Talk:Orthomolecular medicine

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[edit] "vitamin" Accutane?

re: "pharmaceutical analogues such as...isotretinoin" It is the conventional medical crowd & campfollowers that have insisted upon the disinformational BCCA page here, as well as at other similar Wiki articles (I count at least 10 errors, misrepresentations, etc in BCCA, I stopped dissecting at 4 earlier because they incrementally do get so much more time consuming exploring the depths). Isotrentoin was mentioned because it was among the best to fit more BCCA descriptions & allegations than anything else that might be conventionally twisted to fit such a view of OM, although that might not be BCCA's intent. Your favorite, Whaleto, had more accurate material than BCCA, so why the preferential treatment?

from BCCA: "When vitamins are consumed in excess of the body's physiological needs, they function as drugs rather than vitamins because the human body has limited capacity to use vitamins in its metabolic activities." (Hafner), "High doses of some vitamins are toxic hence supplements are generally not recommended unless recommended by a physician. (Hislop)", "Because vitamins in large doses may have drug like effects, they could compromise the effectiveness of standard medical treatment in the same way that taking two different drugs might." (McDonald), "Pregnant women or those planning to become pregnant should not use megavitamin therapy. Congenital abnormalities and spontaneous abortions may occur." (Ontario) (Loescher), "Megadose vitamin therapy may cause injury that is confused with disease symptom. High vitamin intake is more hazardous to peripheral organs than to the nervous system, because the central nervous system vitamin entry is restricted." (Snodgrass).

sarcasmWow! Isotretinoin must be it, nailed OM to a cross. Ha!end sarcasm

Isotretinoin is an in vivo interconversion of a rare dietary form of vitamin A, used pharmaceutically in "megadose" quantities for disfiguring acne and is infamously pathological for inducing birth defects. Orthomed probably would better agree with naturopaths on environmental and dietary changes, and then, if you insist on something biochemical, look at 4%-5% niacinamide gel, oral pantethine, mixed tocopherols oil, lecithin, and maybe some vitamin A and zinc supplementation or even niacin or enzymes but haven't researched them deeply. Although my & wife's brothers suffered serious even disfiguring acne, son stopped his scarring with mixed tocopherols topically, hadn't heard of niacinamide gel or pantethine then. Of course this is an individual situation where there are many.

As far as I can tell from conversations here, Isotretinoin is as orthomolecular as conventional medicine can see, perhaps even best of that genre. If the shoe fits, wear it; even wallow in it.--TheNautilus 10:07, 4 November 2006 (UTC) Retry, clarify writing, sarcastic point, above.--TheNautilus 23:22, 5 November 2006 (UTC)

I'm a little confused here. Are there people in the orthomolecular community who recommend using Accutane for purposes other than acne? Andrew73 18:21, 5 November 2006 (UTC)
No, orthomed is not interested in isotretinoin. My complaint is that what BCCA charges & insinuates often traces back to previous (40s-50s) mainstream megadose uses or misbegotten pharmaceuticals and better describes current mainstream modalites of "megadose" retinoic acids (birth defects etc) while dumping utter trash on OM, including the retinol(old)/retinoid(new) therapies. Orthomed is like conventional medicine - if something turns out poorly in retrospect, it gets thrown out or, hopefully, improved.
Orthomed, with wider possible treatment ranges & individualization with non- or very low-toxicity nutrients, can automatically monitor for (rare) complications/side effects more tightly because it uses tighter, "subclinical" parameters in clinical tests; orthomed emphasizes safe/optimal forms (part of why I keep nailing specific molecules/formulas/uses rather than broad "vitamin" labels). The BCCA page is laughably inaccurate, a source of negative bilge that some previous editors have delighted in metastasizing (it is, by far, the most referenced footnote in the OM article as well as other articles-spamlinked), except that it might be a real killer for uninformed readers & maliciously perpetuate confusion. The BCCA page might be considered an exemplar of conventional medical sentiment, confusion & ignorance about orthomed, it is not WP:RS about orthomed itself, but I feel that I need conventional agreement on this point since my position is, ah, compromised. I thought "4 strikes and it's out" was more than fair as for WP:RS on factual references about orthomed itself.--TheNautilus 23:22, 5 November 2006 (UTC)

[edit] "cost"

"Nutritional supplements often cost less than pharmaceuticals." has a number of issues. (1) My original point is that regulation can bring vast cost increases (retail prices as well as manufacturing, support, & mktg costs) with it. (2) The stmt's veracity at retail may be geographically conditional i.e. high drug costs, low cost supplements in the US may be true, but prescription priced supplements in Europe, Canada or Australia, at higher costs than US, vs lower drug costs outside the US, this statement is often false. (3) At actual manufacturing costs, this statement is probably often false. ie. 0.8 mg Baycol vs even 3 - 6 grams of cheap niacin ($0.05-$0.10 Costco retail), Baycol could have probably "won" with a lower manufacturing cost ("you", of course, would lose ;-> ).--TheNautilus 01:18, 10 November 2006 (UTC)

Valid points... I've rephrased a little, to be more clear about sourcing, but carried through the point that less regulation usually equals lower prices (U.S. compared to Europe). MastCell 02:49, 10 November 2006 (UTC)

[edit] " and safety"

The current presentation about FDA regulated "safety" misleads a normal reader to imply that drugs (new or old) are safer than orthomolecular supplements (pls careful about what is considered OM), the historical record does not support that proposition by a long shot. Drugs certainly are not "proven safer" at the point of introduction than exisiting vitamins and supplements, merely that most dangerous drugs were not recognized as immediate threats to life and health beyond small "acceptable" percentages in a given category (mgmt game: max the number of slices) that can be balanced in net efficacy approaching zero within p=0.05 and all the test features one can walk through. Again the recent historical record is pretty strong here. I realize my edit and sentence construction may need polishing but I am serious about the point.--TheNautilus 05:03, 13 November 2006 (UTC)

It doesn't say pharmaceuticals are "safer" than vitamins/OM. That would depend on the specific drug/vitamin/dose in question and cannot be generalized. It says that pharmaceuticals are held to a higher standard of proof than vitamins/nutraceuticals in the U.S., which is a fact. MastCell 05:16, 13 November 2006 (UTC)
"It says" I have left the efficacy part of statement, while fussing with the "proof" wording because, well, it isn't in most general senses, it is a p=0.05 significant (or better) statistical result, a good demonstration, that can be massaged in many ways, that should not fail on use so often (20% w/d, blk boxed or downgraded?)... I don't dispute that more formal testing is required for new drugs. I am concerned about the communicated impression left with less saavy readers who haven't any ideas of what is going on here, a possible supposition that GMP nutritional supplements are, on balance, less safe than the incoming new pharmaceuticals, a proposition which the mortality figures don't support by at least orders of magnitude, even without OM grade medical advice. Hence I wish to treat safety in a separate sentence about this and carefully reflect the relative safety story (two conditions here - meets GMP and orthomed protocol based, not just "big ones" "Hecho en Timbuktoo" or old Pharmaloo willy nilly carpet bombing with something ugly and then saying its OM-MV.)--TheNautilus 12:00, 13 November 2006 (UTC)
Quite simply, pharmaceuticals must be proven safe and effective to the FDA's satisfaction before being marketed. Vitamins and "nutraceuticals", on the other hand, can be marketed freely and must be proven unsafe by the government before any regulatory action can be taken (ephedra, anyone?). This says nothing about the safety of specific meds; it speaks directly to where the burden of regulatory proof lies. This is an important point for the "relationship to mainstream medicine" section. The fact is that the standards are different, and this deserves mention. You've already hammered away at the relative safety records of prescription drugs vs vitamins quite a bit elsewhere in the article. Our job is to provide accurate and at least somewhat balanced information; protecting "less sophisticated" readers from themselves is a paternalistic justification which doesn't fly for removing a clearly worded and accurate sentence. MastCell 20:52, 13 November 2006 (UTC)
proven safe and effective - I am picking at this oft bandied construction as a self congratulatory (FDA, pharmas etc) slogan and advertising phrase because there *are* a lot of upset people who are, and have been, pretty unhappy with it & the FDA. As I indicated, there seems to be a large disparity between promise and performance that doesn't sound like a hard science version of "proof" either, "demonstrated" would be about right. You referenced CFR on DSHEA - although I haven't run the dumpster dive on CFR and US Statutes, I have to say that phrase doesn't quite sound like direct language either (INAL). Standards are different is a fact, as are the results, and other relevant information/experience. I am all game for a brief, cogent statement about a clearly worded and accurate sentence. We are collaborating from somewhat different perspectives and need to carefully work out what that means.
I doubt ephedra was ever on the OM list, that's the commercial herbals department. You might check with the naturopaths for their perspective. OM type recommendations rarely cite herbal extracts w/o vitamin, mineral, antioxidant, etc/OM list content or such use (pls reread Pauling's definition). Artificial stimulation like this would be less OM than ordinary overusage of sugar and coffee, perhaps a "farmaceutical" in sheeps clothing. Neither am I clear that the FDA acted wisely & regulated maturely rather than playing political games feeding rope to some manufacturers and then declaring a disaster, (self servingly) crying they didn't have enough power. Horsefeathers, they will *never* "have enough power".--TheNautilus 23:09, 13 November 2006 (UTC)

Why don't we say something along the lines of "pharmaceuticals must be proven safe and effective to the satisfaction of the FDA before they can be marketed." That way, readers can draw their own conclusions, based on their level of distrust of the FDA, but the statement is still accurate. The fact that vitamins/supplements are unregulated has a number of implications for their relationship to mainstream medicine - perhaps the most direct is that it's really hard to do a well-conducted, meaningful trial (witness all the flack Miller and others have gotten) when formulations are anything but standardized and may vary from lot to lot or manufacturer to manufacturer. I realize ephedra's not OM, but that (and other cases like the PC-SPES debacle [PMID 12208892]) point up the danger of unregulated supplements in the hands of an unscrupulous manufacturer/marketer, and may make mainstream docs a little wary of recommending them - hence relevant to the "relationship to mainstream medicine" section. MastCell 01:08, 14 November 2006 (UTC)

[edit] Broken link

I commented out the sentence about Robert Cathcart and how he's "not allowed" to test his theories. (the text is still there, but I enclosed it in comment tags so it doesn't show in the article). The main issue is that the citation appears to be broken. The other thing is that it's not clear what it means to say testing has not been "allowed". No one prevents Cathcart, or anyone else, from testing their theories. Perhaps the source had some information on this, but it appears to be a broken link. MastCell 17:25, 16 November 2006 (UTC)

Testing not allowed occurs at several levels. Reasonable research or clinical trials of IV vitamin C have been unsupported since Jungeblut in the late 1930s (derailed, perhaps sabotaged, by Sabin), Klenner, ca late 1940s-70s, his articles commented repeatedly about lack of interest in IV "C" studies (as close to a slap in the authoritative faces or throwing the glove down as you'll see keeping license. ignored); Pauling came and went 70s-90s (applicants with less than 3 Nobels need not apply - laughed at, he was finally attacked); conventional medical trials have had a terrible record achieving amounts more than 1000 mg/d even though FR Klenner, Riordan, T Levy have mapped out IV administration that many college grads should be able to follow to 100+grams C/day and even 1000 mg/d IV "C" has been demonstrated to be important. Cathcart publicly broadcast about SARS & West Nile, with no response for something that is pretty much all upside if one suspects that multiple mature physicians with multiple credentials across multiple decades and languages aren't all delusional.
SARS patients (rare - how many in the US?) and access to patients can be pretty difficult, remember I previously mentioned "exile".--TheNautilus 21:31, 16 November 2006 (UTC)
OK... so if you'd like to say that OM proponents allege that there's a conspiracy to sabotage their research, that would be fine (provided it is sourced). This is Wikipedia, after all. MastCell 22:26, 16 November 2006 (UTC)
No, I am not for replaying Jungeblut & Sabin in the article, I mention it FYI so if *you* want to look up the available Jungblut & Sabin papers(ca 1935, 1937, 1939) you could consider your own opinion. (Andrew Saul will not be your favorite author but for possible convenience, I've linked it here. ) The fact is that promising IVC results have never been adequately *or equivalently* followed up, by a long shot, when made by nominally qualified physicians with outstanding claims. 1935-1937, in relation to FRK's later clinical data, Jungeblut is on the threshold of a pronounced measurable effect on polio, Sabin comes in with 1/4 dose IVC and a more severe innoculation method, announces *his* failure as C's failure; Klenner at even higher doses (in terms of mg/kg & over 30 gm/day IVC preferred) and starkly claimed successes never gets tested in almost 60 yrs. Pauling's 10 grams/d IVC, lowish (vs 30-100+g/day Klennerian regimes), gets conveniently overlooked for 20-30 yrs (the Moertel fiasco oral only "oversight" was finally wimpishly acknowledged at NIH by someone), when to an outsider, IVC's absence is one of the first discrepancies likely to be noticed. And that BCCA reference as the primary ref as a source for doctors' opinions reflects poorly on the profession as well as fatally misrepresenting a number of items. Adjudging conspiracy vs bias vs slop - I am not going there in the article. Failure to perform similar tests (ie. oral vs IV, X grams vs XX grams, wrong molecule, or absent cofactor *for decades*) and funky (mis)representations are historical facts and should be mentioned/described as these items *greatly* affect the ground (mis)assumptions & thinking of most people, including physicians, about OM topics.--TheNautilus 00:21, 17 November 2006 (UTC)
My reply yesterday, above, was hot under the coller because I only read the OM article's dif on an old screen and read it as *commenting out* the entire second paragraph that you had formed instead of just the one sentence that you commented out. So my apologies in this hot zone where small communications errors could cause wider misunderstandings.--TheNautilus 19:15, 17 November 2006 (UTC)

No worries... thanks for the note. MastCell 21:38, 17 November 2006 (UTC)

[edit] "Complementary and alternative medicine"

Hello, TheNautilus. Could you explain why you feel that describing OM as part of "complementary and alternative medicine" is unacceptable? Most of the article is taken up with explaining the ways in which OM differs from/rejects conventional medicine, so it seems logical to state upfront that it's a complementary/alternative field. These terms are not pejorative, to the best of my knowledge; they are descriptive. MastCell 00:44, 30 November 2006 (UTC)

Orthomed's *relation* to CAM should identified and summarized, but the CAM article is not a good, literally, first line reference for several reasons. 1. Orthomed claims both mainstream and alt med aspects as Steve Harris earlier explored at length in orthomed Talk: Orthomolecular medicine is not the same as alternative medicine; Definitions; Can a study or treatment be "orthomolecular" without anyone admitting it; Overlap between nutritional science and OM. 2. CAM as defined & described in the "Alternative medicine" article is not even well agreed, and introduces complexity, confusion, & distraction too soon, 3. CAM as a subject is quite *broad* including many things unrelated to OM or science and risks more confusion where people are already quite confused about OM to begin with(see Talk:OM 2005-2006), 4. the CAM article introduces negatives that apply to other areas, again confusion or guilt by association. 5. the "Alternative medicine" article is still POVish by title, discussion and overconsolidated structure.
I have attempted to edit the Introduction to appropriately work in the CAM point & link in a reasonable and informative way.--TheNautilus 18:53, 30 November 2006 (UTC)
But OM is clearly used primarily as an alternative to, or complement to, mainstream medical treatments. Look at the laundry list of diseases that OM is supposed to treat/cure - no mainstream medical practitioner would treat those diseases with OM as a primary method (although nutrition in general - but not megavitamin therapy - is an important complementary method in the treatment of many diseases). A belief that SARS can be cured with megadoses of Vitamin C is "alternative". Again, I don't think it's a smear to say that OM is complementary/alternative (if anything, the pejoratives in this article are the references to "conventional" doctors) - it's an accurate, neutral description of the field's position with respect to mainstream medicine. Of course, OM is a subset of CAM; CAM includes many things that don't pertain directly to OM. And the state of the alt-med article isn't a reason not to link to it; in fact, it might be worth your efforts to improve its deficiencies. MastCell 20:55, 30 November 2006 (UTC)
I think focusing on definitional items in the first paragraph is correct, nutrition is definitional to OM, CAM is not. Clearly much of OM is not considered mainstream medical therapeutics (yet or again) but still do have a scientific or clinical basis, even if not FDA blessed. "Alternative medicine" carries the stigmata of other less science or measurement based subjects and the reader absolutely has their hands full trying to build up to grasp the nature of orthomed even in close focus w/o secondary & extraneous comments (witness that the article struggles to credibly communicate the OM points to MD/PhD/Ivies who are considered superior readers). At the risk of already being redundant, the next two introductory paragraphs each link the altmed article in slightly different contexts. This is more than adequately informative (or warning) for an uninformed reader, presented in an orderly fashion.
Edit Altmed? Thanks for the invitation but my interest in much of alt med is not that high, the CAM/altmed article(s) has made less progress with many times the effort (archive length), the OM article already stretches my ability to add or detract where I have a much stronger grasp of the issues.--TheNautilus 00:19, 1 December 2006 (UTC)
Some forms of CAM do have a scientific basis... I don't think it automatically implies that something's totally unfounded. I think the "struggle" in convincing allopaths has less to do with the prose/organization of the article and more to do with differing opinions about validity of medical evidence, etc. That said, I don't feel strongly enough to make a federal case out of it. You're right that CAM is linked in the second paragraph; that will be fine. MastCell 01:25, 1 December 2006 (UTC)

[edit] QW opinion pages

QW's opinion pages concerning vitamin C and Orthomolecular medicine are dated, not peer reviewed publications (the least of my concerns) and flat wrong or misrepresentations on both current treatment protocols and the general science part, now cumulatively acknowledged by experts or authorities in conventional medicine on a number of points. I've detailed this several times now. Although the current OM treatments may remain conventionally unaccepted as yet, the specific QW criticisms that are made are erroneous, reduciing the QW point of view on these opinion pages, about OM and vitamin C, to only WP:RS for the sentiments of a group of doctors that fail to read or understand the current literature, 2000-2006. This applies to the vitamin C articles, both cancer and colds, and the original, long obsolete, orthomolecular psychiatric monotherapies for HOD selected, or equivalent, psychiatric patients that various parties have slowly acknowledged about the 1973 APA task force report's flaws. Interestingly the tests are still stuck trying to catch up testwise to Hoffer in 1952, several generations of treatment protocols behind, although other bits and pieces of those are beginning to leak into the mainstream, e.g. DHA/fish oil. Accordingly "references" to QW's misstated opinions are due to be reduced, although not eliminated.--TheNautilus 09:50, 30 January 2007 (UTC)

I can certainly understand TheNautilus' POV, and can see the sense in it. All the same, I question whether, as a matter of procedure, it is the most prudent way of proceeding. The result of summarily yanking all sources that support one POV that can't quite jump through all the WP:RS hoops, could be to create an extremely lopsided article. Would it not be better to start going over QW dubium after QW dubium, and explain in the article why they might not quite be WP:RS, ahd why proponents of orthomolecular medicine feel that they do not do OM justice.
The benefit of this would be to: 1) give the critics of orthomolecular medicine time to find better and better sourced critiques of OM, 2) make sure that the article doesn't "get a case of whiplash," and, 3) best of all give the lay reader an insight into the arcana of the controversies about OM--Alterrabe 18:14, 30 January 2007 (UTC)
I'm not sure that a debate over each of Quackwatch's claims is appropriate for a Wikipedia article. There are actually quite a few reliable sources that are skeptical or critical of OM listed here (BCCA, Cassileth, ACS, etc etc) - I'd be fine with emphasizing those more than Quackwatch. The article will have "whiplash" so long as criticisms are presented as "Critics claim x, and they are wrong because y." MastCell 18:44, 30 January 2007 (UTC)
MC, I claim even more problem points for BCCA, but detailed these fourbias and errors so link is pretty discredited, on the reduction list. The BCCA link was spammed by an editor with a strong POV that finally revolted the admins, "first" [ meltdown] then [ this]. Since I am an often misunderstood "minority" I have taken things, very slowly, point-by-point. If points are so correct *and* conventional, they certainly should have better sources.--TheNautilus 22:29, 30 January 2007 (UTC)

Sure, the BCCA isn't a great reference, although it does represent an aspect of the "mainstream" view (which is nowhere near as monolithic as this article makes it sound). But the ACS link is a reasonable summary of the mainstream position, at least as far as cancer and OM. There's generally a lack of peer-reviewed literature saying, "Hey, this alternative approach doesn't work" (although the Vitamin E meta-analysis was an example), but I think good summaries of the mainstream position exist outside of Quackwatch. I'd actually favor getting rid of Quackwatch refs because they're so controversial, hit-or-miss with regard to quality, and lend themselves to strawman attacks. MastCell 22:41, 30 January 2007 (UTC)

Mastcell: Do you know of any study that replicated Pauling and Cameron's work with ascorbate in a chemotherapy-naive patient population at the same dosages?--Alterrabe 23:52, 30 January 2007 (UTC)
Where is this going and why have you attached so many qualifiers to your question? There was an NCI review where they found 3 cases of possible benefit from IV ascorbate (PMID 16567755), although the subsequent Phase I trial (PMID 16570523) seemed pretty disappointing (1 patient with disease stabilization out of 24, the remainder apparently having no response). But since you phrased your question so legalistically, perhaps you'd tell me what you have in mind? MastCell 00:01, 31 January 2007 (UTC)
I think it's quite obvious where "this is going." These are not "so many qualifiers," nor is the phrasing "legalistic," as it has nothing to do with legal issues. It is rather a matter of using the logical precision that is indispensable in meaningful scientific work. Only inter-apple comparisons hold water. Pauling and Cameron did their work with IV ascorbate in chemotherapy naive patients, and arrived at very promising results. Then a study was done at Mayo's with patients with a history of chemotherapy, and very little if anything happened, and the ACS, and Mayo's were keen to tell the world that Pauling was wrong. Pauling's response was that he had no problem with the Mayo study, but that he disagreed emphatically with the claims that this had proven that his and Cameron's findings were incorrect. Pauling believed that chemotherapy somehow altered the immune system to an extent that ascorbate no longer was a viable therapy in patients who had been exposed to chemotherapy. Obviously, only an exact replication of Pauling's work that does not support his work would be a WP:RS to pit against Pauling's claims. Everything else is basically irrelevant, and perhaps even misleading. I would urge you to read Pauling and Cameron's book. (Pauling and Cameron may also have insisted on radiation-naive patients.) This website, for whose accuracy I make no claim, explains the arguments that are used to explain why the experiments that prove that ascorbate doesn't work may have been flawed:
http://www.cancertutor.com/WarBetween/War_Pauling.html
Obviously, the only way to disprove Pauling and Cameron's work is to reduplicate it, exactly as they did it.--Alterrabe 09:39, 31 January 2007 (UTC)
Wouldn't that be unethical, as chemotherapy has been shown effective? — Arthur Rubin | (talk) 15:37, 31 January 2007 (UTC)
Ralph Moss, PhD, formerly of Sloan Kettering, a protege of Szent-Györgi, a Nobel Laureate and cancer researcher, and good friend of Dean Burk PhD, a VIP at the National Cancer Institute, wrote a book called "Questioning Chemotherapy, which questions how much of the "proven effectiveness" of chemotherapy is based on the "data," and how much of it is based on the "interpretation" of the data.
Here he is, in his own words: "In 1989, a German biostatistician named Ulrich Abel, Ph.D. published a groundbreaking monograph called "Chemotherapy of Advanced Epithelial Cancer. It made few waves in the U.S. and soon went out of print. In this excellent work, however, Dr. Abel rigorously demonstrated that chemotherapy had never been scientifically proven to extend life through randomized clinical trials (RCTs) in the vast majority of "epithelial cancers." These are the common types of carcinoma that affect most cancer patients in the Western world."--Alterrabe 17:58, 31 January 2007 (UTC)

For that reason, I think such a proposal would be highly unlikely to make it past the IRB of any medical center, regardless of the wording and disclaimers used. I suppose it could be proposed for patients with tumors for which no good first-line chemotherapeutic options exist (although these are few - advanced hepatocellular carcinoma comes to mind) - but even in those cases there are proven effective palliative options, and it wouldn't be a "replication" of Pauling's experiment and hence still liable to be disputed by his supporters. MastCell 17:19, 31 January 2007 (UTC)

I agree with you on the probability, or lack thereof of this happening any time soon. Cameron, who was a very respected Scottish oncologist got drawn into it as a "hail mary pass" in patients for whom there was no hope whatsoever. The metastases were far too advanced. If you want a published and edited account of the episode, read Linus Pauling, Force of Nature by Thomas Hagen (Simon & Schuster 1995). I still think that any trials in chemotherapy-naive patients would be helpful, even if they wouldn't exactly replicate Pauling and Cameron's work, because if they produce positive results, it will be so much easier to discuss the subject.--Alterrabe 17:58, 31 January 2007 (UTC)
If you look at the most common epithelial malignancies, chemotherapy for metastatic disease (as compared to best supportive care) is clearly effective in breast cancer, and less so (but still effective) in metastatic colon cancer. In lung cancer, the survival and quality-of-life benefit for chemotherapy is pretty small, but real. Much of this work has been published since 1989, so the German monograph likely did not address it. I guess you could make a case in metastatic lung cancer, since the benefit for chemo is smallest there. But again, with an established benefit to chemo, it would be hard to randomize people not to get it. On the other hand, patients with poor performance status (bedbound or nearly so) going in typically don't benefit much from chemo and may not be offered it; that might represent a study population, but typically those are folks with very advanced disease. MastCell 20:51, 31 January 2007 (UTC)
To be very upfront about what I am, and what I am not, I'm not a physician, nor do I want to play one on wikipedia. What I am, is an extremely cynical and critical health care consumer. A few years ago, I had dinner with a physician, who told me that he was being asked at his top tier medical school in the US to "reinterpret" data so that a therapy on which 20 patients improved and 30 patients got worse (i.e. 2:3 against), was to be reported that 20 patients improved and 10 got worse (i.e 2:1 for); 20 patients were to be dropped because they "apparently had been wrongly included in the study." This for an ailment that can be fatal. He refused, and found himself having to deal with unwarranted deportation proceedings, which could not be construed to not be retaliation. And there are plenty more such horror stories. BBC's Panorama just reported this week that in the Seroxat / Paxil approval studies, 4 suicides or suicide attempts disappeared from the study without explanation. If I'm not very mistaken, if the data is correctly crunched, seroxat / paxil on average actually is worse for patients than placebo. Zyprexa has just been in the New York Times for 5 straight days; Lilly is suing to keep the warnings it received about it causing diabetes, and did nothing about, secret. Then there's Vioxx, where there were articles in the PNAS explaining why cox-2 inhibitors were very bad long term propositions years before they hit the market. I do not believe that I know whether chemo helps in metastatic lung cancer or not, but I refuse to believe studies, especially for "pretty small but real" benefits, until I see the raw data, obtained under sub poena. Until then, I merely deal in probabilities. What I am certain is a fact, is that a few oncologists beyond the reach of the FDA, who are as cynical as I am about mainstream medicine, have for decades had a steady stream of patients who are relatives of American professors of oncology and functionaries at the FDA, and the IRBs. What does that tell you? Sad that medicine has come to this, but there you have it. Unfortunately WP:RS does not mean realworld:RS.
I would, once again, urge to get your hands on a copy of Pauling and Cameron's "Cancer and Vitamin C; if you really want to seriously discuss orthomolecular medicine, I can even email you a few scans. The results are definitely not "pretty small but real."--Alterrabe 23:20, 31 January 2007 (UTC)

I agree with you 100% that WP:RS does not always equal real-word reliable sources. It pays to be skeptical about the pharmaceutical industry, but I'd argue that at least the same level of skepticism should be applied to Linus Pauling et al. That's all. Sorry for getting things off-topic. MastCell 00:00, 1 February 2007 (UTC)

Alterrabe, I am an oncologist. I have been frustrated by the lack of scientific evidence on orthomolecular medicine, and for a lot of other so-called "non-mainstream" treatments. There are probably some good treatments out there, but the world may never know, since a lot of the data are preclinical (i.e., have only been tested in animals or cell culture petri dishes), or observational (one or two cases reported). As you may or may not know, the most reliable way to test a hypothesis in clinical medicine is to conduct a randomized clinical trial. Only by controlling the variables does one approximate the truth. We in so-called conventional medicine have a long track record of building on documented clinical trial results. When the trials fail to confirm our expectations, we abandon a treatment. The process is not perfect, but it works. This is how we have arrived at treatments that extend the lives of lung cancer, colon cancer, and breast cancer patients. Treatments like "orthomolecular" treatments or other non-scientifically validated treatments have, in my clinical experience, taken patients away from their main treatments, contributed to side effects, and have even led to the untimely death of patients. The problem is that it's much harder to tell which treatments work if all you have to go on are poorly-designed clinical trials or preclinical data. Cancer patients deserve better.--Dr.michael.benjamin 07:01, 12 March 2007 (UTC)

[edit] bcca, too slowly

Arthur, the BCCA reference is highly flawed with respect to conventional medical *science*, partly discussed many times since. The BCCA link has never been shown to have real merit. I stopped my long dissections at four but would have another half dozen to prepare (they get/take longer). Some of the BCCA points are so obsolete and / or misrepresented that they have become demonstrably dangerous. e.g. re "vitamin K": pharmceutical K3, an incomplete molecule, variously banned almost 50 years, sometimes rotted livers at pharmaceutically prescribed dosages whereas there is no established toxicity amount for human form(s) vitamin K2, that is both life saving and bone saving [1], probably better than *any* bisphosphonate, and less distressing too, see Fossy jaw. Because orthomed is a "minority report" I have taken these steps *very slowly*, perhaps too slowly. The BCCA reference problem started in June with a serious ("conventional") POV troll (subsequently indefinitely blocked) when I was still an IP. The deletions of the BCCA hotlink are long overdue, these edits just mean that the related articles are more mature and that my counterparts are better informed why.--TheNautilus 06:45, 12 February 2007 (UTC)

Now I will agree that it would be good to have some referenced counterpoint that reflects both some idea of "mainstream" AND fairly current science. The point that I have finally come to is that the Cassileth reference is least objectionable (it is still really poor quality on accuracy) of several including BCCA but should be replaced also. I have been long willing to let *conventional editors* give it a shot - I have been more than patient on this and feel like I have do 10x the legwork of anybody else. The BCCA reference, from the BC Cancer Agency, is really, really, really bad from *any* viewpoint and I am now willing to contest it. Again, I do not think that WP should present seriously deficient statements as fact, even though it may be believed by many professionals or some provincial "authority", as current knowledge when it is well documented history and *science* that it is not. Also the BCCA page does not appear to be from a peer reviewed journal. Perhaps use Cassileth or ({cn}} in the spots that you feel are too naked.--TheNautilus 08:37, 12 February 2007 (UTC) edited
OK, I don't have time to do the necessary research. However, unless you can find mainstream criticism of BCCA, it should remain. You haven't reported any (and I seem to remember cases of overdoses of Vitamin K. Must have been K1 rather than K2....) — Arthur Rubin | (talk) 08:41, 12 February 2007 (UTC)
There are 10 things wrong with the BCCA page, it really needs to go. Probably ({cn}} would be best in the "naked spots" to attract more eyes to the V RS problem, to verifiably describe the "mainstream" this time (I am not going to start stuffing the text). This seems most consistent with policy. As for vitamin K1 (plants), the rare reaction cases at very high doses are suspected to be hypersensitivity to some injected component(s) PDR, Goodman & Gillman's of the formulations e.g. propylene glycol, (oxidized?) vegetable oils, micellar emulsions and emulsifiers (ummm), polysorbates, etc.--TheNautilus 11:22, 12 February 2007 (UTC)
What's "BCCA"? --Coppertwig 11:48, 12 February 2007 (UTC)
The provincial British Columbia Cancer Agency[2] trying to play qu*ckw*tch on a subject, Orthomolecular medicine, that they either know very little about (and/)or can't report accurately. Follow and read the links above in this section.--TheNautilus 12:59, 12 February 2007 (UTC)

The BCCA ref is not used to support an assertion of "fact", or as a primary scientific source. It's clearly labeled as "mainstreamers believe..." or "The conventional view is..." I agree that the BCCA report is pretty poor, but it's being used to demonstrate a mainstream take on OM, not to authoritatively debunk it. I think Arthur is right here - TheNautilus has a number of good points about the BCCA, but they constitue original research unless an outside source making the same criticisms can be cited. By the same token, the BCCA is not peer-reviewed research and should only be cited to indicate what a mainstream organization wrote about OM - and that's how it's been used. I'd like to replace it, but there just aren't that many mainstream "rebuttals" to OM. If I find one that's better, I'll put it in. I'm not going to revert right now, because this is in danger of turning into an edit war, but I agree with Arthur that the BCCA ref, while not useful as a primary scientific source, is citable as an example of a mainstream reaction to OM. It should go back in in that context. If TheNautilus can find a source critical of the BCCA report, then that could potentially be added as well. MastCell 16:59, 12 February 2007 (UTC)

The BCCA page is not so much a report of what most "mainstream" doctors and scientists believe (the BCCA page only redundantly cites Cassileth's opinion, already referenced in the Orthomed article) as it is a blatant attempt to promote that "belief" with negative "factoids", on a putative authority's site, with repeatedly inaccurate material (self-impeachment). Since the page's points frequently contradict current science or sources either directly or by crude misrepresentations (e.g. way out of context), it violates WP:V and the principle of verifiability. This is *not* original research (OR) which in the words of Wikipedia's co-founder Jimmy Wales, would amount to a "novel narrative or historical interpretation but rather source based research (...research that consists of collecting and organizing information from existing primary and/or secondary sources is, of course, strongly encouraged. All articles on Wikipedia should be based on information collected from published primary and secondary sources. This is not "original research"; it is "source-based research", and it is fundamental to writing an encyclopedia.) about science and history matters where BCCA's little POV piece is conventionally *wrong* and perhaps even medically dangerous. An interesting form of unverified (not peer reviewed) POV pushing by a "source". Fact checking is about verifiability, not OR.
Cassileth, another underlying reference, simple deletion (if other references present), deletion+({cn)) or a new WP:V/RS reference seem to be the citation choices for the previous orthomed references to BCCA, a-e. This erroneous POV source w/o other unique material has demonstrated its ability to inappropriately reproduce and metastasize where not even a single citation of it is needed. MastCell, I am hopeful that you, or somebody, will find a better sentiment indicator where the ({cn}} tag creates a better incentive for the "bare spots". Collaboration through better sources--TheNautilus 22:08, 12 February 2007 (UTC)
In my opinion, the words "mainstream" and "conventional" appear far too many times in this article. This article could do with shortening: not to remove any of the information about orthomolecular medicine, but to collect in one place all the stuff about the "mainstream" view of it and shorten that into a coherent message of reasonable (i.e. not too long) length. The article should focus more on what orthomolecular treatment is, and some interesting facts about it, how widespread it is, what it's good for, etc. rather than constantly talking about controversy.
If a quote from BCCA or someplace is presented as "mainstream" or "conventional", that can imply (at least to many, perhaps most, readers) that that is the correct view. It's very similar to simply stating that those statements are fact. It's like saying "scientists have established that ..." I'm just pointing out that we need to be careful with the wording. It might be better to say "BCCA has criticized..." or "organizations such as BCCA have criticized ..." or "government organizations such as BCCA..." --Coppertwig 03:07, 13 February 2007 (UTC)
Directionally I would agree with your 1st paragraph and that the vitamin E controversy played out here needs to integrated into the Vitamin E (tocopherols) article but I am not too eager to go another article and am a little concerned about "information attrition".
With regards to the BCCA page, I regard that as a dead letter, that its balancing text might be considered controversial, and would like better, more current source(s) material to replace BCCA and even Cassileth. Ultimately I think improved sources will cost less time and effort than trying to sort out bad ones. I went to the library tonight and read "Natural Causes:..." (DH, 2006), was disappointed.--TheNautilus 07:57, 13 February 2007 (UTC)

[edit] Blog?

Is the recent addition by User_talk:24.122.18.130 qualify as a blog under WP:EL? Comments?Shot info 07:44, 11 March 2007 (UTC)

Absolutely, and it looks like editors on every other article he's added to agree as well. It's a blog by a non-notable author. It doesn't look like he even comments on the articles he links to. He just finds articles he likes, copies the first few paragraphs from them, then links to the full article. Certainly not a link that should be on an encyclopedia article of a topic as well-defined and stable as Orthomolecular medicine, but that could be said for much of the External links section. --Ronz 04:08, 13 March 2007 (UTC)
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