Talk:Alternative medicine

What is conventional medicine?

The more positive definition offered here for alternative medicine, "any healing practice that does not fall within the realm of conventional medicine", has alternative medicine depending for its coherence on the idea that there is a coherent "conventional medicine" that has excluded and excommunicated its healing practices. But there is no Pope, no hierarchy, in medicine, to separate out what is conventional from what is alternative to conventional. The healing practices that have achieved currency as Medicine, have done so on their own, not because there is any formal apparatus policing the borders of any sort of "conventional medicine".

It seems to me that that point is tolerably clear except to people who need to imagine that there must be an expertise, (perhaps as yet undiscovered) with clear answers to all at least important questions, and some hierarchy of experts who hold the secrets (or will hold them once the secrets are discovered) of that expert knowledge. The tell on the paradoxically greater than normal faith in rationalism that informs people who think that there's anything to alternative medicine, is that second definition that is touted, "that which has not been shown consistently to be effective." Well, as a practitioner of "conventional medicine", I'm here to tell you that most of what I do, and everything that I do that couldn't be replaced by an algorithm, totally lacks any basis in the quantitative evidence that is used by "evidence-based medicine", and would therefore have to be classified as "alternative medicine" under this definition. Before you can even begin to count apples and oranges, do quantitative methods to generate the evidence, you have to distinguish apples from oranges, and the pattern recognition involved in generating a nosology, then applying those patterns to the individual patient (diagnosis) is qualitative, not subject to quantitative evidence.

Quit trying to be more Catholic than the Pope. Physicians aren't much like physicists. Practitioners of medicine freely accept all sorts of practices that have no basis in quantitative evidence.

Where's the Wiki article on "conventional medicine"? That's the article I'ld like to see, would need to see, before I even consider giving "alternative medicine" any attention. Let's explore the terra incognita that we know exists, that we can actually walk across. Speculations about the nature of medicine would be much better focused on actual medicine, not medicine as hyper-rationalism imagines it should be. —Preceding unsigned comment added by Glen Tomkins (talk • contribs)

I think your point that "conventional medicine" contains, for historical reasons, a mixture of evidence-based and evidence-free practice is a valid one. But the evidence-based fraction will gradually increase through time because new treatments are now forced to jump through evidence-based hoops, and long-standing practices are beginning to be scrutinised through evidence-based eyes. So, yes, the boundary between "conventional" and "alternative" medicine is somewhat blurry. I don't think anyone seriously disputes this point. But, at the same time, it's safe to say that there are a number of identifiable (and ostensibly medical) practices that do not conform to known laws of chemistry, physics and biology, or which have been demonstrated as no more effective than placebo (or are even dangerous). So while there may (currently) be no definitive, hard-and-fast distinction between "conventional" and "alternative" practices, there are certainly some that clearly fall into the latter category. --PLUMBAGO 09:53, 13 April 2010 (UTC)

What is Conventional medicine ?, part 2

WP:NOTFORUM, please. - 2/0 (cont.) 23:14, 20 May 2010 (UTC)

My PDR tells me that roughly 17% (or so ) of prescriptions are written for "off-label" use. Is this alternative medicine ? Beats me. The point that technically most physicians practice some sort of "alternative medicine" is well taken, as is the point that persons who are not medically-trained often have difficulty understanding the wierd combination of science, empiricism, and plain old voodoo that docs traditionally practice. Ya learn early on that trials (favorable or not ) must be carefully examined. People are not white mice. Come to think of it, white mice are not white mice. My favorite example is the stroke drug NXY-059. Gave pretty good results the first leg of its phase-3 trial, but then failed the second leg. The active drug may have been a contaminant that got cleaned up. Point being that docs generally tend to be more forgiving of "alternative" methodologies than those less experienced with the vagarities of disease. So you do not see a lot of denouncements of it in the formal medical literature. Which is why the anti-alternative medicine folks here must often rely on questionable sources like "quackwatch". True, professional bodies will put out position statements aimed at keeping (say) cancer patients going to us regular docs. Yet the regular docs may use the same methodologies as adjunct treatment. Similarly, alternative medicine may become mainstream. High-dose time-release niacin is now a standard treatment for hypercholestrolemia and hyperlipidemia. It started out in "alternative medicine". Interestingly, while other treatments have come and gone, essentially the only change in over 50 years of use has been the addition of statins (and sometimes fibrates ). Similar things have happened with (e.g.) acupuncture, now a well-accepted treatment modality for (e.g.) musculoskeletal pain. It helps that mechanisms of action are pretty-well defined. OTOH, is psychotherapy merely the placebo effect writ large ? So what it alternative and what is conventional? An old joke goes that an alcoholic is anybody who drinks more than his doctor. Similarly, my definition of "Alternative medicine" is any treatment methodology that somebody else uses that I don't, particularly if that person is not a physician. Drjem3 (talk) 03:55, 19 May 2010 (UTC) Lacking any citations, this is original research and contains no suggestions to adjust the main page. Talk pages are not discussion forums and should be reserved for discussions regaring improvements to the main page. WLU (t) (c) Wikipedia's rules:simple/complex 16:09, 19 May 2010 (UTC) Er, that s what I thought I was doing. Point being, that "alternative medicine" is hard to define. I can't do it. Medicine is a "art", as well as a "science", with training and experience integrated into the book learning. Anyway, the review articles and text-books are written by docs who are as confused as the rest. Been there, done that. E.g., FDA-approval of a certain drug for a certain indication can't be used to define something as "conventional" when 17% of prescriptions are written "off-label". Anyway, the PDR says so. Another example: the anti-alternative medicine folks like to use www.quackwatch.org as authentication. The rationale for using a source that breaks the usual wikirules is that the regular scientific literature is often slim on backup for their positions. This is no accident. Much of the stuff denounced by www.quackwatch.org is either generally accepted with literally thousands of literature sources and a relatively-well-defined mechanism of action ( like accupuncture ) or minimally the subject of significant on-going research. A good example is Redox-directed cancer therapy. Review: Redox-Directed Cancer Therapeutics: Molecular Mechanisms and Opportunities, Georg T. Wondrak, Antioxidants & Redox Signaling. December 2009, 11(12): 3013-3069. Free on line [1]. All wiki authenticatable, naturally. I suppose I could post this to the article, but prefer to discuss it here first. No point in getting into some sort of silly edit war. Drjem3 (talk) 14:56, 20 May 2010 (UTC) This is not a forum. If you wish to explore your own thoughts on alternative medicine, you should publish an article in a peer-reviewed journal. Wikipedia is based on what can be verified by reliable sources. It's not based on idle musings by editors. The page has 102 citations, an extensive further reading section, and a large number of external links. The page is past the point at which editors should debate how to define it. The definition for alternative medicine sourced on the main page is "any healing practice 'that does not fall within the realm of conventional medicine', or '"that which has not been shown consistently to be effective'". We do not need to add to that an idiosyncratic definition that one editor believes has merit. I have my own definition of alternative medicine, but I am not discussing it on the talk page. As has been repeatedly pointed out to you, for medical articles, Quackwatch is an acceptable parity source regarding fringe perspectives, topics and theories. It should be replaced where better sources, that require no interpretation can be found. Pulling out primary sources on redox-based cancer therapy, that don't mention, say, megadose vitamin C chemotherapy, and using them to vindicate megadose vitamin C chemotherapy, is original research and particularly egregious at that. When secondary sources (review articles, textbooks, statements by mainstream medical bodies) discuss specific chemotherapeutic interventions as mainstream, effective or even paradigm-breaking, then that can be placed on the chemotherapy page. It shouldn't be placed on alternative medicine (or Abram Hoffer for that matter) as if it vindicated the entire approach. The best quality trials of acupuncture have consistently found that it doesn't matter where you stick the needles, whether the needles penetrate the skin, whether you use needles at all, or what "theory" backs it up. Though many suggestsions have been made as to how or why acupuncture works (elaborate, dramatic placebo acting on two very subjective and liable sensations - pain and nausea - that are easily modulated based on perception, the pain gate theory, circulation of qi, etc.) no single theory has been universally accepted or proven. WLU (t) (c) Wikipedia's rules:simple/complex 15:24, 20 May 2010 (UTC)0 Straw. Little in medical science is "universally accepted or proven". The point about Quackwatch.org as a source is that Dr. Barrett bases much of what he says purely on his personal opinion. Often the equivalent of " I don't understand how it works, so it is quackery ". Often, this is in direct opposition to what the literature says. Go over to www.pubmed.gov and do a literature search-- " Acupuncture " was merely the first thing alphabetically that I searched. But likely the same treatment could be done to many other things he considers "quackery". Dr Barrett also hits people who question his assertations with a SLAPP suit. This is not conducive to rational discourse. What really peeves me is that the same editors who use Dr Barrett as a source will wikilawyer to deny the validity of legitimate literature sources which happen to contradict his naked opinion. Similarly, If all these other "literature sources" agree with Dr. Barrett, why use him as a source? Surely, it should be easy to find something better. We are all supposed to be operating under the same wiki-rules, no matter how expert ( or not ) we all are. Otherwise, the door gets opened to POV-pushing. Lot of that going around recently. Also see Off-label use. This wikipedia article cites sources indicating that about a fifth of all prescriptions are written "off-label", climbing to 30% or so for use in psychiatry. Is such use "alternative medicine"? I doubt most physicians would agree. In fact, enforced, it would result in a lot of malpractice suits, "standard of care " being a slippery thing. Minimally, this should be introduced into the article. The other physician here also notes that much of what docs do in the real world is technically "unproven". He also notes that people sometimes assume that there is some sort of "Pope" in medicine who decides what is and what is not "alternative". Likely, many such get their knowledge of medicine from TV shows-- true, "Scrubs" is pretty accurate about the ambience, if not very factual. As for me, I've got about as good credentials as you can get in the trade. More degrees that a thermometer, etc. However, if ignorance were bliss, I'd be very happy. I make the assumption that if I can't figure out what is "alternative" ( except at the margins, naturally), nobody can. Stated-simply-- Docs use whatever seems to work. Again, I refrain from posting anything to the main article because I understand the need to vet it here first. But the article does need some work to bring it into line with real world practice, all wikipedia-consistent, naturally. Drjem3 (talk) 17:41, 20 May 2010 (UTC) You're right about the difficulty of defining the topic except as the negative of mainstream medicine, which does have a meaningful core, and significant institutions with both formal and informal sanctions. This is a point I have made again and again. It's a semantic problem. But difficulty of definition does not render the term meaningless. The "off-label" canard has been brought forward time and again, as has the rejoinder ("It is important to recognize that off-label use of medication is not the same as non-evidence-based used of medications.""). DavidOaks (talk) 20:56, 20 May 2010 (UTC) Sometimes this is true, depending upon what you mean by "non-evidenced based". And it is true that medicine has a "meaningful core". But opinions among physicians ( much less the medically-untrained ) differ on just what this is <Grin>. When I determine what it is, I'll let you know-- I've spend several decades trying to figure it out. But often enough, your statement is simply wrong. As for the "off-label" use business being a canard-- by the definition you-all give, it is definitely "alternative". E.g. Off-label use states that " A study published in 2006 found that off-label use was the most common in cardiac medications and anticonvulsants. This study also found that 73% of off-label use had little or no scientific support. ( giving cite ) " Ya con't define something away just because it falsifies your position or because there is a wild inconsistancy in defining what most physicians do as "alternative medicine". People might start asking questions. Anyway, In the science trade, we call selective use of data "cherry-picking" and it is definitely an abuse. Drjem3 (talk) 22:30, 20 May 2010 (UTC) You can't define something based on your opinion. You appear to be asserting that alternative medicine incorporates off-label use. There are sources to support alternative medicine being a poorly-defined set of interventions that lack proof and are considered outside of mainstream medicine. Despite off-label use of medications being less well-supported than their on-label use, you have not provided a source to support the idea that off-label medicine is considered "alternative" the same way meditation, acupuncture, homeopathy, shamanism, traditional chinese medicine and other interventions are. Without that source, you are wasting everyone's time. Your opinion is not sufficient to adjust a page, and arguing closely to the definition of two words separately does not invalidate the use of those same words when used together. Per the sources on the page, alternative medicine is not off-label use. Lacking a source, the rest of your comments are irrelevant. WLU (t) (c) Wikipedia's rules:simple/complex 22:36, 20 May 2010 (UTC)

Wikipedia:Consensus " Consensus is not immutable. Past decisions are open to challenge and are not binding, and one must realize that such changes are often reasonable. Thus, "according to consensus" and "violates consensus" are not valid rationales for accepting or rejecting proposals or actions. While past "extensive discussions" can guide editors on what influenced a past consensus, editors need to re-examine each proposal on its own merits, and determine afresh whether consensus either has or has not changed. " Drjem3 (talk) 02:30, 21 May 2010 (UTC)

Endorse closure by 2/0. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:21, 20 May 2010 (UTC)

I second the motion, but express respect for the reservations eloquently and authoritatively laid-out. These need to be foregrounded in the lead. It's contested ground, by definition. DavidOaks (talk) 01:25, 21 May 2010 (UTC)

Against closure. My understanding is that this is reserved for either resolved matters or people who clearly don't know what they are talking about or are causing deliberate disruption. Not the case here. Anyway, this seems a bit hurried. Just perhaps, I have stepped on some toes. Drjem3 (talk) 02:30, 21 May 2010 (UTC)

Please feel free to start a new discussion making reference to reliable sources and proposing specific changes to the article. I have not been paying much heed to this page of late, but the above discussion was veering far from the topic at hand. There are any number of general discussion sites elsewhere on the internet where that sort of discussion is welcomed. The definition of alternative medicine genuinely *is* a thorny issue - that is why we have to resolve it using sources instead of rhetoric. - 2/0 (cont.) 02:54, 21 May 2010 (UTC)

Endorse new section, and need for sources as the essential first step. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:41, 21 May 2010 (UTC)

The above caution states: " This is a controversial topic that may be under dispute. Please discuss substantial changes here before making them ..." ( emphasis-added ). Which is what we are attempting to do, rather than enguage in some pointless edit war. It is also contrary to claims that such matters are not to be raised on the discussion page. Ya can't have it both ways.

For late-comers-- the issue documented by the only two "real" doctors who post here ( and now hidden ) is that regular medical practice often involves what the article claims is "alternative medicine". It is true that the uses of any one such tends to be limited. But collectively, use of technically "unproven techniques" represents a large part of clinical medicine. Drjem3 (talk) 19:00, 21 May 2010 (UTC)

The discussion advocated by the talk-page header needs to be based on sources, not personal opinions. I think that's what 2/0 and WLU are getting at - not that the topic shouldn't be discussed, but that the discussion shouldn't take the form of free-range exposition of one's personal opinions on the topic.

As an aside, it's probably not worth continually presenting yourself as a "real" doctor. I've no doubt you are, but since editors are pseudonymous, such assertions of personal expertise tend to be hard to verify and, even if true, accorded little weight. For example, I could tell you that I'm a "real" doctor as well, or even a tenured professor of religion at a major Northeastern university, but in the end I still need to follow this site's policies. Meaning that I need to find and cite sources and use talk pages to discuss source-based improvements rather than as a forum for general discussion. MastCell ^Talk 19:19, 21 May 2010 (UTC)

The "I'm a real doctor" statements are both worthless and insulting. The criteria for being able to edit wikipedia includes finding, summarizing, and referencing sources. "Being a doctor" isn't one of them, and gives no-one's opinion any more weight. Deepak Chopra is a doctor who has ostensibly written books on quantum physics, but I wouldn't trust his opinion on either, even if I could be reasonably sure that it was actually he who was posting a message. By failing to find and cite sources, you are essentially guaranteeing that your post on this controversial page will be reverted. In other words, by continuing to post opinions on the talk page rather than sources, you are wasting your, and everyone else's time. MastCell has exactly grasped my point and frustration. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:52, 21 May 2010 (UTC)

WLU, you're starting to slip into forum talk here. If you've already said something and aren't adding anything to the discussion (in this case, repeating MastCell in a more emotional manner), think about whether you should just hit random page and edit an article. You do a lot of good article work but your talk page comments tend to be long and overly personal, IMO - and I'll I can get overly personal too when there's frustrating things. And I agree with everyone else that this discussion could be closed. I think it's also notable that this sentiment is reflected in the statement "some researchers state that the evidence-based approach to defining CAM is problematic because some CAM is tested, and research suggests that many mainstream medical techniques lack solid evidence", which is in the lead. II | (t - c) 20:50, 21 May 2010 (UTC)

In my defence, I've been dealing with these same issues, from the same editor, on other pages. Part of my exasperation is that I've been banging my head against this wall for longer than anyone else, and based on that experience I don't see this going anywhere except WP:DEADHORSE unless we start seeing sources. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:20, 21 May 2010 (UTC)

In my defense, I have provided sources, ad nauseum. I understand what the rules are. Further, I see sources used here ( e.g., www.quackwatch.com ) that would never be acceptable on any other page. The rationale seems to be that "Well, we can't find much in the regular scientific/medical literature that agrees with us. Since we know we are right, there must be something wrong with the regular medical literature. " Just perhaps, the problem is not with the medical literature. Which is the point I am trying to make-- collectively physicians practice a lot of "alternative medicine". Yet good stuff from the main-stream medical literature gets questioned by WLU. Seems (well) unfair.

I have also had other wikilawyering problems with WLU. E.g., After discussion, I thought I had permission from WLU to post some cites to one page, Abram Hoffer. Basically, he doubted I had them, so dared me to post them. Which I did, " assuming good faith ". In doing so, I inadvertantly did a third revert. I immediately got a banning threat from WLU, just for doing what he had essentially told me to do. Naturally, I felt sandbagged.

Anyway, this is all getting to be an enormous waste of time. It is pretty clear that any attempts to bring a little NPOV to the page will not be effective. Drjem3 (talk) 02:13, 23 May 2010 (UTC)

What attempts? It's still not really clear to me what concrete changes you'd like to see in the article. I might support them, if I knew what they were. You were interested in exploring the semantics of "alternative" medicine, which is indeed interesting but not really suitable for this particular forum. It would be most useful to find and discuss definitions used by reliable sources - for example, how does NCCAM handle the demarcation question? How about Edzard Ernst or other well-known scholars on the topic? I get that you're peeved about Quackwatch, but as best I can tell it is used for one (1) citation, out of >100, which hardly seems like excessive reliance. What specific changes do you want to see? MastCell ^Talk 04:26, 23 May 2010 (UTC)

Revision Suggestion

I'd like to propose a revision to the "Testing of Efficacy" section, particularly here:

Cancer researcher Andrew J. Vickers has stated:

"Contrary to much popular and scientific writing, many alternative cancer treatments have been investigated in good quality clinical trials, and they have been shown to be ineffective. In this article, clinical trial data on a number of alternative cancer cures including Livingston-Wheeler, Di Bella Multitherapy, antineoplastons, vitamin C, hydrazine sulfate, Laetrile, and psychotherapy are reviewed. The label "unproven" is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been "disproven.""[89]

This paragraph/quote represents an apparent conclusion of one commentator, Andrew J. Vickers, but isn't completely accurate or objective. For example, hydrazine sulfate has indeed been involved in a number of double-blind studies conducted in the United States and Russia. There are a number of studies published in peer-review that have shown a statistical advantage for patients receiving hydrazine sulfate who also suffered from non-small cell lung cancer and other tumor types. It is not accurate to say that hydrazine has been proven "ineffective" in all clinical trials. It is true to say that several studies also conducted at the behest of the National Cancer Institute either showed no effect from the drug, or were inconclusive. But not all studies were ineffective. One of the main issues here has to do with disagreements over whether trial patients were also receiving other MAO inhibitors which are alleged to negate the effects of hydrazine (also an MAO inhibitor) according to the drug's developer Joseph Gold MD. Gold argues this point, the NCI disagrees and the GAO seconds the NCI. But there are a number of controversies regarding the GAO findings. For example, an ammendment to their original NCI-suppportive report supports Gold's contention that mutliple psychotropic drugs were being used concomittantly with HS forcing even the GAO to write an ammendment saying that these findings only "add to the controversy".

Forgive me for trying to write a chapter on Hydrazine Sulfate! I'm only doing this to show how deep and complex the issues are and that the blanket statements, this drug is ineffective doesn't really even touch the tip of the iceberg.

Bottom line: hydrazine sulfate remains controversial with some patients reporting benefit.

Also, please consider the Vickers reference to Livingston-Wheeler. Only one clinical trial was conducted by Barrie Cassileth MD and published in the NEJM. In that study, neither group---Livingston's OR those treated conventionally---improved and both groups deteriorated at a similar rate. In addition, one-third of patients in the Livingston treatment arm were still reportedly receiving conventional therapy. Medical author Michael Lerner who is one of the most balanced commentators on alternative cancer therapies suggests that the results of the NEJM study could theoretically be interpreted to say that both treatments---Livingstons' and conventional--are "equally dubious".

I think it important to delineate that the Cassileth trial did not show a dinstinct and decided advantage of one treatment over the other in terms of treatment response and survival. In fact, Dr. Cassileth herself, explained at the study's conclusion that the Livingston results aren't necessarily applicable to results that might be gotten with patients less seriously ill treated in a similar trial---in effect, leaving the question open. At the very least, I think Cassileth's comments should be included here as she was the principal investigator of the study and one of the more prolific alternative medicine investigators in the nation.

One final point if I may. Gold never referred to hydrazine sulfate as a "cure". The Vickers reference to 'alternative cancer cures' thus represents a presumed conclusion on the authors' part but not a position advocated by the drugs' inventor. I have never heard any responsible party who has written about hydrazine sulfate refer to it as a 'cure' including Lerner, Moss or others. The drug is referred to as an adjunctive therapy that might improve patients' health statuses by neutralizing cachexia (weight loss) and possibly promote a control of disease over time though that question is still controversial. This reference might thus need some qualification or clarification.

I would be glad to offer any feedback regarding this revision as requested of me. Best Ronsword (talk) 16:30, 24 April 2010 (UTC)

Would it be OK to move this discussion to hydrazine sulfate? This page should have at most one or two sentences on hydrazine sulfate. II | (t - c) 23:05, 4 May 2010 (UTC)

Actually, a reasonable suggestion. Waiting to see how the discussion on hydrazine sulfate unfolds here - I believe with the intent of only including one or two sentences in this article.Ronsword (talk) 18:11, 15 May 2010 (UTC)

Proposed revision

Closing discussion per WP:NOT#FORUM WLU (t) (c) Wikipedia's rules:^simple/_complex 19:09, 17 May 2010 (UTC)

<span id="Closing discussion per WP:NOT#FORUM WLU (t) (c) Wikipedia's rules:^simple/_complex 19:09, 17 May 2010 (UTC)"> Here's a rough draft of the revision I'd like to propose as an addendum to "Testing of Efficacy":

Advocates of alternative therapies, however, present completely different viewpoints and cite what they say are deeply held, inherent biases against their treatments. For example, Dr. Joseph Gold MD, the developer of the cancer drug hydrazine sulfate, notes that while the FDA has officially stated that “Hydrazine sulfate has shown no anticancer activity in randomized clinical trials….” (U.S. Food and Drug Administration Transcript, meeting of Pharmacy Compounding Advisory Committee, Rockville, Maryland, May 7, 1999) there have been “many controlled human studies demonstrating the anticancer activity of hydrazine sulfate, dating from as far back as 1975 and published in leading peer-reviewed cancer journals which circulate worldwide” (references cited)

Gold also cites four nationally sponsored randomized double blind clinical trials establishing the drug’s anti-cancer effects (references cited). Other issues may involve biases inherent to studies used to assess alternative therapies. For example, the therapy of Virginia Livingston is officially considered “unproven” but the trial in question only included patients suffering from unresectable cancers not amenable to any know form of therapy. Author Michael Lerner questions whether such biases only insure a potentially negative outcome. In fact, both groups of patients (Livingston and those receiving conventional therapy) deteriorated at similar rates and none were cured, leading to a possible interpretation, as noted by Lerner, of both therapies being “equally dubious” regarding end stage disease (references cited).

Ronsword (talk) 16:01, 4 May 2010 (UTC)

Of course, this is excellent, and I believe it should be in the article. Ron, do not think that your earlier post has not been seen--many people watch this article and have read your post. As is pretty obvious from reading the alt med article, there is a very strong bias against it here at wikipedia. A few of us have tried to make changes to reflect the changing attitudes re alt med without any luck what so ever. For instance, a few months ago I assumed that it was appropriate to delete from the opening sentence in the lead, " that which has not been shown consistently to be effective."[2], which comes from a English prof at some state's folklore site! Eventually, after MUCH discussion, not only was it not deleted, it now appears twice in the article. Since then I just avoid this article. It will change eventually, but for now there is a core group of editors who will frustrate any changes that reflect the changing view of alt med. Gandydancer (talk) 16:28, 4 May 2010 (UTC)

Gandydancer Thank you for your comments. Wikipedia should most definitely not condone any selectively biased screening of material.

The fact is, Andrew Vickers' citation in "Testing of Efficacy" reflects the conclusions of a mainstream investigator who may be reflecting an institutional bias against alternative cancer therapies by virtue of his black and white conclusions. However, the issue is far too complex to be so black and white. For example, there are differing conclusions than Vickers' that have been rendered by other authorities regarding some alternative cancer theapies; how, then, can Vickers be the only source that supercedes all others as the citation of choice in an encyclopedia purporting toward objectivity? As I have written earlier, I am not a hydrazine sulfate advocate; I only present this addendum because there are numerous scientifically controlled, double blinded studies published in peer review journals worldwide which present a different perspective to what Vickers articulates.

I therefore wish to present this perspective to allow readers another concrete and scientific side of the equation. To not do so would be irresponsible in my view.

For those interested, here are a few of the citations I refer to:

1. Seits, J.F., Gershanovich, M.L., Filov, V.A., et al. Experimental and clinical data on the antitumor action of hydrazine sulfate. Vopr. Onkol. 21:45-52, 1975. 17. PMID 1090085

2.Gershanovich, M.L., Danova, L.A. , Kondratyev, V.B., et al. Clinical data on the antitumor activity of hydrazine sulfate. Cancer Treat. Rep. 60:933-935, 1976. 23. PMID 1009524

3.Gershanovich, M.L., Danova, L.A. , Ivin, B.A. and Filov, V.A. Results of clinical study of antitumor action of hydrazine sulfate. Nutr. Cancer 3:7-12, 1981. PMID 7050922

4.Filov, V.A., Ivin, V.A. and Gershanovich, M.L. (eds.). Medical Therapy of Tumors, U.S.S.R. Ministry of Health: Leningrad , l983, pp. 92-139. (in house publication)

5.Filov, V.A., Gershanovich, M.L., Danova, L.A. and Ivin, B.A. Experience of the treatment with Sehydrin (hydrazine sulfate) in the advanced cancer patient. Invest. New Drugs 13:89-97, 1995. PMID 749915

6.Chlebowski, R.T., Heber, D., Richardson , B. and Block, J.B. Influence of hydrazine sulfate on abnormal carbohydrate metabolism in patients with cancer cachexia. Cancer Res. 33:867-871, 1984. PMID 6692384

7.Chlebowski, R.T., Bulcavage, L., Grosvenor, M., et al. Hydrazine sulfate in cancer patients with weight loss: a placebo-controlled experience. Cancer 59:406-410, 1987. PMID 3791153

8.Tayek, J.A., Heber, D. and Chlebowski, R.T. Effect of hydrazine sulphate on whole-body protein breakdown measured by14 C-lysine metabolism in lung cancer patients: Lancet 2:241-244, 1987. PMID 2886716

9.Chlebowski, R.T., Bulcavage, L., Grosvenor, M., et al. Hydrazine sulfate influence on nutritional status and survival in non-small-cell lung cancer. J. Clin. Oncol. 8:9-15, 1990. PMID 1688616

Ronsword (talk) 17:00, 4 May 2010 (UTC)

Perhaps, Ron, you might take the trouble to link those citations with a DOI or a PMID as you go about looking them up? It would save us all time. We're interested to know if any might be reviews that meet WP:MEDRS. Cheers, LeadSongDog come howl 19:14, 4 May 2010 (UTC)

See hydrazine sulfate. I don't think this proposed revision will work. It's not clear what the inline citations are. For example, the statement "For example, the therapy of Virginia Livingston is officially considered “unproven” but the trial in question only included patients suffering from unresectable cancers not amenable to any know form of therapy" is unreferenced. This also might be too much detail for a page this high-level. II | (t - c) 23:05, 4 May 2010 (UTC)

Yes, the statement of Virginia Livingston being 'unproven' is in this citation: ^ Cassileth, B (April 25). "Survival and Quality of Life Among Patients Receiving Unproven as Compared With Conventional Cancer Therapy". New England Journal of Medicine 324: 1180.

The trial in question including patients with unresectable cancers is also per the NEJM article. Ronsword (talk) 23:32, 4 May 2010 (UTC)

LeadSongDog, I present a few examples of peer-reviewed citations below with their PMIDs suggesting validity for the use of hydrazine sulfate in the clinical realm; I hope you don't mind, but I simply pasted the entire abstracts for easier perusal.

. Vopr Onkol. 1994;40(7-12):332-6.

[Therapy of primary brain tumors with segidrin]

[Article in Russian]

Filov VA, Gershanovich ML, Ivin BA, Danova LA, Gurchin FA, Naryshkin AG, Leshchinskiĭ VI, Zemskaia AG, Nikiforov BM, Breĭvis PV.

The results of segidrin administration to 46 patients with malignant and 6 patients with benign tumors of the brain are presented. Pronounced therapeutic effect for the whole group was 63.5% and 73%, if partial regression of neurologic symptoms in the entire brain and separate foci is considered. These indexes for patients with malignant tumors only were 61 and 71.7%, respectively. Since segidrin has virtually no significant untoward side-effects, it is considered a most safe medicine for managing brain tumors. It is recommended in cases of inoperable tumor and for post-operative adjuvant chemotherapy with a view to extending the patient's survival time and improving the quality of life.

PMID: 7610631 [PubMed - indexed for MEDLINE]

Experience of the treatment with Sehydrin (Hydrazine Sulfate, HS) in the advanced cancer patients. Filov VA, Gershanovich ML, Danova LA, Ivin BA.

Prof. N.N. Petrov Research Institute of Oncology, St. Petersburg, Russia.

Abstract The results of Sehydrin (Hydrazine Sulfate, HS) treatment of 740 patients with the advanced, recurrent or metastatic solid tumours of various localizations or malignant lymphomas, for whom all the methods of specific treatment (surgery, radiation, chemotherapy) had been exhausted are presented in this work. The objective response, symptomatic therapeutic effects and toxicity were estimated. Clinically significant objective responses were registered in patients with the soft tissue sarcomas, including neuroblastomas, and paradoxically--in such semimalignant tumours as desmoids. Although the objective response in patients with the lung cancer (90%--non-small cell) was only 4%, stabilization of long duration was registered in 22% of cases connected with the impressive relief of heavy common symptoms in 38.5% of the treated patients. Such a subjective response was established in 46.6% of all the 740 cases. The drug given per os was well tolerated by patients in primary and subsequent courses and did not induce myelosuppression or other significant side effects. On the basis of observations available, Sehydrin may be assessed as an alternative drug for the treatment and symptomatic therapy of patients with some advanced solid tumours and malignant lymphomas at a disease stage when the other methods of treatment can not be used. A possible mechanism of antitumour and symptomatic action is being discussed.PMID: 7499115

Ronsword (talk) 23:53, 4 May 2010 (UTC)

Sorry Ron, I should have been more explicit. I wasn't suggesting we needed a copy of the abstracts, just a link to them. For now, if you simply were to add PMID 7610631 or PMID 7499115 (no colon) at the end of the citation, the mediawiki software would take care of generating the link. For this sort of purpose on some talkpages, people now skip the talkpage cites and just list the PMIDs. Both the examples you abstract above are primary studies, not the reviews that WP:MEDRS seeks. WP regards it as absolutely proper, even admirable, to discriminate on the basis of source quality. Pubmed makes it very easy to distinguish reviews. When viewing the abstract there, one just clicks on the "Publication type" and looks to see if it says "Review" or something lesser.

@II, thanks, but it looks as if only the Chlebowski et al. cites are on that article. I can look them up, but I'd prefer to try and help teach Ron the way to better wiki-collaboration. LeadSongDog come howl 06:11, 5 May 2010 (UTC)

Thank you and advice noted (see revised citations above). Also, II's point as to too much detail is a valid one. Presumably, said revision can be shortened to something such as

Advocates of alternative therapies, however, present completely different viewpoints. For example, Dr. Joseph Gold MD, the developer of the cancer drug hydrazine sulfate states that a number of clinically controlled "human studies demonstrat(e) the anticancer activity of hydrazine sulfate, dating from as far back as 1975 and published in leading peer-reviewed cancer journals which circulate worldwide” (references cited).

Michael Lerner notes potential issues with study biases in the evaluation of alternative cancer therapies. For example, the Livingston therapy was found ineffective in a government sponsored trial, but patients treated with conventional therapies were also found to deteriorate at a similar rate, and none survived (PMID 2011162). Lerner points out that all the patients in question were diagnosed with unresectable and incurable cancers raising questions about actual treatment efficacies and study design for both conventional and in this case, Livingston's unconventional therapy.

Ronsword (talk) 16:11, 5 May 2010 (UTC)

Comments? Ronsword (talk) 18:41, 10 May 2010 (UTC)

Thank you for linking those, Ron. It looks that each individually fails to rise to the standard for inclusion. WP:MEDRS calls for review papers, which none of these are. Searching pubmed for the three terms: "hydrazine sulfate" cancer review finds several hits, though most are older. Since 2002 there are three. PMID 16293879 and PMID 15061600 were both clearly against the use of hydrazine sulfate, while the latest, PMID 16768027, (full text here)is in Spanish. While my Spanish is anything but strong, I'm pretty sure that the conclusion "El Sulfato de Hidracina no debería utilizarse por su inefectividad como estimulante del apetito" is in line with the other two. LeadSongDog come howl 19:51, 10 May 2010 (UTC)

Agreed, HS is one of those treatments considered "disproven" rather than "unproven", per [2]. We must consider first what the best sources say, and unfortunately those are usually in English. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:08, 13 May 2010 (UTC)

I won't quarrell the above points, and I will yield to the majority. Though I would like to clarify for the record, hydrazine sulfate (HS) has only been "disproven" depending on the sources cited. In Russia, for example, the drug (named "Sehydrin") has been "proven" in multiple peer reviewed, clinical trials, and is prescribed routinely for cancer patients as an adjunctive not front line therapy. Russian scientists have found that HS---which has never been considered a cytotoxic drug---results in "disease stabilization" i.e., halting of tumor progression (not necessarily reduction of tumor mass---an endpoint not claimed by its developer) in 30-35% of patients so evaluated. The Russians have had extensive clinical experience with HS spanning three decades and involving over 700 patients For those interested, please see full article at: [3]. Finally, the Russians are aware of, and have addressed the 3 negative clinical trials sponsored by the National Cancer Institute, offering their views on why their American colleagues' results differ from their own. I personally remain somewhat agnostic on the entire issue (it is an extremely complex one), but hardly feel empowered enough to argue that one group of American investigators are right, and the rest of the world is wrong Ronsword (talk) 16:46, 14 May 2010 (UTC)

The article by Filov et al. that you link to is PMID 7499115. Just to clarify, it has nothing to do with nationality and everything to do with the science. Unless I misread it, even Filov found HS to be nearly irrelevant to disease progression, though perhaps helpful for appetite in palliative use. The later papers discussed above found the appetite evidence to be inconclusive at best. LeadSongDog come howl! 18:47, 14 May 2010 (UTC)

LeadSongDog, you're correct, nationality should have nothing to do with it as per the comment posted above that the "best sources" are "unfortunately usually in English".

FYI I'd suggest reading the full text article I provided above (see URL) for better perspective. It is incorrect to say that Filov found HS to be "nearly irrelevant to disease progression". In the study I cite, he clearly describes disease "stabilization" as synonymous with "interruption of the tumour progression". In that regard, 'interruption of the tumour progression' of more than "3 months... was observed in 216 out of 740 patients (29.2%). Filov continues that "Stabilization (totally in 35.5% of patients) was most frequently observed in the patients with the Hodgkin’s disease, breast, lung, rectal, and colon cancer, in hypernephroma (in 5 out of 9 patients), generalized melanoma (in 13 out of 31 patients), soft tissues sarcoma (in 19 out of 39 patients), head and neck cancer (23 of 48 patients) and in the disseminated b cancer (28 out of 66 patients). It must be re-emphasized that the objective responses and stabilization of the tumour growth occurred in patients having the terminal phase of the disease".

[Also per the Filov study, 6 advanced and unresectable cancer patients experienced complete and total remission. While too small a number to ascribe any significance, it is nonetheless interesting considering the usual odds for spontaneous remission are in the estimated 1:60,000/1:100,000 range].

Incidentally, this trial was published in 1995---several years after the negative NCI sponsored trials commenced. And the latter trials are addressed in the Filov article. If I'm reading the data correctly, the last large scale trials conducted in the US were concluded in 1994. Several of the newer citations you mention are, I believe, references to the earlier negative trials but not additional and contemporary trials. Thus, rehashing earlier negative trial results doesn't necessarily comprise a new body of research.

To reiterate, Sehydrin continues to be prescribed as a proven cancer adjuvant drug in Russia based on the above quoted citations. Thus, Hydrazine sulfate is now "disproven" in the United States, but "proven" in Russia. That is simply a statement of medical and historic factRonsword (talk) 19:58, 14 May 2010 (UTC)

What's the best, secondary source for HS being used in Russia? If it's good, I'd be in favour of a "Though used as an adjuvant in Russia, in the United States HS is considered a disproven approach." What's the source for the Russian statements about the American trials? WLU (t) (c) Wikipedia's rules:^simple/_complex 16:33, 15 May 2010 (UTC)

WLU, the source you are asking about is in the Filov published article of 1995 [4]]. I include a link to the full article text here because the abstract PMID 7499115 doesn't include the discussion/observations of the Russian oncologists concerning the failed NCI studies. In that discussion, Filov et al. specifically reference the 3 most current NCI sponsored trials that failed to show any benefit from HS (PMID 8201372, PMID 8201374 and PMID 8201373) as per their own article references 17,18, and 19. Filov acknowledges that his own trial also didn't show "tumor regression" but instead, cessation of tumor growth - that being a major point of disagreement among the Russians. They consider HS an adjuvant used for disease stabilization as opposed to its objectively cytotoxic role.

For your benefit, I include the Filov conclusions below. (Note, when he references "single-arm trial" as per first sentence, he is talking about his own Russian trial. Please also note, when Filov references "frequency of stabilization" he is describing interruption of tumor progression):

The most important question is the one: whether the data from the single-arm trial being presented are contradictory to the ones from the randomized placebo-controlled, double-blind, multicenter clinical studies mentioned above that failed to demonstrate any benefit for HS in the advanced colorectal cancer [19] or non-small cell lung cancer when this drug is administered along with the combination chemotherapy - cisplatin and etoposide 18 or cisplatin and vinblastine [ 17]. The comparison of the data from Table 1 and from the first of the mentioned publications makes it understandable that there are no significant contradictions in them. No tumour regression was seen in the multicenter trial (NCI) in both the placebo and HS groups, while in this phase II trial PR (partial remission) were registered only in 5% of the patients that was within the limits of the measurement error. The frequency of stabilization (i.e. interruption of tumor progression) is not indicated in the article, and the evaluation of the other therapeutic effects of HS was made with the use of different parameters: in the randomized (NCI) study - quality of life according to the performance status, appetite, weight ratios, survival rates, and in this study - according to the effect of the drug on the separate disease symptoms. That is why the data are not comparable and can not be used as an argument against the results of this single-arm trial.

In the other two above-mentioned trials [17, 18] HS was given simultaneously with the chemotherapy drugs. Meanwhile, HS is not "a neutral substance” as regarding to the effects of cytostatics. Experimental data have indicated that the combination of HS with some of the cytostatics may result in the additive therapeutic or antagonistic effect [20].

The question of what type of these effects manifests itself in case of the combination of HS with cisplatinum, etoposide and vinblastine remains... unclear. Anyway, until the special experiments on this subject are....carried out, it is possible to suppose that HS has a relatively probable unfavourable “intervention” into some of the variants of chemotherapy, and hence, that it is impossible to evaluate these data from the phase III trial as an argument against the results of the single-arm trials.Ronsword (talk) 17:37, 15 May 2010 (UTC)

• I don't think this is likely going to fit into here, as this is a fairly high-level article, but some more detailed discussion on the substance could go into hydrazine sulfate and possibly even alternative cancer treatments. Filov's article is cited and discussed in [[ The HS article doesn't present the timeline in the same way that you do in Hydrazine_sulfate#Clinical_trials, which could perhaps be improved. Can we move that part of the discussion? Is there anything for this article that you think needs to change Ron? II | (t - c) 08:12, 16 May 2010 (UTC)

Agreed, this discussion would probably be a better fit for Hydrazine Sulfate and I have no problem with moving it. But let me clarify, II, I think the reason for the back and forth here (extensive as it has been) has been to address the issue of modifying a few brief sentences in the "Testing of Efficacy" section, this article. Thus, WLU proposed the following revision: "Though used as an adjuvant in Russia, in the United States HS is considered a disproven approach." So I guess the proposed revision/addition here consists basically of one or two sentences. Thoughts?Ronsword (talk) 15:16, 16 May 2010 (UTC)

Ugh, that's 15 years old, no research has been done since then that I can tell, it's only been cited 11 times (and not by a lot of mainstream research), it's still not a mainstream treatment, and even in that refrence there's no information about increased survival time. Based on that, I don't think it's good to portray it as positive or useful as a form of cancer treatment. If that's the best information available about HS, I don't think there's much reason to include it in the page. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:36, 17 May 2010 (UTC)

You suggested the modification: "Though used as an adjuvant in Russia, in the United States HS is considered a disproven approach." The current Russian use of Sehydrin is indeed a statement of fact. Thus, can you tell me in earnest why readers of an online encyclopedia should not know this fact?Ronsword (talk) 15:00, 17 May 2010 (UTC)

In Mexico they use HS, the Gonzalez regimen, laetril, coffee enemas, high-dose vitamin C, etc. That doesn't mean we note it. We should base this on the best evidence - and that evidence isn't great. In fact, I was going to suggest mentioning it's possible use as an antianorexic, until I saw this. Also, if you note, my initial comment was qualified with a question about the best evidence, and only if the evidence was good, would I support such an inclusion. Well, that's not a good source. It's old, and contradicted by other, newer sources. That seals it for me. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:05, 17 May 2010 (UTC)

Also, reading through the source itself, it seems rather badly written (could be a bad copy-paste from a PDF though) but more substantially than that - it is a primary source, per WP:MEDRS. It's the reporting of the results of a single trial, which we are urged not to use, particularly not for a high-level article like this one, and certainly not to vindicate an entire approach like alt med. From a scientific perspective, it appears to lack randomization, matched controls, placebo groups, the history of the patients is hopelessly heterogeneous, the end measure was progression or not, rather than say, five-year survivability (clinical indicators are useful, but far less meaningful than death rates), the use of self-reported symptoms is also problematic, and the results themselves are hardly a slam-dunk. They claim a therapeutic effect only after several cycles, when it could be a matter of several cycles merely indicates the person wasn't going to die in the first place. It uses anecdotes to "demonstrate the effects" of HS. I'm not surprised this study isn't heavily cited, and I'm not surprised it had virtually no effect on HS being considered a "disproven" remedy. The lack of controls is crippling and means you can never tell if the effect is due to HS or something else, or for that matter whether HS actually increased mortality. This study was essentially a waste of money. As the study says, the data are not comparable with other investigations of HS, but not for the reasons they give. This primary source study is not appropriate to adjust any page; I wouldn't even mention it on the hydrazine sulfate. This study tells the adequately informed reader nothing. Yuck. It is typical of the poor-quality research that tends to infect alt med studies though, both in terms of a lack of controls and shoddy reporting. "Feeling better" after being given something is not an outcome, particularly if it is not compared to a placebo control. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:30, 17 May 2010 (UTC)

Disease stabilization is a meaningless endpoint unless you have a control group. Cancer progression is notoriously unpredictable, even in a "terminal" setting. So if you follow a single uncontrolled cohort, some percentage will have "disease stabilization" (or lack of progression) at a given time point, even if they receive treatment at all. In order to distinguish a drug effect from the natural history of the disease, a control group is necessary.

The difference between the Russian and Western studies is simple: the Western studies were placebo-controlled and randomized. The Russian study was an observational cohort. It's that simple. That's why the Russians reported a positive finding and the Western studies didn't. A scientifically literate individual would assign more weight to the randomized, placebo-controlled results than to the uncontrolled observational cohort. MastCell ^Talk 16:16, 17 May 2010 (UTC)

The Chlebowski studies were double blinds and found "statistically favorable" responses from hydrazine sulfate.

Incidentally, for the record, I forgot to mention that hydrazine sulfate is also an approved and legal drug in Canada--a 'scientifically literate' country. But be assured, I don't believe the Canadian pharmaceutical society also endorses the use of coffee enemas!(LOL). The drug is also---for better or worse---used legally and illegally worldwide.

As I've said earlier, I won't continue quarreling the point if it's not quite right for Wikipedia. For the record, and for those who wish to understand the nuances of this complex controversy which in my opinion, is not resolved, please see here: [5] Ronsword (talk) 16:43, 17 May 2010 (UTC)

It is odd that none of the authors of Filova et al. 1995 have since published anything more on hydrazine sulfate in the past 15 years, though they have certainly published on other topics in medical oncology during that time. Is there a more recent reliable source to back the assertion that its use, even in Russia, is continuing? As for the assertion about Canada, again, citations are needed. LeadSongDog come howl! 16:50, 17 May 2010 (UTC)

Again, wikipedia is based on secondary sources, not primary. Also, what is HS approved for in Canada? I looked on Health Canada and frankly couldn't even find where to look. Being used world-wide isn't the same as being effective worldwide. And none of this addresses the fact that this is the alternative medicine talk page, not the hydrazine sulfate page. So frankly, if anyone wants to keep talking about hydrazine sulfate, they should go to talk:hydrazine sulfate. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:24, 17 May 2010 (UTC)

Interestingly, the Canadian Task Force on Alternative Therapies of the Canadian Breast Cancer Research Initiative did a review of HS in 1998 (PMID 9614826) and concluded that the concurrent use of MAO inhibitors with HS (also considered an MAO inhibitor) in the NCI negative trials render the "potential benefits of HS as an adjunctive therapy in the management of cancer...controversial". Kaegi et al also said: "there is good evidence that HS inhibits gluconeogenesis...and may play a role in reducing the severity of cachexia and improving the quality of life of cancer patients".

Of more interest, however, were the authors' response to the claim that the final verdict on HS should be rendered as "ineffective". The Canadian authors argue, instead, that the current verdict should be "uncertain" (and certainly not "disproven"). See Kaegi's response to this claim and the controversy surrounding the GAO investigation of the NCI trials here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1230613/pdf/cmaj_161_6_686.pdf

In summation, the hydrazine sulfate issue is far from resolved. The 3 American negative trials which included known incompatible agents---admitted by the General Accounting Office---are not the end of the story. Whether or not the single sentence "hydrazine is a drug that has been approved in other countries" is worth mentioning as a historical fact in an article on Alternative Medicine or elsewhere is thus left to Wiki editors knowledgeable of the nuances of Wikipedia protocols and the like.Ronsword (talk) 17:24, 17 May 2010 (UTC)

Please be more careful in your representation of the published literature. You've juxtaposed a quote from the Canadian article inappropriately - their description of "controversy" was not linked to the use of MAO inhibitors, but was a general statement. Patients in the NCI trials were not given MAO inhibitors anyway - they just weren't explicitly barred from receiving them. Furthermore, the GAO found that the NCI's protocols were "appropriate given the information available to them" - which is a supportive statement, not an "admission" that the trials were invalid. That's three misrepresentations right there, ranging from minor to extremely questionable. MastCell ^Talk 17:44, 17 May 2010 (UTC)

I promise WLU, not another peep on HS here. Only reason I am posting is because contributors keep raising points and questions.68.204.111.27 (talk) 17:42, 17 May 2010 (UTC)

Ya, the conclusion of that 12 year old paper is that it may have a role in quality of life, but it's status as a chemotherapeutic agent is unclear - in other words, there's no evidence that demonstrates antitumour properties. And as I pointed out above, lots of sources demonstrate that it's considered disproven. All the shoddy-quality trials in the world are of no use in determining how useful HS is, and the best trials demonstrate no effect. That is what we demonstrate on all pages - though this applies to HS, it's a lesson that should be taken to heart for all of wikipedia. We report the mainstream, we are not a soapbox to proclaim a treatment unjustly maligned. The other contributors to this page are politely saying to you that HS is essentially worthless as a cancer treatement agent, and cherry-picking studies doesn't help (though it does foster false hope in cancer patients who then waste what remaining time and money they have on interventions like this one; it also forces researchers and research funding agencies who are looking for real treatments to waste time and money investigating improbable or disproven treatments when advocates keep claiming it wasn't quite right - such as vitamin C megadoses which is now being re-investigated because it wasn't intravenous). After a certain point, real researchers give up pet theories and move on to more promising investigations. Quacks don't, they just claim conspiracy from Big Pharma. And keep shoddy records of everyone who doesn't get better, so they can claim a 90% success rate. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:53, 17 May 2010 (UTC)

Ya, the problem with the 'best' trials you refer to is that they were, in fact, considered flawed by other reputable scientists. These trials included the potentially fatal use of incompatible drugs---MAO inhibitors---with hydrazine sulfate, also an MAO inhibitor. Is it quality science, or shoddy science to include two or more incompatible agents in a carefully controlled study trial? Therefore, I referenced the Kaegi article because its conclusion of "uncertain" is based on this very controversy (e.g GAO's admission that the NCI trials did in fact allow additional drugs that were not supposed to be allowed). Yes, the Kaegi article is 12 years old---and written 5 years AFTER the NCI trials which are now, um, 16 years old.Ronsword (talk) 18:25, 17 May 2010 (UTC)

Again, please be a bit more scrupulous in paraphrasing. The Canadian review makes clear that it is only Gold and a few other "supporters" of hydrazine sulfate who claim that MAO inhibitors are contraindicated or "potentially fatal". As the Canadian paper notes, scientific support for such an interaction is "limited" at best, but Gold "insists" that it is real. It is a stretch of the imagination to blame this scientifically unsupported interaction in an unquantified number of study patients for the negative outcome. Of course, the question is easily resolved - if one believes that MAOIs are to blame, then it would seem incumbent upon them to conduct an additional randomized, controlled trial in which MAOIs are strictly prohibited. Have Gold or other HS proponents conducted such a study? MastCell ^Talk 18:45, 17 May 2010 (UTC)

Agreed. Then why doesn't NCI launch additional randomized, controlled trials restricting MAO's? [Are only Gold and a 'few supporters' correct or incorrect in asserting that combined use of MAO's can have potentially fatal outcomes?] Ronsword (talk) 19:02, 17 May 2010 (UTC)

I don't believe I have taken the Canadian article out of context. The Canadian citations I quote are, in fact, related to the GAO controversy. If you read the PDF link I provided above, the Canadians---in addressing criticisms of their conclusion of "uncertain" in a later editorial (1999) write that their "concerns" ..."were reinforced by our review of additional material pertaining to an investigation into the conduct of the HS trials, which was...carried out by the GAO." One can reasonably infer from this last sentence that they are referring to the GAO's concerns about MAO's---the primary thrust of the GAO investigation in the first place.

The Canadian's thus conclude that "on the basis of that material, it was entirely reasonable to conclude that the evidence for and against the efficacy of HS was uncertain".

I can't speak to Gold's objections to MAO incompatibility. But from a purely pragmatic standpoint, I again ask the question: is the use of two or more incompatible drugs in a clinical trial good or bad science---non withstanding efficacy outcomes?Ronsword (talk) 19:02, 17 May 2010 (UTC)

Gentlemen, this is all very fascinating but the purpose of the talk page is to discuss improvements to the main page. Based on the discussion, this isn't going to happen. So if people want to debate this further, I have one word - email. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:09, 17 May 2010 (UTC)

Characterization

The "characterization" section looks very good, at least in principle. One problem: under the section headed by "Scientific community", "institutions" are given far less space than "scientists", even though it is widely accepted on WP that institutions are superior sources for scientific topics (see, e.g., WP:MEDRS). By word count, "institutions" receives 100 words and "scientists" receives 546. More specifically, Stephen Barrett (most of whose work is self-published without indications of peer review) alone gets 110 words, more than the entire "Institutions" section; the Institute of Medicine, one of the best English-language sources for the life sciences, gets only 26 words. One might justify that state of affairs by arguing that Barrett and others have published a great deal more than some of the scientific bodies cited: the NSF, for example, devotes only 7-8 paragraphs to CAM in a paper discussing science fiction and pseudoscience. The IOM, however, published a 360-page book, Complementary and Alternative Medicine in the United States. (Barrett has criticized the IOM book, but his criticisms depend on CAM being held to a different set of ethical standards of research than biomedicine, and if anything, his reasoning, tone and self-publication show how far he has diverged from mainstream discourse.)

Yes, sometimes we do need to rely on less than wonderful sources (like Barrett) as "balancing" sources when few sources other than promoters of a given CAM exist. But for characterization of CAM itself, we have an extremely high-quality source in the IOM, one that is superior to any individual scientist publishing via peer review, let alone scientists who self-publish and eschew the peer review process. Yet this source is given extremely short shrift. Therefore, we have a major undue weight problem as things currently stand. Does anyone disagree? regards, Middle 8 (talk) 01:27, 3 June 2010 (UTC)

Would you like to propose some wording from the IOM? That might be a good place to start. -- Brangifer (talk) 02:26, 3 June 2010 (UTC)

Sure; in a nutshell, I'd expand the "Institutions" section and prune the "Scientists" so they were, at a minimum, 50:50. I'm pretty busy IRL so am not in a rush. Just wanted to get a sense here of how other editors feel about the general idea before proceeding. regards, Middle 8 (talk) 04:59, 3 June 2010 (UTC)

Expansion...yes. Pruning....no. This edit drastically reduced the size of the article and changed its format. I can hardly recognize it anymore. -- Brangifer (talk) 06:02, 3 June 2010 (UTC)

@Brangifer: Wow, that's some diff. I take it you don't necessarily consider it an improvement, but there was adequate consensus for it? Don't worry, I won't delete anything. In this case, adding sounds better. --Middle 8 (talk) 03:49, 7 June 2010 (UTC)

Exactly. If I haven't been involved in a discussion of such a change, I usually don't revert, as long as there has been adequate discussion. I feel the old format was good and conveyed the sense of reality.....that there is much discussion and not full agreement. I hope that didn't get lost in that huge edit. It was so huge that I can't figure it out and I don't like headaches! -- Brangifer (talk) 14:13, 7 June 2010 (UTC)

I agree with BR. Expand don't delete. Verbal chat 06:22, 3 June 2010 (UTC)

complementary?

uf, I see talk pages here are huge, could there be a FAQ page, made by editors which have been involved in this article for a longer time? I see the issue was debated many times, but getting to the gist of the argument seems fairly time consuming if it means digging through archived conversations. I'm simply wondering if either the article or title or both might reflect the opinion of some who consider complementary and alternative medicine quite distinct - for instance, Prof. Michael Baum Interview from "The Enemies of Reason." , or at least the uncut version of it available at Richard Dawkins Foundation channel - where he takes 'alternative' to mean basically unproven alleged remedies, and complementary only to actually proven medicine that 'complements' traditional treatments - he worked with art therapies, and proven herbal remedies, though its not clear to me what he actually means by 'complementing'.. Aryah (talk) 20:19, 27 June 2010 (UTC)

References

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