effect (while the other group(s) show a smaller effect). I suspect that if they had been presenting 95% confidence intervals instead of just p-values, it would be much more conspicuous just how wobbly these putative effect sizes are.

The authors appear to have lumped together all uses of 'oral CAM', which included any and all of "'food supplements..., traditional Chinese medicine (TCM), special diets, and vitamins." I suspect that their samples wouldn't have been large enough to produce statistical significance for anything if they didn't pool all those disparate therapies into one 'CAM' group. I'm not going to cough up $15 to read the entire study, as the dubiousness is already apparent from the first page. TenOfAllTrades(talk) 13:28, 25 May 2012 (UTC)

Final paragraph of Lede

At present, the first sentence of the final paragraph of the Lede says: "Claims about the efficacy of alternative medicine tend to lack evidence, and have been shown to repeatedly fail during testing." This sentence seems to contain weasel words doesnt appear sourced, nor does it seem accurate. There is a source later in the body of the article, under evidence, that says: "A 2005 review of 145 alternative medicine Cochrane reviews using the 2004 database revealed that 38.4% concluded positive effect or possibly positive (12.4%) effect, 4.8% concluded no effect, 0.69% concluded harmful effect, and 56.6% concluded insufficient evidence." Thus, the Lede does not accurately summarize the body of the artice. I propose changing the current first sentence of the last paragraph of the Lede with a more accurate statement without weasel words, such as: "Some of the claims about the efficacy of alternative medicine are controversial and only one-third of alternative treatments have evidence to support their use."Puhlaa (talk) 15:16, 7 September 2012 (UTC)

I totally agree with you! Lova Falk talk 16:45, 7 September 2012 (UTC)

That raises a couple of interesting points. The cited source (an 2005 Institute of Medicine report) goes on to note that the prevalence of low-quality trials with positive results exaggerates the effectiveness of CAM (p. 143), and that "most trials of homeopathy, herbal medicine, and acupuncture had major problems with their reporting and the study methodology." (p. 144) In other words, the source's conclusion is quite a bit more nuanced than simply reporting the percentage of published clinical trials showing positive results.

Secondly, the positive trials of "alternative medicine" described in the Cochrane review include a number of trials showing that calcium +/- Vitamin D is effective in preventing bone loss, that iron supplementation is useful in pregnancy, or that folate supplementation in pregnancy reduces the risk of neural-tube defects in children. It's debatable whether those are truly trials of "alternative medicine", since these uses have been accepted and well-established parts of mainstream medicine for quite some time and are probably not the sorts of things people have in mind when they talk about "alternative medicine". If you remove those trials from the analysis, the effectiveness statistics look quite a bit poorer. But anyhow... MastCell ^Talk 17:14, 7 September 2012 (UTC)

MastCell, with regard to your second point, I would say that if 'Cochrane' called it an 'alternative therapy' in their review, then unless a good source contradicts this, we call it alternative here (be it calcium/Vit D/iron or other). Thus, I dont agree that this is a issue. However, with regard to your first point, quality of studies, I would not be opposed to qualifying the proposed statement in the Lede with something in the order of "...,however there are notable issues with some of the research methods used." or something like that. Either way, the sentence under scrutiny needs a source and should be made to better align with the content in the body. 'Cochrane' doesnt seem to agree that 'most therapies fail during testing'. Puhlaa (talk) 18:52, 7 September 2012 (UTC)

Yeah, I brought up the second point (about the definition of "alternative" therapies) mostly as a point of personal interest (although the IOM report does spend a lengthy footnote detailing how they defined "alternative" for these purposes). It would be interesting to see a Cochrane update, as there have been quite a few large, major randomized trials of alternative therapies with negative results in the past several years (e.g. SELECT, gingko biloba for the prevention of dementia, etc.) MastCell ^Talk 20:23, 7 September 2012 (UTC)

I do not believe there is an updated version of the 2005 report, however, I agree that it will be interesting to see it when it happens! In the meantime, I have not seen anyone disagree that the existing sentence is unsourced and not representative of the body of the article. Below I have suggested an alternate way to start the last paragraph of the Lede, please make suggestions on how to improve it further.Puhlaa (talk) 03:53, 8 September 2012 (UTC)

• Many of the claims regarding the efficacy of alternative medicines are controversial. While one-third of alternative treatments have evidence to support their use, there often exists problems with the research methodology used, which might cause these results to be exaggerated.(ref)

As no one has disagreed that the first sentence of the last paragraph of the lede is unsourced and inconsistent with the body of the article, I will go ahead and make the change proposed above.Puhlaa (talk) 14:50, 14 September 2012 (UTC)

Eh, SELECT was just a pointless waste of money, as the participants were all replete in selenium (which, if I recall correctly, wasn't even a footnote in the published report). This kind of stuff is very damaging as many medical professionals interpreted it as contradicting an earlier trial which found that selenium prevents cancer in those with marked deficiency). With regard to ginkgo biloba: there are lots of much better interventions, e.g. alpha-GPC or rhodiola rosea which could have been investigated and would likely fall under 'alternative medicine'. It's truly astonishing that ginkgo biloba was selected out of all the promising treatments. Saw palmetto extract is a better example of a notable recent failure. I actually added the cite to Cochrane's 2005 study. I agree with MastCell's overall point, especially in terms of the definition of alternative medicine. However, defining it as only interventions which aren't evidence-based is obviously problematic. Does that mean that the 30% or so of mainstream medical interventions which aren't evidence-based are actually alternative medicine? As my comments about the trials above show, our medical institutions are hardly perfect. The "fringe" of alternative medicine hardly has a monopoly on bad medical decision-making. Alternative medicine includes quite a lot of interventions (mostly herbal/nutritional or lifestyle-based) with decent or highly promising evidence and low side-effect risk which are flat out ignored by the industry, and therefore by doctors who are highly reliant upon the industry to learn about therapies. Many doctors are so deeply afraid of being viewed as quacks that they reflexively reject anything which doesn't come at a huge price tag and a long list of side-effects. II | (t - c) 01:38, 8 September 2012 (UTC)

Might I suggest that we not have a general "efficacy" section in this article at all? Clearly there are positive results for some areas more than others, and lumping them all together is not something that is generally done in the medical literature. This makes as much sense as talking about the efficacy of antibiotics in general as opposed to their utility in specific situations (great for pneumonia, not so much for heart attacks). Yobol (talk) 22:26, 9 September 2012 (UTC)

This could work, provided we remove every reference to efficacy altogether, both negative and positive. It would then be up to the individual alt med articles to discuss the respective efficacy. This could be difficult however, because most of the criticism of alt med is with regard to exagerated claims of efficacy. I doubt that many editors would be satisfied with removing the criticism of the claims of efficacy from the article.Puhlaa (talk) 00:28, 10 September 2012 (UTC)

Or we could only mention those efficacy that have been extensively studied and reported on in specific areas (i.e. alt med for cancer, etc). I think a general discussion of efficacy makes little sense; subdividing it into specific areas makes much more sense, or having no discussion at all. Yobol (talk) 02:52, 10 September 2012 (UTC)

Subdividing it by area is a good idea. Not sure if there's anything good in that vein, but I agree that overall statistics are not very helpful. II | (t - c) 03:17, 10 September 2012 (UTC)

QuackWatch and NPOV

Noting revision 10:30, 14 September 2012 (TimidGuy), and in view of discussion connected with the recent decision to merge Whole medical systems, it can be said that mention of QuackWatch (here and elsewhere) may be useful for NPOV. Given that the everyday terms "regular / conventional / mainstream" can be used for a more or less restricted range of medical practice, the name "QuackWatch" points both ways. It alerts those who look further than the more restricted range that the opinions, claims or information which it publicises may lack NPOV, while at the same time it is likely to give comfort to those who favour the use of those terms for a narrower range. Qexigator (talk) 11:24, 14 September 2012 (UTC) (typo correction Qexigator (talk) 07:00, 18 September 2012 (UTC))

--Also noting: 1_ Well-designed studies have shown that most "alternative" methods are used in addition to—rather than instead of—standard methods.;[2] and 2_Quackwatch received a 2003 award as a useful source for online consumer information (article on Stephen Barrett). There is an everyday use of the word "sceptic" and most people probably learn to practice mild scepticism in respect of such matters from any source, including sources using the word as a distinguishing badge or title of their own. --Qexigator (talk) 23:15, 14 September 2012 (UTC)

--For further information: The National Council Against Health Fraud - Scientific Review of Alternative Medicine - Wallace Sampson - Paul Kurtz - Consumer advocacy groups - Committee for Skeptical Inquiry - Committee for Skeptical Inquiry - Council for Secular Humanism. --Qexigator (talk) 00:37, 26 November 2012 (UTC)

NPOV issues in Lede

A series of recent edits (possibly by a single editor under 3 IPs) seems to have removed all neutral sources and re-written the Lede to reflect a purely skeptical POV that is largely WP:OR. The single instance of a neutral POV that remains from the original has been qualified with possible weasel words ("One author defines it circularly as ..."). The lede now reads more like a skeptics guide, as opposed to an encyclopedia. In addition to these extensive WP:NPOV issues, the recent edits have also made the Lede inconsistent with the body of the article. For example, the Lede now begins with a very bold, direct and POV statement of efficacy: "Alternative medicine is any practice claiming to heal but whose "therapies are anomalous practices for which claims of efficacy are either unproved or disproved" However, as indicated in the body of the article, ("...one-third of alternative treatments have some published literature supporting their use...") the situation/definition of CAM is far more complex than is now suggested in the Lede. Lastly, the image (recently added as part of these edits) is full of OR, POV statements and Weasel words. I have tagged the article to indicate these concerns. Puhlaa (talk) 03:38, 8 November 2012 (UTC)

Yes, it certainly looks like that, whether or not due to ignorance of Wikipedia practice generally or the history of this article in particular. To which revision would you propose a revert? As edited 21:51, 1 November 2012[[3]] perhaps? Qexigator (talk) 09:41, 8 November 2012 (UTC)

I'd support a deep revert to the Oct 29 version. TimidGuy (talk) 10:24, 8 November 2012 (UTC)

--Agree back to 29 Oct[[4]]. --Qexigator (talk) 11:41, 8 November 2012 (UTC)

Agree with revert back to Oct 29 version. Puhlaa (talk) 15:53, 8 November 2012 (UTC)

This is pathetic but not surprising. I tried for years to improve this article and finally just gave up because it is owned by a few editors that refuse to accept that all of alt-med is not voodoo. Gandydancer (talk) 15:13, 8 November 2012 (UTC)

Gandydancer, who claimed all alt med is voodoo? The article specifically states the opposite, that voodoo is only one of many traditional medical practices, and it is of at least two types, Haitian and Central West African. 18:49, 8 November 2012 (UTC)

Pulah, please specify the sources removed in your claim "removed all neutral sources". I will put the content back in if there is an evidential basis for the claim that it was removed. The ten sources recently added are all highly respected neutral and reliable sources, not "skeptics guides" - Annals of the New York Academy of Sciences, Journal of the Association of Medical Colleges, Academic Medicine, Canadian Medical Association Journal, American Psychological Association, Medical Journal of Australia, Continental Journal of Tropical Medicine, Health and Environments Education Association of Egypt. No content present in the "Oct 29 revision" was deleted, except for minor deletions of sentences unsupported by the source or without a source at all. Each edit summary was specified. So a claim of POV to delete content and change well summarized edits is not supported. ParkSehJik (talk) 18:28, 8 November 2012 (UTC)

The issue as far as I'm concerned is that you so greatly skewed the lead to a particular point of view. WP:NPOV is a core policy, and the lead as of Oct 29 was in accord with policy, presenting multiple views in a balanced way. TimidGuy (talk) 18:23, 8 November 2012 (UTC)

The issue is stated as "removed all neutral sources" and POV of the sources. At Wikipedia, you cannot make claims without supporting evidence. Please specify evidence for the assertion "removed all neutral sources" by listing at least a few of the sources claimed to be removed, please specify which of the above listed new sources are "skewed" to one POV and state the evidential basis of the assertion, and cite your source that the ten new sources, such as Annals of the New York Academy of Sciences and Journal of Academic Medicine are "skeptics guides". If neutral and reliable sources were removed as claimed, and content from them, I will put it back in. ParkSehJik (talk) 18:40, 8 November 2012 (UTC)

There was a lot of original research in the text. Break your suggestions down into small chunks, and get consensus for each. IRWolfie- (talk) 19:09, 8 November 2012 (UTC)

• Note that I've reverted back to this version: [5]. IRWolfie- (talk) 19:11, 8 November 2012 (UTC)

Thanks for reverting it. Editors should discuss any drastic planned changes before changing the article. Gandydancer (talk) 00:11, 10 November 2012 (UTC)

Not always. But I think in this case there are a number of issues that can only be solved by going through the edits block by block in detail. IRWolfie- (talk) 00:51, 10 November 2012 (UTC)

Additional reliably sourced content needed re criticism of evidence based medicine by some alt med practitioners

Recent edits added content from about ten major scientific journals, such as Annals of New York Academy of Sciences and Journal of Academic Medicine, . There is a need for additional information in the lead section, such as regarding many alternative medicine practioners claims that conventional "science doesn't measure everything" (e.g., types of health that are more general, or are specific to a single patient, and thereby not subject to a scientific methodolory involving multiple subjects, and thereby only detectable by a one-on-one relationship between doctor and patient), on defects and inconsistencies in the scientific method, and other clearly valid points. A problem I am having with sourcing this is that there is such a diversity of alternative medical practices, that no source from the diverse group appears to be reliable in speaking for a community that does not recognize that one source as speaking for their own position. I would support adding this kind of material to the lead since it is on point to the article topic, and ask for assistance in sourcing it. Please discuss. ParkSehJik (talk) 19:16, 8 November 2012 (UTC)

The lead is meant to summarize the article. The lead is not meant to advance new points. Perhaps some of what you propose belongs on Alternative_medicine#Criticism. IRWolfie- (talk) 19:19, 8 November 2012 (UTC)

Yes, you are correct that it belongs in the lead only if it is a big part of the article body. But it does not belong in a criticism section, since it is the opposite of criticism of alternative medicines. It is a criticism by alternative medicine practitioners of the scientific method. I have clarified this by changing the section header above. ParkSehJik (talk) 19:31, 8 November 2012 (UTC)

Perhaps you could suggest a lead edit with a RS here and we could all discuss it. Keep in mind that the lead should generally not even need to be sourced because it is expected that anything in the lead is well-covered in the body of the article--so perhaps you should start with info that you'd like to see in the body? Gandydancer (talk) 00:19, 10 November 2012 (UTC)

On fringe articles it ends up being generally sourced because fringe proponents usually try and remove any unsourced criticism, even if it essentially repeats the body of the text. IRWolfie- (talk) 20:39, 10 November 2012 (UTC)

Can you clarify for us if you are editing here as a proponent or opponent?Qexigator (talk) 21:50, 10 November 2012 (UTC)

I hope people are editing as wikipedians. IRWolfie- (talk) 00:04, 11 November 2012 (UTC)

The lead is top-heavy

"The lead is meant to summarize the article" per IRWolfie 8 November 2012. Given that the main topic is simply "Alternative medicine" and not "The current controversy about 'alternative medicine' " the lead seems to be topheavy, and in point of editing parts of it would be better placed in later sections (leaving aside the sourcing and NPoV questions mentioned above), perhaps as follows, showing by "...1/2/3... " parts omitted for placing later in the article, enumerated below for ease of reference.

--PS, added In view of certain later comments on this page: The article has been declared of interest to four WikiProjects, 1_Alternative medicine, [[6]], [[7]] 2_Medicine, [[8]], [[9]] 3_Rational Skepticism[[10]],(Portal:Philosophy of science) and 4_ Alternative views. [[11]] Editors will be aware that this results from a continuing tension among those who engage themselves in formulating and applying "policy", which reflects a tension among the world wide readership generally, namely, between those who would hold that "science" (in all aspects) is within the scope of (or in some way a branch or extension of) epistemology, and those who hold the opposite or something else. The proposal here is neutral about any of that, and is merely concerned with the convenient distribution, arrangement and editorial presentation of the information. Qexigator (talk) 10:45, 14 November 2012 (UTC)

• Alternative medicine is any practice claiming to heal "that does not fall within the realm of conventional medicine."[1] Alternative medicine is frequently grouped with complementary medicine or integrative medicine, which, in general, refers to the same interventions when used in conjunction with mainstream techniques,[2][3][4] under the umbrella term complementary and alternative medicine, or CAM.[5][6] ... 1.... Alternative medicine varies from country to country......2...... Alternative medicine methods are diverse in their foundations and methodologies. Methods may incorporate or base themselves on traditional medicine, folk knowledge, spiritual beliefs, or newly conceived approaches to healing.[13] Many of the claims regarding the efficacy of alternative medicines are controversial.....3....

_1 Critics maintain that the terms “complementary” and “alternative medicine” are deceptive euphemisms meant to give an impression of medical authority.[7][8][9] A 1998 systematic review of studies assessing its prevalence in 13 countries concluded that about 31% of cancer patients use some form of complementary and alternative medicine.[10]

_2 Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them. Edzard Ernst has said that in Austria and Germany complementary and alternative medicine is mainly in the hands of physicians,[5] while some estimates suggest that at least half of American alternative practitioners are physicians.[11] In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance based on their Commission E legislation.[12]

_3 While one-third of alternative treatments have some published literature supporting their use, research on alternative medicine is frequently of low quality and methodologically flawed, which might cause these results to be exaggerated.[14]. Qexigator (talk) 09:39, 10 November 2012 (UTC)

Excellent suggestion. I vote yes. TimidGuy (talk) 09:57, 10 November 2012 (UTC)

• I think the lead is now fine for its size. IRWolfie- (talk) 11:57, 10 November 2012 (UTC)

I can't see where anything has been left out; things seem to be just moved around. This: Critics maintain that the terms “complementary” and “alternative medicine” are deceptive euphemisms meant to give an impression of medical authority.[7][8][9] should be removed from the lead. The Skeptic's Dictionary is not a medical authority and the NEJM article was way overblown in importance. Gandydancer (talk) 12:23, 10 November 2012 (UTC)

No, that would be removal of content indicating the mainstream position. I think it should be worded away from "Critics maintain". We can also use quackwatch too, which is very well respected if you wish. IRWolfie- (talk) 12:25, 10 November 2012 (UTC)

I'm wondering about this one-third comment "While one-third of alternative treatments have some published literature supporting their use, research on alternative medicine is frequently of low quality and methodologically flawed, which might cause these results to be exaggerated.[14]" I don't see where the citation actually says this number.

Chapter 5: 'State of Emerging Evidence on CAM' Page 135 - "The results from all eligible Cochrane reviews of CAM therapies were assigned to one of the following categories.....The largest number of treatments described in the reviews were classified as insufficient evidence of an effect (n = 82; 56.6 percent), followed by positive effect (n = 36; 24.8 percent) and possibly positive effect (n = 18; 12.4 percent)." 24.8% positive effect + 12.4 possibly positive = 37.2% positive or possibly positive effect. Puhlaa (talk) 16:13, 10 November 2012 (UTC)

Also 1998? Isn't there something more current than 14 years ago? "A 1998 systematic review of studies assessing its prevalence in 13 countries concluded that about 31% of cancer patients use some form of complementary and alternative medicine.[10" Sgerbic (talk) 14:26, 10 November 2012 (UTC)

Yes it looks too old for WP:MEDRS for that claim. IRWolfie- (talk) 16:26, 10 November 2012 (UTC)

What about some newer secondary sources that look at CAM use? Heres a newer one looking at Cancer patients [12] Looks like utilization of CAM has increased since the 90s. Heres one on use by the general population [13] Here is one on use by the general pop. and healthcare workers [14] and one for people with CVD [15] Puhlaa (talk) 17:40, 10 November 2012 (UTC)

The moves proposed below are neutral either way, i.e. neither for nor against any of the other points under discussion such as updating sources, and may be helpful for both readers and editors. Qexigator (talk) 18:37, 10 November 2012 (UTC)

• Proposed moves, noting per IRWolfie "an already bloated lead" (article revision 00:46, 10 November 2012), and "a number of issues that can only be solved by going through the edits block by block in detail" (above 00:51, 10 November 2012)-- Overall and for improving the readability and presentation generally, as well as for convenience of updates and other revisions, propose moves with minor copyedits (and keeping sources as now refd. until any are otherwise altered later) as follows:

_1.1 Some critics maintain that the terms “complementary” and “alternative medicine” are deceptive euphemisms meant to give an impression of medical authority.[7][8][9]"

--to Section "Criticism"

_1.2 "A 1998 systematic review of studies assessing its prevalence in 13 countries concluded that about 31% of cancer patients use some form of complementary and alternative medicine.[10] "

--to Section "Usage"

_2.1 "Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them.":::--to Section "Regulation"

_2.2 "Edzard Ernst has said that in Austria and Germany complementary and alternative medicine is mainly in the hands of physicians,[5]" to Section "Regulation" (?)

_2.3 (while) "Some estimates suggest that at least half of American alternative practitioners are physicians.[11]"

--to Section "United States"

_2.4 "In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance based on their Commission E legislation.[12]"

--to Section "Regulation" or "Usage"

_3 While one-third of alternative treatments have some published literature supporting their use, critics maintain research on alternative medicine is frequently of low quality and methodologically flawed, which might cause these results to be exaggerated.[14].

--to Section "Criticism"

--Qexigator (talk) 16:57, 10 November 2012 (UTC)

Moves 1.1 and 1.2 now done: please advise or emend if misplaced or otherwise faulty. Qexigator (talk) 20:35, 10 November 2012 (UTC)

You quoted me before I said "Now it's fine". You moved the criticism out and then subtly changed it to "Some critics", which is a weasel. IRWolfie- (talk) 20:37, 10 November 2012 (UTC)

Thank you for responding. Perhaps you could remember that it would be well not to bandy pejoratives or imply bad faith too readily. Your comment re "Now it's fine" not understood, nor your assertion about subtle or weasel. But will await further comment from others. Qexigator (talk) 21:05, 10 November 2012 (UTC)

It is important (according to policy) to include the perspective of both advocates and skeptics in a controversial article, thus, I have no issues with the text that Qexigator removed staying in the lede. However, I do take issue with the sources; I dont believe that skeptic websites are appropriate sources. Is there not a more neutral source that criticises the use of the term CAM?Puhlaa (talk) 21:42, 10 November 2012 (UTC)

Skeptic websites have a reputation for fact checking. If you disagree you can ask at RSN. Alternatively you can also use Quackwatch if you wish. IRWolfie- (talk) 21:47, 10 November 2012 (UTC)

If the skeptical websites were being used as a source for facts that they had checked, then I would agree. However, we are using skeptical websites to support what is simply an opinion by skeptics.... that the term CAM is used "to give a false impression of medical authority".Puhlaa (talk) 21:57, 10 November 2012 (UTC)

They are reliable for that, you can check it at RSN. Bring the text and reference to WP:RSN if you wish, IRWolfie- (talk) 21:59, 10 November 2012 (UTC)

Like the article as it now stands, this thread seems to need untangling. But here are three points arising from above indents. Qexigator's proposed moves are not intended 1_to further any partisan cause for or against; 2_nor to meddle with sources; 3_nor to take any position on the relative or absolute merits of CAM or Quackwatch. My concern is as stated: the lead is top-heavy, and the topic is "Alternative medicine" not "The current controversy about 'alternative medicine' ". Qexigator (talk) 22:06, 10 November 2012 (UTC)

The lead is now within normal sizes for wikipedia articles. IRWolfie- (talk) 00:02, 11 November 2012 (UTC)

--For the time being, and while you (or others) are still working on it, let it be. But a lead should be judged by its quality and character, not by an average, or supposedly normal, measurement of line-age or word-age, or in another medium column inches. Experienced editors (as you are) also know that shorter leads will often suffice for well written and constructed articles. Qexigator (talk) 00:56, 11 November 2012 (UTC)

Removal of one possible definition

While I agree that CAM is difficult to define, a recent edit removed one very valid definition of CAM, ie: "Alternative medicine is any practice claiming to heal that does not fall within the realm of conventional medicine" The rational being that the editor doesnt think this is correct and the source is weak. I dont need to detail why the editor's opinion is insufficient cause for removal of this text, however, as this is a common and valid definition, I have addressed the second concern by providing some better sourcing options:

1. WHO [16]: The terms "complementary medicine" or "alternative medicine" ... refer to a broad set of health care practices that are not part of that country's own tradition and are not integrated into the dominant health care system.
2. NCCAM [17]: NCCAM defines CAM as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.
3. Peer-reviewed article in British Medical Journal[18]: a group of therapeutic and diagnostic disciplines that exist largely outside the institutions where conventional health care is taught and provided.

• Note: A search of recent, mainstream, peer-reviewed, secondary sources reveals that the NCCAM definition is commonly accepted. Here are a couple examples for evidence of this. [19][20]

Thus, I agree with the addition of new text that states that "CAM is difficult to define", however, I request that the very common and mainstream definition that was removed be re-added.Puhlaa (talk) 01:29, 11 November 2012 (UTC)

Done. Also, "CAM is difficult to define" is unreferenced, so it can go.TippyGoomba (talk) 04:30, 11 November 2012 (UTC)

Trimming subtopic

One or two editors may be aware of a continuing discussion at Talk:Science about including subtopics such as "criticism", arising from an excessive delete. One of the comments, referring to WP:Summary style, could be applicable here. It remarked that the criticism section was overlong and the article would be improved by retaining a brief criticism section there while trimming the text by about 20% and leaving the details to the linked pages. In principle this also applies to "Alternative medicine". For ease of writing and speaking it is usually convenient to use terms such as "mainstream" and "alternative" but editors generally will be aware that the practise of healing, in the name of Medicine, is not exclusively the province or domain of the kind of "science" which is anxious for its own reasons to be distinguished from what used to be known as "natural science" or "natural philosophy". The all round view appropriate to Wikipedia needs particular care when reporting unpopular or minority topics, which may in time join the curiosities of history or be seen as contributing to a new found reform. Qexigator (talk) 08:46, 12 November 2012 (UTC)

Irrelevant here. The issue at the science article was undue weight. With this topic, a very substantial proportion of the coverage in reliable sources is criticism, and to downplay that would violate WP:WEIGHT. The rest of your argument is run-of-the-mill special pleading, bordering on POV pushing. Nothing there worth even considering. Dominus Vobisdu (talk) 10:55, 12 November 2012 (UTC)

Anyone can see for him/her -self that DomVob's remarks above, separately and together, are mistaken or irrelevant and baseless as regards the opening paragraph here, and may see that his/her "argument is run-of-the-mill special pleading, bordering on POV pushing. Nothing there worth even considering" to use that turn of phrase. Constructive comment from editors wishing to improve the article would, of course, be welcome. Qexigator (talk) 21:14, 12 November 2012 (UTC)

• I actually think this article is overly biased towards alternative medicine, and the current article unduly legitimises it. IRWolfie- (talk) 00:55, 13 November 2012 (UTC)

Indeed, the whole article should be a criticism section, otherwise we can just redirect to Medicine and be done with it. TippyGoomba (talk) 02:49, 13 November 2012 (UTC)

I agree, page should have a heavy hand taken to it. Sgerbic (talk) 04:21, 13 November 2012 (UTC)

It is really a question of good practice in distributing the relevant information between the articles, with cross-ref. links, redirects and disambigs. for the convenience of readers. Given the topic (Alternative medicine), to one who is an empirical sceptic indiscriminate remarks such as the following: _"the article unduly legitimises" the topic, _"we can just redirect to Medicine and be done with it", _"should have a heavy hand taken to it" indicate that, for the sake of editorial practicality, while "Alternative medicine" may well be seen to be within the scope of "medicine", and seeing that the article "Medicine" has the section "Criticism of modern medicine", the Medicine article itself needs some protection from overload. Hence retaining a separate article for AM may be preferable, where points for and against and neutral can be succinctly stated without overt or implicit polemic. Would that be done adequately in "Medicine"? Qexigator (talk) 09:01, 13 November 2012 (UTC)

Your "points for and against" comment makes it seem like you think of WP as some sort of "neutral" debating forum where each side is "fairly" allowed to get up on their own soapbox and make a direct plea to the general public in their own words, after which the general public makes up their own mind. If that's the case, you're sorely mistaken and at total odds with WP policies and guidelines, especially WP:WEIGHT, WP:GEVAL, WP:FRINGE and WP:SOAPBOX. Dominus Vobisdu (talk) 14:17, 13 November 2012 (UTC)

DomVob's comment is as far off the mark as the origin of Straw man is obscure. How odd. Qexigator (talk) 16:00, 13 November 2012 (UTC)

You are creating a false equivalence by comparing this article to medicine and science. These topics do not have a comparable sort of coverage in the reliable sources. IRWolfie- (talk) 19:09, 13 November 2012 (UTC)

Another failure to read as written-- perhaps another instance of straw manning: even odder. Qexigator (talk) 23:04, 13 November 2012 (UTC)

What's really odd is that you've failed to notice that you have failed to get consensus for your proposal, or to spark any interest among the four editors responding. Quite the opposite in fact. If people are "misreading" your argument, perhaps you should consider whether you have "miswritten" it. In any case, I can't see any point in further discussion. You've lost my ear. Dominus Vobisdu (talk) 23:21, 13 November 2012 (UTC)

No claim to consensus has been made, and the comments of the four editors, including DomVob's assurance that s/he can't see any point in further discussion, has not been unremarked by...Qexigator (talk) 23:47, 13 November 2012 (UTC)

Rewrite of Lede required under WP:MEDRS, WP:MOS (lede), WP:FRINGE, and WP:NPOV

Lead first sentence must be deleted under WP:MEDRS because it is false

Wikipedia articles about medical topics cannot contain false statements under WP:MEDRS. "Alternative medicine is any practice claiming to heal 'that does not fall within the realm of conventional medicine'." is false so must be deleted under WP:MEDRS. "Unconventional" evidence based medicine is still evidence based medicine, and is not alternative medicine.

• All new evidence based medical procedures are unconventional when first introduced, but they still are evidence based medicine, not alternative medicine.
• Examples of unconventional evidence based medicine that is not "alternative medicine" include the hyperbaric medicine of Dr. Ralph Potkin, former head of Pulmonary at Cedars Sinai Hospital in Beverly Hills, prescription of LSD and MDMA by Dr. Charlse Grob, Head of Pediatric Psychiatry at UCLA Harbor Medical Center, anti-circumcision views of Dr. Paul Fleiss of USC, and any early stages of change in protocol procedures. ParkSehJik (talk) 00:59, 22 November 2012 (UTC)

That may be a valid objection to the source, and to the use of the term "unconventional", but a reasoned discussion about Unconventional medicine is difficult. There seems to be a valid case for making claims for or against a medical practice or procedure being "evidence based" to the extent that "evidence based" is sufficiently defined. But editors here will know that "Conventional medicine" redirects to Medicine, and in that article the term "conventional" appears only in a list of "Some interdisciplinary sub-specialties of medicine": Wilderness medicine entails the practice of medicine in the wild, where conventional medical facilities may not be available. That is not sufficiently informative to help a reader know what is meant by "unconventional medicine", a term which appears in a number of articles. Is the lack of definition due to vagueness of the concept and/or lack of Wikipedia consensus on a disputed topic or set of topics? Are better informed editors able to comment? Qexigator (talk) 21:09, 21 November 2012 (UTC)

Yes, I agree it is a valid objection because we cannot have false sentences starting articles at Wikipedia, so it must be deleted by Wikipedia policies. ParkSehJik (talk) 03:08, 22 November 2012 (UTC)

Lead first sentence must be deleted as violating WP:FRINGE and WP:NPOV in its sourcing

"Alternative medicine is any practice claiming to heal 'that does not fall within the realm of conventional medicine'." is sourced by quoting Steven Bratman and using him as the source. This violates WP:FRINGE because Bratman and his opinions are considered as fringe as they come by the mainstream medical community. ParkSehJik (talk) 01:01, 22 November 2012 (UTC)

The first sentence of the lede currently uses a mainstrem and well-accepted definition of alternative medicine, that of the NCCAM [21]. A search of recent, mainstream, peer-reviewed, secondary sources reveals that the NCCAM definition is commonly accepted. Here are a couple examples for evidence of this. [22][23] In fact, this source [24] explains why it uses this definition: "the NCCAM definition is widely known and used.....Since the NCCAM definition is inclusive of many different types of therapies and products, we will use it in the present article"

Moreover, many other mainstream medical organizations and scientific bodies accept this definition:

1. WHO [25]: The terms "complementary medicine" or "alternative medicine" ... refer to a broad set of health care practices that are not part of that country's own tradition and are not integrated into the dominant health care system.
2. Peer-reviewed article in British Medical Journal[26]: a group of therapeutic and diagnostic disciplines that exist largely outside the institutions where conventional health care is taught and provided.

As this definition is the most widely accepted and used, it is the best way to start the article. If there is concern about the source that is used (which is fine IMO) then we could use NCCAM or WHO or British Medical Journal as the source instead, however, the definition is mainstream and well-used, it should stay.Puhlaa (talk) 21:24, 21 November 2012 (UTC)

Not being a specialist in these matters, but a general reader looking for information, my comment is that it would be good to see NCCAM and WHO and British Medical Journal as sources. Better still if they can be viewed online, or quoted in the article or a footnote. Qexigator (talk) 21:37, 21 November 2012 (UTC)

In response to suggestions by Qexigator and Pulaa, I suggested how to include the NCCAM, WHO, and British Medical Journal as sources in the list in the sub-section below, to correct the lede, and still to meet MEDRS and MOS standards, further supporting restoration of the below cited version with the additions with qualifications to the wording as required by MOS, MEDRS, and NPOV. ParkSehJik (talk) 02:31, 22 November 2012 (UTC)

Puhlaa writes, "The first sentence of the lede currently uses a mainstrem and well-accepted definition of alternative medicine, that of the NCCAM". That is a false statement. The source is a highly POV and FRINGE MD named Steven Bratman. Bratman is the opposite of a "mainstream" MD. He is one of the most highly ridiculed MDs who currently still holds a license. Furthermore, NCCAM is POV, being a body appointed by elected politicians. That is no better than using a politically appointed body to source our article on Evolution. No one has responded to the fact taht the first sentence is outright false and must be immediately removed under WP:MEDRS. ParkSehJik (talk) 22:29, 21 November 2012 (UTC)

Perhaps you have not read the Bratman source, it uses the NCCAM definition of CAM, which is very similar to the definition used by the World Health Organization, the British Medical Journal and the examples of new systematic reviews that I posted full-text for above. The Bratman source is fine for the mainstream definition of CAM (IMO), however, as I said, if the source is bothering you, we can use one of the other mainstream sources I provided above.Puhlaa (talk) 22:35, 21 November 2012 (UTC)

I did not fail to read the Bratman source. Bratman is certainly not a "mainstream" MD. Furthermore, it is directly quoted in the lede first sentence, so no one can fail to read it. Bratman's definition is entirely different from the NCCAM definition, which is cited later in the lede, and is specically based on US licensing, not on methodology, and places all evidece based medicine practiced outside the US and not in the US as being alternative medicine, a highly controversial and jigoistic position. ParkSehJik (talk) 02:08, 22 November 2012 (UTC)

Seeing the further section about sources below, as well as earlier discussion of the topic, it looks as though

1_The lead should now read: "This article describes types of treating ill-health which have been condemned by some official bodies representing some medical practitioners in some countries. Some of those types of treatment have been recognised by some other official bodies in some countries."

and 2_The article should be re-named "So-called 'Alternative' medicine". Qexigator (talk) 22:55, 21 November 2012 (UTC)

I oppose the suggestion Quexitor just made as to what "the lede should now read" and to rename the article, as not being supported by the sources. I will thereby delete any such change if made. However, I supported Quexitor's and Pulaa's suggestion to include NCCAM, WHO, and British Medical Journal definitions, even though the former two MEDRS and NPOV, and the later violates MOS (Lede) and MOS "Plain English... avoid... jargon, and vague or unnecessarily complex wording". ParkSehJik (talk) 02:32, 22 November 2012 (UTC)

So far you have not made any specific proposals for new text, you have only suggested that we should delete the first sentence of the lede, however, you do not have consensus for this suggestion. So far, you are the only editor pushing to make this change. Bratman is a good source and because it is consistent with the mainstream view of CAM, there is no reason to suggest his source is flawed. I have clearly explained why I object and that I think the current sentence in the Lede is good, it seems that 'Qexigator' also objects to your suggestion of deleting the first sentence and there has also already been other editors who agree keeping the current text in the first sentence (see [27]). Thus, you might try suggesting some new text that you think could replace the current text, to see if that sways any of the currently interested editors so that you can gain consensus (or you could wait for additional editors to become interested and involved that might agree with your perspective).Puhlaa (talk) 03:03, 22 November 2012 (UTC)

Consensus is not needed to delete false sentences that violate MEDRS and core Wikipedia policies. Truth is not a matter of "perspective". ParkSehJik (talk) 03:11, 22 November 2012 (UTC)

Sources for the rewrite of Lede required by WP:MEDRS, WP:NPOV, WP:MOS (lede), and WP:FRINGE

WP:MOS (lede) states “The lead section should briefly summarize the most important points covered in an article in such a way that it can stand on its own as a concise version of the article... The first paragraph should define the topic with a neutral point of view.” The first paragraph fails to define the topic and is based on highly POV and Fringe sources. The current lead is not concise. The current lede is filled with specifics. The current lede is filled with WP:LEADCLUTTER. For example, “prevalence of use by cancer patients in US in 2011” is a gross violation of MOS (lede). I suggest the following sources to base a lede that meets WP:RS, WP:MEDRS, WP:FRINGE, and WP:NPOV, and can be used to restore This version to bring the lede to Wikipedia’s required standards under WP:MEDRS, WP:NPOV, WP:Fringe, and WP:MOS (lede).

• 1 Academic Medicine: The Journal of the Association of Medical Colleges is WP:MEDRS, WP:NPOV, and is not WP:FRINGE. In its article on alternative medicine, it simply defines alternative medicine as follows - “CAM therapies are anomalous practices for which claims of efficacy are either unproved or disproved.” (Source: The Need for Educational Reform in Teaching about Alternative Therapies, Journal of the Association of Medical Colleges, March 2001 - Volume 76 - Issue 3 - p 248-250)
• 2 The Canadian Medical Association Journal is WP:MEDRS, WP:NPOV, and is not WP:FRINGE. It defines alternative medicine as "Alternative therapies are those lacking scientific validation". (Source: Canadian Medical Association Journal, November 15, 1997 vol. 157 no. 10)
• 3 The Annals of the New York Academy of Sciences is WP:MEDRS, WP:NPOV, and is not WP:FRINGE. It provided the definitive peer reviewed article defining alternative medicine in its special edition titled The Flight from Science and Reason, with an article speciic to alternative medicine - ANTISCIENCE TRENDS IN THE RISE OF THE ‘ALTERNATIVE MEDICINE’ MOVEMENT Source: The Flight from Science and Reason', Annals of the New York Academy of Sciences, Volume 775 pages 188–197 and related articles, June 1995. It defines alternative medicine based on its methodological bases including antiscience, pseudoscience, fraud, and propaganda.
• 4 The Journal of Academic Medicine is WP:MEDRS, WP:NPOV, and is not WP:FRINGE. It expressly describes alternative medicine in a way consistent with all of the above definitions, including being based on “common errors of reasoning”, and ”most of these either are known to be useless or dangerous or have not been subjected to rigorous scientific testing”, a definition very similar to the Stanford Medical School definition. (Source: Alternative Medicine and Common Errors of Reasoning, Beyerstein, Barry L. PhD, Academic Medicine: March 2001 - Volume 76 - Issue 3 - p 230-237)
• 5 The Stanford University School of Medicine course description of its Alternative Medicine class of the 1990’s defines alternative medicine identically as the above four good sources - any healing practice that “proven not to work, not proven to work, or proven using faulty scientific reasoning”.
• 6 Carl Sagan is a very highly respected RS and NPOV authority on scientific methodology. He writes that "alternative medicine" is not “even remotely scientific”. (Source: The Demon-Haunted World: Science as a Candle in the Dark)
• 7 The American Psychological Association is WP:RS, WP:MEDRS, WP:NPOV, and not WP:Fringe. Its article on alternative medicine describes alternative medicine as based on pseudoscience and belief in the paranormal. (Source: Pseudoscience and the paranormal (2nd ed.), Hines, Terence, American Psychological Association)
• 8 The Medical Journal of Australia is WP:RS, WP:MEDRS, WP:NPOV, and not WP:Fringe. Its article on the sociology of the rise of CAM is specifically called for in the Lede under WP:MOS (Lede) – “establish context… including any prominent controversies.” The article discusses the sociological perspective of the "enigma" of how alternative medicine can be on the rise “in countries where Western science and scientific method generally are accepted as the major foundations for healthcare, and ‘evidence-based’ practice is the dominant paradigm", an issue also taken up by the American Psychological Association as noted above, and featured as a topic of a review in Nature Medicine Magazine as follows. (Source: The rise and rise of complementary and alternative medicine: a sociological perspective, Ian D Coulter and Evan M Willis, Medical Journal of Australia, 2004; 180 (11): 587-589)
• 9 Nature Medicine is WP:RS, WP:MEDRS, WP:NPOV, and not WP:Fringe. Its article on alternative medicine with its definition and discussion of context and controversies is the same as those above.(Source: Nature Medicine, September 1996, Volume 2 Number 9, p1042)
• 10 The Continental Journal of Tropical Medicine is WP:RS, WP:MEDRS, WP:NPOV, and not WP:Fringe.
• 11 The Nigerian Partnership For Safe Motherhood is WP:RS, WP:MEDRS, WP:NPOV, and not WP:Fringe.
• 12 NCCAM does not define alternative medicine by methodology or efficacy as the above NPOV reliable scientific sources, but defines it in terms of its own country’s licensees and their allies - that which is not "medicine as practiced by holders of M.D. (medical doctor) and D.O. (Doctor of Osteopathic Medicine) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses”. This US-centric definition could be broadened in a later part of the lede to something like "political bodies of some countries define alternative medicine in terms of their own licensing." NCCAM is included as a source in the above cited version suggested to be restored, even though it is a POV and MEDRS violating source, as a body appointed by elected politicians in a single country, and fails MEDRS without proper qualifying wording. But that qualified wording is provided in the above cited version.
• 13. The World Health Organization is also a politicaly appointed body which arrives at statements by political consensus, not by standards required by WP:MEDRS. But its definition can also be included as a direct quote with proper qualifying wording re MEDRS and NPOV in relation to it being a POV political board, and added to the restoration of the above cited version.
• 14. The British Medical Journal defines alternative medicine as "We use the term complementary medicine to describe healthcare practices such as those listed in the box." This definition, which requires understanding "such as", is not consistent with any Wikipedia policy. The British Medical Journal also cites the Cochrane Collaboration, which can be used as below.
• 15. The Cochrane Collaboration defines “Complementary and alternative medicine (CAM) is a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period." This definition grossly violates MOS "Plain English... avoid... jargon, and vague or unnecessarily complex wording", as well as WP:MOS (lede) standards on not being overly technical. It requires the user to know the defiition of "the politically dominant health system", which in turn requires understanding Marxist theory, a controversial theory under which science and truth are relative to a political orthodoxy. I would not object to quoting it directly by either tacking it on at the end of the lede or in a sectino below, even though it violates WP:MOS (lede). ParkSehJik (talk) 02:35, 22 November 2012 (UTC)

You have listed a bunch of sources. So far you have not made any specific proposals for new text, you have only suggested that we should rewrite the lede. Thus, we have no proposal to discuss or for you to gain consensus for. In my experience, the best way to get lasting changes is to suggest an edit to one sentence (or a small group of sentences that follow the same theme), in the form of: Current text:____; Proposed text:_____; rational_____. You do not have to follow this suggestion, but it does avoid more frustration this way because it respects other editors perspectives, which facilitate good discussion and editors can follow exactly what is being proposed. Please dont interpret this suggestion as an order; last time you edited this article you followed WP:BOLD to the extreme and you got very frustrated when you were met with WP:BRD. This is why I am suggesting that you make a specific proposal for 1 sentence at a time that we can discuss. Puhlaa (talk) 03:14, 22 November 2012 (UTC)

The above sources support the following as the first lede sentence:

"Alternative medicine is a claim to heal that is not based on evidence from the scientific method, but is instead based on beliefs from tradition, belief in supernatural energies (antiscience), pseudoscience, errors in reasoning (bad science), propaganda, or fraud."

The main problem I see with this definition, consistent with all of the above MEDRS sources and supported by most of them, is that practitioners and believers may object that the "OR" in the definition is not more prominent, since, for example, belief in "Qi" energy by an acupunturist certainly does not mean they are fraudsters, and deliberate fraudsters on the other hand do not really believe in the supernatural energies or traditions. Another problem is that practitioners of one kind of alternative medicine do not want to be associated with other kinds of alternative medicine. For example, it is common for pracitioners of chiropractic, a traditional US medicine, not to want to be associated with Haitian Voodoo healers, and likely vice versa. Christian faith healers often do not want to be associated with what they call "pagan" healers of other cultures, e.g., Traditional Lassa medicine doctors, TCM practitioners, N'anga healers, or Traditional Yup'ik medicine doctors, since that would be heresey. Christian science healers reject science altogether, while chiropractors overwhelmingly endorse evidence based medicine. ParkSehJik (talk) 06:04, 22 November 2012 (UTC)

Am I understanding this correctly that he wants to more explicitly state that Alternative medicine is BS? TippyGoomba (talk) 04:19, 22 November 2012 (UTC)

TippuGoomba is not understanding correctly. Alternative medicine is a claim to heal that is not based on science, but is based either on tradition, belief in supernatural energies, antiscience, pseudoscience, errors in reasoning (bad science), prppoganda, or fraud, but not necessarily all. The above cited sources support this, and there is no source cited by anyone that anyone in the alternative medicine community claims additional bases for their belief system than cited in the sources above. No source uses the expression "BS". These are the most reliable and mainstream on the subject that exist and support restoration of content. Belief in supernatural energies or belief based on tradition does not seem like BS to some people, like acupuncturists, chiropractors, and faith healers, but might seem like BS to people trained in science. But that is not relevant. The MEDRS sources support restoration unless the sources are objected to. The article as it currently stands violates the Wikipedia policies as cited above. Content was deleted from these sources in the above referenced version, and another editor suggested discussing the sources on the talk page before restoring [Belief in supernatural energies or belief based on tradition does not seem like BS to some people, like acupuncturists, chiropractors, and faith healers, but might seem like BS to people trained in science. that version, to see if there were objections to the sources. I am additionally suggesting not objecting to adding content from NCCAM, WHO, Cochrane Collaboration, and British medical Journal sources to the restortion based on requests by editors in the above subsection, even though this addition is not entirely consistent with Wikipedia policies as stated above. Since the article currently violates MEDRS, no consensus is needed to delete most of the article, but I am not doing that, and instead allowing discussion of each of the above sources to see if there are objections to these sources before restoring them as here, to bring the lede to Wikipedia’s required standards under WP:MEDRS, WP:NPOV, WP:Fringe, and WP:MOS (lede). ParkSehJik (talk) 04:51, 22 November 2012 (UTC)

I hope so. I like the "antiscience, pseudoscience, fraud, and propaganda" definition from the NYAS. Nice way of saying "BS". Dominus Vobisdu (talk) 04:26, 22 November 2012 (UTC)

Dominus Vobisdu, we must be careful to use "OR", not "AND" in the definition, and be complete. The NYAS boils down to claims to heal based on "antiscience (supernatural energies not accounted for in physics), pseudoscience, fraud, OR propaganda", OR tradition, OR errors in reasoning, according to the above sources. ParkSehJik (talk) 05:09, 22 November 2012 (UTC)

Yeah, I think I'm following now. We should definitely incorporate your references but let's do it slowly, one by one. For reference #1, we have CAM therapies are anomalous practices for which claims of efficacy are either unproved or disproved. For the moment, let's put that one somewhere in the body of the article. We'll move it up to the lede later, if we can get others to agree. But before that, let's get through all your references. Would you be ok adding it yourself? TippyGoomba (talk) 05:00, 22 November 2012 (UTC)

Tippy, I already did about a week ago. I took this last version by Woohookitty, and changed it to this . The sources were already in it here. IRWolfie removed the above sources until they were discussed at talk, so I brought them to this talk page as he asked. So here we are. So far, I see no objection to any of the sources, but this discussion is less than a day old right now. You can restore it back to the Woohookitty version with no objection from me, or to my own previous version, but it can't hurt to hold off a bit and see if there are objections to any of the sources. ParkSehJik (talk) 05:24, 22 November 2012 (UTC)

I think that ParkSehJik is twisting the truth a little.... A series of edits in early November by him/her and a couple of IPs [28] were subsequesntly reverted by IRWolfie because they drastically altered the Lede, with no prior discussion, there was OR and they were POV. There was an extensive discussion at IRWolfie's talk page [29] regarding the correct way to edit and describing the problems with the version that ParkSehJik created. That discussion also included a suggestion that ParkSehJik propose one edit at a time so that his suggested edits could be properly discussed. Thus, restoring the version that ParkSehJik previously created is not acceptable. I do support systematically going through the references proposed by ParkSeJik, adding them to the body if appropriate and then discussing if they should also be added in the Lede. Puhlaa (talk) 05:59, 22 November 2012 (UTC)

Hi ParkSehJik, the edit you give me contains many more changes than just the single quote I am suggesting. Would you mind starting with the single quote and we'll go from there? TippyGoomba (talk) 06:02, 22 November 2012 (UTC)

Cited sources appear reliable. But what is the discussion supposed to be about? As a sociologist who learned about this discussion from the note at WT:SOCIO, I can comment if any of the sociology texts are unclear, but so far there is little I can contribute here. --_{Piotr Konieczny aka Prokonsul Piotrus| reply here} 04:56, 22 November 2012 (UTC)

Piotrus, [this version, contains sociological discussion in the lede, especially in regard to the Journal of Australian Medicine, American Psychological Association, and New York Academy of Sciences sources. ParkSehJik (talk) 05:09, 22 November 2012 (UTC)

The following is from a parallel discussion on this talk page section at Wikipedia Project Philosophy, copied here under WP:RTP reasoning.

A discussion involving retoring content from sources describing alternative medicine as being based on pseudoscience, antiscience, tradition, and bad science, including the first 14 sources of this version, such as Journal of the Association of Medical Colleges, Annals of New York Academy of Sciences, Academic Medicine, Canadian Medical Association Journal, Medical Journal of Australia, Nature Medicine, etc., to the Alternative medicine article is now going on here. ParkSehJik (talk) 02:57, 22 November 2012 (UTC)

I agree whole-heartedly with your point. I reinserted the category "pseudoscience" to the category, and I will monitor that. One point that the other side has, is that you should propose specific wording and the discussion should be based on that. If you go in and boldly reword it to your liking, I will join in and help you out. Greg Bard (talk) 04:38, 22 November 2012 (UTC)

Thank you. I am trying not to have "other sides", by strictly adhering to Wikipedia policies and solid sources. I have now made some specific proposals (above).This comment was moved here from discussion at Wikipedia talk:WikiProject Philosophy under WP:RTP. ParkSehJik (talk) 06:15, 22 November 2012 (UTC)

That's very confusing, can you make the suggestions here instead of above? I'm having trouble following this discussion... TippyGoomba (talk) 06:22, 22 November 2012 (UTC)

I have taken a stab at the lede. It may need some expansion based on the material in those sources. The lede should consist in four paragraphs. Can we agree that the "Handbook of Alternative Medicine" is not a credible source? Greg Bard (talk) 07:09, 22 November 2012 (UTC)

No, we have not agreed on anything yet, which kind of makes your Bold edit somewhat unhelpful (although completely allowed according to policy, as was my revert per BRD). Your edit removed a definition of CAM that is sourced, NPOV, mainstream, used by multiple reliable peer-reviewed medical sources and consistent with international medical body definitions (such as that of the WHO and the Cochrane collaboration). Please read the discussion above regarding the use of that definition [30]. We may reach consensus to include additional definitions, but what you removed is an internationally accepted and inclusive definition that should be retained and given alot of weight.Puhlaa (talk) 07:22, 22 November 2012 (UTC)

I am pretty sure your revert is more unhelpful. We should start with that language and expand from there. If "CAM" is supported by any credible sources, that still doesn't change the content of that edit. If there are credible claims to support your view they can be included in a later paragraphs. This article should certainly NOT start out with the idea that this is accepted by the experts. Some people only read the first paragraph, so the priority is not misleading anyone. Greg Bard (talk) 08:55, 22 November 2012 (UTC)

Hmmmm GregBard, perhaps you could share what policy you are following by reverting a revert that was based on policy (WP:BRD instead of joining propoer discussion? I will not revert your revert, but I am hopful that another quality editor will also disagree with your approach and violation of policy when there is active discussion underway.Puhlaa (talk) 16:07, 22 November 2012 (UTC)

The "definition of CAM" is a quote by Steven Bratman, a FRINGE POV MD who is ridiculed in the medical extablishment. What is your source that Bratman is "mainstream"? Furthermore, no matter what the sources, false sentences cannot be in a Wikipedia article. It is false that unconventional evidence based medicine is alternative medicine. Bratman's definition is entirely different from Cochrane Collaboration, which defines "truth" as what is determined by a political hegemony. WHO is a political body, the most POV source one can get. The first sentence can be removed as failing MEDRS. But I propose replacing it with what I suggest in the next sections below, which is based on all of the sources (except FRINGE POV Bratman), including WHO and Cochrane, since NYAS "anomolous practices" encompases their definitions. ParkSehJik (talk) 07:47, 22 November 2012 (UTC)

Proposed opening lede sentence and paragraph following sentences, based on the above sources to fix current false and WP:Fringe first sentence

• 1 - Based on the above listed sources -

"Alternative medicine is a claim to heal that is not based on evidence from the scientific method, but is instead based on beliefs from tradition, belief in supernatural energies (antiscience), pseudoscience, errors in reasoning (bad science), propaganda, or fraud." ParkSehJik (talk) 07:09, 22 November 2012 (UTC)

I agree whole-heartedly with your point. I reinserted the category "pseudoscience" to the category, and I will monitor that. One point that the other side has, is that you should propose specific wording and the discussion should be based on that. If you go in and boldly reword it to your liking, I will join in and help you out. Greg Bard (talk) 04:38, 22 November 2012 (UTC)

• 2 - The first two lede sentences and fourth lede sentence in the last version by Woohookitty could follow to complete the lede first paragraph and bring it into compliance with Wikipedia policies. -

Alternative medicine is any practice claiming to heal but whose "therapies are anomalous practices for which claims of efficacy are either unproved or disproved". "Alternative therapies are those lacking scientific validation". NCCAM, a branch of the US political body appointed to comment on medicine, defines alternative medicine based on their own country's licensing and the concept of "allies" of their own licensees, not on methodology - that which is not "medicine as practiced by holders of M.D. (medical doctor) and D.O. (Doctor of Osteopathic Medicine) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses”. ParkSehJik (talk) 06:56, 22 November 2012 (UTC)

(As someone who has been watching the discussion, but felt like taking a closer look after the notes on other articles) I think that such a long description of NCCAM and its specific definition is undue compared to the sources describing alt med in terms of evidence and scientific approach. I think this is mainly due to the convoluted sentence that it's described in - "In the United States, NCCAM defines alternative medicine as that which is not "medicine...professionals" seems substantially equivalent. Other than that, this proposal seems significantly better than the current version. Arc de Ciel (talk) 09:00, 22 November 2012 (UTC)

NCCAM's definition

A further comment: actually, I think a good argument can be made for leaving NCCAM out of the lead, as it currently is. It does not carry the same weight as, say, the National Cancer Institute describing cancer, or some of the sources given above. Arc de Ciel (talk) 09:13, 22 November 2012 (UTC)

Arc, please go ahead and make your arguememt for leaving the NCCAM definition out of the lede, I have not seen your argument yet. I am not sure what the national cancer institute has to do with anything...it has not been proposed as a source with a definition for CAM? If you are interested, the national cancer institute uses a definition similar to that of NCCAM, ie: "Complementary and alternative medicine (CAM) is the term for medical products and practices that are not part of standard medical care." The NCCAM definition is also consistent with the definition of the cochrane collaboration, The WHO and a paper in the British Medical Journal titled "What is Complementary Medicine". Moreover, as I have detailed repeatedly, high quality secondary medical sources have described the NCCAM definition as "commonly used and inclusive". You are suggesting that a definition that is accepted and supported by multiple internation and mainstream medical bodies should recieve less weight than a definition proposed by a few sole authors in a few individual publications? Can you confirm that this is your opinion?Puhlaa (talk) 16:00, 22 November 2012 (UTC)

Here are two arguments Arc can make for leaving NCCAM out of the lede. The NCCAM definition violates WP:MOS. Under the NCCAM definition, if evidence based "day-after abortion pills" were outlawed by politicians, they would not be used by MD's DO's and their allies, so they would be called "alternative medicine" by NCCAM, which is not MEDRS valid. A second argument to leave it out is the specificity of being US-centric, which violates MOS (lede). A counter argument for putting it in is to qualify it as being a shifting definition made by politically appointed boards, not based on peer reviewed medical science, or peer elected medical science associations, to satisfy MEDRS, and to cite NCCAM as just one "example" to satisfy MOS (lede). ParkSehJik (talk) 17:28, 22 November 2012 (UTC)

I was comparing it to the NCI when the NCI is discussing cancer, which is the field in which it represents the scientific consensus. NCCAM is highly controversial within the scientific community and does not have the same level of scientific authority.

You could, however, say that the definition is nevertheless influential, which is a different matter and which I think has been demonstrated. My question then is whether it is influential enough to be in the lead; and secondly whether it is influential enough to be in the lead as a competing definition rather than a popular one, and based on my reading of the discussion above the answer to the second question is no. Also, which sources call it "commonly used and inclusive"? Arc de Ciel (talk) 21:22, 22 November 2012 (UTC)

This MEDRS-compliant source [31] explains why it uses the NCCAM definition: "the NCCAM definition is widely known and used.....Since the NCCAM definition is inclusive of many different types of therapies and products, we will use it in the present article" Moreover, the NCCAM definition is consistent with the definition given in this source [32] in the British Medical Journal titled "What is Complementary Medicine". Finally, the NCCAM definition is consistent with that of the WHO [33] and the Cochrane collaboration [34]. This definition should get far more weight than the skeptical definition currently being pushed. The definition suggested in these proposals eg: "Alternative medicine is any practice claiming to heal but whose "therapies are anomalous practices for which claims of efficacy are either unproved or disproved" are inconsistent with mainstream sources that suggest one-third of CAM have some scientific evidence in the cochrane library to support their use.Puhlaa (talk) 21:34, 22 November 2012 (UTC)

I suggest adding the WHO, NCCAM, and Cochrane definitions in the section below, as follows, so please comment unless you do not object -

"Some organizations and political bodies define alternative medicine as that which differs from their own local medical practices or licencing".

The definition of healing practices whose "therapies are anomalous practices for which claims of efficacy are either unproved or disproved" is a direct quote from the peer reviewed Annals of the New York Academy of Sciences central published article on alt med. It is also consistent with WHO, Cochrane, and NCCAM, because "anomolous practices" summarizes each of their definitions. The source you cite as a "MEDRS-compliant source" is not. It is not even about medicine, and is a self-pay web post. It cannot be used as a source to support how widely used NCCAM definitions are because it is posted at NIH, of which NCCAM is a part. The article is about "questionnaires assessing the prevalence of CAM use" by kids. Using questionaires to establish "prevalence of use" is a marketing tool, not a measure of efficacy. This has nothing to do with MEDRS. ParkSehJik (talk) 22:29, 22 November 2012 (UTC)

I do not agree with this, you are qualifying a commonly used and inclusive definition used by multiple international bodies with "some organizations define". The British medical journal does not say "some organizations" it says "Complementary medicine refers to a group of therapeutic and diagnostic disciplines that exist largely outside the institutions where conventional health care is taught and provided." This is consistent with the NCCAM definition, almost exactly. The NY Academy is not consistent with NCCAM or BMJ, it is a critical definition that is flawed because it tries to define CAM as untested, whereas one-third of CAM have scientific evidence in cochrane reviews to support their use. I maintain that the NCCAM, WHO, BMJ, Cochrane theme of definitions is the most neutral and inclusive definition that represents a world view. I suggest that this well-respected definition should receive the most weight and the NY academy of sciences definition can be qualifies with "some organizations define CAM..."Puhlaa (talk) 00:28, 23 November 2012 (UTC)

Just a few things and I will continue with my main comment below.

- if you're not aware, PLoS One is primarily peer-reviewed only for methodology. It's a valid source, but there are better ones; a single source is not sufficient for the claim, unless it cites multiple other sources.
- "most inclusive" doesn't make a definition more accurate.
- I agree that "some organizations define" should not be used (WP:WEASEL), but that applies for your proposal as well (which you have repeated below).
- I'm not sure why you're calling Greg Bard's version "the skeptical definition", and you implied that there is POV pushing - is that your intent?
- it is possible for something to be unproven and for there to be some scientific evidence supporting it. Arc de Ciel (talk) 06:01, 23 November 2012 (UTC)

Arc, thanks for your respectful discussion and the chance to respond.

- You confirm that the NCCAM source indeed has a single independent source that suggests their definition is commonly used and inclusive, I admit, it would be nice to have more independent support, but I ask, are there ANY independent sources that support the newly proposed definitions (such as that of NYAS)? I think only the authors of those alternate definitions themselves have claimed they are valid? This is why I suggest below that they be attributed, whereas NCCAM definition needs not be because it is 'widely used'. Either way, it does not matter, I think I have made a better proposal with the BMJ source. The BMJ source says essentially the same thing and is not as prone to claims of bias like the NCCAM. The 'big picture' is getting a NPOV and inclusive definition to start the lede of the article, so it is consistent with policy and reads like a NPOV encyclopedia.

- I called the newly proposed definitions (such as NYAS) POV because they are an actual POV....not to accuse any editors of bad faith. The proposed definitions are the opinions of the authors that wrote them and published them. As I asked above, do any high-quality independent sources say anything like: "the NY academy of sciences definition of CAM is commonly used and inclusive in the literature"? If so, then I apologize and will consider the NYAS definition as deserving more weight and no attribution.

- I called Greg Bard's version 'skeptical' because it implies that all CAM lacks scientific evidence, which is a skeptical POV in light of secondary sources that suggest ~30% of CAM has evidence to support it in the cochrane database and another ~12% 'possibly' positive. Do you disagree that a defintion that implies 'CAMs are therapies that lack evidence' is a skeptical POV on the broad spectrum of POVs? Either way, I suppose some of my comments were based out of frustration that he made his edits without joining discussion at the talk page, even though his dialogue with Parksij at the Wikipedia Project Philosophy page suggests that he knew discussion was underway to try and reach a consensus. In reality, I dont have an idea or opinion on the intent behind his edit so would not suggest bad faith, I apologize to Greg Bard if this was the impression I gave with my comments.

- You state "it is possible for something to be unproven and for there to be some scientific evidence supporting it." I agree with you 100%, however, your preferred version below (that with Parks refs instead of BMJ) for the first sentence says "CAM...is not supported by evidence using the scientific method". As such, the discussion is not over what is proven (or the list would be very short based on my knowledge of the medical literature), but rather what is supported by evidence using the scientific method. Cochrane reviews only consider evidence that follows the scientific method (or do you challenge cochranes standards?) and they conclude that there is evidence of positive effect for 1/3 of CAMs, thus, 1/3 of CAMs do not fit your preferred definition of "...not supported by evidence...". Puhlaa (talk) 06:42, 23 November 2012 (UTC)

I agree that the BMJ is more reliable than NCCAM. However, NYAS is an academy of sciences, i.e. it implies that it is an accepted definition within the academy. The most respected academies of science, such as NYAS (or NAS, the Royal Society, etc), also generally speak for large parts of the scientific community. In this case, there is the additional benefit that the authors are among the most reliable sources in existence about science vs nonscience, the scientific method, etc and what falls into either category. You're also focusing on NYAS to the exclusion of the other sources that were offered - it's true that NYAS is the one that carries the most weight, but the others are strong as well and corroborate it. Can you provide equally respected scientific societies that endorse your interpretation?

I'm not sure what your POV concern is. There's not really any such thing as a "skeptical POV" the way I understand the word, which basically means "requiring evidence to support one's beliefs." If you mean "the position that none of CAM has any evidence to support it," the phrase "not supported by evidence" reads as saying that there is not sufficient evidence, rather than that there is no data at all that supports the conclusion. Then again, "not supported by evidence" isn't the same as "not based on evidence", which is what's currently in the article - you can follow an evidence-based conclusion for reasons that aren't based on evidence (or they are based on evidence but the evidence isn't sufficient). This is semantics, but definitions need to be semantic. :-) Now that you mention it, though, I realize that it could be more clear. I would be fine with something like "...but has no or insufficient evidence to justify its effectiveness" (we can throw in "gathered using the scientific method" if anyone prefers, but it's already implied in that, and simplicity increases understanding). Arc de Ciel (talk) 13:51, 24 November 2012 (UTC)

In context with other articles

Seeing that much of the discussion on this page is about critical examination of the lead and working towards a consensus for improving it in a way which is within the scope of the title, is it agreed that related articles, particularly any which are linked, should be taken into account? As of 8:48, 22 November 2012 UTC there are two competing leads[[35]] Of those, Gregbard's appears largely preferable, and the following is a critical scrutiny of the links (making no comment about sources):

The trend or tenor or skew of some of the interlinked articles seems to be for the promotion of "Health care" as described in that article with its external links to certain American, UK and Australian sources. This, presumably, is the context for editing "Alternative medicine", regardless of any one editor's personal convictions either way. Any undue skew may be redressed by the other links. Perhaps "academic scholars" is not quite right: a hint of irony may be intended, but is it policy-permitted? Links in Gregbard's edit for the opening paragraphs, and some further links:

Medicine. That article begins with further links, thus "Medicine is the applied science or practice of the diagnosis, treatment, and prevention of disease. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness in human beings. Contemporary medicine applies health science, biomedical research, and medical technology to diagnose and treat injury and disease, typically through medication or surgery, but also through therapies as diverse as psychotherapy, external splints & traction, prostheses, biologics, ionizing radiation and others. The word medicine is derived from the Latin ars medicina, meaning the art of healing."

applied science begins "Applied science is the application of human knowledge to build or design useful things. Examples include testing a theoretical model through the use of formal science or solving a practical problem through the use of natural science. Fields of engineering are closely related to applied sciences. Applied science is important for technology development. Its use in industrial settings is usually referred to as research and development (R&D). Applied science differs from fundamental science, which seeks to describe the most basic objects and forces, having less emphasis on practical applications. Applied science can be like biological science and physical science."

Healthcare science is the applied science dealing with the application of science, technology, engineering, or mathematics, to the delivery of healthcare. Healthcare scientists directly involved in delivering the diagnosis, treatment, care, and support of patients in healthcare systems, rather than those individuals whose primary focus is with academic research.

Academia-- removed

Evidence

Scientific method

Scholarship-- removed

Peer review-- removed

"errors in reasoning" links to Fallacy

Integrative medicine

Evidence-based medicine

Qexigator (talk) 12:39, 22 November 2012 (UTC)

List of links above updated as at 15:12, 24 November 2012(diffs at [[36]]) with additions but not including any in source notes/refs :

Scientific validation (redirects to Scientific method)

Efficacy

unproved-- links to Scientific method

disproved-- links to Scientific evidence

World Health Organization

Qexigator (talk) 16:48, 24 November 2012 (UTC)

Qexigator's statement "As of 8:48, 22 November 2012 UTC there are two competing leads[[37]]" is false. There are four ledes being discussed, including the two above, that of Woohookitty[38] ,and my revision of it[39]. Ignoring information that you cannot respond to like this is a "propaganda technique" discussed in the NYAS article on alt med. Ignoring something to make it go away will not work at Wikipedia. There are too many MEDRS sources in the first 14 references here[40] to ignore. These MEDRS references will not go away. ParkSehJik (talk) 17:38, 22 November 2012 (UTC)

Yes, I daresay my comment could have said simply: "....of the two leads proposed on page [[41]]..."; but no, I was not practising a propagandist technique. I am now following with interest your proposals for further revision, but I am hoping that revisers will not fail to take account of seeing this article "In context with other articles". The product needs to be reasonably intelligible for the reasonably intelligent reader who is looking for unbiased information about topics of which s/he has a knowledge deficit. Qexigator (talk) 23:21, 22 November 2012 (UTC)

Greg Bard's recent edit to the Lede first paragraph

I am adding a construction tag to allow Greg Bard's edits to be further developed. ParkSehJik (talk) 20:38, 22 November 2012 (UTC)

Cited sources

I suggest that actual quotes from the sources be included in the references for long term stability, and for possible rewording to more strictly adhere to what the sources say. I have fully read each of these sources, and will do so, but I suggest that any editors who want to serious contribute to this article fully read the sources before making changes based on them. ParkSehJik (talk) 20:38, 22 November 2012 (UTC)

Lede first sentence

The current lede first sentence states "Alternative medicine is any practice that is put forward as having the healing effects of medicine, but is not supported by academic scholars in the area of medicine." I propose, based on the sources cited, changing this to ""Alternative medicine is any practice that is put forward as having healing effects, but is not supported by evidence using the scientific method as in medical science." ParkSehJik (talk) 20:38, 22 November 2012 (UTC)

Agree with the spirit of the latter statement - the divide between conventional and alternative medicine is based on scientific evidence, not scientific personality. -- Scray (talk) 20:59, 22 November 2012 (UTC)

--Commenting as an alert reader with a knowledge deficit, my first thought on seeing this in the lead would be "Experience shows that Wikipedia articles, or their editors, are not always in agreement about whether or not a given practice satisfies the criterion 'not supported by evidence using the scientific method as in medical science' according to available and acceptable sources". I would then read on to see whether the article showed signs of being slanted either way. But this and the proposals for sentences 2,3 and 4 look about right, subject to comment from editors more knowledgeable than...Qexigator (talk) 23:47, 22 November 2012 (UTC)

The proposed sentence is innapropriate to start the lede because it is POV and is contradicted by other mainstream sources.

1. Inconsistent with other sources: The proposal suggests that the lede start with "Alternative medicine is any practice that is put forward as having healing effects, but is not supported by evidence using the scientific method as in medical science" However, we currently have secondary sources in the body and the lede that conclude 1/3 of CAM has some scientific evidence to support their use. "The results from all eligible Cochrane reviews of CAM therapies were assigned to one of the following categories.....The largest number of treatments described in the reviews were classified as insufficient evidence of an effect (n = 82; 56.6 percent), followed by positive effect (n = 36; 24.8 percent) and possibly positive effect (n = 18; 12.4 percent)." This is not consistent with CAM being ANY therapy with NO evidence....are 1/3 of CAMs not really CAM? It does not make sense to use a definition to start the article that is so easily contradicted, especially when there are better definitions available.
2. Better definition: A clinical review titled "What is complementary medicine", published in the British Medical Journal [42] defines CAM as: "a group of therapeutic and diagnostic disciplines that exist largely outside the institutions where conventional health care is taught and provided." This definition is NPOV and is inclusive of all CAMs, not just the 66% with NO evidence. Moreover, the BMJ definition I propose for the first sentence is consistent with the WHO definition [43] and the Cochrane collaboration definition [44] and the NCCAM definition [45]. It is an added benefit that the BMJ definition I propose for the first sentence is very similar to the NCCAM definition, because the NCCAM definition is "widely known and used" according to this source [46].

As this is an encyclopedia, a definition that is "widely known and used" is appropriate, a definition that is contradictory with other mainsream sources is not appropriate when there are better options available.Puhlaa (talk) 03:45, 23 November 2012 (UTC)

It's worth noting that the phrase "NO evidence" did not appear prior to your comments, and is not equivalent to "not supported by evidence using the scientific method as in medical science." That said, I don't object to the definition from BMJ. -- Scray (talk) 04:30, 23 November 2012 (UTC)

As a correction, what we want is the definition widely known and used among the relevant experts. Park is saying that e.g. the WHO should not be used as it is a political body rather than the consensus of experts. I don't agree with that reasoning, but I also see that there could be more authoritative definitions - it is a reliable source but it would be subordinate to a greater weight of sources; I think the list Park provided would be sufficient for that. Let me also add this one from Nature.

I also have some concerns about the sources you (Puhlaa) presented. The BMJ and WHO sources are imprecise and are better characterized as descriptions, not definitions: "X refers to a group of Y" does not define X (it only says that all X have a certain characteristic Y, which may or may not be their defining characteristic) and should be only used in the absence of a more specific definition. The Cochrane source would be better (it presents a defining characteristic), but then I found that it's published in an extremely poor journal (mission statement is "to promote the art and science of integrative medicine"; and I can find almost no information on the credentials, affiliations, and achievements of the editor; etc) and I'm not yet sure what to think about that.

I don't have any major objection to your proposal so long as the lead paragraph continues to contain the rest of the information that it already contains, but I think a more specific version (like the current one, or Park's proposal using the term "scientific method") would still be better. Arc de Ciel (talk) 06:08, 23 November 2012 (UTC)

I find it difficult to understand your suggestion that an article titled "What is Complementary medicine" in BMJ can be considered a less-valid source for a definition of CAM than the articles suggested by Park. I agree that the articles suggested by Park are high-quality sources as well, but their scope is not to define CAM, but rather specific to other CAM issues. It is also noteworthy that the BMJ source quotes the Cochrane definition below their own definition (or description as you prefer), so could potentially be used as a source for the cochrane definition? Anyways, your comment is reasonable despite my minor objections, thanks.Puhlaa (talk) 07:04, 23 November 2012 (UTC)

It's not less valid as a source, and it backs up the statement; it's just that the statement isn't really a definition. It's more along the lines of "this is something we can all agree upon before we narrow our discussion further," and the very next sentence starts to talk about how there is confusion about what CAM is. They then go on to select a definition (not really a definition either; they give a list of examples), acknowledging that it's a selection for the purposes of the article, and go on to describe CAM based on that. You made a good point about the citation of Cochrane, but they're not endorsing it either, just describing it as one among many. About scope, if CAM is a source's primary topic, I think that a definition would be within the scope. "What is complementary medicine?" doesn't mean that the scope of the article is about defining CAM - it's a common title for any introductory-level discussion. And as you can see, only the first section is relevant to the issue of definitions.

As you might have gathered, I'm still thinking through this (and spending a lot more time than I should be, incidentally). I don't think that listing so many specific definitions in the first paragraph is useful though, as in the current version - they should be summarized, and I can try to take a look at that later. Arc de Ciel (talk) 13:51, 24 November 2012 (UTC)

"...what we want is the definition widely known and used among the relevant experts." per Arc 06:08, 23 November. So far so good, and before finalising, will editors please remember that when addressing the ordinary reasonably intelligent reader it will need to be such as to let the reader see that it is authentic and authoritative, and sufficiently self-explanatory in itself or is explained. This should be too obvious to mention, but could be left behind by the time a lengthy discussion reaches a point of agreement. Qexigator (talk) 11:10, 23 November 2012 (UTC)

Agreed. :-) Arc de Ciel (talk) 13:51, 24 November 2012 (UTC)

Lede second sentence

The current second sentence states "The medicine to which alternative medicine purports to be an alternative is based on evidence gathered consistent with the scientific method, has been subjected to scholarly peer review, and is accepted by the credible experts in the area of medicine." I suggest that the word "purport" be removed, and the sentence be modified to read "alternative medicine is not based on evidence gathered using the scientific method", which would be redundant if my suggestion in the previous section is used. ParkSehJik (talk) 21:16, 22 November 2012 (UTC)

As described above, this statement is contradicted by other mainstream sources because we currently have secondary sources in the body and the lede that conclude 1/3 of CAM has some scientific evidence to support their use. "The results from all eligible Cochrane reviews of CAM therapies were assigned to one of the following categories.....The largest number of treatments described in the reviews were classified as insufficient evidence of an effect (n = 82; 56.6 percent), followed by positive effect (n = 36; 24.8 percent) and possibly positive effect (n = 18; 12.4 percent)."[47] Thus, we could keep a mention of this description of CAM, but it would have to be attributed. I suggest we change it to: "While 1/3 of CAM therapies have some evidence to support their use, some authors suggest defining CAM as those therapies not based on evidence gathered using the scientific method" — Preceding unsigned comment added by Puhlaa (talk • contribs) 03:57, 23 November 2012‎

That makes sense to me, though I'm not sure counting therapies is the best way to summarize. -- Scray (talk) 04:32, 23 November 2012 (UTC)

Lede third sentence

The current lede third sentence states "Alternative medicine is instead often based on traditional beliefs, including belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, or fraud." I suggest changing this to "Alternative medicine includes a wide range of practices with differeing bases, including tradition, antiscience (belief in supernatural energies), use of pseudoscience (attempts to appear scientific without being so), errors in reasoning (faulty scientific methods or inferences), and sometimes fraud or quackery." These terms are directly supported by the sources, and I will cite exact wording. MOS rewuires defining technical terms used in the cited sources in plain English, so the parenthetical explanations. I am suggesting this slight change because medicine based on, e.g., tradition, does not require belief in anything - it just requires following tradition. Healing traditions that have some efficacy would tend to survive over time because the patients are more likely to survive to perpetuate them, but there is no belief system required. E.g., most rational skeptics injured in a remote location without a real doctor would likely use a traditional poultice made from local plants by a local traditional, rather than randomly select some plants themselves and hope they do not make things worse. This is use of alternative medicine based on tradition, without having a belief in the bases. ParkSehJik (talk) 21:21, 22 November 2012 (UTC)

I like the proposed change.Sgerbic (talk) 22:31, 22 November 2012 (UTC)

I also like the proposed change. It helps to clarify some of the terminology, which I think is important--particularly in the lede.Dustinlull (talk) 06:14, 23 November 2012 (UTC)

Suggested fourth sentence

"Some organizations and political bodies define alternative medicine as that which differs from their own local medical practices or licencing" This is the upshot of the NCCAM definition, the Britich Medical Journal (which cites Cochrane) definition, and the WHO definition. These definitions are subject to change based only on local politics. For example, if an evidence based and highly effective abortion pill was banned by a vote of politicians, it would switch from being evidence based medicine to being alternative medicine under the NCCAM, WHO, and Cochrane definitions. It would switch back and forth from being alternative medicine to evidence based medicine with each election. The NCCAM, WHO, and Cochrane definitions not well thought out, but they exist anyway, and must be in this article, qualified as suggested above to satisfy WP:MEDRS. ParkSehJik (talk) 21:16, 22 November 2012 (UTC)

Alternative definitions of "health"

A major theme in at least some alternative medical practices is the claim that some kinds of health are either not measured, or are incapable of being measured, by scientific methods. For example, "spiritual health". This should be included in the article. Perhaps some editors who are practitioners can suggest sources as to these claims. ParkSehJik (talk) 21:29, 22 November 2012 (UTC)

Lede first paragraph - Gregbard edit trimmed; sources wikified; exact quotes added from definitions of CMA, NYAS, NCCAM, BMJ, and WHO per above discussion

I trimmed redundancies from Gregbard's first two sentences in the lede[48], wikified citations in his edit, and , as per te above discussion, added definitions by using exact quotes[49] from Canadian Medical Association, Annals of the New York Academny of Science, NCCAM, and British Medical Journal-

The Canadian Medical Association Journal published the definition - "Alternative therapies are those lacking scientific validation".[7] The Annals of the New York Academy of Science published a definition that alternative medicine "therapies are anomalous practices for which claims of efficacy are either unproved or disproved".[1] NCCAM defines alternative medicine as that which is not "medicine as practiced by holders of M.D. (medical doctor) and D.O. (Doctor of Osteopathic Medicine) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses”.[9] The British Medical Journal published a definition - “Complementary and alternative medicine (CAM) is a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period."[10] The World Health Organization states that "the terms 'complementary medicine' or 'alternative medicine' are used inter-changeably with traditional medicine in some countries. They refer to a broad set of health care practices that are not part of that country's own tradition and are not integrated into the dominant health care system."[11]

The eleven sources supporting the lede first paragraph are now[50] -

• Annals of the New York Academy of Sciences,
• Academic Medicine,
• Nature Medicine,
• American Psychological Association,
• Journal of the Association of Medical Colleges,
• Medical Journal of Australia,
• Canadian Medical Association Journal,
• Carl Sagan,
• NCCAM,
• British Medical Journal, and
• World Health Organization.

If anyone questions the reliability of any of these sources, please do so here to consolidate discussion. Otherwise we can move on to bringing the next paragraphs of the lede. ParkSehJik (talk) 04:46, 24 November 2012 (UTC)

• The first two sentences as at 15:12, 24 November 2012 UTC[[51]] are:

"Alternative medicine is any practice that is put forward as having the healing effects of medicine, but is not based on evidence gathered with the scientific method. Alternative medicine is based on tradition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, or fraud":

That may seem as fair and balanced as editors intend. But it is open to being read as if meant to apply exclusively to "Alternative medicine" and not at all to "Medicine". Can it be truthfully said that Medicine other than that here being classed as "Alternative" is always and everywhere wholly free from some of that-- at least tradition, pseudoscience, errors in reasoning, propaganda, or fraud? Is Medicine as practised anywhere always based on evidence gathered with the scientific method? How many are so naive as to suppose that? What is the basis for such a belief? Can the statement be clarified to avoid such unintended naivety? Qexigator (talk) 17:24, 24 November 2012 (UTC)

Perhaps your concern is with Medical malpractices such as reported at [[52]], [[53]], [[54]], [[55]], [[56]]?

-Qexigator (talk) 18:33, 24 November 2012 (UTC)

What do these links have to do with this article in any fashion? IRWolfie- (talk) 18:43, 24 November 2012 (UTC)

I am sorry to keep picking on you Park, but I believe that there are a number of problems your new version.

1. There was still no consensus reached on how to improve the article, your edits are not similar to what was discussed above, and most definitely, no-one agreed to add every definition in existence to the lead.
2. The lead is supposed to be a summary of the article, these edits [57] make the first paragraph of the lead a list of definitions, which does not read like an encyclopaedia.
3. Many of the definitions listed are similar; for example, the WHO[58], NCCAM[59], BMJ[60] and Cochrane collaboration [61] all have the common theme of defining CAM as not part of the conventional, or dominant health care system. Thus, these can be combined into one summary sentence.
4. You added the CMA published the definition: “Alternative therapies are those lacking scientific validation” . This source [62] is a CMAJ ‘news brief’, written by freelance writer Heather Kent and is not a peer-reviewed or highly reliable source, it hardly deserves the weight needed to be included on its own in the lead. Moreover, even if it were a high-quality source and appropriate for the lead, the statement should actually be attributed to the "”Tzu Chi Institute', the country’s first centre for evaluating alternative and complementary therapies.” , who made the statement to the freelance writer who wrote the CMAJ 'news brief’. Finally, the source is not found in the body of the wikipedia article, so is not appropriate for a lead that is supposed to "summarize the body of the article".
5. You added The Annals of the New York Academy of Science published a definition that alternative medicine "”therapies are anomalous practices for which claims of efficacy are either unproved or disproved" [63], however, this definition is not commonly used to my knowledge and is also not logical. Do many other sources use a definition where treatments are requiring "to be proved" to be considered conventional medicine? Or are considered CAM if unproven? Can you provide those sources? Rarely are things in conventional medicine considered 'proved', only supported by the current level of evidence. For example, this study [64] found that only retrospective or anecdotal evidence was available to support 55% of the identified decision/interventions in hematology and oncology. I would thus challenge the 'legitimacy' and thus 'noteworthiness' of a definition that uses extreme phrases like "not proved" to define CAM. The source is also not found in the body of the wikipedia article, so is not appropriate for a lead that is supposed to "summarize the body of the article".
6. Your edits failed to remove the incorrect inference that makes up the first sentence of the Lead, that is "“Alternative medicine is any practice put forward as medicine but not based on evidence.....” " As explained above, we have high-quality sources that say ~1/3 of CAM has some positive evidence in Cochrane reviews, thus many CAMs do not fit this flawed definition. Further, as shown above, many (55% of decision/interventions in hematology and oncology) conventional treatments are based on only retrospective or anecdotal evidence, yet are still not considered CAM, thus many conventional treatments are also at odds with this definition. I don’t feel that it needs to vanish altogether, but it is not worthy of the first sentence of the lead when there are better definitions available, such as the theme of definitions used by BMJ, WHO, NCCAM and Cochrane.

In summary, I don’t think that your edits have improved the article, or are consistent with the discussion that was still ongoing. My recommendation is that the edits be reverted back to the last stable version from November 21 and start over on working towards consensus for the revisions discussed above, to sentence 1,2,3 of the Lead. I would be happy to make a fresh proposal for edits similar to what was discussed above, but am not going to invest the effort until I hear from other editors. Do any editors feel that the current version is an improvement from the November 21 Version? Puhlaa (talk) 22:37, 24 November 2012 (UTC)

I don't think the November 21 version was better than the 22 or 24, although as we have both pointed out the Nov 24 version is stylistically undesirable. I made a quick edit to summarize the definitions, though of course other concerns remain. Let me know what you think - I used your phrase for the summary of the second definition.

A couple of brief comments: "proven" and "supported by the current level of evidence" are essentially the same thing in science; also, some positive evidence is not equivalent to the evidence being sufficient to justify effectiveness. Did you have an opinion on my proposal above? Arc de Ciel (talk) 02:28, 25 November 2012 (UTC)

Reply to IRWolfie's "What do these links have to do with this article in any fashion?" Are you referring to the source links proposed above? or to the reply to ParkSehJik? If the latter, please see above comment on "The first two sentences..." and ParkSehJik's response--which was at[[65]]-- which give sufficient explanation. Can you now propose opening sentences which are better suited to the topic which other editors can consider? Qexigator (talk) 19:14, 24 November 2012 (UTC)

--Since the present concerns of other editors are mainly about sources, I am abstaining from IRWolfie's question about reverting to November 21. Qexigator (talk) 19:26, 24 November 2012 (UTC)

The third lede paragraph violates MOS (lede)

The third lede paragraph is -

"A 2011 multi-National systematic review concluded that about 40% of cancer patients use some form of complementary and alternative medicine.[21] Alternative medicine varies from country to country. Jurisdictions where alternative medical practices are sufficiently widespread may license and regulate them. Edzard Ernst has said that in Austria and Germany complementary and alternative medicine is mainly in the hands of physicians,[15] while some estimates suggest that at least half of American alternative practitioners are physicians.[22] In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance based on their Commission E legislation.[23]"

• Per MOS (lede), the third lede paragraph has too many specifics to be in the lede. It is about a specific year (2011), a specific disease (cancer), specific countries (Austria and Germany), and one country's "Commission E Legislation".
• Per MOS (lede)#Relative emphasis, the third paragraph has little "relative importance to the subject".

I am therefore moving the paragraph to the appropriate section. There may be other problems with the content, such as WP:MEDRS and WP:UNDUE weight, but I am retaining all of the content in the section I moved it to for now, until the content can be discussed according to these and other relevant policies and guidelines. ParkSehJik (talk) 18:16, 24 November 2012 (UTC)

Replace false sentence re efficacy in lede per MEDRS Academic Medicine, the Journal of the Association of American Medical Colleges

• This lede sentence is false - "one-third of alternative treatments have some published literature supporting their use".

• It is false that the thousands or millions of completely different traditional medicine practices, and millions or billions or more "alternative treatments", including every culture and triabl practice in the Pacific Island, of North and South American, native cultures of Africa, cultures ancient European, widely divergent Asian traditional practices currently and in history, Neolithic practices around the world, etc., "have some published literature". It is also false that the publications "support" the use. Just the opposite is true.

• This is confirmed by a publication in the Academic Medicine, the Journal of the Association of American Medical Colleges (among the very highest standards of WP:MEDRS), which says,

"products and therapies of alternative medicine... most of these either are known to be useless or dangerous or have not been subjected to rigorous scientific testing". (Source - Journal of Academic Medicine article), Beyerstein, Barry L. PhD, Academic Medicine: March 2001 - Volume 76 - Issue 3 - p 230-237)

• I will replace the false MEDRS violating sentence with the exact quote from the MEDRS Journal of Academic Medicine. ParkSehJik (talk) 18:45, 24 November 2012 (UTC)

The finding that 1/3 of CAM are supported by some evidence comes from a review of Cochrane collaboration database, it can not be called 'false' because you have a single editorial by one author that says something different, but provides no systematic review of the literature to back it up. "The results from all eligible Cochrane reviews of CAM therapies were assigned to one of the following categories.....The largest number of treatments described in the reviews were classified as insufficient evidence of an effect (n = 82; 56.6 percent), followed by positive effect (n = 36; 24.8 percent) and possibly positive effect (n = 18; 12.4 percent)." I would argue that it is clearly the editorial piece in AAMC that is false, because a high-quality source has shown that ~30% of CAM have evidence.Puhlaa (talk) 19:10, 24 November 2012 (UTC)

As I said a few sections above, I'm not convinced that counting therapies is useful. Stated another way, the treatments summarized by Cochrane were enumerated in their report, but were not claimed to be representative worldwide, so any summary from that report would need to be qualified by, "of the treatments described in the review" rather than "of CAM treatments" (the latter of which statements would be construed to apply more generally). Thus, the AAMC and Cochrane statements are not mutually exclusive. -- Scray (talk) 19:47, 24 November 2012 (UTC)

• 1 Scray is entirely correct in saying that "the treatments summarized by Cochrane were enumerated in their report, but were not claimed to be representative worldwide". More specifically, "1/3 of 'all eligible Cochrane reviews of CAM therapies'" is not equivalent to "1/3 of all alternative therapies".
• 2 Scray is correct in saying that "the AAMC and Cochrane statements are not mutually exclusive". The AAMC conclusion is more general, being about all alt med therapies, and not just about the very small number included in the Cochrane review. So the AAMC conclusion is what belongs in the lede per MOS (lede). The Cochrane review with its specifities, at best belongs in a section below, subject to further discussion about MEDRS. (Puhlaa is incorrect that the Academic Medicine article is an "editorial" - It is a peer reviewed article, supported by 60 major references[66], then edited further.) ParkSehJik (talk) 20:33, 24 November 2012 (UTC)

@ Scray, you comment that they are not mutually exclusive, but gave no comment towards the suggestion of Park to remove a well-sourced text from the lead and replace it with a POV statement. It is still my opinion that the CMAJ source is an opinion of an author that is being used to contradict a review of cochrane articles (a stronger source for claims of efficacy). This is against WP:MEDRS in every sense. Please provide the evidence (independent source) that says that the CMAJ article defintion represents a world view and I will agree that it deserves to be given at least equal weight to that of the source that says 30% of CAM have evidence to support them. If the CMAJ is verified as a world view then what we have is two contradictory POVs that at the very least need to be given equal weight in the lead. Puhlaa (talk) 20:51, 24 November 2012 (UTC)

Rather than throwing around "POV" and other accusations, if someone can provide a succinct, clear set of alternatives then visitors here may have a better chance of commenting. I'm lost in the ocean of text above. -- Scray (talk) 01:12, 25 November 2012 (UTC)

As I said, a source like the NYAS already speaks for a large number of scientists - it does not need an additional source stating that the definition is widely used. There is an NSF source used later in the article that has equivalent weight (it also recognizes that there are multiple definitions but you shouldn't have a problem with that if you're supporting the BMJ article), and a couple of other strong sources as well. The authority of the CMAJ source (or any of the individual sources in isolation) is beside the point, and in fact the number of sources is already more than sufficient (WP:CITEKILL) - we are discussing total weight.

Speaking of which, I agree that the "one-third" statement is misleading. First, almost all of them are nutritional (NCCAM classification 3), probably because these are self-selected by scientists as the most plausible to study; second, they are tested for very specific indications despite being marketed for an extremely wide range of things. If the statement remains, it should be qualified appropriately.

@Scray, I'm not sure that such a set of alternatives exists given the state of this discussion :-), but the main versions showing the differences to the first paragraph are original, Nov 22 (Gregbard), Nov 24 (Park), and Nov 25 (my summarization of Park, +2 sources). Arc de Ciel (talk) 02:37, 25 November 2012 (UTC)

Thanks - current version looks fine to me, very easy to parse. -- Scray (talk) 03:39, 25 November 2012 (UTC)

Arc de ciel's recent edit to lede first paragraph

Arc de ciel's recent edit to the lede first paragraph now makes it very readable and explanatory of the topic, in addition to being very well sourced. ParkSehJik (talk) 02:54, 25 November 2012 (UTC)

(Description of the edit was made above.) It's still your version, I just tried to make some improvements since it's the current one after all. :-) Arc de Ciel (talk) 03:12, 25 November 2012 (UTC)

It seems that you guys have consensus between the 3 of you, As I am the only editor that is saying that your edits represent a single POV in a complex issue, I will concede. Note that I am not implying bad faith, but I still contend that your preferred version of the lead currently gives all the weight (the first 3 sentences of the lead) to the 'skeptical' POV that CAMs are defined by having no science, proof, evidence, etc, when clearly there are reliable sources that say some CAMs have proof [67] and some conventional treatments do not [[68] ]. I have already detailed my opinion of this issue...although you disagree with me, it was fun to be involved with the discussion either way :) Arc, your edits are better than the list of definitions, but still fail WP:NPOV because there is no room for mention of the alternate POV regarding the CAMs that have evidence. I will still suggest you try to balance the lead somewhat with the more 'neutral' POV, that “certain CAM interventions do have evidence, and the entire industry should not be tarred with the same brush. For example, a snake oil spray for miracle weight loss should not be lumped in with a standardised St John’s wort formulation for depression” [69], hence why 'non-conventional' is a "commonly used definition"[70]. I will also suggest that at some point the body should be updated with all of the references that you guys have added to the lead, as the lead is supposed to summarize the body. Puhlaa (talk) 04:13, 25 November 2012 (UTC)

I think this may be a problem of scope. Based on statements (cited in our article) from NCCAM, NSF, and others, previously-unproven (CAM) treatments become conventional when shown to be safe and effective. In this light, if there is a big divide it's the definition of CAM rather than the characterization. -- Scray (talk) 04:29, 25 November 2012 (UTC)

Very nice improvement. Has anyone cross referenced new citations with google scholar to attempt to find e-versions of the articles? If not, I'll gladly take care of it. TippyGoomba (talk) 04:49, 25 November 2012 (UTC)

It would be great if someone could do that. :-) Arc de Ciel (talk) 07:35, 25 November 2012 (UTC)

I can stick relevant quotes into the footnotes from hard copies of the refs for WP:V, but some of these are seminal articles (e.g. NYAS) which editors of this article would likely want to read in their entirety, and which any user wanting more info would benefit from access to a complete copy of. ParkSehJik (talk) 20:21, 25 November 2012 (UTC)

In agreement with Puhlaa's point about updating the body, which is a previous proposal in suspense while editors sort out sources. When addressing the readership it is also desirable to avoid the naivety mentioned above of the second sentence combined with the first, which, regrettably, if left there would put the authenticity and reliability of the whole article into doubt. Qexigator (talk) 09:04, 25 November 2012 (UTC)

Seeing that there has been no further revision to the lead, it appears that the present discussion about sources cited in the text there is settled. If not, please advise that it is continuing. Qexigator (talk) 18:18, 25 November 2012 (UTC)

This seems like a classic case of of going for a one size fits all and when we're intelligently discussing 'CAM' an evolving entity we should at least be current with the definitions and statements. First, it is incorrect to state that alternative medicine= CAM = complementary medicine. Many authors, journals and citations have already adequately explained that complementary medicines are those, by which, by and large, have shown a sufficient body of peer-reviewed evidence of effectiveness and that has either a) been incorporated to some extent in the medical and public consciousness as being culturally legitimate or b) is in the process of doing so such that it has separated itself from the the fringe element of alternative medicines. To sum of, there needs to a separate article for complementary medicine and it needs to be contrasted and compared with 'alternative medicine'. This could be done under the generalized 'CAM" heading. I'm sure those who are pure of heart and intent can see the logic in doing this and come to a compromise. DVMt (talk) 18:37, 25 November 2012 (UTC)

Got a references for these definitions? TippyGoomba (talk) 18:58, 25 November 2012 (UTC)

I'll have to go search for them again, but a quick perusal of Pumed displays the 'separation' of these definitions in real world use eg. http://www.ncbi.nlm.nih.gov/pubmed/23041680

http://www.ncbi.nlm.nih.gov/pubmed/22945962 and http://www.utoronto.ca/CAMlab/publications/Healthcarepapers.pdf so on. Furthermore, what is neglected in discussing the different therapies of 'alternative' medicine is degree of professionalization. Thus, comparing 'Reiki' to 'Chiropractic' or even 'Acupuncture' is not valid on several levels, including professionalzation, evidence-basis, cultural legitimacy, public acceptance, reimbursement and academic criteria. A few fresh eyes on this article is needed for such a myopic view is being pushed here that lumps everything into a one size fits all breakdown of 'CAM' which is not only disingenious but also not supported by the literature which makes these distinctions. DVMt (talk) 21:20, 25 November 2012 (UTC)

Let me be more specific, can you give references and direct quotes from these references supporting your new definitions? Although, I'm guessing your "Furthermore, <change of topic>" was to escape this discussion. If that is the case, references for the new topic please. Some specific suggestions for changes to the article would be nice as well. TippyGoomba (talk) 21:26, 25 November 2012 (UTC)

It is interesting to see the way the discussion is progressing and the points DVMt has brought to it. But in the meantime, some editors may agree that the credibility of the present article as recently revised has been destroyed irrespective of the sources. Can this be regarded as acceptable for Wikipedia? Qexigator (talk) 22:29, 25 November 2012 (UTC)

"propaganda"? "fraud"?

For the improvement of this article it would be better had ParkSehJik paid more attention to comments above and removed "propaganda and fraud" from the second sentence. The revision of 09:40, 26 November 2012 was unobjectionable. It is undoubtedly the fact as sourced and not OR that Sampson and Kautz and Barrattt are self-proclaimed opponents and highly critical of alternative medicine generally or more specifically. And why not? It is obviously in their favour to mention that their publications are "For the exposure and prevention of propaganda and fraud", whatever anybody else may think.

It should be too obvious to mention to experienced editors that at the least the citations should be more specific about which is a source for actual "propaganda" or "fraud", and be sure that the specific passages in any given source assert that and are truly evidence based. Otherwise, the article will be seen as a parody of itself.

In the body of the article "fraud" is mentioned only once: under "Regulation"..."Alternative medicine providers recognize that health fraud occurs....." . I have found "propaganda" nowhere.

Citation 1 is to "Wallace Samson" as author of "The Flight from Science and Reason: Antiscience Trends in the Rise of the "Alternative Medicine Movement", Volume 775, Annals of the New York Academy of Sciences. Is there anything to vouch for his authenticity? Or to show that the content of the article is evidence based and has not been superseded in later years? Qexigator (talk) 18:15, 26 November 2012 (UTC)

parody

Editors concerned with improving this article may be interested to see its continuing development as parody now that a quote has been added sourced to National Science Foundation which is described as a United States government agency with a director, deputy director, and the 24 members of the National Science Board (NSB) appointed by the President of the United States, and confirmed by the United States Senate. The first citation now links to "According to one group studying such phenomena, pseudoscience topics include yogi flying, therapeutic touch, astrology, fire walking, voodoo magical thinking, Uri Gellar, alternative medicine, channeling, Carlos hoax, psychic hotlines and detectives, near-death experiences, Unidentified Flying Objects (UFOs), the Bermuda Triangle, homeopathy, faith healing, and reincarnation (Committee for the Scientific Investigation of Claims of the Paranormal" linked to The Committee for Skeptical Inquiry at [71]. "The mission of the Committee for Skeptical Inquiry is to promote scientific inquiry, critical investigation, and the use of reason in examining controversial and extraordinary claims. (Inset Paul Kurtz, 1925-2012> biog.) The FDA is giving serious consideration to our petition to require that all over-the-counter homeopathic drugs meet the standards of effectiveness applicable to non-homeopathic drugs. Read the letter from the FDA." Qexigator (talk) 19:49, 26 November 2012 (UTC)

Is there a suggestion related to the article's content in there? If not, this is not the right place for this as per WP:NOTAFORUM. a13ean (talk) 20:47, 26 November 2012 (UTC)

Thank you for inquiring. Indeed there is as you can see from the above comments. To summarise for you:

__In agreement with Puhlaa's point about updating the body... it is also desirable to avoid the naivety of the second sentence combined with the first, which, regrettably, if left there would put the authenticity and reliability of the whole article into doubt. __...For the improvement of this article it would be better had ParkSehJik paid more attention to comments above and removed "propaganda and fraud" from the second sentence. __.... the credibility of the present article as recently revised has been destroyed irrespective of the sources.__...the citations should be more specific about which is a source for actual "propaganda" or "fraud", and be sure that the specific passages in any given source assert that and are truly evidence based. __In the body of the article "fraud" is mentioned only once: under "Regulation"..."Alternative medicine providers recognize that health fraud occurs....." . I have found "propaganda" nowhere.__ Can you now propose opening sentences which are better suited to the topic which other editors can consider?

I am of course assuming you are seeking to improve the article and you or others may be able to make more suitable revisions for that purpose, and remove the parody-like condition to which it has been reduced. Qexigator (talk) 22:06, 26 November 2012 (UTC)

When one considers that more than one in four U.S. hospitals offer alternative and complementary therapies, such as acupuncture, homeopathy, chiropractic, herbal medicine and massage therapy, among others, and that more than half of Americans think that combining CAM with conventional medicine is helpful (and the percentage goes up, not down, among more highly educated people), the opening comments in the lead: Alternative medicine is based on tradition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, or fraud.[2][3][4][5][6][7][8][9][10 sound like a disgruntled rant rather than a reasonable Wikipedia entry. Gandydancer (talk) 00:11, 27 November 2012 (UTC)

Agreed with Gandydancer and Qexigator, especially in light of statements such as that made in the Australian Medical Journal like: “certain CAM interventions do have evidence, and the entire industry should not be tarred with the same brush. For example, a snake oil spray for miracle weight loss should not be lumped in with a standardised St John’s wort formulation for depression” [72] That said, I have made these points before and stated that the lead now represents only one narrow POV, but my concerns were largely ignored. Puhlaa (talk) 00:38, 27 November 2012 (UTC)

Great reference actually. In particular, peer-reviewed is good. I particularly liked:

Thus, the current situation lies in the hands of academics, clinicians and the public, who must raise their voices to demand from the CAM industry better quality research, with greater transparency in reporting results.

I await their research! Please let us know as it arrives. TippyGoomba (talk) 05:14, 27 November 2012 (UTC)

Yeah, no one is disagreeing with those facts TippyG. I am confused by your comment, You agree that the article in AMJ, which clearly indicates that a more neutral POV exists, is a good source, but you decided to add some anti-CAM rhetoric to the discussion rather than comment on the challenge of the lead based on WP:NPOV? Puhlaa (talk) 06:10, 27 November 2012 (UTC)

Those comments show all the more that the article as it now stands needs untangling, as mentioned above under "The lead is top-heavy" about 58 article edits ago. Qexigator (talk) 08:45, 27 November 2012 (UTC)

What a bs article

Whoever wrote this bs, no way is alternative medicine "belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, or fraud.[2][3][4][5] Alternative therapies lack scientific validation, and their effectiveness is either unproved or disproved.[3][6][7] They have also been defined more broadly as the treatments that are not part of the conventional healthcare system.[8][9][10]". Alternative medicine is well-respected and reliable. Perhaps you are confusing it with something else.--Tomcat (7) 23:23, 27 November 2012 (UTC)

It appears those statements are sourced - are the sources unreliable? Also note that when a therapy is shown to be efficacious it generally ceases to be alternative. When I go to the alt med section of my grocery store I see a bunch of compounds that are either known to do nothing or, if they do work, have no evidence to demonstrate they do something. When a compound is demonstrably efficacious, however, there's no point in calling it alternative (of course there are exceptions both ways). Sædon^talk 23:36, 27 November 2012 (UTC)

You are using Sagan, a science-fiction author, as a source? The lead consists 95% of negative reception, didn't you notice it? However, I don't want to speak with quasi-experts. This article is a mess and should be cleaned up from top to bottom. Forms of alternative medicine are used even in mainstream medicine, yet you state it is based on "belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, or fraud". Disgusting. Regards.--Tomcat (7) 23:43, 27 November 2012 (UTC)

Is there anything in particular that you feel is unsourced, or is unsupported by the sources provided? Do you have any suggestions for additions based on WP:MEDRS? a13ean (talk) 01:31, 28 November 2012 (UTC)

The article is extremely non-neutral, that is the problem. No way can you call the whole alternative medicine a fraud. It seems like it was written by horrible skeptics. Additionally, it is US-centric. Too unbalanced, does not fully exhamine what actually alternative medicine is, but contains a lot of criticism. Please tell me what is the name of this article? Is it "Criticism of alternative medicine"?--Tomcat (7) 00:03, 28 November 2012 (UTC)

You appear to be falling into the common misunderstanding that "neutral" means something like "balance" in journalism, where equal time and consideration are given to all sides. This is not the case. Neutrality means following reliable sources as closely as possible and not interjecting our opinions as editors. If the experts on a given subject say X, then we summarize X. On some topics, the experts are overtly negative and thus our articles reflect this. Such appears to be the case with alt med. See WP:FRINGE and WP:UNDUE. Sædon^talk 00:31, 28 November 2012 (UTC)

First off, if you're going to enter in discussion here please be civil and WP:AGF, otherwise there's no reason to take you seriously and you'll end up screwing off while accomplishing nothing. Secondly, I'm not using anything; I didn't write this article, I didn't write the lead, and I didn't use a Sagan reference. However, you don't seem to know that aside from being a science fiction author, Carl Sagan was literally one of the most brilliant scientists in human history. Thirdly, I have a biology degree, do you? You don't want to argue with quasi-experts so what exactly is this expert degree you possess that elevates you to such status that you immediately dismiss people you know nothing about? Lastly, your opinion and my opinion don't matter - sources matter. If you think the sources are poor then argue that point (though, again, you won't get far by calling Sagan a fiction writer, that's simply asinine) and present reliable counter sources that comply with WP:MEDRS and/or WP:RS where applicable. Sædon^talk 00:19, 28 November 2012 (UTC)

• This statement is not true and should be reworded: "Alternative medicine is based on tradition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, or fraud.[2][3][4][5]". Not correct. Suggest: "Alternative medicine is based on tradition, while some practices are based on belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, or fraud.[2][3][4][5]" The mainstream medicine has also many flaws, but yet those are not mentioned. Propaganda, fraud, errors in reasoning, etc may all appear in the mainstream medicine.--Tomcat (7) 00:17, 28 November 2012 (UTC)

Mainstream medicine (also known as evidence based medicine) is not mentioned because..oh I dunno, maybe because it's not the topic of the article? Just a thought. Regarding the former, does your wording represent the sources better than the current wording? If not, then no, there will be no change. Our job as editors is to summarize reliable sources, not provide what we think is the Truth™. Sædon^talk 00:21, 28 November 2012 (UTC)

What the current lead needs is to better adhere to WP:NPOV. As has been discussed above in multiple threads, the current lead does not reflect that “certain CAM interventions do have evidence, and the entire industry should not be tarred with the same brush.” as was pointed out in an article in the Australian Medical Journal. Moreover, Tomcat is correct in that the current lead (especially the first couple sentences) is flawed in that it does not account for the fact that some CAM do have evidence ("The results from all eligible Cochrane reviews of CAM therapies were assigned to one of the following categories.....The largest number of treatments described in the reviews were classified as insufficient evidence of an effect (n = 82; 56.6 percent), followed by positive effect (n = 36; 24.8 percent) and possibly positive effect (n = 18; 12.4 percent" [73] or "Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option."[74] ) or that some conventional medicine does not have good evidence ("only retrospective or anecdotal evidence (level 3 evidence) was available to support 55% of the identified decision/interventions" [75] ). There is a reason why well-recognized international medical bodies like WHO [76], Cochrane collaboration [77] and mainstream articles with a scope of defining CAM in the peer-reviewed literature [78] define CAM very different from the definition emphasized in our current lead. So far, editors supporting the new version of the lead have only responded with anti-CAM rhetoric and have not addressed the challenge of the current lead according to WP:NPOV. Puhlaa (talk) 00:48, 28 November 2012 (UTC)

Thanks for the elaboration. Tomcat, the above is a good example of how to discuss on WP. Anyway, it sounds like all we need a couple decent tweaks to convert the aforementioned sentences into neutral ones; the way it's worded now, all alt med is indicated to be in all those categories, and obviously this isn't the case (e.g. a particular form of alt med may be based on tradition and be pseudoscience, it may also be based on tradition and not pseudoscience). Sorry I didn't read the rest of talk first, I mainly stopped by to explain why the 'hoax' tag didn't make sense. Sædon^talk 01:04, 28 November 2012 (UTC)

--Saedon, nice of you to have stopped by (so had I), but perhaps you are now more aware that Tomcat had clearly noticed the point at issue. Here is an opportunity to try a straight answer to comments above on this page, expressed with mildness and civility:

_"...the citations should be more specific about which is a source for actual "propaganda" or "fraud", and be sure that the specific passages in any given source assert that and are truly evidence based.

_In the body of the article "fraud" is mentioned only once: under "Regulation"..."Alternative medicine providers recognize that health fraud occurs....." . I have found "propaganda" nowhere.

_Can you now propose opening sentences which are better suited to the topic which other editors can consider? Qexigator (talk) 01:21, 28 November 2012 (UTC)

Unfortunately I'm rather short on time these days, I just happen to be doing some research for a project and checked my watchlist out of habit heh. I'm sure it'll get figured out soon enough. Sædon^talk 01:30, 28 November 2012 (UTC)

Luckily, there is no rush on wikipedia! We will get it right in due time. Thanks for stopping-by and giving your input Saedon, good luck with your research.Puhlaa (talk) 01:44, 28 November 2012 (UTC)

Tomcat, Saedon may not be actually able to help right now, and I'm not sure what is meant by soon enough. Qexigator (talk) 01:48, 28 November 2012 (UTC)

Soon enough = WP:NODEADLINE :) Sædon^talk 08:01, 28 November 2012 (UTC)

Truthfulness, a lifelong project perhaps, tending to the final deadline, the deadline in the sky, always and everywhere. Exempla: Wikipedia controversial topics, B-Class Alternative medicine articles, Category:B-Class medicine articles, to name a few. Meantime, Wikipedia:Version 1.0 Editorial Team is working at it, while some other editors could be attempting to restore this article to credibility. Converse (logic): hoax. -- Qexigator (talk) 09:19, 28 November 2012 (UTC)

• Sagan and Dawkins have no degree in medicine, so they are not reliable. They are claiming something that every other skeptic would state. I actually wanted to add a section about alternative medicine in Soviet Union/Russia and Germany, but I don't want to waste my time. I am unwatching this and will take a break.--Tomcat (7) 11:03, 28 November 2012 (UTC)

Proposal to help improve the lead according to WP:NPOV

There have been numerous editors that have commented that the current lead fails WP:NPOV, (see [79] and [80] ), thus I am starting the process of proposing ways to remedy this. I apologize if this is repetitive from previous discussions, but perhaps this time we can focus the discussion to one sentence at a time and make some improvements that everyone agrees with.

The current version of the lead starts with this definition of CAM: “Alternative medicine is any practice that is put forward as having the healing effects of medicine, but is not based on evidence gathered with the scientific method.” And is sourced to: [81] from the ‘National Science Board’. While this source meets WP:RS, it’s is not a good definition to start the lead because it is not very inclusive of all CAMs and is a POV of the NSB. I say that it is a POV of the NSB because no independent sources have been provided that vouch for this definition, such as a source stating that the NSB definition is commonly used, or is a ‘good’ definition. Moreover, the idea that CAM is ‘defined’ as having no evidence is very flawed, because good sources say that some CAM do have evidence:

1. “Some CAM do have evidence” [82]
2. “The largest number of treatments described in the [cochrane] reviews were classified as insufficient evidence of an effect (n = 82; 56.6 percent), followed by positive effect (n = 36; 24.8 percent) and possibly positive effect (n = 18; 12.4 percent”[[83]
3. “Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option” [84]

Because of the above verified contradiction inherent to the POV of ‘CAM lack evidence by definition’, most well-recognized and international medical groups do not use this definition of the NSB. Rather, most international medical organizations prefer to define CAM more inclusively, as those ‘medicines’ that are not part of the ‘conventional’ health care system. This definition was proposed by an article in the British Medical Journal entitled “What is Complementary Medicine” [85]. Moreover, this definition is supported by multiple medical bodies:

1. WHO [86]: CAM refer to a broad set of health care practices that are not part of that country's own tradition and are not integrated into the dominant health care system.
2. NCCAM [87]: CAM is a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.
3. Cochrane collaboration [88]: Cam is a broad domain of healing resources …. other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period.

• And, this theme of definition has also been independently verified as being ‘inclusive’ of all CAMs and ‘commonly used’ [89], making it very appropriate to start our lead for the CAM article.

‘’’Proposal:’’’ The definition expressed in the last sentence of the lead’s first paragraph “They have also been defined more broadly as the treatments that are not part of the conventional healthcare system” should be moved to the first sentence, because it is inclusive, not contradicted by independent sources (but actually independently verified) and is used by numerous medical organizations. The same cannot be said for the current text that begins the lead. Note that this proposal is not to remove anything, simply to move a mainstream and common idea to the position of most weight in the paragraph. Comments are welcome, but lets please keep comments focused on the single proposal made and it's merits ie: to move the last sentence in the paragraph, to the first sentence!! Puhlaa (talk) 22:46, 28 November 2012 (UTC)