Talk:Alternative medicine

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Issues with definition in lede[edit]

Two things:

  1. Lede used to include three definitions, which only partly overlap, but now only gives one (the "lacks evidence" aka EBM one). The other two have excellent MEDRS -- Harrison's; NAS (formerly IOM) -- which in fact dispute the EBM def'n (see Harrison's: [1], IOM: [2] pp.16-20). All three definitions belong in the lede based on the weight of these MEDRS.
  2. Lede says "or fringe medicine" but where is the proof that e.g. Harrison's or IOM consider that term synonymous with CAM? (cf. WP:RS/AC)

Suggest restoring replacing current 1st sentence of lede with something like the original 1st sentence, which is now the first sentence under the Definitions and terminology section.

Addendum; clearer proposal: old version with better-weighted lede --Middle 8 (tc | privacyCOI) 09:22, 7 February 2017 (UTC) || revision: rephrased last sentence for clarity and struck RS/AC 10:42, 7 February 2017 (UTC); addendum: old version 22:43, 7 February 2017 (UTC)

The lead is four large paragraphs long. I have no idea at all what you are asking here. -Roxy the dog. bark 09:45, 7 February 2017 (UTC)
Not the misrepresentation of WP:RS/AC ploy again! This applies to statements that specifically invoke consensus, it does not apply to general assertions. Alexbrn (talk) 09:47, 7 February 2017 (UTC)
@Roxy the dog Is the final sentence above now clearer? @Alexbrn RS/AC not central here, so for sake of argument, struck. -Middle 8 (tc | privacyCOI) 10:42, 7 February 2017 (UTC)
No, because in fact your definition relies on misunderstanding and misrepresenting the sources. Experimental medicine ≠ alternative medicine. Carl Fredrik 💌 📧 11:40, 7 February 2017 (UTC)
You are suggesting we replace ...
"Alternative medicine or fringe medicine are practices claimed to have the healing effects of medicine but are disproven, unproven, impossible to prove, or only harmful."
"It is loosely as a defined set of products, practices, and theories that are believed or perceived by their users to have the healing effects of medicine, but whose effectiveness has not been clearly established using scientific methods, or whose theory and practice is not part of biomedicine, or whose theories or practices are directly contradicted by scientific evidence or scientific principles used in biomedicine."
Have I understood your question? -Roxy the dog. bark 12:51, 7 February 2017 (UTC)
(e/c) @Roxy the dog - Yes, that's the gist of it. Obviously we'd open with "Alternative medicine..." and we might improve the prose for (a) readability and/or (b) to stick closer to sources. --Middle 8 (tc | privacyCOI) 14:49, 7 February 2017 (UTC)
No. Roxy the dog. bark 16:57, 7 February 2017 (UTC)
Why? --Middle 8 (tc | privacyCOI) 17:41, 7 February 2017 (UTC)
Because it would be a retrograde step. Roxy the dog. bark 22:33, 7 February 2017 (UTC)
How is giving due weight to top-flight MEDRS [3][4] retrograde? (note: clarified proposal in thread-starter w/ older page version) --Middle 8 (tc | privacyCOI) 22:39, 7 February 2017 (UTC) || revision: added note re clarification, 22:46, 7 February 2017 (UTC))
I don't believe that our current lead fails in that regard. -Roxy the dog. bark 23:01, 7 February 2017 (UTC)
That belief is inconsistent with the facts; cf. e.g. my and Carl's exchange just below. --Middle 8 (tc | privacyCOI) 23:15, 7 February 2017 (UTC)
alternative text much less biased against alternative medicine as per Wikipedia guidelinesACN574 (talk) 23:39, 4 June 2017 (UTC)
@ CFCF You wrote: "No, because in fact your definition relies on misunderstanding and misrepresenting the sources. Experimental medicine ≠ alternative medicine."
Huh? Who mentioned experimental medicine? What do you mean by "your [Middle 8's] definition"? I'm arguing straight from cited material, e.g.:
  • Harrison's, explicitly contradicting the lede: "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."[5]
  • IOM, summarizing: "This discussion of definitions shows that no clear and consistent definition of CAM exists" (but then they adopt a provisional one) [6]
Unfortunately the above material was disregarded when the lede was rewritten, without discussion, to portray a single definition: [7]. Those were your edits, so.... please be careful with sources, and AGF, OK? I'm not misrepresenting, and am sure we can get this right. --Middle 8 (tc | privacyCOI) 14:54, 7 February 2017 (UTC)
I absolutely believe that you are acting in good faith, and misinterpreting things or relying on misrepresentations does not mean you are acting in bad faith. However, good faith does not compensate for lack of knowledge or want of ability to interpret sources correctly. Carl Fredrik 💌 📧 18:18, 7 February 2017 (UTC)
@ Carl Indeed. Which is why I don't doubt your good faith.  :-) Harrison's and IOM, above, could scarcely be clearer; I'm frankly amazed that anyone could imagine otherwise and be both (a) scientifically literate and (b) paying attention. (BTW, misrepresentation usually connotes deceit, hence the AGF concern, but thank you for clarifying that you didn't mean it that way.) --Middle 8 (tc | privacyCOI) 21:10, 7 February 2017 (UTC)

Posted at Wikiproject:Medicine seeking input, here --Middle 8 (tc | privacyCOI) 18:00, 7 February 2017 (UTC)
{{fixed}} — added:

"; and where scientific consensus is that the practice does not or can not work."

Carl Fredrik 💌 📧 18:25, 7 February 2017 (UTC)

────────────────────────────────────────────────────────────────────────────────────────────────────I strongly support relying on an independent medical authority (e.g. the NIH's page on complementary and alternative medicine or the NHS's page on the same theme) to formulate the lede. Clean Copytalk 02:44, 8 February 2017 (UTC)

  • since the lead just summarizes the body, this discussion should focus on the definition in the body first, and if that is agreed upon, then a discussion about whether the lead accurately summarizes the body would be appropriate. Not before. I suggest this be tabled until the body is discussed. Jytdog (talk) 18:48, 7 February 2017 (UTC)
  • I generally agree with Jytdog, but I think that the first sentence in the lead is particularly (predictably) poor. It encompasses disproven (arthroscopic knee surgeries), unproven (codeine for cough suppression), impossible to prove (treatment of extremely rare diseases), or only harmful (hundreds of discontinued conventional treatments) treatments that have always been conventional medicine, but it excludes known-to-work unconventional treatments, such as honey for tickle-in-your-throat coughs and using a kitchen knife to cut off skin cancer, or self-inducing chemical burns to burn them off. Additionally, it completely fails to address the social issues that separate alternative medicine from conventional medicine. For example: a birth attended by a midwife (not a registered nurse who has subsequently specialized obstetrics) is still a form of alternative medicine in the US, but it's standard, conventional medical care in Sweden – and has been for about a century before the first RN was ever registered. How about Lamaze techniques, which were alternative then and conventional now? They don't work any better or any worse in 2017 than they did when the midwives started it in Soviet Russia, or when it became popular in the US during the 1960s. The definition of conventional depends upon what the society accepts, and therefore the definition of alternative depends upon the society, too.
    I believe that it's important to provide a basic (if perhaps sometimes oversimplified) definition of a subject in the first sentence. I think that this definition from the Merriam-Webster dictionary is worth using as a model: "any of various systems of healing or treating disease (such as chiropractic, homeopathy, or faith healing) not included in the traditional medical curricula of the U.S. and Britain". What's "alternative X"? It's the stuff that's sort of X, but it isn't the regular kind. It doesn't really matter whether "X" is medicine, rock, fuel, history, or facts: what makes it be 'alternative' is merely the fact that it's not the regular kind. WhatamIdoing (talk) 22:44, 7 February 2017 (UTC)
    • @WhatamIdoing -- just in case the discussion above your comment is getting tl;dr -- I think your concerns are largely addressed by the MEDRS I propose restoring: Harrison's and IOM (now National Academy of Medicine. (again; IOM's def'n is provisional; it's even more important to note that they concluded that there is no clear, consistent def'n of CAM) --Middle 8 (tc | privacyCOI) 23:15, 7 February 2017 (UTC)
    • in these discussions it is a very, very bad idea to start with a ref that is not already used in the article. The LEAD summarizes the body (which, btw, does have extensive, sourced discussion that includes curricula and the differences among countries) Jytdog (talk) 23:38, 7 February 2017 (UTC)

*** but they ARE already in the article, Jytdog. Linked in my reply to WhatamIdoing. In the pertinent section, definitions. Which opens with a sentence modified from the old lede, which I propose restoring -- just that first, definitional sentence, reflecting the definition section. ("old lede" = four months old; the article hasn't changed enough to matter.) What's the problem? --Middle 8 (tc | privacyCOI) 23:52, 7 February 2017 (UTC) || (added to cmt 23:57, 7 February 2017 (UTC))strike; never mind, I see you're replying to WhatmIdoing --Middle 8 (tc | privacyCOI) 01:31, 9 February 2017 (UTC)

In the interest of not pointlessly replying to a reply that is only vaguely related to a different reply may I make a recommendation that an RFC would be in order if only so that some order can be brought to the conversation. Personally I think the information in the first sentence while true is not much of a definition and would do better as a second sentence. 2601:645:C201:5D0:7526:B28B:A5FD:67BE (talk) 04:06, 8 February 2017 (UTC)

In order to do that we have to have concrete proposals. Carl Fredrik 💌 📧 09:41, 8 February 2017 (UTC)
I certainly see no reason to engage in substantial rewrites just so that an acupuncturist is happier with it. Guy (Help!) 09:51, 8 February 2017 (UTC)
Heavens no, JzG, don't do it because of me, do it based on the weight of MEDRS in question. But if that's too much intellectual heavy lifting, yes, there's always a lazier route. --Middle 8 (tc | privacyCOI) 10:05, 8 February 2017 (UTC)
@IP 2601... Point well taken; the language in the old lede is awkward, so better to start from a fresh proposal(s). Which I think should include refs and footnotes, so we can all tell what's sourced to what. --Middle 8 (tc | privacyCOI) 10:17, 8 February 2017 (UTC)
No, much better to start fomr what we have and let reality-based editors propose any changes, rather than True Believers. You're an acupuncturist, Clean Copy is IIRC a Steinerite, essentially a believer in homeopathy. Both of you have ideological beliefs that are best served by watering down the facts. Guy (Help!) 10:53, 8 February 2017 (UTC)
  • Specifics: "Committee on the Use of Complementary and Alternative Medicine by the American Public" is an industry-friendly group and not a MEDRS. The front matter of this report starts with the fallacious appeal to popularity and moves on from there. This can be viewed as much of a piece with OAM/NCCAM/NCIH - a politically-driven attempt to crowbar SCAM into reality-based medicine, promoted and funded by people with financial and ideological commitment to SCAM.
Harrison is a red herring since it merely recognises the fact that the SCAM industry has been successful in promoting quackademic medicine. The existence of quackademic medicine does not in any way offset the fact that the defining feature of SCAM is that it is not based in reality. Guy (Help!) 11:16, 8 February 2017 (UTC)
@Guy Re your beliefs about my beliefs, see our conversation on your user talk page.
Re sources: No. These are both gold-standard MEDRS that refute the lede's assertion of a single definition. (For specifics pls see green text above in my exchange with Carl.)
Besides those sources, there's other stuff in the Definitions and terminology section that rejects a single def'n, despite which the lede goes ahead and asserts one anyway, running afoul of WP:LEDE and WP:WEIGHT. --Middle 8 (tc | privacyCOI) 21:16, 8 February 2017 (UTC)
The problem here is that the world of quackademic medicine is full of flatteriing self-description. Its entire raison d'etre is to normalise quackery. So we should not use quackademic self-descriptions that undermine the fact that the foundational definition of alternative medicine is that it does not work. Minchin's Law applies. Guy (Help!) 21:53, 8 February 2017 (UTC)
That a definition is given does not in and of itself asset that only a single definition exists. It seems you read a lot of subtext that maybe doesn't exist. Your two sources while reliable do not seem very useful. The IOM source names every definition possible before deciding to just choose a working definition with the scope of just the report. The Harris source seems more interested in ducking the question than answering it. 2600:1010:B061:FE66:F13F:F6F7:946F:DF7F (talk) 01:11, 9 February 2017 (UTC)
@Guy I sense tigers afoot. There's self-evidently no scientific consensus on the def'n of CAM, and I can't think of anything that would justify discounting opinions endorsed by "the most recognized book in all of medicine" or a US National Academy (a nonprofit, nonpolitical NGO).
@ip260x:... On WP, asserting one view exclusively, such as a definition, is tantamount to saying that there are no other important ones. That subtext comes from NPOV. --Middle 8 (tc | privacyCOI) 06:46, 9 February 2017 (UTC)
There will never be a scientific consensus on SCAM., because SCAM is defined by its rejection of the scientific method. By definition, alternative medicine either hasn't been proven to work, or has been proven not to work. The name for alternative medicine that is proven to work, is medicine.
SCAM, under its various brands, most recently "integrative medicine", is not scientific. You can see this very easily indeed by reviewing the quackademic medicine groups around the world. They variously include homeopathy, acupuncture, reiki, chiropractic, therapeutic touch and a number of other treatments that are based on entirely fictional concepts.
Don't take my word for it, go out and check. See what proportion of "integrative" departments you can find that do not use homeopathy, reiki or therapeutic touch. I pick those three because they should not raise cognitive dissonance for you, and because they are all comprehensively demonstrated to be bullshit.
If you integrate cow pie with apple pie, you don't make the cow pie taste better, you merely ruin the apple pie. Science knows that. There will never be a scientific consensus that the bullshit practices of alternative medicine are valid, because if they were, they would, by definition, no longer be alternative. Guy (Help!) 09:41, 9 February 2017 (UTC)
@Guy I understand what you're saying, but don't see where you're going content-wise. These other, "non-Minchin's-Law" definitions are silent on efficacy and pseudoscience. You can be the biggest CAM skeptic in the world and still use them. So I don't understand your objections. --Middle 8 (tc | privacyCOI) 22:48, 9 February 2017 (UTC)
The article title is alternative medicine. Alternative medicine is defined by its lack of evidence. SCAM and integrative are rebrandings explicitly designed to co-opt possibly legitimate therapies in order to fallaciously assert that membership of a category which also contains legitimate therapies, thus makes illegitimate therapies, legitimate. That is the purpose of the rebrandings. And we're not going to fall for it. Guy (Help!) 09:38, 10 February 2017 (UTC)
@ Guy Are you saying that the "Minchin's-Law" definition of (C)AM ("treatments that lack evidence") is the only valid one? --Middle 8 (tc | privacyCOI) 21:19, 10 February 2017 (UTC)
No, but it is the simplest and most concise one.
  • Alternative medicine is defined as that which is either unproven or disproven (because otherwise it would not be alternative).
  • Complementary medicine is any practice which complements that of reality-based medicine - such practices may be legitimate or not.
  • Supplements, complementary and alternative medicine (CAM or SCAM) is a marketing ploy to co-opt the legitimate parts of complementary therapies in order to try to portray alternative medicine as sharing that legitimacy. It is an example of the categorical fallacy.
  • Integrative medicine (aka quackademic medicine when found in medical schools) is a further rebranding, seeking to entirely remove the word alternative, without fixing the actual problem. I believe it was Dr. Gorski who popularised the aphorism that integrating cow pie with apple pie does not make the apple pie better.
  • Holistic medicine is purest hogwash. All medical practice is holistic, or none is.
I don't think any of use are really confused about these things. Guy (Help!) 11:06, 14 February 2017 (UTC)
  • just checking in. i've read the definitions sections about five times since i first posted above and am trying to think about how to summarize that content. this is not a simple problem. Jytdog (talk) 01:49, 9 February 2017 (UTC)
Minchin's Law is a good starting place. Guy (Help!) 09:41, 9 February 2017 (UTC)
yep the normative definition is discussed in the body, along with other things. Jytdog (talk) 09:47, 9 February 2017 (UTC)
Sidebar Q1: It's odd that Minchin's Law redirects to a target which doesn't mention it, someone have a usable source? Sidebar Q2: Do we have a concise name for conventionally accepted non-EBM interventions? LeadSongDog come howl! 17:44, 9 February 2017 (UTC)
Just google it :) it is ~a~ starting point but it is not the end point, should have mentioned that. One of my favorite comments ever on the relationship between alt med and conventional med was made by MastCell at a discussion at WT:COI. See here. Jytdog (talk) 20:22, 9 February 2017 (UTC)
Minchin's Law – which ought to redirect to Tim Minchin, the comedian(!) who started it – is the starting point of the True Believer. The only difference is that this true believer believes that the humans in conventional medicine can and do immediately accept data even when it contradicts their (biased) personal experiences and costs them both their livelihood and pride. In other words, they believe in a fairy tale that is every bit as pernicious to public health as the homeopaths'. The homeopath believes something that is scientifically laughable, but the skeptic believes that millionaire surgeons will stop doing the surgeries that made them millionaires just because researcher somewhere figured out that the benefits were all placebo effect. In reality, those surgeries are still happening, and the primary reason that fewer are happening is because the people in charge of the money refuse to pay for them now. There's not been a single report of a surgeon calling up a patient and saying "You know, we planned to do that surgery, but the data says it doesn't work anyway. I'm not going to do this surgery any more. Let's send you to physical therapy instead." Even people with solid scientific credentials and who believe that specific surgeries are inappropriate for a given patient will still perform them on demand, because they're humans instead of data machines.
Again, I think that the best starting point for a definition is to look at how professional definition-writers (such as dictionaries) and general sources (such as major medical textbooks) have defined it. I don't think that we should start with either group of true believers: neither the ones who think that most of it works, nor the ones who think that it's merely a question of scientific efficacy rather than (also) being a question of society's conventions. WhatamIdoing (talk) 23:01, 9 February 2017 (UTC)
WP:MEDRS, WP:FRINGE etc. clearly place scientific fact over societal convention. The most obviously applicable parallel is intelligent design. It's a religious belief which is objectively wrong, and that is exactly how we describe it. Guy (Help!) 09:34, 10 February 2017 (UTC)
I feel like we're talking past each other, so let me try again with a specific example:
  • Fact: A planned home birth is "alternative medicine" in the US (in this century). Right? In parts of the US, it is actually illegal for a board-certified obstetrician to attend a planned home birth (Alabama, I'm looking at you).
  • Fact: A planned home birth is "conventional medicine" in The Netherlands right now. 30% of Dutch women do it, it gets full social and insurance support, and it's normal. Right?
Given those facts, can we agree that the definition of "alternative medicine" is not exclusively a matter of scientific facts? Otherwise, we're going to have to re-write the definition of "scientific fact" to say that scientific facts depend on whether you're in The Hague or Montgomery. WhatamIdoing (talk) 21:39, 10 February 2017 (UTC)
A home birth isn't "alternative medicine" because it isn't medicine. Some of what happens at a home birth may be alternative medicine or conventional but the birth location itself is not. Lamaze for instance is no more conventional or alternative because they happen in your living room as opposed to a hospital bed. Turing down pain meds is going to have the same effect either place. You could argue it is an alternative practice but that would seem to be out of scope for this article. (talk) 22:35, 10 February 2017 (UTC)
@ WhatamIdoing, ip 137... - Depends on which definition is used; e.g. home birth &c. could qualify if (C)AM is defined as care given outside the conventional medical system. In Germany, IIRC, midwives aren't part of the latter. --Middle 8 (tc | privacyCOI) 00:25, 11 February 2017 (UTC)
Attending childbirth is practicing medicine, no matter what you do while you're there. If you attend a birth without a license and do everything according to the most perfectly scientific system, then you get charged with "practicing medicine without a license". If you attend a birth without a license and sacrifice a chicken while dancing around a flame, and tell the mother that your dance will save the baby's life, then you still get charged with "practicing medicine without a license". Medicine is not defined exclusively by its relationship to modern science (which is a good thing, because medicine existed long before modern science did).
Lamaze, of course, is a classic example of the problems with the 'Science über Alles' idea of defining alternative medicine purely in scientific terms. The science didn't change between the 1960s and the 1990s. The only thing that changed is how American society (=lay people, not researchers) felt (=as in "their emotional reactions") about it. If "stuff that works is medicine", then it isn't even theoretically possible for something to change categories (without re-writing the laws of physics). WhatamIdoing (talk) 03:50, 11 February 2017 (UTC)
So then we are in agreement that home birth is practicing medicine and not just medicine. You earlier referred to it as alternative medicine and not the practice of medicine and that is why I explained it was out of scope. I am sure there would probably be more alternative medicine at a home birth than at a hospital but each intervention would be judged on its own merits. I don't think the legality of an intervention has much to do with whether it is alternative or not. If a surgeon gets drunk before a heart transplant it doesn't mean that if he loses his license he was practicing alternative medicine.
I don't see why Lamaze would cause any issue with modern science except maybe ethically. It is a series of practices each of which could be tested if it wasn't ethically dubious to run tests during labor that effect pain. You can still do population studies to look at the whole system. As there doesn't seem to be much money involved though I doubt anyone will2601:641:4001:5C36:2156:FF19:1ADE:C996 (talk) 21:19, 11 February 2017 (UTC)

──────────────────────────────────────────────────────────────────────────────────────────────────── LeadSongDog, I think that there are two kinds of non-EBM conventional medicine:

  1. Stuff that doesn't work, shouldn't be done, and gets done anyway: "Bad medicine". (Example: Over-the-counter cough syrup)
  2. Stuff that hasn't been researched (to proper levels of evidence), and probably won't ever be: "Professional judgment". (Example: Multiple co-morbidities or extremely rare diseases)

WhatamIdoing (talk) 23:15, 9 February 2017 (UTC)

Thanks, WAID. (Jumping full into OR rant mode, here goes....) Certainly "Bad medicine" is a pretty massive sub-field. The persistent, widespread abuse of placebos or worse (e.g. using phenylephrine as a decongestant) is only one component.
I was rather hoping to find more specific terms to organize the overlapping subfields of bad, such as suboptimal-, ineffectual-, untested-, unproven-, untestable-, implausible-, dangerous-, et cetera. Obviously there are also the usual malpractice options of excessive ambition, blind incompetence, ignorance, fatigue, sloth, distraction, fraud, and so forth, but these are by no means specific to medical or even alt-med practice.
In altmed, one might consider energy medicine, faith healing, and homeopathy to be ineffectual, untestable, and implausible, but it's a bit of a reach to construe them as directly dangerous (save by omission to seek better options). Herbal treatments may tick off suboptimal, ineffectual, unproven, or even dangerous, but implausible doesn't always pertain: foxglove, belladonna, coca, opium, etc. have very well documented effects. Chiropractic or deep tissue massage are fairly safe and plausible for some specific indications, but are so routinely misapplied as to significantly discredit the whole of the practice. Acupuncture is rumored to work, but not very much, not verifiably using any blinding scheme yet devised, and no plausible mechanism has been elucidated.
There's lots of shame to go around. In conventional non-EBM, PSA testing and mammography are done regularly even though they are devalued as being both unreliable due to high false positive rates and even somewhat dangerous due to the stress or invasive interventions consequent to those false positives. Weight loss only rarely works long-term but it is still advised routinely, even including the use of some near-heroic interventions rather than reining in the fast-food monster. Esthetic plastic surgeries may achieve the physical effects sought, but how often do they really improve general health or self-esteem, and at what risk? Then there's the whole practice of patent evergreening, which has the effect of reducing access to effective medicines strictly for corporate profitability.
(Rant done.) By lumping all the alt-/comp-/integ-med fields together, we hide some of these distinctions. The same can be said about conventional non-EBM but we lack clear terminology. LeadSongDog come howl! 21:44, 10 February 2017 (UTC)
I believe that there's supposed to be a term for the 'argument from authority' issue in pre-modern medicine (from "Galen wrote..." through and including the "My attending said that in his experience..." model of medical education that persisted at least through the 1970s), but I don't know what the name is, and we don't have a separate article for it. WhatamIdoing (talk) 03:50, 11 February 2017 (UTC)
Not gonna lie, I've only skimmed through the above pages of discussion, but I also take issue with the lede as currently written -- I kind of like the NIH's definition of alternative/complementary medicine as being anything "non-mainstream". This allows for the inclusion of interventions with both scientifically-based rationales for efficacy and a slowly but surely growing body of trials (e.g. pretty much anything that decreases anxiety such as yoga, mindfulness meditation or pet therapy), while also encompassing interventions which have been disproven (like homeopathy). (Note: I came here from an article about a method that is, I think correctly, labelled as alternative medicine, but for which there is evidence of efficacy. If the Wikipedia definition of alternative medicine requires non-efficacy, then that and many other articles likely need to be changed and not link here.) -Kieran (talk) 22:25, 10 February 2017 (UTC)
What you "like" is not relevant; this isn't Facebook. The lead needs to summarize the body. Jytdog (talk) 23:32, 10 February 2017 (UTC)
@ Jytdog - NCCIH's definition is already in the article body under Definitions and terminology § Different types of definitions (not the exact page Kierano gave but essentially the same def'n). --Middle 8 (tc | privacyCOI) 00:18, 11 February 2017 (UTC)
The lead needs to summarize the body. Jytdog (talk) 00:20, 11 February 2017 (UTC)
Jytdog FWIW, just saying that perhaps the lede's summary of definitions will eventually encompass NCCIH's, et. al. -- IIRC they're not the only ones to use it so it may be sufficiently weighted (but really no point in arguing over this now). --Middle 8 (tc | privacyCOI)

proposed leads[edit]

  • Alternative medicine is an umbrella term with unclear boundaries for a set of practices marketed or intended to improve or maintain human health, which are outside the norms, practices, or institutions through which medicine is practiced and taught in a given time and place. Some forms of alt med are continuations or adaptations of traditional medicines with prehistoric roots; some are based on folk medicine, and some of them are more recent inventions, but almost all of them are based on notions of the human body and mind, and their inter-relationship, that differ from those generated by science. Normative definitions characterize practices as constituting alternative medicine when, used independently or in place of evidence-based medicine, they are put forward as having the healing effects of medicine, but are not based on evidence gathered with the scientific method.
Something like that is how I summarize the body..... thoughts? Jytdog (talk) 04:15, 11 February 2017 (UTC)
  • It's really long and difficult to understand. The last sentence in particular will be impenetrable to English-language learners and probably culture-bound to boot (but perhaps not in a bad way). How do you feel about splitting it into shorter sentences, like this?

Alternative medicine is any practice that users intend to improve or maintain human health, but that is outside the norms or institutions through which conventional medicine is practiced and taught in a given time and place.  It is an umbrella term with unclear boundaries.

I think that more, smaller sentences will work better. (Note that I've specified 'conventional medicine', since it is the contrast with conventional medicine that makes AltMed be 'alternative', and that is the only distinction that makes sense in historical [pre-existence-of-EBM] contexts.) WhatamIdoing (talk) 08:23, 12 February 2017 (UTC)
  • Provisionally, looks very good; pace WAID, I don't have any problems with the prose. Sentence length and reading level are in line with other articles on en-WP. Am assuming that under this proposal the rest of the lede would remain as is.  !vote is provisional because am still digest\ng Def'ns section, which is non-trivial; kudos to Jytdog for putting in the work. --Middle 8 (tc | privacyCOI) 11:01, 12 February 2017 (UTC)

──────────────────────────────────────────────────────────────────────────────────────────────────── I disagree entirely and think that both those definitions are considerably worse than what we have now. They entirely ignore that part of the definition is that alternative medicine either: does not work; or is very unlikely to work — often with scientific consensus behind those positions or otherwise based on absolute faults or misunderstandings in the reasoning behind the practices (e.g. homeopathy). Any even potential effect of homeopathy is entirely due to placebo, and there is no dispute about this. All of is clear in the sources we cite, and is important enough to belong in the first or second sentence. Carl Fredrik 💌 📧 12:21, 12 February 2017 (UTC)

I agree however that something along the lines of Jytdog's "Some forms of alt med are continuations or adaptations of traditional medicines with prehistoric roots; some are based on folk medicine, and some of them are more recent inventions, but almost all of them are based on notions of the human body and mind, and their inter-relationship, that differ from those generated by science." should be added and that some rephrasing of the first paragraph can be done — just not by removing facts that are fundamental to the definition. Carl Fredrik 💌 📧 12:24, 12 February 2017 (UTC)
  • In giving an example of how to write with shorter sentences, I did not mean to exclude the rest of the proposed sentences from the first paragraph.
  • What makes something "alternative" isn't merely – or even most importantly – the absence of efficacy. Current conventional medicine has a long list of treatments that "do not work", and they're still conventional. Statistically, we know that most experimental drugs are "very unlikely to work", and they're still mainstream and science-based. Chiropractic was alternative even when conventional medicine was completely non-evidence based. The lack of scientific efficacy is (in modern times) a matter of strong correlation, not causation. WhatamIdoing (talk) 17:42, 12 February 2017 (UTC)
Okay, that makes more sense. However the first one or two sentences are potentially the most important in the entire article — many readers do not read more than to grasp a definition of the subject, and Google only includes two sentences. If we want to rewrite it we need to include that there is scientific consensus that alternative treatments don't work — whether this is based on statistics or a fundamental understanding of biological or physical processes is less important. Carl Fredrik 💌 📧 22:42, 12 February 2017 (UTC)
We might have to consider what "they don't work" means, given that the scientific consensus is that some do work (as well as highly effective placebos), others work (albeit worse than conventional treatments), a few work (about as well as the existing lousy conventional treatments), and still others work well (when the needs are emotional rather than biological). (On that last point, it's easy to dismiss this as lonely people seeking facetime by manufacturing medical symptoms, but it's more complicated than that. I remember reading a complaint from an oncology nurse that it sucked that her supposedly science-oriented hospital was doing reiki massage, but that in reality, patients needed to feel a human touch during their treatment, and signing them up for reiki massage was the only way the staff could guarantee that someone would have time to make that human connection happen. The hospital seemed to have chosen "add cheap reiki practitioner and get media love for doing cool altmed stuff" over "reduce the patient load for expensive nurses".)
On perhaps the more important point, Google Search is giving me between one and four sentences in the descriptions. It seems to depend partly upon sentence length, since there's a limit to how much can be displayed. I suspect that the choice of what to display depends more upon your keywords. But overall, I think that if the reader has gone to Google Search and is looking for just a definition of 'alternative medicine', then they're going to read the definition that Google provides in the big fat box at the top of the page. In that case/for that type of reader, it doesn't matter what we're putting in our articles. WhatamIdoing (talk) 06:55, 13 February 2017 (UTC)
  • The Minchin definition is much clearer. Based on that:
Alternative medicine is any medical or pseudomedical practice whose efficacy is either unproven or disproven.
That is short and I believe 100% accurate. Guy (Help!) 11:11, 14 February 2017 (UTC)
It also has to be routinely used on patients as a treatment, as opposed to new medical practices which are still in the test stage - they are unproven too, at that time, but they are not alternative medicine. They can become alternative medicine if they are still used after they fail the test.
I think that those who contest the Minchin definition take issue with the implied statement that medical practices are automatically accepted by the medical community as soon as they are proven - SCAM proponents have a lower standard of proof and do regard SCAM practices as proven (by anecdote), but those practices still remain outside medicine. So, in their eyes, Minchin's definition is wrong. But that's just because of their wrong-headed definition of "proof". --Hob Gadling (talk) 11:52, 14 February 2017 (UTC)
@ Guy, Carl et al. - Ernst says some (C)AM's work.[8] He cites St John's Wort in two other refs as well [9]. There's another ref right in the article in which Ernst's methods found 7.5%, which he caveats as likely a "gross overestimate", but still, a good source saying some CAM's work refutes Minchin and makes the article contradict itself. At any rate Minchin wasn't the first def'n ever used, nor is there sci consensus it's the only or best one, or else our sci-consensus-level(ish) sources would all say so.
More important: As mentioned above but weirdly ignored/dismissed by proponents of Minchin, Harrison's flat-out contradicts Minchin (4th sentence) and our very best source (US Nat'l Academy of Med, née IOM) concludes that "no clear and consistent definition of CAM exists" so in light of the weight of these sources please indicate the basis in policy for solely asserting Minchin?? --Middle 8 (tc | privacyCOI) 12:14, 14 February 2017 (UTC)
Well, there is no point using that — if we conclude that no definition exists we can only redirect to Quackery. That in turn wouldn't be too bad, but I don't think that is what you're looking for. Carl Fredrik 💌 📧 17:50, 14 February 2017 (UTC)
@ Carl Ah, better stick with giving primacy to Minchin, then, because all roads lead back to Minchin because I say so. That is one way to look at it. --Middle 8 (tc | privacyCOI) 19:51, 14 February 2017 (UTC)
St. John's Wort is not alternative medicine, it is herbalism, which is the medical equivalent of historical re-enactment. Herbal remedies may indeed work. The reason St. John's Wort is not used in reality-based medicine is mainly due to dangerous interactions with other drugs: there are pharmaceuticals which have the same or similar effect with less risk.
And actually this is a perfect example of the fraud that is SCAM. St. John's Wort is not alternative, it has been investigated in the field of pharmagognosy and it would be used in medicine if it were not for the fact that safer alternatives already exist, but SCAMmers hold it up as if it validates entire categories of still-mainly-bullshit.
OAM/NCCAM/NCCIH has spent in excess of $3bn trying to validate complementary and (mainly) alternative therapies. The result? Nothing. Oh, except a post-hoc subgroup p-hacked out of possibly the most unethical clinical trial in modern history. At least they eventually stopped funding tests of homeopathy, which is something. Guy (Help!) 21:40, 14 February 2017 (UTC)
And there is the fact that each study corroborating the effect of St. John's Wort is out of Germany, while all studies from elsewhere equate it with placebo or worse than placebo. Carl Fredrik 💌 📧 21:43, 14 February 2017 (UTC)
@ Guy, Carl Yes, it is weird re St John's Wort; it seems to be better than placebo only in Germany, but as good as conventional antidepressants everywhere.[10][11] But here is the central point: Ernst defines herbal treatments, whether effective or not, as part of (C)AM because he uses a def'n different from Minchin's. It amazes me that you guys -- if I read you correctly -- are still arguing for Minchin as the main (or only?) definition when Ernst chooses a different one, IOM says there's no single best one, and Harrison's outright calls Minchin's "not useful". On what basis do you discount these good-as-they-get MEDRS? --Middle 8 (tc | privacyCOI) 23:44, 14 February 2017 (UTC)
Again, this is tangential because herbalism is not alternative, it is proto-medicine, but the difference in results is to be expected given statistical variation and regional variations in standards of preparation of herbal products. The dose of active ingredient can vary wildly by season and by batch, because it's unevenly distributed around the plant and it varies according to growth cycles. The active ingredient works, but interacts potentially fatally with other drugs, so the dosage is incredibly important - and that's a real problem when the dose is not actually standardised at all. In the end, other drugs are less risky, which is why it's not used in the medical profession. And that is actually pretty much the only reason it's not used. Nobody has any ideological bias against it just because it's form a plant, whatever works and yields good treatment compliance is fine.
Your misunderstanding about Harrison is a simple and obvious one. Minchin does not say that alternative medicine is defined by lack of evidence, but lack of proof. There is an absolute mountain of evidence in respect of homeopathy, but it remains alternative because it is not proven to work (in fact isn as much as one can prove a negative it is pretty much proven not to).
Unproven or disproven does not have anything to say about the quantity of evidence, only the sum total of what that evidence says about efficacy.
Acupuncture is alternative because it's disproven for most conditions and unproven (with weak and often equivocal evidence) for a few. There's loads of evidence, but the evidence does not prove the claims. If it did, it would not be alternative any more.
Therapeutic touch is alternative because it is comprehensively debunked. A child of nine can design an experiment that disproves it.
Evidence is a part of the process by which proof is derived. Lack of proof in the presence of substantial evidence can be implied as disproof.
So your "good-as-they-get" MEDRS is not addressing the point. Nor is it addressing alternative medicine; it's talking about SCAM more generally. SCAM includes alternative medicine and also valid (and some not-so-valid) complementary therapies. And that's leaving aside the issue of whether it has succumbed to the dreadful postmodernist bullshit of "Integrative". Guy (Help!) 00:04, 15 February 2017 (UTC)
Guy: You keep asserting definitions as if they were settled, which is counter to the demonstrable scientific consensus (IOM) that they're not.
A) You're mistaken re Ernst.
  • Ernst does address AM when he discusses CAM's: he says AM and CM are the same, the only difference being whether, respectively, they're used alone or along with biomedicine (see Question 1: [12]).
  • Again, Ernst says that AMs can be effective, and he includes herbs; sources follow. To the question "So what areas of alternative medicine are helpful or effective, according to your research?" he replies "[s]ome herbs, like St. John’s Wort, are both effective and safe if used properly". (Also check out his answer to the first question -- provocative comparison, eh?) [13]. See also [14],[15],[16] (latter already in article).
  • Ernst's def'n of CAM (also adopted by Cochrane) is relative to mainstream treatments, and is silent on efficacy, [17][18] in stark contrast to Minchin and the current lede. (Yes the therapies that come under each overlap to a great degree, but equating the two def'ns on that basis would run afoul of WP:SYN, of all things. :-)
So yeah, Ernst does address the point, and in several ways his opinion differs from yours.
B) You're mistaken re Harrison's.
  • Harrison's also addresses AM: the same way Ernst does. Did you read the 2nd sentence? [19] Harrison's is also silent on efficacy (1st sentence).
  • Yes, yes, "evidence (for efficacy)" is not exactly the same as an "evidence base". But Harrison's (4th sentence) still addresses the "unproven" part of Minchin, who defines AM as either unproven (i.e. evidence base absent or inconclusive) or disproven (evidence base conclusively negative).
  • But it doesn't matter whether Harrisons (or any other MEDRS) outright criticizes Minchin: point is, they still differ. As with the demarcation of what is and isn't science, there are multiple credible, considered opinions, which are not to be depicted as facts.
So, yes.... Harrison's addresses the point too.
BTW, the UK's NHS agrees with IOM that "There is no universally agreed definition of CAMs" (and draws the AM/CM distinction as Ernst and Harrison's do) [20] .... so there's yet another gold-standard MEDRS telling us not to assert just one def'n, in case any doubt whatsoever remains after an unbiased reading of these sources. --Middle 8 (tc | privacyCOI) 19:21, 19 February 2017 (UTC)
This article is not about SCAM. It's about alternative medicine. Of course there's no uniform definition of SCAM (or integrative), because they are deliberately designed to blur the lines by including potentially valid therapies with the deliberate intent to confer a halo effect on the bullshit that is alternative medicine and confuse the public into thinking that abject nonsense is no different from complementary therapies that have at least minimally plausible mechanisms of action. Guy (Help!) 21:54, 19 February 2017 (UTC)
Whatever Ernst and Harrison's (and NHS) say about CAM applies to AM. Read the sources I linked to. They do NOT say that CM includes anything that AM doesn't; that would be from someone else's definition -- enough already with the IDHT on this point. They say AM and CM are the exact same set of therapies, differentiated only by where they're used. Ernst makes this super-clear when he answers the "what areas of AM are helpful or effective" question with "herbs", above. That's Ernst saying there's an Alternative Medicine that is safe and effective, which totally contradicts your position. (BTW complementary medicine and integrative medicine happen to redirect here, so any lede that summarizes the body has to define those.) --Middle 8 (tc | privacyCOI) 02:29, 20 February 2017 (UTC)
Ernst is certainly not under any illusion as to the difference between alternative medicine and SCAM. I know this because I have discussed it with him in person. This article is about alternative medicine, for which the Minchin definition is absolutely correct. SCAM and "integrative" are deliberate marketing ploys designed to create exactly the confusion you promote. Wikipedia's mission is to inform, not to assist the SCAM industry with its marketing, so we can and must make the distinction.
Alternative medicine was the original brand, and alternative medicine is defined by the fact that it either hasn't been proven to work or has been proven not to. That's why it is alternative.
After a while, they realised this was excluding them from lucrative areas of practice, so they co-opted complementary therapies in an attempt to claim a halo effect. That worked for a while but SCAM still includes "and alternative", and if we know one thing about alt-meddlers it is that they refuse to accept that their bullshit is anything other than ineffable truth (this is one of the main reasons I think alt-meddlers are actually a quasi-religious cult).
Thus we got "integrative" which drops the now-hated "alternative" altogether. But it doesn't change anything. Alt-med is still unproven or disproven. Selling it alongside things that are at least marginally plausible changes nothing.
Wikipedia is a reality-based encyclopaedia. We can describe the evolution of the marketing brand to minimise the impact of the alternative label, but we must not join the SCAM industry in pretending that because massage is plausible as a treatment for pain, thus homeopathy and acupuncture are too. That would be a dereliction of our foundational goals. We can tell the reader this is what happened, but we absolutely must not tell the reader that the rebranding changes anything, because it doesn't.
The SCAM industry has been doing fake news for decades via bullshit sites like Natural News, crunchy magazines, the FUD Babe and other such tools. Now is a great time to be really firm on not succumbing to that. The Trump presidency is the large-scale political manifestation of all the people who died because a supermarket tabloid told them baking soda cures cancer. Guy (Help!) 09:20, 20 February 2017 (UTC)
"It's alternative because it either hasn't been proven to work or has been proven not to" is not something that modern scholarly sources say. The comedian's definition is popular on the internet, but it's been explicitly rejected by scholarly sources. Instead, scholarly sources are saying that "it's alternative because it's not the regular kind". (One hopes that the stuff that doesn't work will never become the regular kind, but...) WhatamIdoing (talk) 22:05, 22 February 2017 (UTC)
I have to keep repeating this point. They are not addressing alternative medicine, they are addressing SCAM / integrative medicine, and the fact that some of SCAM is not obviously bogus is deliberate and by design: they co-opted legitimate complementary therapies in the hope of getting people to fall for a category fallacy. And it has worked rather well, as this discussion shows. Guy (Help!) 22:41, 22 February 2017 (UTC)
@ Guy and pinging WAID: Actually a number of them (Ernst, Harrison's, NHS) are addressing AM in the same breath as they address CAM. They define AM as "not the regular kind, used instead of the regular kind". They define CM as "not the regular kind, used alongside the regular kind", and they define CAM as the superset of the two. --Middle 8 (tc | privacyCOI) 21:57, 2 March 2017 (UTC)
You can indeed make a case for a single article that traces the evolution, rather than separate articles for AM, SCAM and integrative. I don't dispute that. But Ernst absolutely does not consider AM and SCAM to be the same thing. This is obvious form his books and his blog posts and actually also you can ask him directly. So, I am happy to discuss the evolution in this article or separately, but I am absolutely not happy to buy into the SCAM industry's marketing ploy of bundling apple pie with cow pie and pretending this makes the cow pie a tasty treat. Guy (Help!) 09:45, 6 March 2017 (UTC)
@Guy As I said below, you'll need to produce those Ernst sources; the ones I've found say differently. [21] --Middle 8 (tc | privacyCOI) 15:12, 16 March 2017 (UTC)
See below. Endlessly restating your interpretation of the sources does not change the documented facts. Guy (Help!) 10:55, 17 March 2017 (UTC)
  • Support Jytdog's proposed lede as far superior to the current one. As observed by many, the current lede does not match the literature, which typically defines "fringe medicine" as medicine that is outside "Orthodox medicine". Jytdog's version correctly captured this distinction by the phrase "which are outside the norms, practices, or institutions through which medicine is practiced and taught in a given time and place." I did a Google book search on Fringe medicine and the first four sources all define "fringe medicine" this way. None of them simply define it as either unscientific or ineffective. There are statements such as:
"It would be historically misleading to imply that official medicine has always been competent where fringe medicine has been ineffectual or fraudulent."
"Orthodox medicine, for its part, has sometimes seen fit to assimilate fringe practices rather than lose patients en masse to marginal medicine....[e.g.] MESMERISM; it may be occurring today with acupuncture. In short, the historical distinction between medical quackery and orthodoxy has been more social than scientific." The Oxford Illustrated Companion to Medicine [22]
"The Faculty was obliged to recognise reluctantly that quack or secret remedies could do good. After a crusade against secret nostrums the BMJ was forced to acknowledge in 1912, 'It would be folly to deny that quack medicines ever did good. It would be strange indeed if they did not sometimes, as for the most party they are made of the materials in common use in medical practice.'[100 BMJ, 13 July 1912] And instances of serious illnesses, cited at this time as being untreated because of a recourse to nostrums, revealed several--TB and cancer amongst them--where contemporary medical treatment could have equally limited efficacy.[101 Report as to the Practice of Medicine and Surgery by Unqualified Persons, PP 1910 (Cmd 5422), p.20.]"
Digby, Anne, Making a medical living: Doctors and Patients in the English Market for medicine, 1720-1911, Cambridge Univ. Press. 1994, 2002. [23]
--David Tornheim (talk) 13:28, 15 April 2017 (UTC)

Alternative medicine vs. SCAM vs. Integrative[edit]

Complementary and alternative medicine redirects here. I don't know whether that is helpful or not, it certainly leads to the kinds of confusion Middle8 displays above. It seems to me that these are in fact two separate topics. Alternative medicine is relatively easily defined - I like the Minchin version but others exist. Alt-med includes things like homeopathy and Reiki, which are obvious bollocks. Alternative means unproven or disproven, this is simple and unambiguous.

A big chunk of the article is given over to the branding efforts of the SCAM industry. I would argue that this centre section describing things like complementary and integrative should be split out, with Complementary and Alternative Medicine and integrative medicine redirecting there. It's my view that alternative medicine is a useful categorisation, but as Middle8 has pointed otu at length above, SCAM is so vague as to be meaningless as a category, and it makes sense only as the marketing term which the facts show it to be.

I therefore propose that the content addressing definitions and classifications of SCAM and integrative, are spun out, in the interests of clarity and accuracy. Guy (Help!) 09:29, 20 February 2017 (UTC)

[I don't know how to contribute to this discussion, but I completely agree with the suggestion above.] — Preceding unsigned comment added by Lbertucci (talkcontribs) 07:09, 16 March 2017 (UTC)

In your personal opinion, is Cansema for skin cancer 'alternative medicine' or 'conventional medicine'? WhatamIdoing (talk) 22:12, 22 February 2017 (UTC)
It's alternative medicine. It's definitely not conventional medicine, because (a) it doesn't work and (b) its principal effect is disfiguring chemical burns and no doctor with even the most tenuous grasp of medical ethics would prescribe it. Guy (Help!) 22:38, 22 February 2017 (UTC)
It works better than placebo for superficial skin cancers (~10% permanent cure rate). That means "it objectively works", right? WhatamIdoing (talk) 03:12, 23 February 2017 (UTC)
That qualifies for a {{citation needed}}. Black salve is a caustic substance - it is possible that in burning out an area of skin it might also remove all signs of a low grade tumour, but that does not make it a sensible or safe way of doing so. There are surgical techniques that are much more accurate and do not damage the surrounding tissue. And of course a number of people who have "cured" cancer with escharotics never had a pathologically confirmed cancer in the first place. Final tip: don't do an image search for black salve unless you have a strong stomach. Guy (Help!) 08:28, 23 February 2017 (UTC)
PMID 24150196 (from Pathology of Royal College of Pathologists of Australasia) is one such source. And as you say, it's a biologically plausible mechanism. Any sort of caustic substance will cure some superficial skin cancers.
For anyone who wanders past this discussion later, let me point out that self-treatment with a kitchen knife gets a much higher cure rate for this condition, and a scalpel wielded by a trained person usually produces a cure rate that is very nearly 100%, usually with very minor scarring. Cansema is probably the least effective treatment that does anything at all.
So "it works" (better than denial, but not anything like as well as other options). Given that it does work (sometimes), is Cansema still "altmed" to you? I ask, because under the over-simplified definition you are supporting here, anything that "works" (even if it works poorly and has disfiguring side effects) is "not alternative". If we follow that definition, then Cansema is not altmed.
Personally, I'd rather have a better definition – one that easily includes Cansema. How about you? WhatamIdoing (talk) 17:48, 23 February 2017 (UTC)
Escharotics are not an effective treatment for cancer any more than a flame thrower is an effective treatment for cancer. Both will remove some skin cancers, but that's a side effect of the harm that they do and not a medically useful benefit. Guy (Help!) 21:59, 26 February 2017 (UTC)
If it "will remove some skin cancers", then it is effective for curing some skin cancers. That's what those words mean. We cannot say out of one side of our mouths that it removes some skin cancers and then say out of the other side of our mouths that it does not remove any skin cancers. If it removes any skin cancers, then it's an effective treatment for skin cancer.
Safety is a completely separate consideration. Relative efficacy, i.e., that the other options are better, are faster, have less scarring, are less likely to leave cancer cells behind, and even [for some of them] are cheaper than Cansema, which seems to be running around US $1 per gram online to give you a tenth of the curative chance that you'd get from two minutes with a doctor and a scalpel, is also a separate consideration. If it works at all = it is effective (to whatever degree it works). WhatamIdoing (talk) 04:44, 27 February 2017 (UTC)
No, it doesn't remove skin cancers. It removes skin. You might just as well say that a bath full of hydrofluoric acid bath cures cancer. Pretty much as per XKCD 1217, in fact. Guy (Help!) 09:39, 27 February 2017 (UTC)
It (cansema) removes both skin and skin cancer. A kitchen knife and a scalpel do the same; it's just each in turn removes a higher ratio of cancer cells to healthy cells, depending on how skillfully they're wielded. --Middle 8 (tc | privacyCOI) 01:33, 2 March 2017 (UTC)
I point out here that the statement that Cansema "will remove some skin cancers" is a direct quotation from your immediately prior comment. I realize that we can all mis-speak, but really: it does actually cure a few skin cancers (through a particularly damaging mechanism that I wouldn't recommend even to people whom I dislike). It really does work (in a tiny minority of cases). And, in fact, it used to be mainstream medicine. Escharotics and other caustic approaches were the thing in mainstream medicine, for centuries – up until mainstream medicine decided that those barbers had a good idea, and they finally (after much kicking and screaming) gave up on it. (Cansema itself is strongly connected with the physician most famous for developing the Mohs surgery for skin cancer.) Cansema works (barely). It's still altmed (and a disaster for most people who use it). I conclude that we therefore need a more nuanced definition than "anything that works is mainstream medicine". WhatamIdoing (talk) 06:21, 2 March 2017 (UTC)
Again, XKCD 1217. Guy (Help!) 08:25, 2 March 2017 (UTC)
Unlike a bullet in a petri dish (which doesn't necessarily kill all the cancer cells; you could scrape the splattered cells up off the floor and put them back in a petri dish), Cansema works in real-world humans, and it's not fatal. But if you want to insist upon that silly example, then a perfectly placed gunshot can cure localized skin cancer, too (by physically destroying the cancerous tissue – which, unlike a culture of cancer cells in a petri dish, would not keep living if you scraped them up off the floor and put them back on the person's remaining skin). It would "work". That wouldn't make bullets a mainstream medical treatment for skin cancer.
We can do better than this simplistic definition, and we should. WhatamIdoing (talk) 16:08, 2 March 2017 (UTC)
"Cansema" (a bullshit marketing term for escharotics) works exactly as well as a flamethrower. It is not used medically for exactly the same reason that flamethrowers are not used. It is not clinically useful. It destroys tissue. If you point it at a cancer, some of the tissue it destroys will be cancerous, but this is pretty much incidental. It does not "work" in any meaningful sense. It is clinically useless. Guy (Help!) 18:14, 2 March 2017 (UTC)
Still it works, if only just. But if you want a safe and effective alt-med, just ask Ernst about St John's Wort. --Middle 8 (tc | privacyCOI) 21:38, 2 March 2017 (UTC)
A flamethrower would burn the entire body. But if you said that it was as effective as those wimpy propane torches that they sell to home cooks who want to make crème brûlée, then I'd probably agree with you.
But: "it works". Minchin's definition doesn't require clinical relevance. It doesn't require specificity of action. It doesn't require anything except that "it works" better than random chance. (Even mainstream medicine has a 2% death rate for non-melanoma skin cancers, so perfection cannot be expected.) WhatamIdoing (talk) 07:14, 3 March 2017 (UTC)
Escharotics burn the entire body (or at least the bit to which they are applied). They are indiscriminate. People selling cansema pretend this is not the case, but they are lying. Escharotics "work" in the same way that chopping the affected body part off with an axe "works", which is to say, not in any meaningful sense. Middle 8 mentions St. John's Wort. That's not alternative, it's herbal. It's not used because the dosage is so hard to get right and there are substantial interactions with other treatments but there is active investigation into the active ingredient and safe ways to isolate and use it. That's the difference. Nobody is investigating escharotics, because they show no differential action in respect of cancer, they just burn indiscriminately. Guy (Help!) 15:25, 3 March 2017 (UTC)
@Guy Re herbs: look above where I posted "Again, Ernst says that AMs can be effective, and he includes herbs...", with sources. This is the 7th time I've mentioned this and the 0th time you've acknowledged it. --Middle 8 (tc | privacyCOI) 04:28, 4 March 2017 (UTC)
Bored now. I have met Ernst, and neither he nor I nor indeed the sources consider herbs to be alternative - indeed, the desire of alt-meddlers to co-opt the occasional validity of herbal remedies is part of the reason for the SCAM rebrandings. There is an entire branch of science - pharmacognosy - devoted to the study of active substances in plants, it's not alternative. Herbalism, as a class, is distinct from alt-med, and the reason it si not mainstream is different. Herbalism would be mainstream if it withdrew remedies found to be ineffective (which it never does), and if it were able to demonstrate safety, efficacy and dosage of active ingredients for its products (which it also never does). This blog encapsulates it neatly. The stark difference between that and the usual "cannabis oil cures cancer" bullshit from hucksters is exactly what we're looking at here. Cannabis oil as a cancer cure, is alt-med (and based on alt-facts). Study of cannabinoids' potential to treat symptoms of chemotherapy-induced nausea, MS and the like, is science. Selling cannabis leaves is herbalism. There's an overlap but the differences are clear enough. Guy (Help!) 09:42, 6 March 2017 (UTC)
@Guy Bored you may be, but mistaken you certainly are. What you think, and what you claim Ernst thinks, make no difference here unless they help us track down (MED)RS, so I encourage you to start doing the latter. Recapping (the reader can decide for themselves): What I've found is that Ernst (and Cochrane) define CAM vis-à-vis the mainstream (and not efficacy)[24]; that Ernst defines alt-med and comp-med as CAM's used as replacements and adjuncts, respectively, to mainstream therapies[25]; and that Ernst explicitly classifies safe & effective herbal therapies under alt-med.[26][27]. That last one is from his blog, last October; has he recanted since then? Let's see those other Ernst sources that must exist, if you're correct. --Middle 8 (tc | privacyCOI) 15:07, 16 March 2017 (UTC)
See below. Endlessly restating your interpretation of the sources does not change the documented facts. Guy (Help!) 10:54, 17 March 2017 (UTC)


  • "Alternative means unproven or disproven, this is simple and unambiguous.". Guy, there are two big things you need to do to get consensus for that assertion:
  1. Please list the (MED)RS's supporting it, i.e. showing that the definition is in fact widely accepted.
  2. Please square it with contrasting sources, starting with the fact that Ernst says that herbs, including ones proven safe and effective, are part of alternative medicine (note, not CAM, but specifically AM in these sources).[28][29]
Thank you. As for spinning out content, most sources use the phrase "complementary and alternative medicine" (and differentiate the two based only on sphere of use and not efficacy), so that's probably what the parent article should be. --Middle 8 (tc | privacyCOI) 07:48, 23 February 2017 (UTC)
There is actually only one thing I need to do, and that is to get you to stop promoting the SCAM industry's deliberate conflation of alternative and complementary therapies. The difference is quite clear, and the problem is entirely down to the fact that the article has drifted in line with the SCAM industry agenda. It needs to be pulled back, and then SCAM/integrative treated separately. Alternative medicine is a class that can be easily described, and SCAM / integrative are marketing ploys designed to weasel alternatives to medicine into legitimate practice. Easy. And let's not forget that only one of us has a vested interest in SCAM, and it's not me. Guy (Help!) 08:15, 23 February 2017 (UTC)
Looking at the sources I'm unconvinced there is a significant different between complementary/integrative and alternative medicine. Many of the objections in this article address the interaction between medicine and alt/int/comp-treatments. I see no reason to split these up, seeing as they are ostensibly only different names for the same things. Carl Fredrik 💌 📧 11:48, 27 February 2017 (UTC)
There is a very important difference. Integrative (aka quackademic) medicine uses homeopathy, which is unambiguously alternative to pretty much anything including reality, but also uses exercise and physical therapy, which is complementary. That is the entire point, in fact. The woo-mongers are determined to get their beliefs misunderstood as valid. Guy (Help!) 12:38, 27 February 2017 (UTC)
Which demarcation system are you using? Note that Ernst says (emphasis mine) "Complementary describes the use as an adjunct to conventional medicine and alternative as a replacement. But it is important to realise that one modality can be used as either alternative or complementary medicine. This is why many use the term ‘CAM’ (Complementary and Alternative Medicine).".[30] (I guess exercise is a CAM but not sure about PT; I'm pretty sure that's part of mainstream medicine in the US - but as IOM and other good sources note, what's considered mainstream can vary, and boundaries are fuzzy.) --Middle 8 (tc | privacyCOI) 01:45, 2 March 2017 (UTC)
I would not define exercise as complementary. In fact exercise can be prescribed by doctors in Sweden which will give you reduced fares at the gym or if needed sessions with a physical therapist free of charge (general sessions to for example promote weight loss or increase cardiac function and not specific for an injury). Carl Fredrik 💌 📧 08:15, 2 March 2017 (UTC)
Guy The two things I'm asking for are routine for any article, and the only reason I called them "big" is because they're almost certainly impossible to answer satisfactorily. The sources I've provided plainly demarcate CAM/AM/CM differently than you do, and it's fatuous to say that by doing so, they're somehow promoting CAM. (Or if they are, then promoting CAM has become the scientific consensus! -- cf. IOM, Harrison's, NHS, Ernst). They're silent on efficacy, which is not promotional.
Your comments above contain far too much "general discussion of the article's subject" and too few specifics, e.g. your refusal to answer my #1 and #2 above, which go straight to WP:BURDEN. That's bad for collaboration. In a good debate you address your opponent's/collaborator's best arguments, and stay as high on Graham's hierarchy of disagreement as you can. --Middle 8 (tc | privacyCOI) 11:59, 28 February 2017 (UTC)
SCAM articles are not routine. The SCAM industry mastered fake news long before the alt-right discovered it, and we have to apply especial care to ensure we do not carelessly repeat industry marketing and PR as fact. Guy (Help!) 12:16, 28 February 2017 (UTC)
Oh, please. IOM, Harrison's, NHS, Ernst = sources that demarcate differently than you do ≠ SCAM marketing/PR. But you knew that, right? It's well past clear that this discussion with you is going nowhere, and not for lack of effort on my part. --Middle 8 (tc | privacyCOI) 12:55, 28 February 2017 (UTC)
As usual, you are ignoring the history. As usual, the history is the important bit. As usual, that is the problem. SCAM = Supplements, Complementary AND ALTERNATIVE MEDICINE. The wider category includes the narrower. This article is about the narrower. The history shows the wider category exists solely in order to confer spurious validity on the narrower. And I can say with complete confidence that Ernst agrees, boith from his writings and from conversations with him. Guy (Help!) 13:06, 28 February 2017 (UTC)
If your position held water you'd have easily answered my #1 and $2 above. Reality-based indeed. --Middle 8 (tc | privacyCOI) 15:03, 28 February 2017 (UTC)
Your repudiation does not qualify as rebuttal. Remember, only one of us has a vested interest in SCAM, and it's not me. Guy (Help!) 18:16, 2 March 2017 (UTC)
WP 101: Source your claims; account for sources that don't support them. You'll have to do better than "The Truth", cartoons et cetera. I'll wait. --Middle 8 (tc | privacyCOI) 19:43, 2 March 2017 (UTC)
This is a talk page, so it's not necessary to footnote here, but if you want sources for the article discussing the evolution of SCAM as a marketing term to obscure the fact that alternative medicine doesn't work then there are plenty including Gardner, Randi, Ernst and others. It's not a controversial fact (unless you need it to be so for commercial reasons). Have a quick look at the article on the National Center for Complementary and Integrative Health, formerly known as the National Center for Complementary and Alternative Medicine, and before that the Office of Alternative Medicine. The evolution of the terminology is in there as clearly as the cdesign proponentsists left their footprints in Of Pandas and People. Guy (Help!) 20:06, 2 March 2017 (UTC)
Guy This is a talk page, where it's necessary to source your suggestions about content. You argue that the history justifies using Minchin's def'n, yes? If you're right, why isn't there general agreement among other MEDRS that in light of the SCAMmers' propaganda, Minchin's the way to go? --Middle 8 (tc | privacyCOI) 22:31, 2 March 2017 (UTC)
Did you check the article I linked and note the evolution of the name? I understand that the world of SCAM would love to be able to say that Oceania was always at war with Eastasia, but the facts show very clearly the evolution of the term. Alternative medicine was the original, then complementary was added (the clue is in the word "and" in the industry acronym CAM), and then the rebranding was completed to "integrative" to fully remove the loathed term "alternative". But the alternative practices remain alternative, and for exactly the same reason: they either haven't been proven to work, or have been proven not to. SCAM and integrative are merely attempts to mix apple pie with cow pie in order to pretend that the two are equivalently tasty. Guy (Help!) 14:45, 3 March 2017 (UTC)
Yes, I did. And I don't see how that changes how we ought to weight strong (or stronger) MEDRS that define AM differently. --Middle 8 (tc | privacyCOI) 06:38, 4 March 2017 (UTC)
They don't. They define SCAM. AM is alternative, SCAM includes the grab-bag of legitimate or quasi-legitimate practices that obscure the alternativeness. And this is obvious to everyone unless they are engaging in motivated reasoning. Guy (Help!) 23:03, 12 March 2017 (UTC)
@ Guy No; I addressed this two weeks ago,[31] and I know you read it because you replied.[32] I doubt that the MEDRS I've cited are "engaging in motivated reasoning". They just define it differently than you'd like, and you seem to find that difficult to accept. --Middle 8 (tc | privacyCOI) 15:25, 16 March 2017 (UTC)
This is rather pointless. You "addressed" it by reference to a source that does not actually refute the documented facts. Alternative medicine, rebranding to include complementary, rebranding to exclude the hated "alternative" label as "integrative", and that is what the sources say, and you can see it in the development of the US government body. Exactly what that means for the structure and title of this article is a philosophical matter, but the facts are beyond dispute. The term alternative medicine existed before the term CAM, and CAM was coined specifically to obfuscate the reason that alternative treatments are alternative, which is that there is no good evidence they work. Guy (Help!) 10:51, 17 March 2017 (UTC)
Um no, Harrison's defines all three (CAM, AM, CM),[33] and I gave more than one source.[34] But over to user talk. --Middle 8 (tc | privacyCOI) 20:02, 18 March 2017 (UTC)

Question: What does SCAM stand for? --NeilN talk to me 16:15, 2 March 2017 (UTC)

Supplements, Complementary and Alternative Medicine. Guy (Help!) 18:16, 2 March 2017 (UTC)
I'm sure that it was meant to be a bit of derogatory marketing by the anti-altmed activists, but it does deal nicely with the people who think "I'm not doing any altmed nonsense; I'm just taking sixteen dietary supplements". The downside is that it also includes and disparages medically appropriate dietary supplements, such as Vitamin C for people at risk of scurvy. It's a bit of a mixed bag. OTOH, the term is pretty effective as a social signaling device: it's very easy to identify the personal beliefs of the people who use the term. WhatamIdoing (talk) 07:14, 3 March 2017 (UTC)
It's quite easy to tell the difference between a worthless supplement and a medically useful one. A medically useful one is prescribed by a doctor based on pathology, usually a blood test, whereas a worthless supplement is either sold over the counter at a shop specialising in separating the worried well form their money, or is sold in the office of a quack (naturopath, chiropractor or whatever). Guy (Help!) 14:47, 3 March 2017 (UTC)
Yes, this. My best friend takes sublingual iron pills to help with iron deficiency anemia, brought on by stomach surgery done due to a possible cancer diagnosis. That's a PRESCRIBED supplement, based on all the available data and a medical diagnosis including blood tests that are done every few months to check the needed dosage. It's also a far cry from someone selling homemade supplements made from "herbs" that they claim will cure anything that the mark... er "patient" feels is ailing them. Morty C-137 (talk) 00:25, 5 June 2017 (UTC)

Commented out citations[edit]

@Johnuniq: My apologies for being late to notice, but I just saw that user:Johnuniq reverted my citation tag on the lead back on March 18 ( The reason given was that there were several citations given, but commented out. Please explain to me the reasoning behind such commented-out (invisible) references being acceptable. They do nothing to substantiate the validity of the claim to the casual reader, only to those savvy enough to wade through the source code, such as experienced editors. Indeed even the manual page on the topic of invisible text suggests that they be used for notes to other editors, with no mention of them being used for embedding references. --Foolishgrunt (talk) 16:09, 16 April 2017 (UTC)

Please see the link that started my edit summary (WP:LEADCITE). That is an accepted style. Johnuniq (talk) 23:22, 16 April 2017 (UTC)
I don't see any reference to commented citations in the manual page you cited. Perhaps it is an "accepted style," I admit that I am not the most versed editor. But perhaps you can answer my concerns more directly? Because I feel I have made clear my belief that this "accepted style" is contrary to the intended purpose of commented citations.Foolishgrunt (talk) 17:19, 22 May 2017 (UTC)
The "accepted style" is that the lead or introduction for an article need not have citations. The content of the lead should be summarizing properly cited information from the body of the article. If you see something in the lead which is not covered in the article, the fix is not to add the citation there. The proper fix is to add the material, with citations, at the proper place in the body of the article and, when appropriate, add or leave a summary - without citations - in the lead. Not everything in the body of the article merits mention in the lead.
I'd have to check, but Johnuniq has been around long enough that I would expect to find that the commented-out refs are simply duplicates of citations that appear later in the article. Commenting them out is not the way I would handle this situation (see prev paragraph - I would remove the citations in the lead if they were duplicates), but it's not a serious break, since the displayed text works the same for both approaches. — jmcgnh(talk) (contribs) 18:41, 22 May 2017 (UTC)


The following text has recently been added:

  • In some states, CAM associations and practicioners have ruthlessly attacked medical licensing boards, demanding that their practices be given state sanction. [1][2][3]
  1. ^ Malisow, Craig. "Dr. Steven Hotze's Weird War Against the Texas Medical Board". Houston Press. Retrieved 30 April 2017. 
  2. ^ Graham, Jennifer. "Is your 'doctor' really an M.D.?". Deseret News.  External link in |website= (help);
  3. ^ Bellamy, Jann. "Licensing Naturopaths: the triumph of politics over science". Science Based Medicine.  External link in |website= (help);
The first reference discusses one individual who is a CAM practitioner and is attacking medical boards, as well as mentioning numerous problematic physicians, many or most of whom are not CAM practitioners, but have various seedy or unethical practices. The second reference talks about CAM, but has no reference to any association or practitioner attacking licensing boards. The third reference discusses state legislatures granting recognition to CAM, again not mentioning attacks.
As far as I can see, it comes down to a single individual who has attacked a single licensing board. Clean Copytalk 01:47, 2 May 2017 (UTC)
I agree that the language is a bit flamboyant and have changed it accordingly. Are you restricted from editing this page? If not you can edit the passage with an edit summary and mention the changes here if they are extensive. Edaham (talk) 05:09, 2 May 2017 (UTC).
Thank you for the less inflammatory language. It still goes way beyond the sources, which mention no cases of CAM associations and only one isolated case of a CAM practitioner engaging in this behavior.
I originally removed the entire passage as unsupported by the one source then quoted and the editor in question reverted the change and added two more sources whichever say nothing about such attacks. I am looking for consensus here and trying to avoid an edit warClean Copytalk 09:23, 2 May 2017 (UTC)
May I suggest a cursory online search to see if other CAM doctors have engaged in similar behavior? It may be that the original passage just needs better sourcing. I don't think the original language was inflammatory, but I try to remove intensifiers from the encyclopedia where they are not required as per WP:PEA. Unless there's a case of very obvious vandalism or someone is trying to insert POV or hyperbole (which the edit in question is not), it's probably better to attempt to build on an editor's contribution rather than revert or blank their additions. You often find that in the act of building on an edit, the compromise you are looking for comes out in the long run. - additional: the search term "CAM lobbyists" returns quite a bit of varied info on similar activities. Edaham (talk) 09:39, 2 May 2017 (UTC)
Fine; I've removed the irrelevant references (which do not discuss licensing boards) and tagged the paragraph as needing further citations. Incidentally, if you found relevant sources, it would have been a good opportunity to include these! Clean Copytalk 23:31, 2 May 2017 (UTC)
If we're going to stick close to sources (always a good idea), we should make sure not to overstate who's attacking whom (cf. WP:WEIGHT and Template:Who?) and to what degree (who says "ruthless"?). --Middle 8 (tc | privacyCOI) 02:59, 4 May 2017 (UTC)
Who says "In some states"? QuackGuru (talk) 03:57, 4 May 2017 (UTC)

Use of word "prove" in lead[edit]

As I understand it, empirical research doesn't offer proofs. In fact, Wikipedia's article on empirical research says, "It is important to understand that the outcome of empirical research using statistical hypothesis testing is never proof." The lead of this article seems to have been written by someone who doesn't understand empirical research, as it states: "Alternative medicine — or fringe medicine — includes practices claimed to have the healing effects of medicine but which are disproven, unproven, impossible to prove...." TimidGuy (talk) 17:13, 23 May 2017 (UTC)

The idea of scientific proof is commonly used as a synonymous with the sort of evidence you get in a properly run clinical trial. I therefore think it's quite clear that "impossible to prove" means impossible to demonstrate by experiment, "unproven" means that no suitably rigorous trial has been carried out, and "disproven" means that sufficiently rigorous trials have shown no benefit.
Also there's no need to go ad hominem with claims that the author "doesn't understand empirical research"; I have no idea if they do or not but please attack the article and not its writer unless there is strong evidence of bad faith. User:GKFXtalk 00:11, 29 May 2017 (UTC)
In very rare diseases (e.g. Cystinosis) conventional medicine does offer treatments where the level of of evidence is low by virtue of the small number of test subjects. As such the 'unprovable' differs in little or no way from conventional medicine with rare diseases and should be removed.
Further the lead is innpropriately long and should merely summarise the general content of the artile in the most balanced way possible. I have never seen a wikipedia article that gives three/four pages of content without a single reference. The earlier comment about leads not having references seems to be almost universally incorrect in Medical entries.--Leopardtail (talk) 12:21, 29 May 2017 (UTC)

External links modified[edit]

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Placebo effect section not about placebo effect?[edit]

Am I missing something? Much/most/all of the section "Placebo effect" appears to have nothing to do with knowingly using placebo effect as treatment in clinical practice, and using this as the excuse for using a treatment that in a controlled trial, performed no better than the placebo. David notMD (talk) 21:31, 4 September 2017 (UTC)

External links modified[edit]

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