Talk:Orthomolecular medicine/Archive 4

message: Previous discussions: 
As I said before,   I am looking at the "conceptual framework" and "pattern of thought and ideas" version of "paradigm" to express an important descriptive, introductory element about orthomed.
 
* Compact Oxford English Dictionary: "2 a conceptual model underlying the theories and practice of a scientific subject."
* Merriam-Webster's Online Dictionary, 10th Edition: "3 : a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations and the experiments performed in support of them are formulated; broadly : a philosophical or theoretical framework of any kind"
* Wiktionary: "3. A way of thinking, perceiving or approaching work in some context"
* The American Heritage® Dictionary of the English Language: "3.  A set of assumptions, concepts, values, and practices that constitutes a way of viewing reality for the community that shares them, especially in an intellectual discipline."
* Encarta: "4. relationship of ideas to one another: in the philosophy of science, a generally accepted model of how ideas relate to one another, forming a conceptual framework within which scientific research is carried out"
It is important to describe the subject and orthomed is more than some mere aberration of medical practice, it has a large philosophical component that its critics here wish to deprecate, such as the old prejudicial "cult" quote which indirectly acknowledges the philosophical component in a very negative way.  Words like "theory" or "hypothesis" certanly are too specific (there are at least many hypotheses in orthomed - in fact, J of Ortho Med's closest cousin in Medline is Medical Hypotheses, with ongoing streams of hypotheses), a "framework of hypotheses and thought pattern" is awkward and still deficient. I think that the average, educated Wiki reader understands from the context that paradigm here *does not* mean: 1. "One that serves as a pattern or model." 2. "an example of a conjugation or declension showing a word in all its inflectional forms"  I am searching for succinct wording that conveys this element.
AGF on your comment about POV, I suspect one definition that might fit your concerns if one assumes that your reading of "paradigm" assumes or associates "Medicine" alone rather than "orthomolecular medicine" is: "the generally accepted perspective of a particular discipline at a given time" which is a little narrow and presumptive in reading for this context. A solution might be to briefly clarify that the orthomolecular paradigm separates or extends from the conventional medicine field in the overlap areas and / or the philosophical / experimental elements.  (I might say "alternative paradigm" but that would be confusing since orthomed overlaps conventional med whether conventional medicine likes to recognize this or not)
:"...paradigm is more or less seem as a byword for pseudoscience). Jefffire 14:37, 19 August 2006"  Although I would agree that in the late 80's "paradigm" became a trendy word to describe every little hypothesis and brain fart d'jour, it is still a good and useful word that is difficult to replace here.  
:"Could you provide evidence of this widely accepted paradigm shift? Addhoc 10:36, 19 August 2006"  No such claim to have won the hearts and minds of the population, the scientific community or medical community is made.  Rather orthomed is a conceptual framework that adds to and challenges conventional medicine as it exists today. Although there are long running "signature" conflicts, such as vitamins C & E, orthomed preparations are progressing more unobtrusively in areas not so clearly identified or labelled as OM related.  See the definitons discussion above about medicine vs orthomolecular medicine assoc'd with paradigm.
I recognize that some editors here may not be comfortable with "paradigm" but orthomolecular medicine has Pauling's organizing principle that he identified as an idea (before paradigm's popular use) and guides its philosophic, scientific and medical directions.  The current introduction without "paradigm" shortchanges this descriptive element.--TheNautilus 21:10, 6 September 2006 (UTC)
thread_title: Paradigm

message: This edit  raised the issue that authoritative studies with the preferred vitamin E have not been done.  However, it then goes on to comment about controlling for "bile, pancreatic function, certain specific heart problems and risk factors, blood levels and cofactors (vitamins C, D3, K1, K2, selenium, co-enzyme Q10, etc.) in the common orthomolecular range, 600-3200 IU alpha tocopherol plus 25%-50% by weight of other R,R,R tocopherols."  Controlling for these vitamin levels seems excessive and not routinely done in clinical trials.  Furthermore, it's not clear if controlling for these levels actually has a medical basis.  (Of course you need to control for heart disease and other comorbidities).  Andrew73 12:33, 7 September 2006 (UTC)
replies: text: Sorry Andrew, I'll have to get back later on this discussion.--TheNautilus 16:52, 8 September 2006 (UTC)
replies: text: Current discussion moved & restarted more chronologically.--TheNautilus 00:44, 24 October 2006 (UTC)
thread_title:  Preferred vitamin E amd controlling for other vitamin levels 

message: I wonder if you'd mind me making a gentle suggestion here. I can't stay but would prefer to see some harmony here, although maybe I'll upset everyone.
I think it is sometimes a fair criticism  of "pro science" cases that they (rightly) demand high levels of evidence for non standard views, but do not display clearly the same standards when describing their case. I don't think there's any excuse for that in the end; good V RS peer reviewed sources, available for inspection (ideally online) and rigorous citation of them should be a hallmark of the "mainstream" approach. Now the information in QW may be reliable; I would expect it to be, but it is not clearly a peer reviewed source; if there are better sources they should be used, if there are not better sources, maybe there needs to be some reflection on why not by the editors. 
On the OM side, some information is referenced to non peer reviewed sources. I can understand why this might be unavoidable. If information is included from sources that are not highest V RS, maybe this can be accomodated by explicitly conceding (coolly rather than provocatively) the weaker nature of the source.
The attribution of references to potentially contentious points does need checking carefully in places. For example "because of unsubstantiated claims, lack of proven benefits, and serious toxic effects.[7][6][5][9][10]", I confess I haven't checked, but do all of these references support all of these points? It is not clear to me that [9] does for example, but your wording implies that all the named organisations endorse all the stated claims; you didn't intend it, but this sentence inadvertently expresses an inference beyond the stated evidence, and from the other side accordingly looks like a blatant POV distortion. Don't you really mean "risks of" serious toxic effects? Are you happy with the quality of these sources - I would prefer sources that are available online for verification, at least in abstract form, and some seem distinctly more authoritative as sources than others. 
I think that some self-critical reflection might help; the science case can, and I think should, be made much stronger by close and rigorous adherence to the standards that it would wish the altmed case to adhere to. OK it might seem pedantic; but precision and close justification builds the best cases. Where the evidence leads I'm in no position to prejudge; I know where I expect it to go, but it goes where it goes, and in the end it's for us just to display the best evidence and most notable opinions clearly, and allow the reader to judge.Gleng 23:04, 14 September 2006 (UTC)
replies: text: Thanks, Gleng this point is where my edits are headed in the body with the moved material, after a succinct Intro summary.  The BC Cancer Agency ref [6] I have criticized at length here before, it is discredited, with more available.   The main, recycled underlying pediatric ref, [10], criticizes megavitamins' lack of validated efficacy and then jumps w/o reference to ("mega")overdoses generally. It *does not* address orthomolecular overdoses of vitamins & minerals (e.g. orthomeds indiscriminately pushing overdosed iron and copper supplementation which they consider iron a conditional male poison for 1/9 of the population & copper a frequent environmental problem??? I think not, this is a problem of conventional supplements, megavitamins usually offer no/low iron & copper versions.) but rather misuses (accidental or otherwise) and more medical/harmaceutical versions like [10] alluded to vitamin analogues and pregnancy.  You know, vitamin Accutane ;>-TheNautilus 23:34, 14 September 2006 (UTC)
thread_title: A gentle suggestion

message: I see the article has been reverted to read: Orthomolecular type treatments have frequently been experimentally or empirically introduced by physicians with advanced scientific backgrounds when conventional medical treatments offered neither solution[11][12] nor hope.[13][14]
The references provided do not back this up. OM has not been "frequently" employed by physicians; the references are from a handful of physicians outside the medical mainstream. I'm removing the "frequently" unless there is some evidence cited that these treatments are, in fact, frequently used by physicians. Also, I'm removing "with advanced scientific backgrounds". The cited physicians have the typical training and credentials of a physician anywhere; to insist that they have "advanced scientific backgrounds" is redundant and sounds like an appeal to authority. MastCell 23:31, 22 September 2006 (UTC)
replies: text: Yes, I corrected it.   Your interpretation of "frequently" here is a total misread, "frequently introduced" or "frequently discovered" is the sense of the usage, i.e. Hoffer (PhD/MD) & niacin, William Kaufman (MD/PhD) and niacinamide, Klenner (near PhD, 1932, MD) on IV ascorbate, and most of the orthomolecular treatment discoverers were in no way typical MD and/or PhD, in the references listed. It's granted in the Intro that conventional MDs don't frequently use anything *labelled* OM (convienently overlooking such mega- treatments used w/o recognition...as discussed in Talk before).  If you read more of the general Bibliographic material that covers the old medical literature, this stmt is covered and contained in bits and pieces; it is summarized in this stmt. Most of us today will not see such an overabundance of MD/PhD servicing the public as "typical" (figure all MD+PhD is ca 4% at the end of residency).  In the context & time of the first introduction/discovery of many OM treatments, the next "treatment" was non-medical & formaldehyde/phenol based... Not bad for ambulatory in a few hours to days in  important cases, e.g. IV vitamin C.--TheNautilus 07:32, 23 September 2006 (UTC)
replies: text: Also will you read *please* the previous Talk sections, it gets repetitious to bring each conventional med proponent even a little way up the information curve on this subject.--TheNautilus 07:32, 23 September 2006 (UTC)
replies: text: Btw, the specific recognition of the advanced scientific b/g of the orthomed pioneers is not directly an appeal to authority but rather an establishment of their creditials in an often hotly controversial area. Their credentials are especially impressive for their times, i.e. double docs, multiple degrees, years/decades of sponsored conventional research when a high school diploma had about the same standing as a BA today and many MDs only had the 2 or 3 yr version.  A number of those unfamiliar with the detailed, underlying science or history of OM have deprecated and lightweighted the orthomed statements and personages w/o consideration that the pioneers were not merely some vodoo queens, wild-eyed charismatic psychos or snake oil salesmen.  This seems to be too common an insinuation, even here in these enlightened pages. So, if I err on my verbiage about this, I ask your careful, considered help.--66.58.130.56 07:35, 24 September 2006 (UTC)
thread_title:  "Frequent" use of OM 

message: ... first of all, this article is really pretty good considering the controversial nature of its subject and the well-documented difficulties of covering minority/dissident scientific ideas on Wikipedia. Areas where it could use improvement:
*There are a few claims that OM is "frequently used" or that its opponents have been "widely criticized"... but then the citation is from the Journal of Orthomolecular Medicine. It's fine to cite this journal, of course, but it represents a minority view and is not evidence of "frequent" use or "wide" criticism.
*The "strawman" claim runs a risk of abuse. It seems any large trial with negative results is disparaged as being a strawman, not using the right drug, racemer, dose, etc etc... while no comparably robust positive trials can be produced by OM proponents. In science, the burden of proof is typically on the claimant; in other words, it's not enough to disparage every negative study for its shortcomings. OM won't be taken seriously until there are robust, peer-reviewed positive trials. That's not bias or closed-mindedness on the part of "mainstream medicine" (as this article repeatedly implies); it's adherence to the scientific method.
*Negative results are buried. The paragraph under "Criticism" detailing all of the negative/harmful trial results with Vitamins E and A is so lengthy, convoluted, and abstruse as to be unreadable. That's why I had tried to summarize it, although I recognize this is a touchy issue that has been discussed at length before I arrived.
*Similarly, the "Criticism" section is more an impassioned defense of OM rather than a true summary of criticisms by "mainstream medicine". MastCell 19:05, 23 September 2006 (UTC)
replies: text: A "controversy" approach seems more appropriate when some "conventional" editors insist on airingbroadsiding obsolete,  erroneous and highly prejudiced references & arguments since some still think these statements are unimpeachably "mainstream", "correct", or even relevant to *long known* OM forms & protocols.  A century of bias, increasingly noted even by mainstream authors, pervades the discussion, testing or interpretation of nutrition, as above  Archives of Internal Medicine: 'Tudes & the Anti-Quackery Quacks..  Most of the criticisms and "condemning" tests *do not* pertain to actual OM forms or protocols, hence the oft bayoneted strawman - although I may describe the differences of some cases, this point is obviously still not getting across.--TheNautilus 11:08, 24 September 2006 (UTC)
replies: text: I guess this illustrates one of my concerns: mainstream, peer-reviewed, reliable-source references are pooh-poohed as "obsolete, erroneous, and highly prejudiced", leaving the Journal of Orthomolecular Medicine as the only "acceptable" source on OM. MastCell 20:20, 24 September 2006 (UTC)
replies: text: One of my concerns is when mainstreams references that support OM are removed on the spurious grounds that if an OM hypothesis is supported by a mainstream source then it can't be OM anymore.  --Michael C. Price talk 20:25, 24 September 2006 (UTC)
replies: text: The presumption of an absolute reliable source because of letterhead or brand in hot zones like this is an especially unreliable practice.  I don't reflexively accept or pooh-pooh a paper because of it's JAMA or JOM, I compare the papers' claims with other sources. It's called fact checking. If I use other, more primary sources to show a presumed WP:RS reference is full of errors & misrepresentations such as the pivotal quote source of black balls like BCCA bias & errors, it is not WP:RS as a source of facts, period.  At most, it is a WP:RS source of opinion that reflects the nonfactual, bigoted opinions of its notable supporters. Please just don't call it Science, it hurts our ears.--TheNautilus 21:03, 24 September 2006 (UTC)

text: It was hardly a clean metanalysis, since the authors did not only include pure E vs placebo studies. They also chose to include studies in which both beta-carotene and E had been given to smokers and which showed a very positive mortality effect-- one which could as reasonably been attibuted to the beta-carotene, as the E. And in fact, since the overall mortality effect disappears from the metaanalysis when these studies are omitted, that's certainly evidence that the E is not the problem. However, when this fact was pointed out to the metaanalysis authors in print, they completely ignored it. That's not the scientific method! SBHarris 20:38, 25 September 2006 (UTC)
replies: text: This is exactly my point. It's fine to poke holes in studies; all studies have flaws, and none is perfect. The meta-analysis is no exception. Mainstream medical practice is based on the best evidence available. Right now, the meta-analysis is part of that "best evidence". Believe me, if a equally or more robust positive study is printed in a peer-reviewed journal, then practice might change. It's too easy to sit back and take potshots, and then complain about bias etc, but that will only get you so far in the scientific world. Let's see an effort to actually address these questions with a better study. That's what I mean when I refer to the scientific method. MastCell 21:33, 25 September 2006 (UTC)
replies: text: Those big studies are the icing on the cake, to resolve doubts (confirmation) or identify new opporunities (usually surprising results).  In other scientific/technical settings, after such a "failure" there might be lots of lower powered investigational studies to develop more semiquantitative estimates and qualitative studies, FIRST. If institutions (ahem) have a poor predictive track record, betting all the money on "36" for only a doubling, spinning the wheel is likely to be disappointing - better to find another game or, at least, another strategy.  Metastudies are "best evidence" if they are complete, with no "convenient" selective (in-)exclusions like Miller et al, *and* are truly  measuring the same properties, otherwise they are only search or propaganda techniques.--TheNautilus 23:59, 25 September 2006 (UTC)

text: Also the journals are losing credibility over the *severe* conflicts of interest that keep showing up in the articles with highly biased methods & conclusions that then become official gospel.  Medicine's very credibility is draining out with the public despite all the claims & trappings of institutional Science; can't fool all the people all the time. When the workers openly laugh at the mgmt (or the citizens at the elite), the end of the current game is near.  Of course, what happens next usually isn't too nice either.--TheNautilus 00:22, 26 September 2006 (UTC)

text: Conventional health care & medicine is a trillion+ dollar industry with undone OM homework for 2 & 3 generations now, from some of the best, brightest physicians & scientists of their generation.  We (the taxpayers) are still waiting. Ooooh, yes, billion+ dollar supplement industry - 1.5c/500mg niacin tab, 1.1c 200mg Se tab, 2c/gm C tab (Costco) - lots of surplus money in OM compared to some poor oncologist with expensive (to buy, not mfr) chemical weapon derivatives to hawk. All Hoffer suggested is maybe $1/day extra supernutritional ingredients added, much less serious stuff like IV C & isoprenoids.  Who's gonna pay? We thought we already did, but now what people really demand is the right to simply be left alone, unobstructed & unmolested.  That old safety argument is so bogus - drugs *really* do kill & maim in volume, we simply can't trust our govt with any more power.  We wish the average doctor knew jack about the high potency supplements (they usually haven't any inkling, much less accurately predict what *really* happens and thereby lose credibility, even on simple, mainstream stuff like niacin). Honest research & testing is ok, but people can't wait any longer and the govt/pharma/medical track record is kind of spotty. I have to admit that cutting NIH funding *might* be even more favorable to pharmas, they already got their money locked in with the Medicare prescription drug subsidy.  Soon there won't be any money to pay doctors either.  Given only enough money to pay the physician or the pharma, doctors may want to choose sides again, later - if the naturopaths don't lock 'em out first.--66.58.130.56 03:22, 26 September 2006 (UTC)
thread_title:  A few things... 

message: The "relationship to mainstream medicine" section is starting to fill up with original research. I placed citation-needed tags behind a few statements; we need to show that others have actually made these claims (besides those of us editing that article). I inlcuded a cite-needed for this sentence: "Long commercialized megavitamin formulas, "ACES", that also include vitamin C and selenium to recycle the first two antioxidants and aid liver peroxide detoxification, were not tested or measured." If it's going to be included, we need a citation where this criticism has actually been raised. MastCell 19:05, 24 October 2006 (UTC)
replies: text: I'll cite it, I would more appreciate your editorial thoughts on the wording before I invest too much, though.--TheNautilus 19:28, 24 October 2006 (UTC)
replies: text: Well, I'm not a huge fan of the above sentence. You make the point that the studied compounds are not what an OM would use. Specifying an alternate compound you believe should be tested sounds like OR, although if you find a source (outside Wikipedia) recommending its use, that might be acceptable. For the other stuff (particularly statements about "preferred OM therapies", I don't have a problem with the wording; just would like to see a source. MastCell 20:09, 24 October 2006 (UTC)
replies: text: They are substantially referenced in the Bibliography texts & External links e.g. JOM & Saul's DYS (& FYD).--TheNautilus 20:20, 24 October 2006 (UTC)
replies: text: The biblio is great, but specific claims need specific citations (source, page #, etc). Please see WP:CITE for policy guidance. As an article on a scientific topic, a scientific referencing style should be used (eg footnotes after specific claims), rather than a general bibliography. MastCell 22:48, 24 October 2006 (UTC)
thread_title:  OR