Talk:Alternative medicine

Recreate IM article?

Hello @Valjean:, Over ten years ago, I noticed that integrative medicine was equated with complementary and alternative medicine and tried to change that here. As you noted, a consensus was reached at the time to keep them as if they are the same thing.

I'd like to reopen this discussion and invite others to join in. Ten years ago, the term Integrative Medicine was not yet "codified", so there was some basis, at the time, for calling it the same as alternative medicine. But over the past ten years that has changed - a lot. Integrative Medicine is practiced by all the major medical schools and hospitals and health networks. The practices under Integrative Medicine are ONLY those practices for which substantial evidence for efficacy and efficiency has been developed. I would like to create a draft Integrative Medicine page and put all of my sources and evidence on it for further discussion, but am not sure about the best way to go about doing that. Can you advise me please? CJ (talk) 18:50, 10 March 2022 (UTC)

I like your idea. It will give everyone a chance to see if the result has merit, especially the newer RS you will use.

I suggest you create the draft at User:Cjrhoads/Draft_Integrative_Medicine. You can copy material from this article, its archives, and the history at Integrative Medicine, where it used to be a separate article. Don't try to recreate the article in article space before a discussion here. The current redirect should not be changed without that discussion. -- Valjean (talk) 19:28, 10 March 2022 (UTC)

That's a good idea. I'll work on it when the University semester is over. Thanks for the encouragement.

CJ (talk) 14:43, 29 March 2022 (UTC)

I'm curious about which AM practices fit under "ONLY those practices for which substantial evidence for efficacy and efficiency has been developed." Please list them. As you may well know, any practice which has such evidence is not called "alternative medicine"; it's just called "medicine". IM and CAM are rightly accused of being attempts to sneak/rename AM quackery into medicine. That's a hurdle you'll need to deal with and discuss in your new article as it's a major criticism. IM and CAM are areas which reveal that anyone, especially hospital administrators, will do anything for money, and adding acupuncture, homeopathy, and such like does draw in more patients and makes more money, even when they do nothing more than give comfort. Such decisions are based on financial considerations, not scientific evidence, but they of course obfuscate and attempt to pass off their decisions as scientifically plausible. Unfortunately they cannot provide anything but the weakest of "evidence" while showing an increase in profits. That's how capitalism works. It isn't evidence-based. -- Valjean (talk) 19:37, 10 March 2022 (UTC)

Hi, Valjean,

I don't plan to get into the "it's all for money" concept because there are too many examples of standard modern western medicine providing therapies of dubious value "just for the money". Let's just agree that both standard western medicine and alternative and complementary medicine each has its share of bad actors who utilize therapies of dubious value because it lines their pockets rather than help the patient. They also both have the MAJORITY of practioners who are just trying to do the best they can for their patients - and sometimes modern western medicine doesn't have the answers while other systems do have the answers.

However, your point - that we don't want quackery to enter into integrative medicine is well understood and agreed upon. From the beginning I have been a dogged researcher who will not allow either personal feelings or financial considerations bias my research. And I'm not alone. Most integrative healthcare practitioners are well aware that we must be diligent against fraudulent practices that don't actually benefit the patient. For example - magnets have pretty much be debunked entirely by medical research, while acupunture, medication, tai chi , qigong, yoga, Pilates, and other activities have been supported - some of them strongly - by the medical research that has been done on them. I noticed that you mentione acupuncture as quackery - but I believe you need to reread the medical research on that topic. Even insurance companies now cover that practice, so it is likely considered "medicine" and not "alternative" by most doctors.

And, of course, here's the info I shared with you on my talk page: CJ (talk) 14:53, 29 March 2022 (UTC)

Here is the list:

Nutritional support such as: botanicals, vitamins and minerals, and probiotics.

Physical Activities such as: tai chi, yoga, acupuncture, massage therapy, spinal manipulation, art therapy, music therapy, dance, mindfulness-based stress reduction, meditation, breathing exercises and guided imagery, qigong, hypnotherapy, Feldenkrais method, Alexander technique, Pilates, Rolfing Structural Integration, and Trager psychophysical integration.

Acupuncture

Cognitive Practices such as Cognitive Behavioral Therapy or Dialectic Behavior Therapy.

That is based on the NIH (Whats In A Name) and on MantraCare

Another good source is:Academic Consortium for Integrative Medicine & Health.

Medical Schools with Integrative Medicine are:

Osher Center For Integrative Medicine at Harvard Medical School

Osher Center For Integrative Medicine Vanderbilt Medical School

Mayo clinic

And, of course, all the members of the Academic Consortium for Integrative Medicine & Health

Once I get a chance to create the draft page, I will be able to post extensive high quality systematic reviews of a variety of integrative medicine and health practices. But as I said, I won't have time until May.

CJ (talk) 15:00, 29 March 2022 (UTC)

CJ, I asked you above for a list of those practices that fit "ONLY those practices for which substantial evidence for efficacy and efficiency has been developed" and decided to do a bit of research. I used the American Board of Physician Specialties link provided above by FloresTindall and found this page: Integrative Medicine Examination Description There I found two sections:

Complementary Modalities

• Manual Therapies
• Biofield Therapies
• Acupuncture
• Movement Therapies
• Expressive Arts

Whole Medical Systems

• Traditional Chinese Medicine
• Ayurveda
• Indigenous Medical Systems
• Homeopathic Medicine
• Naturopathic Medicine
• Osteopathic Medicine
• Chiropractic
• Functional Medicine

Right off the bat we see several fully quackish and unscientific items in the Whole Medical Systems section (which I have wikilinked for convenience), the worst, IMO, being Homeopathy. Wow! Just study those articles to see what RS say about them. None of them fit the "ONLY those practices for which substantial evidence for efficacy and efficiency has been developed", with the exception of Osteopathic Medicine, which is fully modern mainstream medicine, not AM. What is really meant is Osteopathy, which is AM. We have two articles here to make the difference. -- Valjean (talk) 03:05, 11 March 2022 (UTC)

For convenience I have also included the AM series box we include on many of these articles. -- Valjean (talk) 03:05, 11 March 2022 (UTC)

I think you might be confusing approaches to medicine with actual practices of medicine. Most of the "Whole Medical Systems" are simply non-reductive ways to treat patients. Again, there is some research evidence that treating a patient without considering the "whole" body and mind is not nearly as effective as treating patients considering both the body and the mind.

You appear to have a ricochet bias against anything that isn't reductionist, and don't appear willing to actually look at the research that decides WHICH of the actual PRACTICES are evidence-based, and which are not.

Rather than utilizing general lists of modalities and approaches, I prefer to utilize a laser-focused attention on ONLY those practices for which there is medical evidence, and (perhaps) those practices for which we have not YET developed enough evidence but which appear to be helpful without any harmful effects or costs to the patient.

I wish I had more time right now to discuss this more deeply, but I have to teach a class. I will return in May, create the draft page, and continue this conversation.

CJ (talk) 15:08, 29 March 2022 (UTC)

CJ, I look forward to your draft. Feel free to contact me by email. I'd like to know what you teach. -- Valjean (talk) (PING me) 14:50, 31 March 2022 (UTC)

@Valjean: - I think this is pinging Valjean. Could you please help me on the page you set up for me? User:Cjrhoads/Draft Integrative Medicine CJ (talk) 15:21, 4 July 2022 (UTC)

CJ and FloresTindall I need at least one good RS which clearly states that Integrative Medicine are ONLY those practices for which substantial evidence for efficacy and efficiency has been developed. -- Valjean (talk) 15:22, 11 March 2022 (UTC)

I am really looking forward to getting my hand on reliable sources for IM efficacy. Baits Breath -Roxy the grumpy dog. wooF 15:57, 11 March 2022 (UTC)

@Valjean: The problem is that Wikipedia does not follow RS for lumping integrative medicine in with alternative medicine, does it? Can you show me anything other than "skeptic" sources that does? Everything I find on the internet, from sources such as Harvard here, to Cleveland Clinic refer to integrative medicine as something either more or different than alternative medicine. You're not going to convince people just by saying "it's true because I said it!" And you're certainly not going to convince anyone because "capitalism" when conventional medicine is also "capitalism". Pyrrho the Skipper (talk) 16:48, 11 March 2022 (UTC)

?? Right above, the ABPS (a RS) exam for IM covers many AM practices. When mainstream medical practitioners "integrate" AM practices with their mainstream medicine it's called "Integrative Medicine". If that doesn't define IM, then what does? Do you know of RS that say otherwise? It's really simple and easy to understand. -- Valjean (talk) 17:45, 11 March 2022 (UTC)

That's my whole point. In the lead for the alternative medicine article it says, integrative medicine (IM), and holistic medicine are among many rebrandings... of alternative medicine. But integrated medicine IS NOT a synonym or "rebranding" of alt medicine is it? It's defined by all sources, including yours, as a combination of alt and conventional therapies, and should be defined that way. What part of this is hard to understand? Pyrrho the Skipper (talk) 18:11, 11 March 2022 (UTC)

It's not hard to understand, and I agree that wording should be tweaked. How's this? integrative medicine (IM), and holistic medicine are among many rebrandings to describe various ways alternative medicine is combined with mainstream medicine. I think that small change can resolve the matter without starting huge discussions and edit warring. -- Valjean (talk) 17:33, 12 March 2022 (UTC)

Thanks for hearing me out. I think that's a lot better yes. Personally, I would tweak that to integrative medicine (IM), and holistic medicine are terms used to describe various ways alternative medicine is combined with mainstream medicine. But I would personally be fine either way. I just think "rebranding" is an odd word to stick in the lead of an article. Pyrrho the Skipper (talk) 18:03, 12 March 2022 (UTC)

 Done Now it reads: Complementary medicine (CM), complementary and alternative medicine (CAM), integrated medicine or integrative medicine (IM), and holistic medicine are among many rebrandings that describe various ways alternative medicine is combined with mainstream medicine. I hope that is a reasonable solution. Your concern was justified. It was indeed awkwardly written. -- Valjean (talk) 23:19, 12 March 2022 (UTC)

Thanks for the collaborative spirit (and for enlightening me on the functioning of the industry a bit). I think it reads much better now, and I hope others agree. Pyrrho the Skipper (talk) 18:06, 13 March 2022 (UTC)

To illustrate, let's imagine how two construction workers (AM & MM) use their tools on different projects. In this example, each usually works with two completely different types of tools and builds different kinds of buildings for different kinds of customers, although there is overlap; some customers like both, so they make separate work orders from each one.

AM's tools are pretty, esoteric, and really feel good stuff! MM's tools are fairly rigid and boring colors.

MM decides he wants to add AM's pretty tools to his toolbox. When MM uses all those tools together, he is practicing IM because he has "integrated" AM's tools into his construction practice. Now MM snags more of AM's customers who can now get the best of both worlds with one order.

AM + MM = IM. That's how it works. -- Valjean (talk) 18:05, 11 March 2022 (UTC)

So in your example, would you say that that the IM he is practicing is 100% not effective? Do the AM tools spoil the whole toolbox? Because that's what this article definitively states. That IM is a synonym, or rebranding, of alt medicine, and that alt medicine, and thereffor conventional medicine that integrates it, "is not effective." Simple logical fallacy, you see? Pyrrho the Skipper (talk) 18:17, 11 March 2022 (UTC)

No. "100% not effective" is an extreme interpretation. That means 0% effective. It just means that the addition is less effective. While the AM may provide some psychological comfort effects (a nice thing), it doesn't seriously contribute to the physiological healing effects of the mainstream methods, and in some cases may actually weaken the overall effect. It also adds to the cost for the patient as many insurance companies will not cover methods that lack strong evidence, so the patient must pay for it. Unfortunately, the provider usually doesn't (never?!) make it clear that the AM methods being used aren't proven effective. If the IM practitioner is being honest and explains to their cancer patient that the addition of massage, aromatherapy, etc. is for comfort and does not have any curative effect on cancer, then I see no problem with it. False marketing is quackery, gives false hope, and literally empties the patient's bank account. Truth in advertising is good, but it's rare for this stuff, as the pretense of effect, a marketing ploy, is why it's done at all. Massage is great for musculoskeletal issues, but not for curing cancer.

If I had used bricklayers as the example above, the IM practitioner is adding nicely colored bricks of dubious strength to his wall. The cool patterns are prettier, good for marketing, and increases profits, thus fooling the patient. It also adds no real strength to the wall and actually weakens it. -- Valjean (talk) 17:33, 12 March 2022 (UTC)

Lego bricks. pretty but useless in the real building world. -Roxy the grumpy dog. wooF 19:35, 26 March 2022 (UTC)

@Valjean, the addition of one clinically unsubstantiated technique does not inherently decrease the efficacy a the total approach that also includes clinically substantiated treatments. A clinically unsubstantiated treatment is alternative by definition, but a clinically unsubstantiated technique is not ineffective by definition. There are treatments now established with experimental data as effective that were not widely used 20 years ago. In other words, your entire angle misses the temporal aspect of the movement of one technique from "alternative" to "conventional." UserSwamp (talk) 13:51, 5 November 2022 (UTC)

On wikipedia, your edit is what we call a WP:WEASEL wording. It waters down the language in order to make WP:FRINGE ideas seem more plausible. We trust the experts, in this case, medical scientists, to determine what is and is not real. Many such spheres of knowledge are based on empiricism. If you don't believe in empiricism, wikipedia probably is not the place for you. — Shibbolethink ^{(♔ ♕)} 14:02, 5 November 2022 (UTC)

UserSwamp, we agree far more than you realize, but until the efficacy of an AM practice is proven, it remains AM. See the edit summary of the edit I just made. -- Valjean (talk) (PING me) 15:41, 5 November 2022 (UTC)

Pulling the weasel wording card allows opponents of an edit to side step the fact that the discussion of wording in cases of fundamental definitions or epistemology are necessarily pedantic. I assure you as a trained plant scientist I appreciate the nuances of the scientific method, as a process, by which we produce data and arrive at conclusions. This is necessarily an epistemological and linguistic question. If something is considered alternative if not proven, then this is different than considering something alternative if it does not work. There is the category in which something may be unproven by a designed experiment and still function. Before experiments were designed to collect data and PROVE whether nitrogen increased plant growth and yield, nitrogen containing fertilizers still functioned to increase growth and yield. This is not a mere game of words, but the entire point. UserSwamp (talk) 01:56, 16 November 2022 (UTC)

Wiki Education assignment: Global Poverty and Practice

This article was the subject of a Wiki Education Foundation-supported course assignment, between 17 January 2022 and 15 May 2022. Further details are available on the course page. Student editor(s): Angelica.gnlz (article contribs).

Updating and Improving Alternative Medicine Article so it is not rated as C-Class

Th article Alternative Medicine is rated C Class by Wikipedia. The article needs updating to reflect current literature or reliably sourced perspectives and should become more neutral. The article and the Series needs to distinguish between health practice, medical practice, and medical science. In many cases, the article does not describe the topics as the contemporary practitioners themselves but rather jumps directly to derogatory or pejorative descriptions.

Note that Wikipedia:Quotations policy allows useful short quotations subject to Fair Use criterion when it improves an article.

One example is the article on the National Institute of Health National Center for Complementary and Integrative Health (NCCIH) which is called an agency which it is not. The article does not correctly describe the historical progression from starting as an Office and becoming a Center and then being renamed by Congress. The article and Alternative medicine do not reflect the current mission or definitions adopted by the NCCIH. For example under NCCIH Classification, it poorly and non-neutrally presents a 1999 formulation. In 1999 the name was National Center for Complementary and Alternative Medicine (NCCAM) Congress changed the name to NCCIH and Mission in 2014.

Since editing the Alternative Medicine Series is so contentious, a better mechanism is needed for achieving consensus on changes that would get the article to at least a B-Class rating Wikipedia:Content assessment/B-Class criteria

Bbachrac (talk) 23:47, 21 October 2022 (UTC)

Major revisions are going to be resisted, so best to take it one edit at a time. Suggest a particular change you'd like to make, explain it, back it up, and build a consensus here on the Talk Page. You are also welcome to be WP:BOLD and make an edit. Just be prepared to come back here and start a discussion if it's reverted. Pyrrho the Skipper (talk) 00:00, 22 October 2022 (UTC)

@Pyrrho the Skipper Thanks for your comment. The problem as I see it is even if consensus is achieved on this Talk Page, the Alternative Medicine Series Guardians will undo any attempt at revision. Then what? Bbachrac (talk) 17:14, 22 October 2022 (UTC)

If the changes get reverted, you didn't actually have a consensus. MrOllie (talk) 17:31, 22 October 2022 (UTC)

@MrOllie Yes, then the attempts at editing becomes a non-convergent series of attempted editing. There is actually no mechanism or process for closure on consensus.Bbachrac (talk) 17:36, 22 October 2022 (UTC)

Sure there is, WP:DR, particularly WP:RFC. I don't recommend you start one here, though. Consensus is pretty firmly against creating a WP:FALSEBALANCE in a false attempt at neutrality on altmed topics. MrOllie (talk) 17:45, 22 October 2022 (UTC)

@Bbachrac I've had to go through RfC to make what I thought were obvious edits in altmed articles. Sometimes the consensus was for the change, sometimes it wasn't. But if you are truly making a good-faith attempt to improve the article, then I would absolutely encourage you to try. If I support your edit, I would even help create the RfC, if needed. That's the whole point of a community-driven encyclopedia. But right now I don't know what specific changes you'd like to see. Pyrrho the Skipper (talk) 19:04, 22 October 2022 (UTC)

A reminder to avoid RfCs: WP:RFCBEFORE. They are a last resort. -- Valjean (talk) (PING me) 19:17, 22 October 2022 (UTC)

@All Thank you for the comments to date. I would like to see the Alternative Medicine series developed to Class B or A, but I think this is undertaking like the The Myth of Sisyphus and I am not sure that is a hill I want to climb. I like the format used by WikiUniversity: as exemplified in the topic "Does objective reality exist?" in developing its topics. Bbachrac (talk) 20:39, 22 October 2022 (UTC)

Bbachrac, I agree that the current state of the Alternative medicine article is not good quality. It is dated and fails to reflect the terminology used by the recent WHO reports and by several recent major mainstream medical centers. Even more concerning is the distorted use of existing sources, e.g. The Atlantic and the NCCIH, to make statements in wiki voice that do not represent the actual content within those sources. I also agree with Pyrrho that focusing on particular changes, one by one, at talk via BRD is a wise approach to improving the page. Regarding your concerns with the outdated information about the NCCIH outlined above, would you be willing to edit the page or propose how the more accurate and current information be incorporated into the article? Cedar777 (talk) 23:32, 22 October 2022 (UTC)

If that's true, then let's discuss it and make sure those sources are used properly. Provide the exact wording we use, the source, and describe the problem. Let's fix it. -- Valjean (talk) (PING me) 00:31, 23 October 2022 (UTC)

Okay I will do it, but I don't have time today, so later this week. I will create a Sandbox for discussion. Thanks for comments. {You might appreciate UC Berkeley Understanding Science. I have been sending the link to all my grandkids.} Bbachrac (talk) 16:56, 23 October 2022 (UTC)

Conclusion on 4 November 2022
After further consideration, I have decided to put aside the objective of contributing to making Wikipedia less ideological and non-neutral in many of the health-related articles. I therefore will not be following through on editing subjects in the Wikipedia “Alternative Medicine” project. As with all other information sources, individuals will need to sort out for themselves the credibility of any particular article. Hopefully anyone coming to Wikipedia will for themselves go directly to active sources.

I arrived at this position by comparing the way Wikipedia treats the NIH National Center for Advancing Translational Sciences compared to its own web-site NCATS, and what Wikipedia does to The National Center for Complementary and Integrative Health (NCCIH) which conducts and supports evaluation research and provides information about complementary health products and practices.

I also found the thoughtful 2001 conference summary, “A critique on complementary and alternative medicine” by Kenneith I Shine, MD, then , President, Institute of Medicine, of the National Academy of Sciences, published in The Journal of Alternative and Complementary Medicine, Volume 7, Supplement 1, 2001, pp. S-145–S-152, Mary Ann Liebert, Inc. DOI:10.1089/107555301753393922. Unfortunately, this article is behind a paywall. 

Abstract

“Modern medicine regularly uses the products of science to improve health. Until recently, however, medicine itself has not been practiced in a scientific manner. The growth of evidence-based medicine is predicated upon the concept that insofar as possible, all aspects of medical care ought to be examined with regard to the evidence. All forms of treatments and preventive strategies should be subjected to assessments of efficacy and effectiveness. Efficacy is demonstrated in the day-to-day practice of medicine. An evaluation of effectiveness may lead to one or more randomized clinical trials, where the results of these randomized clinical trials may be necessary to maximize effectiveness. From a health care perspective, safety must be assessed, not only with regard to adverse effects of the particular intervention, but also in the context of a comparison to alternative treatments. If evidence demonstrates the efficacy and/or effectiveness of a particular intervention, it may be unsafe to select a treatment for which evidence of efficacy or effectiveness is lacking. Certainly, patients should be fully informed of the evidence that is available for making rational choices. Alternative and complementary modes of medicine should be subject to these principles. The history of digitalis glycosides provides an interesting example of an important treatment arising from herbal medicine, by which many of these elements can be exemplified.”

Wikipedia articles unfortunately do not contribute neutrally to the ongoing exploration of health care topics or convey the evolution of thinking in the medical community.

You might find of interest John M Byrne MD YouTube 2019 talk and article Skeptical Medicine: Critical Thinking in Medicine,

To conclude, I do not advocate for complementary health practices and if they can afford access, individuals should first seek help from what is in artfully called “conventual medicine”. Individuals also need to advocate their health for themselves, because at least in the United States, their science based conventional physicians or health care providers don’t necessarily get to the right treatment for whatever is the problem. Bbachrac (talk) 18:27, 4 November 2022 (UTC)

An excellent outcome. - Roxy the dog 04:43, 5 November 2022 (UTC)

Reducing fluff and matching sources to statements

I'd like to notify everyone that I am going to begin editing to reduce the wordiness of the article. I will try to be unbiased as demonstrated by leaving content of sentences the same while instead changing diction and syntax. As everyone is aware, this article also badly paraphrases sources, and cites multiple sources at the end of sentences in a way in which it is unclear what concept is being supported. I'm not sure I'll do anything about that yet beyond flagging, mainly because that's likely to be more controversial editing. UserSwamp (talk) 02:33, 16 November 2022 (UTC)

First example: "Complementary medicine (CM), complementary and alternative medicine (CAM), integrated medicine or integrative medicine (IM), and holistic medicine are among the various attempts to capture the combination of alternative practices with those of mainstream medicine." "among the various", and "capture the combination" are not meaningful additions of words. This should be simplified as "attempts to combine," which has a more active tone and reduces passive use of verbs. These practices are not "capturing" anything, that is flowery language. Practitioners are attempting to combine practices though.

UserSwamp (talk) 02:40, 16 November 2022 (UTC)

I recommend rather than tag, you make the copyedits yourself, but one edit at a time would be best. Pyrrho the Skipper (talk) 05:22, 16 November 2022 (UTC)

Be very careful about edits to the lead. I had to revert some edits. It's safer to discuss proposed changes as WP:BOLD doesn't work for controversial stuff. -- Valjean (talk) (PING me) 04:23, 18 November 2022 (UTC)

Lead is long and not obviously sourced

The lead paragraph is long compared to most high quality articles. The lead uses relativistic superlatives (e.g., "Much of") that are not obviously sourced elsewhere in the article. Other high quality wikipedia articles have sources linked in the lead; this has none. I believe this is likely because the original author was ranting more than informing. It has already been discussed that this article uses the poor scholarship technique of citing multiple varied sources after several sentences of loose paraphrasing. UserSwamp (talk) 04:38, 20 November 2022 (UTC)