User talk:Leifern/Wikiproject health controversies

• Link to project: Wikipedia:WikiProject Health controversies

Initial comment

Comment What steps are being taken to make sure it doesn't turn out like the old WikiProject Alternative medicine?Geni 19:01, 1 March 2006 (UTC)

Well, what steps do you think should be taken? For one thing, I don't think this aims to resolve any of the controversies but rather create clarity around them. --Leifern 20:14, 1 March 2006 (UTC)

I'd like to also see stability around these articles. They are extremely vulnerable. They are often volatile subjects, since there is a religious aspect to some POV. We're dealing with two different cultures, with very different definitions of evidence and standards of conduct. Conspiracy theories are rampant, and are used to justify deceptive behavior. (Anti-vaccinationists are probably the worst examples, where allowing one's own child to [needlessly] die has been considered a deed worthy of praise.)

To achieve stability, editing of articles needs to be controlled - as in controlled access: First consensus, then article changes. No access without consensus.

Ideally, editing privileges should be limited only to properly identifed (real names and confirmable identities) persons willing to stand up for, and take responsibility for, their edits. As a reward they could be listed as contributing editors. This would promote more serious editing, without attacks and improper behavior.

At an appropriate time in the editing process, controversial articles should be locked until consensus is reached on each additional edit or revision. Thus the existing articles can't get vandalized and all the existing contributions that have been produced through discussions and consensus won't get lost because of some idiot's whim or carelessness, or a passing vandals slash and burn attack. The approved edit should then be submitted to a referee, whereupon it gets added and the article immediately locked again.

I would also propose paragraph by paragraph editing (or section by section). When a whole paragraph or section is edited to everyone's satisfaction, then it can be added to the article. -- Fyslee 21:35, 1 March 2006 (UTC)

1. I think stability is one of the goals of this project, not a prerequisite for it.
2. We neither can nor should restrict access to these articles more than access is restricted to other Wikipedia articles.
3. I have invited people with diverse points of view to this project, in the hopes that even if we won't agree on the issues, we'll at least agree on the standards for writing articles about them that conform to Wikipedia's policies and aspirations. I wasn't part of the CAM project, but my guess is that it deteriorated because both sides to the issue wanted to prevail with their version of the truth.
4. By the same token, we have to avoid ad hominem and other personal attacks along the lines of "you have different standards than me" - the WP:NPOV is very illuminating on this issue.

I have some ideas on how to resolve this, but for now I want to generate interest. --Leifern 22:29, 1 March 2006 (UTC)

My first thought is that if we agree to discuss any controversial changes (IE, anything that's been reverted by another member of this project), that would slash our near-constant low-level edit wars, which would be a huge step forward. Michael Ralston 06:03, 2 March 2006 (UTC)

The Project is a good idea. I'm interested! AED 23:17, 1 March 2006 (UTC)

Comment. I think the best way is to remove extremely controversial aspects of these articles and putting these under separate articles. I think the actions I did with therapies and causes of autism / Asperger's syndrome is a good example of this. Because of these, there will be less edit wars on the main, featured, articles, and less controversy. It is also highly unlikely that the therapy and causes of autism are very interesting to ordinary people. It is the symptoms and manifestations that are interesting, and not so controversial --Rdos 15:35, 2 March 2006 (UTC)

Comment. I also think that the requirements of sources and verfiability in clearly social realms are too high. It seems like autistic culture and autistic advocacy can easily pass VfD processes, while non-professional theories of autism cannot if they are not published in professional journals. I think that today's knowledge of autism, including causes and therapies, are too rudimentary to only feature fantasies produced by people with titles. --Rdos 15:41, 2 March 2006 (UTC)

AMA report on alternative medicine

Found an interesting section in an AMA report on alternative medicine http://www.ama-assn.org/ama/pub/category/13638.html that refers to advice to doctors given in an editorial:

• 1. Maintain an open-minded attitude about all potentially new therapeutic interventions that include those commonly referred to as alternative.
• 2. Encourage carefully performed and appropriately controlled studies of these new therapies.
• 3. Do not ignore or ridicule the potential of the placebo effect to produce marked therapeutic benefit.
• 4. Do not accept all new therapies as efficacious on first acquaintance. Practitioners of quack medicine continue to abound as in all earlier times. Claims of therapeutic efficacy should be rationally examined and tested.
• 5. Avoid hubristic and arrogant attitudes toward alternative medical practices because one might be embarrassed by the subsequent demonstrations of their clinical efficacy.

Gleng 16:41, 3 March 2006 (UTC)

Very interesting tactical advice, since it would be counterproductive to the doctor/patient relationship to express skepticism of the patient's beliefs right away. I encounter this problem often, and experience conflicting emotions. Sometimes I'm tempted to laugh, but more often to weep. In spite of this I have a great relationship with several alternative therapists, with some very interesting discussions. I've taught them when to recognize the symptoms for when a chiropractic patient has been up to Saint Peter and been refused entrance through the pearly gates (the odds get worse after each spinal adjustment....[1]

It also contains quotes from the The National Council Against Health Fraud and the National Association for Chiropractic Medicine, as well as the following...

RECOMMENDATIONS

The following statements, recommended by the Council on Scientific Affairs, were adopted by the AMA House of Delegates as AMA policy at the 1997 AMA Annual Meeting.

• 1. There is little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies.

• 2. Physicians should routinely inquire about the use of alternative or unconventional therapy by their patients, and educate themselves and their patients about the state of scientific knowledge with regard to alternative therapy that may be used or contemplated.

• 3. Patients who choose alternative therapies should be educated as to the hazards that might result from postponing or stopping conventional medical treatment.

• 4. Courses offered by medical schools on alternative medicine should present the scientific view of unconventional theories, treatments, and practice as well as the potential therapeutic utility, safety, and efficacy of these modalities.

As always, Richard Dawkins expresses it very succinctly:

"There is no alternative medicine. There is only medicine that works and medicine that doesn't works" -- Richard Dawkins, A Devil's Chaplain: Reflections on Hope, Lies, Science, and Love

He also explains it in more detail:

"...scientific medicine is defined as the set of practices which submit themselves to the ordeal of being tested. Alternative medicine is defined as that set of practices which cannot be tested, refuse to be tested, or consistently fail tests. If a healing technique is demonstrated to have curative properties in properly controlled double-blind trials, it ceases to be alternative. It simply.....becomes medicine. Conversely, if a technique devised by the President of the Royal College of Physicians consistently fails in double-blind trials, it will cease to be a part of "orthodox" medicine. Whether it will then become "alternative" will depend upon whether it is adopted by a sufficiently ambitious quack (there are always sufficiently gullible patients).

But isn't it still an arrogance to demand that our method of testing should be the scientific method? By all means use scientific tests for scientific medicine, it may be said. But isn't it only fair that "alternative" medicine should be tested by "alternative" tests? No. There is no such thing as an alternative test....Either it is true that a medicine works or it isn't. It cannot be false in the ordinary sense but true in some "alternative" sense. If a therapy or treatment is anything more than a placebo, properly conducted double-blind trials, statistically analysed, will eventually bring it through with flying colours. Many candidates for recognition as "orthodox" medicines fail the test and are summarily dropped. The "alternative" label should not (though, alas, it does) provide immunity from the same fate. -- Richard Dawkins, Foreword to the posthumous book "Snake Oil, and Other Preoccupations" by John Diamond [2]

-- Fyslee 23:05, 3 March 2006 (UTC)

Definition of a controversy

I support the principles behind this project, but I have a few questions. What defines a "health controversy"? I can list numerous health controversies that are conflicts within medicine (e.g. whether TTP and HUS constitute one or two syndromes). There are also conflicts between the vox populi and medicine, such as the MMR/autism link, which is not regarded as serious by mainstream medicine but regarded as the truth by organisations typically representing alternative medicine or patients, parents, or (sadly) busybodies. I suspect this project will not aim to disentangle TTP and HUS, but rather to address those issues where groups of people disagree with the "accepted" medical paradigm.

As an NPOV resource, it goes without saying that Wikipedia needs to give a fair balance. Ideally, no seperate Wikiproject should be necessary. However, some contributors feel that the medical editorship on Wikipedia suppresses their views.

Wikipedia is not an indiscriminate collection of information. Hence, the fact that someone believes something is not automatically notable. When dealing with "alternative" medical viewpoints, there has to be proof (see WP:V) that these viewpoints have a support base. I am personally very weary of one alternative practicioner promulgating an idea (even if that is Andrew Weill) if there is no proof that this view is supported/adhered to/practiced by others.

Since we've had John Gohde I have been generally supportive of well-authored, balanced, referenced and reliable information about "medical controversies". This should, however, not mean that we should support walled gardens, forking, and other subversive activity. In that respect, a continuous dialogue is the only real solution. JFW | T@lk 18:44, 5 March 2006 (UTC)