Talk:Alternative medicine

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How does edit summary explain removal of source?[edit]

A source was removed by User:Cannolis, with this edit summary - "Reverted 1 edit by User:Jonathan Mcrey: Sorry, what? don't see how this has to do with WP:MEDRS. This article cannot be used to support any medical claims".[1] How does the edit summary correspond to removal of the source? Is there an an ongoing discussion on another talk page? FloraWilde (talk) 12:09, 4 November 2014 (UTC)

Right, that summary was more in response to this one. My original rationale for removing the source was this, which I stand by, I don't think an article that apparently looks at a few case studies meets MEDRS. No further discussion that I'm aware of Cannolis (talk) 13:34, 5 November 2014 (UTC)
Thanks, Cannolis. You are correct. The editor you reverted appears very new, appears to have made the edits in goot faith, and likely does not know what MEDRS is. FloraWilde (talk) 16:01, 5 November 2014 (UTC)

acupuncture[edit]

If I read the article right, it says acupuncture (and by extension acupressure) is based on the belief of a supernatural force. My acupuncturist makes absolutely no supernatural claims when talking about treatments: it is all mechanistic.211.225.33.104 (talk) 04:06, 8 November 2014 (UTC)

... and your point is?... Roxy the dog™ (resonate) 08:48, 8 November 2014 (UTC)

First sentence - scientific method[edit]

The first sentence describes AM as not based on the scientific method. I think a better sentence would use a phrase like "not based on scientific evidence" instead. The sentence, as is, is clear enough to me, a scientist. However, saying something is based on evidence obtained using the scientific method is near-meaningless to 75% of the people that I interact with on a daily basis. Since this article is likely an entry-point to Wikipedia for some users, I think the first sentence should be in plainer English.

I am sure a lot of thought has gone into this sentence but I think it would improve the article if there were plainer wording.Vile-eight (talk) 08:00, 13 December 2014 (UTC)

The article has been edited so as to present the information in a way that would make clear, and, it is hoped (from the encyclopedically neutral point of view) unarguable, that the distinguishing feature between "mainstream" and other/"alternative" is precisely that mainstream is (per history section) based on (evidence gathered) using the scientific method pioneered in USA by Welch (after visiting Europe) and promoted by Flexner and now dominant in medical schools in USA and elsewhere. Other practices "put forward as having the healing effects of medicine" are based on a variety of other theories, teachings or traditions, whether or not any evidence of efficacy can be produced using what are currently recognised as "the scientific method". "Can there be any reasonable 'alternative'?" -Arnold S. Relman (1998)[2] --Qexigator (talk) 09:05, 13 December 2014 (UTC)
I agree that it is a logically flawless statement. However, according to WP:Jargon "Every reasonable attempt should be made to ensure that material is presented in the most widely understandable manner possible." Furthmore, WP:EXPLAINLEAD states "In general, the lead should not assume that the reader is intimately familiar with the subject of the article. " Since the lack of scientific method, as you say, is the crux of the distinction for AM, then at this level, readers are not likely to be familiar with the implications of not following the scientific method. As such, the first sentence ought to describe what's distinct about AM, and should be clear to people have no understanding of the scientific method (notably, a full 80% of the American population, see http://www.nsf.gov/statistics/seind04/c7/c7s2.htm#note21) Vile-eight (talk) 23:09, 13 December 2014 (UTC)
I'm listening and intrigued. Clarity is always welcome. Can you propose a compromise which contains both aspects? -- Brangifer (talk) 23:12, 13 December 2014 (UTC)
"Alternative medicine is any practice that is put forward as having the healing effects of medicine, but is not based on scientific evidence.[1] " MIght not be perfect, but I think it's a start. Look forward to your feedback Vile-eight (talk) 23:44, 13 December 2014 (UTC)
The pipe link shows "scientific" but links to "scientific method": that obscures what is being said and thus diminishes clarity: the putative innocent reader is left to puzzle out what that is supposed to mean. May I offer this for consideration as an opening sentence, in a plain words version?
Alternative medicine is any practice that is put forward as having the healing effects of medicine , but is not based on evidence gathered using the scientific method. It consists of a wide range of health care practices, products and therapies The treatments are those that are not part of the conventional , science-based healthcare system.
But then, how would we go on and make some mention of the distinguishing feature that conventional is based on scientific method but alternative is not? Qexigator (talk) 00:11, 14 December 2014 (UTC)
I'll defer to you on your judgment of the pipelink (which I had thought was a widespread and accepted practice.) I'd submit that word 'scientific' inherently carries the notion of scientific method (it is in fact the primary definition in more than one dictionary) but since Scientific (perhaps wrongly) links to Science consider this: there is a page for scientific evidence which would work nicely. I think that the phrase 'scientific evidence' is a more intelligible concept than 'scientific method'. Alternatively, I would not be opposed to the terms 'scientific research' or 'scientific inquiry' which are more broadly synonymous with 'scientific method' than 'scientific evidence' yet, in my opinion, are more generally intelligible than 'scientific method'. I think that the edit you suggested, 1. deletes too much context and 2. has the problem you indicated in your last paragraph.Vile-eight (talk) 00:36, 14 December 2014 (UTC)

──────────────────────────────────────────────────────────────────────────────────────────────────── I don't see that inclusion of both ideas I was seeking. Evidence of effect can be arrived at by accident or by using the scientific method, so I see the "method" as being the biggest difference.

Whether it's taught in the "conventional , science-based healthcare system" is a totally different aspect of the subject, so let's not get into that in this thread.

Let's see if this will work:

Brangifer (talk) 01:01, 14 December 2014 (UTC)

Great suggestion. I'm good with thisVile-eight (talk) 01:40, 14 December 2014 (UTC)
Let's see what Qexigator thinks. -- Brangifer (talk) 01:56, 14 December 2014 (UTC)
The more I read my proposal, the more I think that correct grammar requires the addition of "that" ("but that is not based on..."), so I have added it. -- Brangifer (talk) 07:17, 14 December 2014 (UTC)
A slightly longer, but even more accurate, version reads:
This makes it clear that believers claim "evidence", but it is neither scientific nor discovered by using the scientific method. -- Brangifer (talk) 07:23, 14 December 2014 (UTC)
That seems about right, but "based on" may be more accurate than "backed". I'm hesitant to be more definite, mindful of the lengthy discussions about this paragraph which have occurred over the years. Qexigator (talk) 08:12, 14 December 2014 (UTC)
+(After further thought) Would this be acceptable? : Alternative medicine is any practice that is put forward as having the healing effects of medicine, but that is not based on or backed by scientific evidence or evidence gathered using the scientific method." Qexigator (talk) 15:59, 14 December 2014 (UTC)
That's even better! -- Brangifer (talk) 18:28, 14 December 2014 (UTC)
Alternative medicine is any practice that is put forward as having the healing effects of medicine, but that is not founded on scientific evidence or evidence gathered using the scientific method." perhaps?
Otherwise I'd go with based on or backed by, not both. I like backed for the simplicity but based for the precision Vile-eight (talk) 19:50, 14 December 2014 (UTC)
Cautious yes, reading "founded on" as synonym for "based on". But if you had to spell it out, how would "scientific evidence" differ from "evidence gathered using the scientific method"? Qexigator (talk) 20:29, 14 December 2014 (UTC)
Good point. So, are you proposing that the extra verbiage is unnecessary? For whom? For professionals or the public? I suspect that the public needs extra clarification, but are we going too far? Where is the middle ground? -- Brangifer (talk) 21:08, 14 December 2014 (UTC)
My question is, whether in this context, "scientific evidence" is meant to be distinct from "evidence gathered using the scientific method", and 1_if so/ or 2_if not so, is that a good way of letting the reader know? It may be that if they are practically synonymous here, it does no harm, and may do some good, to have them both as in the above version. But my feeling is this sentence must be as robust as possible, and effectively unarguable and beyond quibble (as mentioned above). Having reworded the article's current version thus far, it may be more effective simply to put: Alternative medicine is any practice that is put forward as having the healing effects of medicine, but that is not founded on scientific evidence or evidence gathered using the scientific method. If there is more to say, let that be added in another sentence. Perhaps, adding to the final sentence of the paragraph, to read: The treatments are those that are not part of the conventional, science-based healthcare system <insert> and are not backed by scientific evidence</insert>. Qexigator (talk) 22:08, 14 December 2014 (UTC)
That sounds good to me. -- Brangifer (talk) 02:05, 15 December 2014 (UTC)

Proposed revision, first paragraph[edit]

As above, will the followiing revision be acceptable, using "founded on" instead of "based on" in the first sentence, and adding "not backed by scientific evidence" at the end of the last sentence, of the first paragraph (citations and middle sentences unchanged, so not put in below)?

  • first sentence Alternative medicine is any practice that is put forward as having the healing effects of medicine, but that is not based <insert>founded</insert> on evidence gathered using the scientific method. ....
  • last sentence ... The treatments are those that are not part of the conventional, science-based healthcare system <insert> and are not backed by scientific evidence</insert>.

Qexigator (talk) 16:27, 16 December 2014 (UTC)

That still looks good. Try it and let's see how it looks. It just might fly. -- Brangifer (talk) 08:19, 17 December 2014 (UTC)
done. Qexigator (talk) 09:03, 17 December 2014 (UTC)
Looks good. Thanks. -- Brangifer (talk) 15:32, 17 December 2014 (UTC)
The constructive work on the first paragraph this tendentious topic is really heartening (in contrast to the many flame wars on other Wikipedia talk pages). I have one pedantic objection. The sentence says AM is "any practice...." Practicing law is a practice as are any number of other activities. I suppose our purported every-woman reader will automatically carry over the "medicine" from the first part of the sentence to use in the form of "medical" or "healing" etc., so for practical purposes the lack of a modifier is not detrimental. Kdammers (talk) 01:36, 18 January 2015 (UTC)

Botanica[edit]

The image of the inside of a Botanica and its associated text is inappropriate. A botanica is NOT a place for alternative healing, but rather a supply shop for a particular religion and/or magical system. While some alternative healing modalities (i.e. herbalism, faith cures, etc.) may be purchased there, that's not its primary reason for existing. If you include this, then you need to include every religious and magical supply shop here - which is patently ridiculous and irrelevant to the topic at hand. Graidan (talk) 22:58, 15 December 2014 (UTC)

It sure looks like a place which sells various herbs and dietary supplements. That's alternative medicine. -- Brangifer (talk) 08:00, 16 December 2014 (UTC)

Junk addition[edit]

Examples:

  • "It is based on a fundamental principle of 'DOSHA '- building blocks of the body which can be roughly correlated to biomedical tissue types that conventional medicine seems to be validating in recent years"
  • "There are a number of research papers available including on Pubmed and other online sites that seem to validate the efficacy of Ayurveda to a trained eye."

Textbook WP:FRINGE. --NeilN talk to me 16:36, 19 February 2015 (UTC)

And to top it off, the IP's removing sourced information and adding unsourced claptrap are registered to the U.K.'s National Health Service. --NeilN talk to me 16:57, 19 February 2015 (UTC)

RfC on COI for alt-med practitioners[edit]

Wikipedia_talk:Conflict_of_interest#RfC_on_COI_for_alt-med_practitioners Jytdog (talk) 16:43, 10 May 2015 (UTC)

The lede's definition is UNDUE, cf. Harrison's[edit]

I'm not surprised that the lede defines CAM in terms of evidence, but there's an UNDUE problem with that. Harrison's Principles of Internal Medicine ("most recognized book in all of medicine") defines it differently, and specifically takes issue with the evidence-based definition. Quote:

The phrase complementary and alternative medicine is used to describe a group of diverse medical and health care systems, practices, and products that have historic origins outside mainstream medicine. Most of these practices are used together with conventional therapies and therefore have been called complementary to distinguish them from alternative practices, those used as a substitute for standard care. ... Until a decade ago or so, “complementary and alternative medicine” could be defined as practices that are neither taught in medical schools nor reimbursed, but this definition is no longer workable, since medical students increasingly seek and receive some instruction about complementary health practices, and some practices are reimbursed by third-party payers. Another definition, practices that lack an evidence base, is also not useful, since there is a growing body of research on some of these modalities, and some aspects of standard care do not have a strong evidence base. (chapter 14-E, Harrisons', 19th edition 2015, from PDF)

Harrison's weighs at least as strongly as the two sources currently cited in the first sentence. Suggest rewording in WP's voice to encompass both definitions; in the body we can mention Harrisons' criticism of other definitions (and just use a footnote in the lede for that). Sound reasonable? --Middle 8 (tc | privacyCOI) 19:06, 10 May 2015 (UTC)

P.S. Also potentially useful, on demarcation: By its nature, the demarcation between mainstream medicine and complementary health practices is porous, varying from culture to culture and over time. Traditional Chinese medicine and the Indian practice of Ayurvedic medicine were once the dominant health teachings in those cultures. Certain health practices that arose as challenges to the mainstream have been integrated gradually into conventional care. Examples include the teachings of Fernand Lamaze that led to the widespread use of relaxation techniques during childbirth, the promotion of lactation counseling by the La Leche League, and the teaching of Cicely Saunders and Elizabeth Kübler-Ross that established the hospice movement. (chapter 14-E, Harrisons', 19th edition 2015, from PDF) --Middle 8 (tc | privacyCOI) 19:06, 10 May 2015 (UTC)
I suggest you start by reading the many pages of archive material that discuss this question. :-) That said, perhaps Harrison's would be a good source to reference for expanding sentence 2 or other parts of the paragraph. Sunrise (talk) 19:23, 10 May 2015 (UTC)
Please specify what exactly in the present version of the lead is at variance with the Harrison text quoted. The first paragraph is indisputable: the practices here and in sources called 'alternative medicine', do not profess to be founded on evidence gathered using the scientific method. The sources support the statement that CAM is used in a belief, not proven by using scientific methods, that it "complements" the treatment. But the article is always open to updating with later sources. Qexigator (talk) 19:43, 10 May 2015 (UTC)
@ Sunrise, I'm sure the wording has been discussed ad nauseam, but Harrison's isn't showing up in the archives at all. And it's a stronger MEDRS than the other two (NSF and Angell, which are still good ones), so....
@ Qexigator -- lede: Alternative medicine is any practice that is put forward as having the healing effects of medicine, but is not founded on evidence gathered using the scientific method vs. Harrison's Another definition, practices that lack an evidence base, is also not useful... et passim. It shouldn't be a surprise, there have always been multiple definitions of CAM.
There are not multiple definitions of CAM. "Lacking an evidence base" is a very different definition from "lacking a scientific evidence base". Harrison simply states that the former is not a good definition, since some alt med has some evidence, so does not lack an evidence base. If the evidence for that particular alt med increases to scientific standards, then the alt med becomes science-based med. FloraWilde (talk) 05:09, 17 May 2015 (UTC)
I don't see how we keep Harrison's out of the first sentence: we need to say, in WP's voice, that CAM is (a - what NSF and Angell say) or (b - what Harrison's says). Anything less is insufficient weight to Harrison's. --Middle 8 (tc | privacyCOI) 20:10, 10 May 2015 (UTC)
Please note that the article's first sentence is indisputably correct, and not rebutted by the quote from Harrison: AM practices do not profess to be founded on evidence gathered using the scientific method. Qexigator (talk) 20:20, 10 May 2015 (UTC)
I'm not arguing about the sentence's correctness about AM and the evidence base, I am saying that it has become insufficient as a standalone definition of CAM given the sources we now have. --Middle 8 (tc | privacyCOI) 20:38, 10 May 2015 (UTC)
OK, first sentence stands. So what is in error in the description of CAM as alternative medicine used together with conventional medical treatment in a belief, not proven by using scientific methods, that it "complements" the treatment? If that needs expansion with reference to Harrison or others, the place for that would be the section "Definitions and terminology", which states: 'These descriptive definitions are inadequate in the present-day when some conventional doctors offer alternative medical treatments and CAM introductory courses or modules can be offered as part of standard undergraduate medical training; alternative medicine is taught in more than 50 per cent of US medical schools and increasingly US health insurers are willing to provide reimbursement for CAM therapies. In 1999, 7.7% of US hospitals reported using some form of CAM therapy; this proportion had risen to 37.7% by 2008.' Qexigator (talk) 21:06, 10 May 2015 (UTC)
@ Qexigator - How would one surmise from my comments that I'm agreeing first sentence should stand? More below to Sunrise. --Middle 8 (tc | privacyCOI) 05:37, 12 May 2015 (UTC)
Some curious turns of phrase are being used here, perhaps because Harrison's is demonstrably wrong? Why would we say "not proven by using scientific methods"? No hypothesis in natural sciences is ever proven by using scientific methods, only tested. Worse, "Standard care", "Mainstream" and "Conventional" are not synonyms for "Evidence based". Each has a distinct meaning. We muddle them only at peril of error. LeadSongDog come howl! 22:25, 12 May 2015 (UTC)
LeadSongDog is correct as to the meaning of "proven". LeadSongDog is especially correct in warning Wikipedians not to create a language muddle by using expressions that may have synonyms in some contexts, but are not synonyms outside those context, i.e., are not synonyms.
  • In the context of a science-based medical publication, the expression "proven" may be used as a synonym for "established using the scientific method" or "tested and got a p-value of .05 or less" (e.g., when a doctor loosely says "this medicine has been proven to be effective"). But in a more general context (like in a logic class, philosophy of science class, or in our encyclopedia) the expressions are not synonymous. I suggested different language, "established", in the proposal at the bottom of this section.
  • LeadSongDog is correct that "mainstream medicine", "standard treatment", "conventional medicine", etc., are not synonymous with "EBM". The expressions may be intended to be synonymous in the context of a science-based medical journal (or science-based medical text like Harrison, which is based on publications in science-based medical journals). But without that context, the expressions are not synonymous. Using such language creates a muddle from nothing. Some of our lead sources explicitly discuss this language-muddle creation being intentional by some alt med promoters, e.g., the Journal of the Association of American Medical Colleges' "Alternative medicine and common errors of reasoning", and the New York Academy of Sciences' "Antiscience Trends in the Rise of the 'Alternative Medicine' Movement". These and other sources we use explicitly discuss how these ambiguities in language are manipulated by alt med promoters to create language muddles from nothing. For example, they discuss how the use of the word "alternative" was chosen to create the false appearance of being an effective alternative because of an ambiguity in the word "alternative", and "complementary" being used to create the false appearance that it actually complements and improves on what is established using science. NSF is unassailable as being as high ranking a MEDRS can get, and its overtly stated NSF definition is consistent with all our sources (including Harrison). We should not deliberately muddle things by taking expressions like "mainstream" that appear in a context (like where it appears in Harrison, in the context of being in a science-based text), and putting them into our lead without that context. FloraWilde (talk) 15:28, 14 May 2015 (UTC)
Yes, I agree that much of the lead is poorly written, that being a good example. I think it's difficult to come up with good incremental improvements from the current state. I think you may be confusing Harrison's with something else though (it's not being used to support "not proven by using scientific methods," which is already in the article). Sunrise (talk) 02:56, 13 May 2015 (UTC)
I would just add that there were (and are) good sources for both definitions already, so the existence of another good source is unsurprising. I would also disagree that Harrison is a stronger MEDRS than NSF and NEJM, which we can discuss if it becomes necessary. Sunrise (talk) 21:19, 10 May 2015 (UTC)
@Sunrise - Hmmm. Dunno, Angell's an editorial (a good one, and it's about demarcation, but still, editorials are not generally real high up the list), and NSF isn't about demarcation. And both are old. Harrison's is, well, Harrison's, and has the added benefit of considering demarcation from a current perspective.
What I don't get is this: if that there are multiple, more-or-less equally-well-weighed definitions around, then why do we open with just one of them? If we're NPOV surely we should open with "CAM is {Definition A}, or {Definition B} etc." Seems like we're getting out in front of the debate with the present text. I may make a bold edit later to show to a broader audience what I'm getting at. --Middle 8 (tc | privacyCOI) 05:37, 12 May 2015 (UTC)
One normally suffices for the top/lead, as here, and the rest in the main body of the article. Qexigator (talk) 05:52, 12 May 2015 (UTC)
No, that violates WP:WEIGHT, we shouldn't favor one when sources (a) diverge and (b) are comparably good. --Middle 8 (tc | privacyCOI) 18:05, 13 May 2015 (UTC)
One covering the thing defined, not a multiple of variants, though competing nuances etc. can be discussed in further detail where they belong in the main body. Qexigator (talk) 18:14, 13 May 2015 (UTC)
The lede should summarize the body and the definitions aren't so close to each other as to justify glossing (and in the case of the EBM definition is specifically disputed by one good source). And the one from the weightiest source should be primary, and that would be IOM -- which has the benefit of fuzziness/broadness which takes in all of them. --Middle 8 (tc | privacyCOI) 18:52, 13 May 2015 (UTC)
Like I said, I'm happy to discuss MEDRS weighting if it becomes necessary. But the article only cites representative sources, so any discussion would need to consider the rest - thus my request that you go through the previous discussions, mainly over 2012-2013. IIRC at one point there were 14 sources supporting the current lead sentence, before it was reduced to something reasonable. (I'd also add that Harrison's definition is unusual in specifying historic origins outside mainstream medicine; the other sources that use the "outside mainstream medicine" description use their present status instead, sometimes also specifying present status within a particular geographical area, so any evaluation of weight would need to consider that difference as well.)
I've never seen an article use "X or Y" before, and I think it violates WP:LEADSENTENCE, specifically "If [the] subject is definable, then the first sentence should give a concise definition." That also presumes similar weighting (which I didn't say, as you suggest I did), although that is probably true. By the time the issue was resolved I was exhausted enough, and sufficiently aware of the weighting of both definitions, that I no longer really cared which definition went first. At this point, absent significant reason to change, I would much prefer to keep the stable version without the edit wars - and hopefully the dozen or more editors whose input has been considered would agree. Sunrise (talk) 20:14, 12 May 2015 (UTC)
I do not see how the Harrison quote can be taken as a basis for revising the present version of the lead. It does not clarify the description of AM or CAM we now have there. Qexigator (talk) 22:06, 12 May 2015 (UTC)
@Sunrise -- Re a construction like "CAM is {A} or {B}" in the first sentence, I'm not sure, but we could also split it into 1. CAM is {A}. 2. Alternatively, it's {B} or {C} etc. The point being to have it right up there instead of buried in the body. And to have the definition from the weightiest first, which is now IOM [3] (see below). Weighting of sources is presently relevant, and good luck arguing Harrisons weighs less than Angell & NSF if that's what you're hinting. :-) Anyway IOM's a good bit weightier still. --Middle 8 (tc | privacyCOI) 18:05, 13 May 2015 (UTC)

────────────────────────────────────────────────────────────────────────────────────────────────────Is there a link so we can see the context of the selected quotes from Harrison?

Qexigator is correct that the Harrison quotes above (which are cited without their context), cannot be taken as a basis for significantly revising the existing lead. They do not clarify the description of AM or CAM we now already have. The Harrison quote is about CAM, not a definition of it. Harrison criticizes definitions of CAM that we do not use in our lead, so the criticism is not relevant. The Harrison quotes are not inconsistent with the existing lead or existing sources, so we do not need to rate NSF against Harrison as the "better" MEDRS.
  • The Harrison quote, "The phrase complementary and alternative medicine is used to describe a group of diverse medical and health care systems, practices, and products that have historic origins outside mainstream medicine.", is not a definition. It is a declarative sentence about CAM. It is like the sentence "The phrase CAM is used to describe a group of practices that are now practiced in shops in some strip malls", which is also a true declarative sentence about CAM, but it is not a definition of CAM.
  • Re - "The phrase complementary and alternative medicine is used to describe a group of diverse medical and health care systems, practices, and products that have historic origins outside mainstream medicine. Most of these practices are used together with conventional therapies and therefore have been called complementary to distinguish them from alternative practices, those used as a substitute for standard care". This part of Harrison is entirely consistent with the existing lead.
  • Re - "Until a decade ago or so, 'complementary and alternative medicine' could be defined as practices that are neither taught in medical schools nor reimbursed, but this definition is no longer workable, since medical students increasingly seek and receive some instruction about complementary health practices, and some practices are reimbursed by third-party payers." This is a criticism of a definition we do not use in our lead, so is irrelevant to any change in the lead first sentence. Harrison is saying CAM is now taught, when it used not to be, and that insurance companies are now paying for it. CAM is taught so that doctors can address questions patients might have, but not as something that should be practiced. What is taught is that CAM does not meet scientific standards for ethical medical practice. Teaching CAM does not mean that it is taught to be practiced, just that it is taught. It is reasonable to teach med students why the evidence for it (if any) does not rise to scientific standards. That insurance companies may pay for cheaper, but inneffective CAM "treatment, speaks to the ethics of the insurance company, and is not relevant to our lead.
The possible relevance of this part of the Harrison quote is to two of our lead's sentences.
  • The lead first paragraph third sentence says, "The treatments are those that are not part of the conventional, science-based healthcare system.". This is ambiguous in that med students may be taught them, but this does not mean that it is taught to be practiced. It is taught not to be practiced, since it is does not meet scientific evidence standards.
Removing the word "conventional" would make this sentence consistent with the existing cited sources, and with the Harrison quote. So I propose changing the first paragraph third sentence to, "The treatments are those that are not part of the conventional, science-based healthcare system", and leave the existing sources.
  • The lead third paragraph first sentence is, "Alternative medical diagnoses and treatments are usually not included in the degree courses of medical schools, or used in conventional medicine, where treatments are based on what is proven using the scientific method."
Adding the word "science-based", and removing the word "conventional" in the third paragraph first sentence would make it consistent with the cited sources and with Harrison. In response to LeadSongDog's comment on the word "proven", changing it to "established" would be more clear. So I propose changing the third paragraph first sentence to be - "Alternative medical diagnoses and treatments are not included as science-based treatments that are taught in medical schools, and are not used in medical practice where treatments are based on what is proven 'established" using the scientific method."
  • Re - "Another definition, practices that lack an evidence base, is also not useful, since there is a growing body of research on some of these modalities, and some aspects of standard care do not have a strong evidence base." Harrison criticizes this definition as not being useful, but since it is not the definition used in the lead, this criticism is irrelevant to our article. Our defining lead first sentence says "not founded on evidence gathered using the scientific method". That is very different from "lack any evidence base". Having an "evidence base", no matter how weak or scant, is very different from having a scientific evidence base, by which it becomes an accepted treatment in science-based medicine. There may be some evidence for some CAM treatments, so there is an evidence base for that treatment, and there may be a growing body of research that may some day add evidence for that treatment until it is established using the scientific method, whence it gets published in a scientific or medical journal and stops being CAM. If it ever reaches that point, it stops being called CAM and becomes science-based medicine. But before a scant or weak evidence base reaches that point, it is still CAM, and is not accepted practice in science-based medicine. So our lead, as it exists, is not inconsistent with this part of the quote from Harrison.
  • Re - "Another definition, practices that lack an evidence base, is also not useful, since... some aspects of standard care do not have a strong evidence base." This is an accurate criticism of medicine as taught practiced. This is an inconsistency in all definitions of "alternative medicine" and "medicine" in all our sources. The logical conclusion to be drawn is that some things doctors put forth as science-based, should be reclassified as alternative medicine. But it is WP:OR for us to do so without sources. And the quoted part of Harrison does not indicate that a significant portion of what it calls "standard" practice fails to meet scientific standards, so it is UNDUE for us to include this in the lead. I would not object to pointing out this inconsistency in the article body, but others might object since it is a WP:OR logical inference.
  • Re - "By its nature, the demarcation between mainstream medicine and complementary health practices is porous, varying from culture to culture and over time. Traditional Chinese medicine and the Indian practice of Ayurvedic medicine were once the dominant health teachings in those cultures. Certain health practices that arose as challenges to the mainstream have been integrated gradually into conventional care. Examples include the teachings of Fernand Lamaze that led to the widespread use of relaxation techniques during childbirth, the promotion of lactation counseling by the La Leche League, and the teaching of Cicely Saunders and Elizabeth Kübler-Ross that established the hospice movement."
This goes to LeadSongDog's comment on getting into a muddle by using ambiguous terms such as "mainstream", "conventional", "standard", etc., in defining alternative medicine. Since our lead, especially with the above minor proposed changes, principally uses the consistent NSF defining idea as claims to heal that are not based on using the scientific method, we don't need to worry. The demarcation between science-based medicine and alt med is not porous. So the Harrison quote critiques a definition of alt med that is not the main thing used in our lead, and so is irrelevant to our lead. Even if our demarcation was "porous", i.e., having small holes through which things pass, or "gray areas", WP:UNDUE does not let us put these small holes in the lead.
  • Middle_8 is correct that Harrison is as good a MEDRS as our other sources. And Sunrise is correct that the existing sources already in the lead such as NSF are almost unassailably good as MEDRS. But we need not be concerned, since Harrison is not inconsistent with the existing top-notch MEDRS sources in the existing lead, such as NSF. (The authors and editors of Harrison are likely in, or associated with, NSF and the other MEDRS sources already in the lead.)
In conclusion, the quoted passages of Harrison do not justify any major revision in the article. Making the small proposed changes will make the existing lead more consistent with Harrison. FloraWilde (talk) 03:43, 13 May 2015 (UTC)
Agree that conclusion, including proposed small changes. Qexigator (talk) 06:29, 13 May 2015 (UTC)
@FloraWilde -- No link AFAIK, and I'm sure others will verify this independently, but I've omitted no context; I'm just quoting from the intro of the chapter on CAM in the 2015 electronic (PDF) edition (it's not in the written edition apparently). Or email me...might have some ideas...
Three basic disagreements come immediately to mind: First, "a group of diverse medical and health care systems, practices, and products that have historic origins outside mainstream medicine" (Harrison's) is indeed a definition, simply a broad one. There's nothing in the nature of a definition that excludes locus of origin as a criterion for demarcation (and I don't believe Harrison's is the first to use such a definition, or something close to it). Second, [practices] not founded on evidence gathered using the scientific method (lede) are tautologically the same as practices that lack an evidence base (Harrison's), EBM being itself based on the sci method (hence its acceptance in the sci community). Which means that Harrison's is very much criticizing the primary definition the article uses now, creating the UNDUE problem. Third, um, demarcation between science-based medicine and alt med is porous if a good source says so (or at least we weight dissenting views, not omit one). It's not the same as a source making a basic factual error -- with respect, you are mistaken on that (cf. WP:WEIGHT and WP:NOTTRUTH), and again a noticeboard will clarify that if needed. --Middle 8 (tc | privacyCOI) 18:05, 13 May 2015 (UTC)
OK, another general comment re sources: I'm very surprised that the Institute of Medicine IOM is absent (in the lede), and that one's certainly unsurpassed, and probably unequalled by most if not all sources here: it's one of the most prestigious bodies of its kind on the planet. It consider demarcation in some detail and concludes: [4] This discussion of definitions shows that no clear and consistent definition of CAM exists, nor is there a recognized taxonomy to organize the field, although the one proposed by NCCAM is commonly used. Given the committee’s charge and focus, for the purposes of this report, the committee has chosen to use as its working definition of CAM a modification of the definition proposed by the Panel on Definition and Description at a 1995 NIH research methodology conference (Defining and describing complementary and alternative medicine, 1997). This modified definition states that:
Complementary and alternative medicine (CAM) is a broad domain of resources that encompasses health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period. CAM includes such resources perceived by their users as associated with positive health outcomes. Boundaries within CAM and between the CAM domain and the domain of the dominant system are not always sharp or fixed.
Obviously IOM is both different from, and weightier than, Angell and NSF (the latter, again, not being about demarcation and only tangentially about CAM, and NSF itself consisting of scientists appointed by politicians rather than scientists). Given IOM, it's just not defensible to leave the opener as it is, and I'm guessing noticeboard or RfC if we can't agree. Weight of sources is as fundamental an issue as it gets, and the article is currently favoring one definition and two sources for no good reason (other than local consensus, which is flawed). regards --Middle 8 (tc | privacyCOI) 18:05, 13 May 2015 (UTC) revised, minor clarification 04:17, 17 May 2015 (UTC)
The IOM definition is not different from NSF and NEJM. In the current historical period, in our society and culture, the science-based health system is the dominant health system. So IOM says alt med is theories and beliefs perceived by their users as associated with positive health outcomes that are other than those based on science. So IOM is no different in what it says than NSF and NEJM (and the other academic sources cited). There is likely a large overlap and close links between members of IOM, NSF, and NEJM. FloraWilde (talk) 05:00, 17 May 2015 (UTC)
Another possibility could be based on the WHO definition, which rather neatly avoids national biases:

The terms complimentary medicine and alternative medicine are used interchangably 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.

— WHO, MDS-3: Managing Access to Medicines and Health Technologies (2012) Policy and legal framework Ch 5: Traditional and complimentary medicine (in Box 5.1)


Of course, in any country where traditional medicine dominates, this would locally define EBM as alternative, which might be rather problematic for WP. LeadSongDog come howl! 19:58, 13 May 2015 (UTC)

LeadSongDog correctly states that misinterpreting the ambiguous word "dominant" in the WHO definition, creates the "problematic" (absurd) inference that "in any country where traditional medicine dominates, this would locally define EBM as alternative, which might be rather problematic for WP." When the ambiguous word "dominant" is correctly interpreted, it is not inconsistent with our lead (or with NSF, NEJM, or our other sources.)
  • The WHO "definition", containing the ambiguous word "dominant", was discussed several times in the archives. The discussions repeatedly resulted in the current consensus lead. I add to those discussions that the WHO statement that "complementary medicine" and "alternative medicine" is synonymous with "traditional medicine" in some (unspecified) countries, is false in countries in which English language is the principal language. Wikipedia is an English language encyclopedia. So we cannot define "alt med" as "traditional medicine". We can make a declarative sentence that alt med includes traditional medicine, which we do with the cited MEDRS sources.
  • When correctly interpreted, the WHO word "dominant" is consistent with our lead (and with NSF, NEJM, and all our other sources). But like the words "mainstream", "standard", and "conventional", "dominant" is ambiguous and can be misinterpreted when taken out of context, so as to create the absurdity that "EBM is alt med", as LeadSongDog states.
- If "dominant" (or "mainstream", "standard", or "conventional") is interpreted to mean "most practiced", then in some countries where traditional medicine is more widely practiced than EBM or science-based medicine (e.g. some countries in Africa, and possibly still in China), EBM would be "alternative medicine". But "EBM is alt med" is false. So this interpretation of "dominant" as used by WHO, is not correct.
- If the WHO use of "dominant" is interpreted in its context to mean "science-based", as the dominant worldwide highest standard of medical decision making, then the WHO definition does not lead to absurdity, and is consistent with our lead (and with NSF, NEJM, and all of our many other sources used in our article). For the WHO, science-based medical treatments are "dominant" in this sense, since they are what is recommended by WHO. Our lead (and the NSF and other sources) is consistent with the correct interpretation of the WHO definition.
- There is no reason for us to modify our lead by introducing ambiguous words that might be misinterpreted, such as "dominant" (or "conventional" or "mainstream"), which only creates a language muddle and the absurdity LeadSongDog points out. NSF, the New England Journal of Medicine, and other sources used in our article, know what they are doing. If some MEDRS such as NSF or NEJM use unambiguous words in their definitions, and other MEDRS sources like Harrison and WHO use ambiguous words like "standard" or "dominant", which can be interpreted to be consistent with the unabigous MEDRS sources, then we should use the wording in the unambiguous MEDRS sources. WHO and Harrison, when their ambiguous words are correctly interpreted, are consistent with our lead and NSF and the NEJM (and all our other MEDRS sources in the rest of the lead). "Conventional", "mainstream", "standard", and "dominant" may be roughly synonymous with EBM in the context of a science-based medical text (like Harrison), but they are not synonymous without that context. Putting ambiguous words into our lead without that context only creates a language muddle in the lead. The lead is currently not muddled, and we should not put in ambiguous words to create a muddle where it does not exist. WHO and Harrison are consistent with our lead and with NSF, NEJM, and all our other good sources used in the lead, but they contain ambiguous words. There is no reason to modify our lead by introducing ambiguous words, when we have a lead with unambiguous words and unassailably MEDRS sources such as NSF, NEJM, and the many other MEDRS sources in the lead.FloraWilde (talk) 15:28, 14 May 2015 (UTC)

<od>In the quantity of text above, the small changes proposed by FloraWilde (03:43 13 May) may be lost to sight. As I understand it, one is to remove the word "conventional" in the sentence at the end of he first paragraph, thus:

The treatments are those that are not part of the conventional, science-based healthcare system.

The other is to change the third paragraph first sentence from "Alternative medical diagnoses and treatments are usually not included in the degree courses of medical schools, or used in conventional medicine, where treatments are based on what is proven using the scientific method." to read:

"Alternative medical diagnoses and treatments are not included as science-based treatments that are taught in medical schools, and are not used in medical practice where treatments are based on what is established using the scientific method."

Qexigator (talk) 20:48, 13 May 2015 (UTC)

I made the minor changes Qexigator just summed up per WP:Silence. FloraWilde (talk) 12:09, 14 May 2015 (UTC)
@ FloraWilde "There is no reason for us to modify our lead by introducing ambiguous words ...." Sure there is: MEDRS do it, specifically strong MEDRS that we aren't weighting enough, if at all. Some things are ambiguous/fuzzy/nuanced, and when sources say so, we do too (one way or another). Nothing in NPOV/VER makes an exception just because a source recognizes ambiguity. For example, WP:WEASEL refers to editorial language that is vague or misleading about a source, not to a source itself making an ambiguous statement.
The problem with making minor changes here is that the weight of sources demands substantially more. Harrison's specifically refutes Angell and NSF, and IOM is barely mentioned, when it and probably the WHO should be at the very top, weight-wise. --Middle 8 (tc | privacyCOI) 19:20, 16 May 2015 (UTC) strike 05:30, 17 May 2015 (UTC)
Harrison does not "refute" NEJM and NSF, unless you misinterpret "mainstream" in "have historic origins outside mainstream medicine", in which case you get the absurdities correctly noted above by LeadSongDog. The context of Harrison is that it is a science-based medicine text, based on published studies (many likely funded by NSF), which only get published if they pass scientific muster. There is no author or editor of Harrison that is not also closely linked to NSF and NEJM. Harrison's wording, "historic origins outside mainstream medicine", in the context of Harrison being a science-based medical text, means founded in non-science, which is exactly what NSF and NEJM say. FloraWilde (talk) 01:18, 17 May 2015 (UTC)
Hi FloraWilde, (1) please see here (scroll to "Three basic disagreements...") re Harrison specifically refuting (or disputing) the EBM definition used in the lede's first sentence. Where specifically is my reasoning wrong? (2) No absurdities necessarily arise; LeadSongDog's objection to the word "proven" is imo beside the point, and does not indicate that Harrison's is "demonstrably wrong". (Besides, the WHO source is caveated; IOM is the 800 pound gorilla.) Anyway, (1) and (2), among other issues, will probably need to be resolved via a broader consensus.
I agree that the multiple definitions and their sources are related in various ways -- per RS (e.g. Harrison's, IOM) -- they are distinct enough for each to have particular advantages and disadvantages. Our task is to summarize and weight these issues as they are discussed by RS, not to synthesize them.
And again, while Harrison's and Angell and NSF and perhaps others are very strong, IOM (p. 19 et. passim) is pretty much unequalled as a source here; see here (scroll to very end). Which means it should be the main one we use, right? --Middle 8 (tc | privacyCOI) 05:28, 17 May 2015 (UTC) add comment re deprecating WHO 05:33, 17 May 2015 (UTC)
@Middle8 - (1a) Re your question - "Where specifically is my reasoning wrong?" - Your quoted portion of Harrision says, ""Health care systems, practices, and products that have historic origins outside mainstream medicine"". This is in the context of being a medical text based on methods published in science-based medical journals. So "mainstream medicine" means "science-based medicine" in the context of the rest of Harrison. In its own context of being a science-based medical text, Harrison says the equivalent of "alt med is Health care systems, practices, and products that have historic origins outside science-based-medicine", which is our definition, and that of NSF, NEJM, and all our other MEDRS sources. (1b) Another error in your reasoning is that you confuse "evidence" with "scientific evidence". "Lacking an evidence base" is very different from "lacking a scientific evidence base". Harrison said "Practices that lack an evidence base is also not useful". Harrison did not say "Practices that lack a scientific evidence base is also not useful". Your confusion may arise from the expression "evidence based medicine", which is a self-description by the science based medicine community, which is used by that community to be equivalent to "science-based-medicine". You are taking the word "evidence" from that expression out of context, to misinterpret it to mean "any evidence", when it means "scientific evidence" as used by the scientific medicine community. (2) LeadSongDog made two points, one about the word "proven", as loosely used in the medical community, and the other about the absurdity that arises from using ambiguous words out of context. The absurdity arises from misinterpreting "dominant", "standard", "conventional", "mainstream", etc., as meaning "most prevalent in number" (as in some African countries). This incorrect interpretation leads to "science based medicine is alt med" in countries where alt med is more prevalent. This is false and absurd. In the context of usage of such terms by Harrison, WHO, IOM, etc, the correct interpretation is that they mean these expressions to be equivalent to "science-based". Outside that context, the expressions are not synonymous. But in the context of IOM, Harrison, and WHO being advocates of science-based medicine, they mean the same as what NSF and NEJM say more clearly, in that the NSF and NEJM definitions do not require providing the context. There is substantial overlap in the participants of NSF, NEJM, IOM, WHO, and Harrison, and the same people do not have inconsistent definitions when they go from one body to the other. The definitions of these agencies, which share participants, are not inconsistent unless those agencies using ambiguous expressions have the expressions misinterpreted by removing the context. Our lead, NSF, and NEJM, are entirely consistent with Harrison, WHO, and IOM, when the ambiguous expressions used by the latter agencies are correctly interpreted with the context in which they appear, i.e., agencies and texts advocating for the use of the scientific method in recommending treatments. FloraWilde (talk) 13:14, 17 May 2015 (UTC)
Of course "evidence" used in a sci context means "scientific evidence". That should go without saying, and we should read all our sources in that light, and my comments presume it. And of course there is overlap among the various definitions; the way I'd put it (not necessarily as article wording) is that "alternative medicine" is generally taken to mean "medicine (or quasi-medicine) outside of mainstream medicine". But there are still differences, e.g. criteria for demarcation. We know this because some of the sources, like Harrison's and IOM, outright say some of the definitions differ from one another, and that they have various pluses and minuses. For example, Harrison's criterion for demarcation is locus of origin, and they contrast that with demarcating according to evidence base (which is how Angell and NSF demarcate). Some mainstream meds are wanting for evidence, some alt-meds have some; that is exactly what Harrison's says, and we cannot and should not hand-wave it away.
Couple more comments: (A) If any of the definitions really do imply that mainstream medicine is, or historically has been, something other than modern science-based medicine, then we report that too: it's not an "absurdity", it's just a source saying something different than what FloraWilde (or Middle 8 or anyone else) of Wikipedia thinks ought to be the case. (B) It makes no difference that the various bodies and commentators may receive grant money from some of the same places, because that is hardly something sufficient to show scientific agreement... I mean come on! On the contrary, scientists are supposed to evaluate stuff on the merits, not who is paying them. (C) IOM remains the weightiest source by a comfortable margin, and (cf. my comment in section below) we should write the definitions sections accordingly and then work on the lede. They agree, btw, that CAM should be held to the same evidentiary standards as mainstream medicine. But they don't use evidence base as the criterion for demarcation. Happy editing. --Middle 8 (tc | privacyCOI) Minor copy-edit for clarity 17:42, 24 May 2015 (UTC)

I do not support removing anything already in the lead, but the following two sentences could be added, with citations to all of the sources mentioned in this section, at the same time - NSF, NEJM, Harrison, WHO, and IOM. The following could be added to the end of the first paragraph - "The diverse types of alternative medicine share that their practices do not have historic origins in the scientific methods that are dominant in standard, conventional, mainstream medicine (medical science.". The following could be added to the end of the second paragraph (which defines terms and expressions that are commonly used in discussions of alt med) - "When contrasted with alternative medicine, medicine (medical science), which is generally based on scientific evidence, may be referred to as "science-based medicine", "evidence based medicine", "standard medical practice", "conventional medicine", "mainstream medicine", "allopathic medicine", or even medicine based on the dominant dogmatic orthodoxy (i.e., science, in developed countries in the 21st century)." These two sentences are consistent with all of the various sources mentioned in this section - NSF, NEJM, Harrison, WHO, and IOM. So all five sources could be refs or each of these two sentences at the same time. Given the above editor comments, we may even get unanimous consensus for making these additions. FloraWilde (talk) 20:02, 18 May 2015 (UTC)

Sorry I won't be able to join that. Per just above (see my comment beginning "Of course "evidence" used..."), the various definitions we have certainly overlap but do not coincide to such a degree that the present wording does justice to them. IOM most especially, being the strongest source we have for demarcation. --Middle 8 (tc | privacyCOI) 08:03, 24 May 2015 (UTC)
@Middle8 - What is one example of an alternative medicine practice that has historic origins in the scientific method? The IOM committee report says that the definition of alt med as being treatments that are untested or unscientific is not airtight (porous), because "many conventional treatments have not been supported by rigorous testing", whereby the "boundaries" between what is put forward as being medical science, and alt med, are "not always sharp or fixed". The IOM committee report cites as an example of a fuzzy boundary being that one study of meta-studies (where 160 meta-studies, which were not randomly selected from the hundreds of thousands of treatments in medical science, and was therefore itself unscientific), a significant percent of the treatments in those 160 treatments did not pass scientific muster. Harrison refers to this problem as a "porous" boundary. This "fuzzy boundary" problem could be brought against any lead first sentence definition of any Wikipedia article, and is dealt with by the WP:UNDUE policy of not mentioning it in the lead. Furthermore, nothing in any of this argues that there is not a sharp boundary between science based medicine and alt med. FloraWilde (talk) 15:12, 24 May 2015 (UTC)
Hi FloraWilde -- In a nutshell: Demarcation is a judgement call that is up to our sources, not up to us.
  1. I don't see any source that mentions "historic origins in the scientific method" as a criterion, so I don't see the relevance of your question. Harrison's says "historic origins outside mainstream medicine" and gives examples of [c]ertain health practices that arose as challenges to the mainstream [and have] been integrated gradually into conventional care.
  2. Re your objections to Harrison's and IOM, please have good look at WP:NOTTRUTH (which elaborates on NPOV, VER and OR): "Editors may not add their own views to articles simply because they believe them to be correct, and may not remove sources' views from articles simply because they disagree with them." That applies to much of what you've said.
  3. Your last assertion that all our sources agree with the lede's sharp boundary is directly contradicted by the IOM (boundaries "not always sharp or fixed") and Harrison's ("porous"). Your arguments seem to be all over the place: One moment you're criticizing Harrison's and IOM for not agreeing with Angell/NSF/lede-opener and for leading to absurdities; the next, you're asserting they all actually agree with one another. That's not helpful.
Please, respect the fact that our sources indeed differ amongst themselves and that we need to depict them accordingly. Happy editing, Middle 8 (tc | privacyCOI) 18:44, 24 May 2015 (UTC)

Definitions section[edit]

The discussion above has highlighted several well-sourced definitions of Alternative medicine. I think it would be worth creating a definitions section, similar to Colonialism#Definitions. Yaris678 (talk) 12:55, 14 May 2015 (UTC)

We have such a section - [5] FloraWilde (talk) 15:34, 14 May 2015 (UTC)
Oh cool. I missed it in the contents list because section 1 has so many subsections it was buried. I have used the {{TOC limit}} template to keep things easier to look over. Yaris678 (talk) 15:57, 14 May 2015 (UTC)
Followup on above: I think we should first work on this section, weighting it properly (e.g. most weight to IOM) and then deal with the lede. Both steps may need wider exposure (RfC, noticeboard etc). --Middle 8 (tc | privacyCOI) 07:29, 24 May 2015 (UTC)