Talk:Orthomolecular medicine/Archive 5

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"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)

"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)

" 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)

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)

"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)

"alternative"

Moved "alternative" here for discussion, it is already associated early on as nonexclusively complementary and alternative medicine in the second paragraph, previously part of the lede. I don't mind recognizing that many specific recommendations of orthomed are still considered alternative by younger generations, even if many orthomed treatments may *derive* from, greatly expand upon, or parallel, much older mainstream medical research and practices, such as described in Vitamins in Medicine^{free pdf} (eds. 1942, 1946, 1953, 1980) with modern, much safer, more effective supplement forms and protocols (if not proven to an adversarial fault, as well as expensive "Class I" evidence). Or that some are still in the embyronic research or experimental category of medical schools. However orthomed is by no means identically "alternative" or even "CAM", it has significant overlaps in mainstream medicine, but they are silent largely because there is not much to discuss, is there? The mainstream is slowly developing, absorbing, and modifying, many, many materials and positions used in orthomed, conveniently and about 12 - 60 years late(r), without any recognition - then it's just orthomolecular medicine in the eyes of the mainstream. In terms of conventional medicine, orthomed is unsubtantiated at the level of FDA drug trials (non-patented, -able foods also don't need advanced ) and is conjectural, experimental and/or empirical in nature.

So let's not just throw a debatable personal opinion (too generalized a statement) in the faces of readers in the first sentence that might distract readers wrestling with what the very concept is on the first instance, or just poison the subject. There is plenty of space below to discuss their common inheiritances and divergences.--TheNautilus (talk) 21:58, 12 January 2008 (UTC)

OM is undoubtedly a form of alternative medicine, I found a reliable source on this and replaced the link (we could also cite the NIH for this link pxxii, or NCCAM link p5, or this review link). It might also be a good idea to note in the introduction that many in mainstream medicine and science regard some of these practices as forms of quackery, but I'll look for a good source for that, but noting that OM is a form of alternative medicine is the very minimum required. Tim Vickers (talk) 23:24, 12 January 2008 (UTC)

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)

As they say, there is no "alternative" medicine, only medicine that has been proven to work, and medicine that hasn't. Any treatment that has a significant beneficial (or deleterious) effect, can be tested to have that effect in a scientifically rigorous manner. The fact that poor science may have been performed (wittingly or not, by pharmaceutical companies, individual scientists, etc.) in the past does not invalidate the scientific method. In fact, good science eventually corrects poor science. When an "alternative" treatment is validated by good science, it ceases to be "alternative" but becomes "proven". (With all the caveats that "proven" holds in the scientific meaning, of course!) PedEye1 21:22, 4 July 2007 (UTC)

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)

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)

Non-orthomolecular study

see also a similar discussion continued at Talk:Multivitamin

Moved Andrew's reference, here, for discussion. I didn't see any mention of orthomolecular medicine or OM design and this paper's presentation is greatly overweighted even if it were OM encyclopedic. Certainly not placebo controlled either. In fact I probably agree with the result of this paper, as subjects who might have strongly benefited from orthomolecular advice. You see, I seriously doubt that any real orthomolecular advisor would have recommended the multivitamin formulas presumably involved or certain component dosages, especially with regard to iron (as well as possibly d,l alpha-tocopheryl acetate[3][4], among other questionable formulation practices for broad use).

In orthomolecular circles, excess iron for males or various iron accumulating risks[5] - perhaps up to 11% with the various heterozygotes, much less with prostate cancer is a big no-no, something to be minimized/optimized for the individual situation (iron management may be medically necessary for a variety of reasons) or avoided altogether. At the time of this study the primary multivitamin formulas were generic with iron (usually 9, 16 or, most common, 18mg, some non-prenatal formulas still 27+ mg!), unless specifically reduced by brand (0 to 4 mg) or segment (e.g "male" or "mature" usually costs more, even for 0 mg Fe as the only change - "iron free" usually isn't cost free).

Also consider this 2006 NIH paper (just pulled it up) about efficacy and possible cancer benefits of multivitamins but not population significant either.

One of the things a serious orthomolecular person is going to watch like a hawk is iron supplementation in males, especially older ones. After checking for anemia related to improper diet/digestion, folic acid, and B12, and probably not recommending the common inorganic iron forms found in many conventional multivitamin formulas if not encouraged more nutritionally. For all the big supplements floating around, one that you will notice is the prevalence of iron free formulas in OM / megavitamin circles (for 20+ yrs), now even leaking into the conventional "male" and "mature" multivitamin formulas. Two Theragran-M (type) tablets, a type specifically referred to in the study, would deliver 54+ mg iron per day. Two generic "one-a-day" multivitamin-multiminerals under medical supervision i.e. often 36+ mg of iron ?!? 62(average), male, prostatic, presumably usually not anemic (on average) and "pregnant"??? What were some authors (not) thinking?--TheNautilus 22:37, 23 May 2007 (UTC)

Snake oil claims

Based on investigational scientific studies, single blinded and double blinded randomized controlled trials, clinical experience, and case histories, claims have been made that therapeutic nutrition can treat, or sometimes cure, acne, bee sting, burns, cancer, common cold, drug addiction, drug overdose, heart diseases, acute hepatitis, herpes, influenza, mononucleosis, mushroom poisoning, neuropathy & polyneuritis (including Multiple sclerosis), osteoporosis,[19] polio, "alcoholism,[20] allergies, arthritis, autism, epilepsy, hypertension, hypoglycemia, migraine, clinical depression, learning disabilities, retardation, mental and metabolic disorders, skin problems, and hyperactivity,"[21] Raynaud's disease, heavy metal toxicity, radiation sickness, * Pyroluria, schizophrenia,[22] shock, snakebite, spider bite, tetanus toxin and viral pneumonia.

This paragraph reads so broadly that it resembles the quackery advertisements from the 19th century. Perhaps the material should be limited to diseases with specific / individual references, and moved down to the section below where the other studies are mentioned.

PedEye1 20:54, 4 July 2007 (UTC)

This paragraph shows the rather surprising scope and claims of orthomolecular medicine, many either foundational or closely associated with recognized pioneers. I can add in more (J)OM references but then there may be complaints about "too much". As for snake oil, this comment, along with some edits in the article, simply show a lack of familiarity with orthomed and its history. As far as prejudice and failure to institutionally evaluate these claims, there is adequate history to call orthomed a third rail in medicine, publicly touch it and you die academically or professionally. No matter how good your results, you will be simply ignored (some deliberate, some inherent for non-patentables), or if too noisy, attacked or destroyed without good scientific foundation (now dull and numerously repetitious examples to me). The communication and experimental gaps are in the record and are that large. I know that will sound conspiratorial but that appears to be clear history, e.g.as one example. Until recently the highest IV/IM dose of vitamin C that I had seen in conventional medical trials was 1 gram IM vitamin C, once a day to triple the cumulative arsenic tolerance in cancer patients (Trisenox) with still less As poisoning. A pale shadow to published 50+ year claims of ~30 grams (relatively routine) to well over 200 grams per day of IV vitamin C depending on type and severity of illness.

If you find these statements challenging, I would suggest reading the Talk archives here at orthomolecular medicine, first, before any reply. Thank you for your interest.--TheNautilus 22:53, 7 July 2007 (UTC)

Method?

The title of this section is potentially misleading or confusing. Should "method" refer to the biochemical effects that given compounds have on specific physiologic states or pathologic conditions? Should "method" refer to the method that practitioners use to come up with a given therapy? Should "method" refer to the manner that the therapy was evaluated?

PedEye1 21:03, 4 July 2007 (UTC)

NPOV concern

The largely unreferenced list of conditions that are claimed to be treated by this disease gives no indication of the reliability of the claims made. This list should be fully referenced and claims backed by rigorous trials separated from those based only on "clinical experience". Tim Vickers 02:55, 8 July 2007 (UTC)

Based on investigational scientific studies, single blinded and double blinded randomized controlled trials, clinical experience, and case histories, claims have been made... The type of studies involved indicate the type of evidences involved. Some of the underlying online papers that discuss them would by examination give the details for the individual claims' origin. Remember this is a general article about orthomed and what it is actually is, not any specific recommendations.

A demand for "modern", "rigorous", "FDA approved" trials to show what the scope of orthomed claims are, is inappropriate. The water's edge would be to simply recognize what level of evidence *is* referenced or online, which is less than what is available in a good research library (not mine). Your local university or regional library is almost certainly larger & older than mine. Many of the references are old, from the age of discovery and patentability, the era of major academic and pharmaceutical financial support that mostly ended before 1960. And yet there is a lot of valid science there, albeit with different methods and uncertainties.--TheNautilus 06:37, 9 July 2007 (UTC)

It is impossible to assess what type of evidence backs this list, since it is not fully referenced. These are controversial claims, so they all need references. Tim Vickers 16:04, 9 July 2007 (UTC)

The article is about defining what orthomolecular medicine is, not proving it against deletionist claims, not advocating it. Just describing it so that average persons, or professionals, even have any idea what it is about. I have actually interviewed quite a few professionals and specialists, 1-2 hours or a whole weekend, during the development of this article. People often have what might be called "negative knowledge", not only no real knowledge but special forms of myths and misconceptions so deeply embedded that it requires a great deal to effort to even explain what the basic technical issues are. Dismissal and closed minds simply make communication extremely difficult with even the most fundamental science examples for technology. But this is an outstanding result if one works in the marketing department of an obsolescent, competing market leader where there are things even "worse" than generics. Again, please read the prior talk pages.--TheNautilus 21:17, 9 July 2007 (UTC)

I'm sure you agree that the claims described here are controversial, as the policy WP:V states "Editors should provide a reliable source for quotations and for any material that is challenged or is likely to be challenged, or it may be removed." I'm not saying that these statements are correct or incorrect, just that they are controversial and therefore all need citations from reliable sources. Tim Vickers 21:32, 9 July 2007 (UTC)

I think the added citations given adequate historical background.--TheNautilus 20:04, 19 July 2007 (UTC)

Robert Cathcart and Bowel Tolerance articles are up for deletion

Interested parties should go to Wikipedia:Articles for deletion/Robert Cathcart and Wikipedia:Articles for deletion/Bowel tolerance and voice their opinion. Lumos3 22:42, 9 August 2007 (UTC)

General flavour

This article reads like a dissertation. Cleanup is needed to make it encyclopaedic. Gordonofcartoon 00:01, 15 August 2007 (UTC)

Studies show schizophrenia is linked to the gut:

Professor V M Buscaino who examined the gut at autopsy of 82 patients who had been diagnosed with schizophrenia. Gastritis was found in 50%, enteritis in 85% and colitis in 92%. Some signs of catarrhal and haemorrhagic inflammation of the intestinal mucosa, patchy areas of sclerosis and also of atrophy were noted. Professor Henri Baruk also understood schizophrenia as it is rarely understood today. He said the cause must be found in every case and that very often that cause would be found far from the brain. He understood the nature of schizophrenia. Baruk found that one patient with long-standing schizophrenia had an e-coli infection. Baruk cured him. The man lost his schizophrenia and went on to become a well-known New York banker, after having spent years in a psychiatric hospital. Then, in the 1970s, the late Dr F Curtis Dohan spoke at our first conference. Curtis Dohan4 reported differences in the incidence of schizophrenia worldwide and noted that the highest incidence was in the wheat and rye eating areas of the world. Dohan told me he was 99% certain of a genetic association between schizophrenia and coeliac disease. Buscaino4 examined, at autopsy, gut samples from 82 patients with schizophrenia. He found gastritis in 50%, enteritis in 88%, and colitis in 92%. Furthermore, a report by Eaton and colleagues5 concluded that a history of coeliac disease was a risk factor for schizophrenia.He told me that he was 99% sure that there was a genetic link between schizophrenia and coeliac disease. This hypothesis is now being investigated further by Dr Jun Wei in Inverness. Gut and mental illness —Preceding unsigned comment added by 211.30.235.237 (talk) 08:15, 17 September 2007 (UTC)

Self Published sources

I have removed the Self Published sources tag which was not supported by any discussion here. Any self published material in the references falls within WP:SELFPUB and is acceptable in this context. If I am wrong please state which items are not acceptable. Lumos3 10:29, 28 September 2007 (UTC)

Are herbs orthomolecular?

I bet Pauling would say not. Is he on record anywhere answering this question?

He is on record as defining orthomolecular chemicals as being required for normal operation of the body. Has anyone ever shown that an active ingredient from an herb is required for normal operation of the body? I doubt it. These chemicals are typically not orthomolecular and achieve their effects by interfering with normal chemical reactions.

Dave Yost 23:00, 4 November 2007 (UTC)

Herbs and botanicals in the most general sense are natural sources of orthomolecular substances such as vitamins, fibers (including prebiotics and even some exotic megadalton biopolymers), enzymes, minerals, antioxidants, lipotropes, prohormones, etc. Two important characteristics standout on orthomolecular substances: (1) more defined substances with specific chemical identities that allow a selection amongst normally supposed "equivalents" (e.g. the most orthomolecular vitamin forms of D, E, K can be much different than many commonly/previously sold "mainstream" forms) and (2) safety profiles - orthomolecular substances stress safety and often find the most effective molecules (and combinations thereof) are also the safest and most tolerable, rather than a xenobiotic (toximolecular) version of where the condition/pathogen hopefully resolves before the subject sickens or croaks. Plant derivation alone means nothing since, well, public services OD'd Socrates on hemlock extract to cure accusations of corrupting the youth...

When herbalists begin using pharmacologic botanicals with more narrow toxicity profiles and strong xenobiotic drug type actions, I would venture to say one might be into the less orthomolecular sectors of naturopathy or herbalism, where traditional empiricism over long time periods is key, and chemical identities are recent, evolving areas of study.

Herbally sourced antioxidants have, with their identification, metabolism and biological effects only a nascent understanding, some interesting flavenoids and caretenoids, among others, that appear to fit well within the orthomolecular paradigm. Skimming through Google, I found this article interesting[6] to illustrate the variety of biochemicals in things like the milk thistle antioxidant extracts. Orthomolecular medicine may overlap or be first to acknowledge the specific value of some naturopathic, herbal and Chinese medicine *components*, where conventional molecular medicine is only happy to join in as soon as someone can figure how to get the patent angle on 1000+ year old remedies, even if it is more toxic or less effective long term. (The FDA style double blind randomized & controlled drug testing often only says that, after allowing dropouts and "negligible" side effects, that after relative short term testing, that the average patient is better off than doing nothing, however close to zero that may be, and that the proven problems were not initially considered significant in magnitude or statistical occurrence, where 20+% of new drugs historically are subsequently black boxed or withdrawn because "insignificant" items turned out to be significant after all.)--TheNautilus (talk) 22:51, 16 November 2007 (UTC)

The fact that a substantial minority of pharmaceuticals are found (after FDA approval) to have significant side effects which warrant a boxed warning does not imply that herbal products are safer or less toxic than rationally developed pharmaceuticals. If herbal remedies were subject to actual monitoring and safety requirements (as are pharmaceuticals), rather than being totally unregulated, then it would not be at all surprising to find quite a few black boxes there as well. Recent examples being ephedra, aristolochic acid, PC-SPES, etc. Chinese herbal remedies in particular have an occasional tendency to be less... unleaded than one would prefer (PMID 11753265, PMID 11879681, etc)MastCell ^Talk 23:49, 16 November 2007 (UTC)

Speaking of Chinese herbals, there has been a disturbing tendency for them to get in trouble because of "adulteration" with real pharmaceuticals, hence the real effects. Since people aren't expecting real (stronger) effects from normally mild herbs, they may easily overdose and end up feeling real side effects from these undeclared ingredients. If they or their doctor had known about it, they may not have dreamed of using them since they might conflict with other medications. Of course the manufacturers protest their innocence, that they don't know how it happened, that it was accidental, blah, blah, blah.... 00:12, 17 November 2007 (UTC)

My apologies. I didn't mean to turn this off-topic into a FDA / herbal criticism section. I don't think Pauling would have considered those three herbal derived preparations as orthomolecular therapies, that's why I mentioned milk thistle antioxidant extracts as an example. Tangentially, I will agree with MastCell that prudence, especially sourcing from 3rd world / small vendor natural products is a consideration, where C^Nertain toys are not the only imported products found with strange chemicals. These days, larger or small, specialized suppliers should have traceability and/or a quality control program, especially for standardized extracted materials that should be considered. As for interactions, commercial preparations (FDA prescription or herbal), even common foods, often have surprising medical interactions and an informed patient, working diligently with careful, qualified care providers, is more likely to avoid medical surprises. Fyslee, despite the import, science base issue, standardization and professional support problems that all herbals together, may have, the poison fatalities associated with herbals is orders of magnitude lower than pharm products (virtually nonexistent with even remotely related orthomed substances, e.g. conventional iron supplements have been far & away the worst and orthomed considers that a conditional male poison, preferring iron-free without a specific indication). Again we are heading offtopic on non-orthomed herbals.

My personal view of the orthomed vs naturopathic references that I have seen is that the non-standardized herbal sources containing orthomolecular components of interest are naturopathic with perhaps orthomolecular influences, fading out of the overlap zone between orthomolecular medicine and naturopathy. Also one has to be very careful to not just lump willy-nilly, indiscriminent "supplement" taking with principled orthomed, scrupulously practiced.--TheNautilus (talk) 07:55, 17 November 2007 (UTC)

The source of a molecule is irrelevant; what matters is whether it is the right molecule to satisfy the definition of ortho-molecular. So herbally-derived compounds are fine, just as are synthetically-derived molecules. But probiotics are not OM since they are not molecules.--Michael C. Price ^talk 10:59, 19 March 2008 (UTC)

NPOV discussion

Move NPOV tag here for initial discussion. An anonymous IP has not discussed any disputed content, per the tag's literal wording, Please see the discussion on the talk page..{{Neutrality}) tag. —Preceding unsigned comment added by TheNautilus (talk • contribs) 19:18, 28 November 2007 (UTC)

Kousmine

I have moved this discussion of this edit to Talk: Catherine Kousmine.--TheNautilus 01:21, 4 December 2007 (UTC)

Jama 2007, "antioxidants", orthomed and vitamin E

Look this, please. Any comment? --151.73.123.170 (talk) 03:44, 7 December 2007 (UTC)

Looks overweighted on presentation, will take a while to see the background on this article. Mainstrean metastudies have a bad habit of selective inclusions and utilizing specific contraindications to produce loudly trumpheted negative results. Examples would vitamin A and caretenoids in smokers (oxidatively stressed) and damaged liver patients are long known contraindications now, as well as with statins, where vitamin C, K and other repletion status are research issues. The A/caretenoid containing studies in smokers contaminate a lot of the negative alpha tocopheryl ester (conventional "vitamin E") conclusions.--TheNautilus (talk) 13:52, 7 December 2007 (UTC)

Until you have specific complaints on why a meta-anaylsis run in JAMA is either non-orthomolecular in dosage or has bad inclusion criteria, there is no reason to exclude this article. Removing cited text without specific complaints smacks of censorship. Djma12 ^(talk) 21:43, 7 December 2007 (UTC)

The "bad habit" is a "objective habit", "bad" is offensive for the researcher. That one of JAMA remains the greatest study on the Orthomolecular medicine and perhaps it has been destroyed, according to the opinion of Scientific research.--AnjaManix (talk) 22:32, 7 December 2007 (UTC)

Ahem, my edit was a far more appropriate formatting. I did *not* exclude the article, I temporarily reweighted it from by far the most glaring "headlights" POV pushing of a single article to a fully (perhaps still over-) credited sentence in the orthomed article even though I am pretty sure that this group of authors is rehashing a previous POV push on vitamin A (e.g. a single study like the Finnnish smokers' excess mortality associated with existing high oxidative stress and vitamin A even still with interesting "finger-on-the-scale" aspects) can be used to distort or reverse the opposite results (improved mortality) for nonsmokers. Both of your comments reek of unfamiliarity with the vitamin A/carotenoid complexities first referred at least over 50 years ago by Henrik van Dam, Nobel prize winner, on the subject of A+E, where known contraindications can be selectively used to incorrectly disparage the results for whole population. As far as "censorship" Djma12, your previous deletionist attacks on the orthomolecular pioneers demonstrated where concerns of censorship really belong. AnjaManix, "perhaps...destroyed" reveals an unfamiliarity with this type literature that suggests substantial inexperience in this kind of test interpretation and its recent history of abuse as well as a seemingly eager expression of disparaging opinion or similar hopes. I suggest that my edit is proper and that we can discuss this article further over the next several weeks (Christmas is coming and I am less available so it will take time).--TheNautilus (talk) 04:27, 8 December 2007 (UTC)

As a comparison, this is the way I discussed the JAMA meta-analysis in the context of dietary supplementation with antioxidant vitamins.

These harmful effects may also be seen in non-smokers, as a recent meta-analysis including data from approximately 230,000 patients showed that β-carotene, vitamin A or vitamin E supplementation is associated with increased mortality but saw no significant effect from vitamin C. No health risk was seen when all the randomized controlled studies were examined together, but an increase in mortality was detected only when the high-quality and low-bias risk trials were examined separately. However, as the majority of these low-bias trials dealt with either elderly people, or people already suffering disease, these results may not apply to the general population. These results are consistent with some previous meta-analyses that also suggested that Vitamin E supplementation increased mortality, and that antioxidant supplements increased the risk of colon cancer. However, the results of this meta-analysis are inconsistent with other studies such as the SU.VI.MAX trial, which suggested that antioxidants have no effect on cause-all mortality. Overall, the large number of clinical trials carried out on antioxidant supplements suggest that either these products have no effect on health, or that they cause a small increase in mortality in elderly or vulnerable populations.

Feel free to use parts of the text or the associated citations. Tim Vickers (talk) 04:59, 8 December 2007 (UTC)

Why this meta-analysis studies would be inconsistent with SU.VI.MAX studies ? All the cited studies confirm increased the risk. For the rest I quote all. For note 5: The risk increase "in women. Supplementation may be effective in men only because of their lower baseline status of certain antioxidants, especially of beta carotene." For note 6: "A harmful effect was found for beta-carotene with retinol at pharmacological doses in people with risk factors for lung cancer" For note 7: "We found no convincing evidence that antioxidant supplements have significant beneficial effect on primary or secondary prevention of colorectal adenoma" For note 8: "The systematic review of the literature does not support the hypothesis that the use of supplements of vitamin C or vitamin E in the doses tested helps prevent and/or treat cancer in the populations tested" Thanks, --AnjaManix (talk) 09:38, 8 December 2007 (UTC)

The SU.VI.MAX study saw no positive or negative effects on cause-all mortality, this is talking about the possible health dangers of antioxidant supplementation. Some studies see increased risk, others see no effects at all. Tim Vickers (talk) 17:38, 8 December 2007 (UTC)

Actually SU.VI.MAX shows a significant benefit to men. Sex-stratified analysis showed a protective effect of antioxidants in men (relative risk, 0.69 [95% confidence interval [CI], 0.53-0.91]) but not in women (relative risk, 1.04 [95% CI, 0.85-1.29]). A similar trend was observed for all-cause mortality (relative risk, 0.63 [95% CI, 0.42-0.93] in men vs 1.03 [95% CI, 0.64-1.63] in women; P = .11 for interaction). CONCLUSIONS: After 7.5 years, low-dose antioxidant supplementation lowered total cancer incidence and all-cause mortality in men but not in women[7], as do other studies.--TheNautilus (talk) 04:35, 9 December 2007 (UTC)

Not significant benefit to men. The report says: Supplementation may be effective in men only because of their lower baseline status of certain antioxidants, especially of beta carotene. It is totally different! Moreover the people been involved were too few. Why continued to speak about benefits when the scientific studies say the opposite? All the serious studies confirm the dangerousness of the therapy, this is all. It's spoken about the life of the people. Why don't say the truth to the people?I don't understand to you. If you want to speak well about the Orthomolecular medicine waited for studies that demonstrate it, don't to talk nonsense like been making, please.--AnjaManix (talk) 10:12, 9 December 2007 (UTC)

may be effective...only because is simply a speculative statement, no authority there. Even if it is true, the question becomes why is their antioxidant status low, which can include a normally inadequate diet, inadequate transport (e.g. malabsorption) and/or some problem involving metabolism (e.g. increased usage or poor conversion if the measure involves a secondary antioxidant). The latter two are also quite acceptable to an orthomolecular medical position utilizing larger nutrient amount to offset problems in transport and metabolism.

Why continued to speak about benefits when the scientific studies say the opposite? Well, many studies say the opposite. Often studies once considered authoritative and mainstream, even when later thoroughly discredited, as in gross oversight, major errors, incompetence or fraud, continue affect the popular perceptions of the population and even various professions. There are important episodes of still nominally revered figures where the othomolecular position has now been authoritatively accepted to one degree or another, or the scientific discrepancies have become so elementary that a beginning science student should understand the error. However, no one likes to wash their dirty laundry in public or say mea culpa. In fact with institutions whether governments, companies or professions, large political and economic stakes catastrophic to the whole or a faction may not allow admission of defeat. Which is actually a common occurence when innovators and new technology(s) threaten the economically and politically established entity that can't or won't voluntarily change. As an example, this behavior is a commonplace both within and between companies.

All the serious studies... Well, actually not. Also some of the "serious studies" you probably refer to have turned out to be unfounded, confounded or even fraudlent in nature. Again, there can be a long perceptual lag as unadvertised failures of old glories diffuse slowly from the pantheons of Science. Even outright, laughable denial will persist in some quarters, mostly defended by embarrassed silence, sometimes actively defended by bigots and/or entrenched economic interests. In any industry, entrenched economic interests can divert huge resources and research to shore up a crumbling facade for a generation, or two. Happens all the time in other industries, part of the scenery in strategic/competitive analysis and response for any MBA or corporate research director.

Moreover the people been involved were too few. Untrue. Some of the studies have been on a very large scale showing strikingly positive benefits. e.g.

Why won't you speak the truth to people? I do. At Wikipedia, I focus on WP:RS and WP:V, where WP:V includes most current science (which can be many decades old), as key to resolving any technical discussion. Here I am often familiar with areas others are not. Many, if not most editors, here have been quite unfamiliar with the orthomolecular literature and its foundations in mainstream experimental sciences and clinical research. You should also acquaint yourself with WP:AGF.

If you want to speak well about the Orthomolecular medicine... That suggests you are not familiar with much relevant mainstream and orthomolecular literature rather than secondary and tertiary opinions that are, well, sometimes rather loudly (un)founded on now recognized error, bigotry or worse, despite their projected veneer of "respectability" and uncritical popular acceptance.

...nonsense I assume that you are primarily basing your opinon on very limited references like in your edits on antioxidants and vitamin E, which do not reflect orthomolecular protocols, systematic testing, or even orthomolecularly preferred chemical forms by a long, long shot.

In your vitamin E reference[8], the Vanderbuilt researchers' "leap" is taking a *small* fractional step toward the cardiovascular orthomolecular protocols by testing d-alpha tocopherol in the 800 - 3200 IU range. The most orthomolecular forms of vitamin E that I know of are this supplement Unique E (since 1962) which is 2/3 beta- gamma- and delta-tocopherols, which are much more powerful antioxidants and anti-inflammatories, or perhaps one of the full spectrum (all 8 isomers) vitamin E(high gamma) vitamin E with tocotrienols, too. If they were orthomolecularly serious about "vitamin E", beyond adding about 200% by weight of the other tocopherols, they would be monitoring vitamin K tissue levels, or simply supplementing K₂ such as menatetrenone [MK-4] and menaquinone-7[MK-7] as well as K₁). If they were serious about the general orthomolecular cardio part they would be testing high dose niacin for lipoprotein modification, magnesium chelates, chromium polynicotinate or lysinate if sugar impaired, EPA & DHA containing fish oils generally, l-acetyl- or l-propionyl carnitine + co-Q₁₀ + taurine especially with CHF, anhydrous betaine+folate+B12+B6 for homocysteine, thiamine, vitamin C + l-lysine + l-proline against Lp(a) deposition, juicing fresh colored vegetables for mixed carotenoids and potassium. In the diebetic or metabolic syndrome associated cardio cases, they would also test R-alpha lipoic acid, even more vitamin Bs including pantothenate/pantathine as well as the basic 11 component B50s, organic selenium forms. Here in the US, all that can cost about $1/day on the supplements side.

Then one would finally be talking about Ortho molecular medicine. Of course, like Bruno, you (or whomever) might be burned at the stake, too. But one would be closer to a correct description.--TheNautilus (talk) 06:53, 10 December 2007 (UTC)

In fact. It seems that in the time idea of the right molecules in the right amounts like said Linus Pauling has gotten lost. Orthomolecular medicines is not a simple assumption of vitamins, to think it can turn out dangerous. I always say that more than medicine we re-enter here in the field of chemistry. Why it is remained the term "medicines", doesn't find it incorrect?--AnjaManix (talk) 07:37, 10 December 2007 (UTC)

I think using expertise, e.g. some kind of doctor - MD, ND, PhD, the severity of the problem, and what may be considered pharmacolgic doses and diagnostic techniques, is an ill defined and somewhat arbitrary transition between health, perhaps as "optimum nutrition", and medicine as "orthomolecular medicine".

Interesting. So the orthmolecular experts recommend semi-synthetic vitamin E over natural vitamin E. (Apparently natural vitamin E has less than 1/3 d-alpha, and has virtulally none of the l- forms.) Just curious. — Arthur Rubin | (talk) 14:03, 10 December 2007 (UTC)

Orthomolecular medicine is not an rigidly organized undertaking so it can't offer formal guidelines, or a precise, undisputed consensus. The Shute brothers were able to do wonders for those with cardiac problems and appear to have favored d-alpha-tocopherol [9] Szent-György preferred to eat lots of wheat germ, which is high in Vitamin E. Nevertheless, my understanding is that the tendency among advocates of orthomolecular medicine is to treat with Vitamin E high in d-alpha, d-beta, d-gamma and d-delta forms. All the more reason for more substantive and fair studies.--Alterrabe (talk) 15:11, 10 December 2007 (UTC)

Arthur, I am not sure what I am unclear on, the fully natural tocopherol spectrum as the natural alcohol is usually ideally preferred.

The only semi-synthetic (esterified) vitamin E available that I have seen OM types recommend, is d-alpha tocopheryl succinate in the old IUPAC nomenclature, R,R,R-alpha- in the current IUPAC nomenclature, for (1) cancer patients based on IV data (and perhaps orally for prevention or treatment), and (2) for a dry form in tablets, still separately supplemented with the natural d-beta-, d-gamma-, d-delta forms.

The isomer situation is very confusing to the unwary. There are 8 natural d- isomers of vitamin E, R,R,R-alpha-tocopherol, R,R,R-beta-tocopherol, R,R,R-gamma-tocopherol, R,R,R-alpha-tocopherol, R,R,R-alpha-tocotrienol, R,R,R-beta-tocotrienol, R,R,R-gamma-tocotrienol, R,R,R-delta-tocotrienol. The first synthetic vitamin, with a natural phytal tail had one chiral center, the original d,l alpha-tocopheryl acetate, now officially called 2-ambo alpha-tocopheryl acetate. The fully synthetic alpha tocopheryl acetate revealed 3 chiral centers and so, in the cheaply common synthetic, all-racemic alpha tocopheryl acetate where there are 8 diastereoisomers of the alpha tocopherol moiety: R,R,R- R,R,S- R,S,R- S,R,R-, R,S,S- S,S,R-, S,R,S- S,S,S-alpha tocopheryl acetate, the all rac synthetic mixture is now labelled as d,l alpha tocpheryl acetate commercially. The diastereoisomers with 2R are considered biologically active; orthomed considers the all rac junk for high dose use although Jialal, while at Southwestern, had a paper that showed some cardiac improvements using it. The big hidden issue is displacement of the more common natural d-beta-, d-gamma-, d-delta isomers by flooding the d-alpha isomers alone if the diet is really poor (as in processed). In the 1940s and 50s more of the population probably got the last three isomers, especially d-gamma-tocopherol, from their diet, today that may be a bad bet for most.

Personally, because the interactions and displacement in the membrane, all these tests of individual oil soluble vitamins (A,D,E,K,Q) that don't track the others, to me, look like scattershot junk data. Regular medical testers only recently woke up to even partly naming names in their papers (still no comprehensive form and ingredients list), recognizing the individual entities to the level of (1) esterified (but not which one, which affects tissue distribution and hydrolysis rate), (2) d- or d,l- and (3) some separate interest in gamma tocopherol; I am unclear whether they are all awake yet. Some anecdotal and other evidence suggests the guys who also had gamma+ repletion were the ones who got the anginal elephant off their chest (in the high dose cases, quickly and long term, and became "fanatics"). The notes that I have seen on therapeutic use of vitamin E for blood thinning used the fully natural spectrum of tocopherols, starting with up to 3200 IU/day of the alpha isomer parts, which suggests they also used about 4200+ mg/day of beta, gamma, delta tocopherols. At that level, I think orthomeds want you vitamin C replete (e.g. 5x day or time release 3x) to recycle the E and to keep the collagen in the blood vessel wall fully forming and tensile (they thin with age and have lower vitamin C levels). Ditto vitamin K has a collagen forming role as well as clotting (and keeping calcium in the bones, out of the arteries). Large dose vitamin K is considered compatible (self limited clot factor processes) with vitamin E thinned blood, whereas the anti-coagulant (vitamin K antagonist) rat poison warfarin is not. This vitamin K and E issue so far is only addressed as "deficiency" at all, and not in any conventional testing I've seen, so I would not be amazed to see a subgroup(s) of non-orthomed treated patients with low collagen, low C, low glucosamine, and/or K (perhaps other wound healing/collagen forming nutrients) packing the unmonitored mortality stats in some trials, as well as the tocopherol spectrum issues. In Europe, gamma tocopherol is a recognized separate nutrient. Also patients dropping iron in along with their vitamin E, are considered to have a serious oxidative interference.

So, that is a little why orthomed, from a vitamin E perspective, is picky about identities, specific molecules, and "the package" rather than rather uncontrolled, single variable searches far removed from a proposed convergence area around some optimum. Ultimately I think the world is dying to see cheap, routine genomics and metabolomics (individualized) data with large trials.--TheNautilus (talk) 17:02, 10 December 2007 (UTC)

There is really no such thing as "Vitamin E" and people are still unclear on what, if anything, the tocopherols and tocotrienols do in the body. For instance, in the journal Free Radical Biology and Medicine earlier this year there were two reviews that argued diametrically-opposing views on alpha-tocopherol's role in metabolism.

• Azzi A (2007). "Molecular mechanism of alpha-tocopherol action". Free Radic. Biol. Med. 43 (1): 16–21. PMID 17561089.
• Traber MG, Atkinson J (2007). "Vitamin E, antioxidant and nothing more". Free Radic. Biol. Med. 43 (1): 4–15. PMID 17561088.

What is clear from the clinical trials is that the current "vitamin E" supplements offer no health benefits and might pose some health risks, but that any effect is small. Tim Vickers (talk) 17:21, 10 December 2007 (UTC)

• In the last studies situated on the official institute of Linus Pauling it has been demonstrated to the failure of the Vitamin E in preventing the attacks cardiac . Another one.--AnjaManix (talk) 04:11, 11 December 2007 (UTC)

Tim, your statement looks highly overdrawn and inappropriately conclusory in a field noted for disputes, cherry picking and incomplete coverage of long known proposals. There are a number of tests showing safety and strong merit, e.g. a very quick example of reviews You are dismissive to a group of nutrients based on very weak tests, where test designs and various biases are often clearly open questions, and even notably disputed within the "mainstream". The mere use of an RCT does not overcome limited tests or weak designs (especially relative to orthomed as discussed above), a common problem in tests with individual vitamin relatives, usually not with the orthomolecular choice version. Anjamax, the Science Daily actually is supportive of the orthomolecular position, where the article is saying that there was a positive effect with the increased dosage of the weakest antioxidant (alpha) toco- compound, alpha tocopherol. One test or even set of tests in a remote corner of the full matrix do not reflect system failure, but rather another brick in the road of development, where the various medical institutions can't quite seem to grasp the nettle in order to test long standing orthomolecular protocols over 25-50 years+ and seem to class their experimental design failures as failures of the class of molecules. In other technical industries one may be more likely to get fired for incompetence doing that, or promoted in marketing if it is a competitor's product.--TheNautilus (talk) 06:10, 11 December 2007 (UTC)

• Confusion, too much confusion. It would have to divide in more parts the voice Orthomolecular medicine to second of the examined vitamin.. But don't exist already the voices on the several vitamins? Too many factors exist that they change from person to person, age, weight, levels of acids, several diseases, deficiencies, etc. Is impossible to establish an ideal amount of one any substance (or many) to give in a person. Would do good on one person but in an other could make badly.. This isn’t spoken more than medicine but quite about alchemy. Don't agree?--AnjaManix (talk) 04:11, 11 December 2007 (UTC)

Orthomolecular medicine is very much about tackling the complexity of individuality. Although an a priori precise optimization may be difficult, a ballpark heuristic optimization that is pretty effective can often be done by titration for symptoms after the diagnosis & initial recommendations. This is not only done in orthomolecular medicine but most industries that use chemicals in a rational manner.

Don't agree? I think the language barrier and a lack of familiarity with orthomolecular medicine's working hypotheses and protocols are creating a substantial barrier to clear communication.--TheNautilus (talk) 06:10, 11 December 2007 (UTC)

I apologize for my stupid error. Are you perhaps trying to change speech?...--AnjaManix (talk) 10:10, 12 December 2007 (UTC)

Views on Safety and Efficacy quote

I've removed the following quote "...with claims such as "Scientific research has found no benefit from orthomolecular therapy for any disease" despite some counterexamples such as megadose niacin..."

This statement is making a claim towards mainstream medicine, but does not use a mainstream medical source. Rather, it uses the Alternative Medicine Handbook, which is not exactly authoratative towards mainstream medical views. If a mainstream medicine source can be used to confirm the quotation, it can go back in. Djma12 ^(talk) 02:58, 13 December 2007 (UTC)

Uh, Djam12, once again you seem to be making "Idontlikeit" (over)controlling declarations about something that you seem to have little familiarity with. Barrie Cassileth is a notable altmed critic with mainstream credentials, viewed as a QW -type mainstream's fox-in-the-henhouse on CAM, a darling of CSICOP[10], Quackwatch[11] and Stephen Barrett(co-editor: Barrett S, Cassileth BR, editors. Dubious Cancer Treatment. Tampa, 1990, American Cancer Society, Florida Division.) with many complaints from "altmed" notables, e.g. Ralph Moss. You may safely consider her book, The Alternative Medicine Handbook: The Complete ... an anti-altmed trojan.

Quackwatch: (1982) "In 1982, shortly after the final National Cancer Institute evaluation of Laetrile was published, Barrie Cassileth of the University of Pennsylvania Cancer Center wrote a short article in the New England journal of Medicine entitled "After Laetrile, What?" [115]"[12];

Cassileth: (1990) "I'm Barrie Cassileth of the University of Pennsylvania Cancer Center..."[];

(1998) Dr. Cassileth is currently a Consulting Professor of Community and Family Medicine at Duke University Medical Center, an Adjunct Professor of Medicine at the University of North Carolina, and a Visiting Lecturer at Harvard University."[13]

CSICOP: (2001) "Barrie Cassileth, Ph.D., of the Memorial Sloan-Kettering Cancer Center in New York City..."[14];

NIH: (2006) "Cassileth, Barrie R Sloan-Kettering Institute for Cancer Research"[15];

Advances in Neurology Faculty, current 2007 bio: "member of the National Board of Directors of the American Cancer Society"[16]

Understand something, when Cassileth says "alternative" she means attack with QW-style "mainstream" views, she claims to consider "complementary" as a possibility, gets news coverage and grant money anyway.

One other misunderstanding that you seem to have on common options: when you complained this summer about resistive/reluctant parents & vitamin C on that pediatric oncology case, the largest vitamin C/orthomolecular oncology related experience before Riordan, claimed C as a complementary use, while what you seemed upset about sounded like a total alternative use of C. Complementary use is the way that seems to be booming in my state, anyway, and provides a middle ground.--TheNautilus (talk) 06:27, 13 December 2007 (UTC)

1. Can you provide a page number for your book citation? If it verifies, then it can stay in.
2. My institution also has a referal service for complementary medicine, specifically acupuncture, yoga, and tai chi. My only concern is when articles like this over-emphasize the benefits of such therapy without addressing the possibility of side-effects or the paucity of randomized research. It is fine to have articles like this but they must be BALANCED. Djma12 ^(talk) 14:34, 15 December 2007 (UTC)

Again, I ask, is there a proper citation for this quote so that it can be confirmed? I will not remove this for a couple of days pending citation search, but will not wait forever for verification. Djma12 ^(talk) 19:43, 16 December 2007 (UTC)

Do not remove references. The accepted course of action if you have concerns is to tag the reference with the template {{Citequote}}. Tim Vickers (talk) 21:02, 16 December 2007 (UTC)

Sounds reasonable. Djma12 ^(talk) 23:34, 16 December 2007 (UTC)

The page number of Cassileth's orthomolecular comments (pp.67-8) was *already* in the reference as "1998:68"

Also "balanced" is a surprisingly slippery, and obscure, object of desire when numerous demonstrations of (anti-competitive, COI) "reliable", "scientific sources" have previously been shown to be malicious, studiously misrepresentative, and even fraudlent in elementary ways that should make high school science students blush. I've traced down a lot of sources to resolve WP:V issues, unlike a number of previous POV pushing "skeptics" to even identify the technical issues beneath the misadvertised, (QW style) "conventional wisdom". I can't emphasize this enough: the WP:V orthomed story turns out much different than the presuppositions of many newbies and hostile pseudoskeptics who haven't done, or won't do, any homework. I can respect honest technical discussions & differences and I am willing to try to explain these. The nature of the orthomed data is clearly stated in the article, the opposition to less than FDA-scale RCT testing is plentifully noted. Many of the risks and side effects that you presuppose are long obsolete forms and really old mainstream (non-orthomed) medical protocols, e.g. pre-1994 time release niacin formulas that dissolve in over an hour, synthetic delisted "K₃" that isn't even allowed in most animal feeds in many countries now, early (acidic) vitamin salt applications of the 40s, (prescribed) megadose (synthetic, xenobiotic) D₂ problems fobbed off on defiencies of the real (human) form of D, cholecalciferol (D₃), important constraints & contraindications in modern protocols, or important absent balancing co-factors of related vitamers especially in B's, natural E isomers, some minerals, and the oil solubles (A,D,E,K,Q) in general. Side effects? I almost gag when I hear worries about niacin flushes with IR niacin while (cardio)myopathies, rectal bleeding, memory lapses, etc with statins seem to have been medically accepted amongst my older acquaintances. "Over-emphasize benefits"? how about even identifying the orthomed claims without the QW-style disparaging nonsense (failing WP:V) spreading literally fraudulently misrepresented "RCT" results with extraordinarily bad design, controls, execution and biased interpretations that, in some cases, at least overgeneralize their test range by factors of 10 to 1000 fold, such as Moertel's ambush, documented by *independent* sociologists and scientists (hard science academic backgrounds).

Ducking? I am the one who originally added the G6PD hemolysis contraindication to the C article, although rare & usually for extremely high IV dosages over days. Most of the vitamin C "dangers" that are listed are pretty bogus (e.g. subsequently unpublished preliminary research results mistaking reversal of collagen wall thinning for "atherosclerosis", with unretracted negativism much ballyhooed in the pharmaceutically $dependent press). I haven't had time to go dig out the other references, e.g. iron and vitamin C concerns are apparently overstated for most people with iron overloads - the operative literature phrase is *rare or unusual forms* of iron overload. Vitamin E's antihemolysis property used to be a short cut test for vitamin E potency, as well as actual treatment; ditto kidney stones when some common forms of urinary sediment/stone material are eliminated by oral vitmain C, and the supposed oxalate problems of many people can be addressed by adequate repletion of Mg (a common or normal deficiency), citrate, B6, B1, B2, adequate hydration, laying off the sugar/starch/alcohol binges, methylene blue, and soon, perhaps in the pharmaceutical mainstream, patented diagnotistics and medical probiotics to replace what was wiped out by new super-antibiotics. These are all things that a competent (orthomed) MD prescribing them should be able to handle. These things have been documented in the old medical literature, sometimes with lesser degrees of evidence e.g. class II, but often can be measured or objectively observed on an individual basis, the US's CLEA notwithstanding simple science applications.--TheNautilus (talk) 10:36, 17 December 2007 (UTC)

obsolete, duplicate point, unreliable link

I have (re)moved this sentence[17] as duplicating the *alternative* medicine point, already overstated POV since OMM has common roots in molecular medicine that is the basis of modern biomedicine, as far as acceptance and substantiation. The QW link is actually off topic and adds no expertise. These APA authors were subsequently shown to be off in exactly the many ways Hoffer rebutted early on, just 30 years for "mainstream" to acknowledge that before a new, still lightweight, experiment began 2005. If QW's article were remotely current on OMP alone, where are the omega-3 fish oil, copper-zinc balance, amino acids, B, C & D vitamins generally discussed, among other nutrients, in the "expert" QW link? The link is mostly offtopic because it is usually addressed as a separate topic in common applications as well as the separate article at WP, although Orthomolecular Pyschiatry is definitionally a subset of orthomed and has common nutrient bases. This addition and link is exactly one of my points about QW being promoted as a reliable source. It isn't, remotely, unless you also think 1 is greater than 20 (a low to typical factor of misformulation, as well as other common protocol breaks BS misrepresented as "mainstream" study replication). Also it would be undue weight and poisoning the well in the lede.

That particular QW's "sentiments" article has already been linked at appropriate places on orthomed articles, that particular link is twice in Orthomolecular Psychiatry and at least once in Megavitamin therapy. I see the Criticism section has still has a lot of damage from earlier efforts to bring one of the medical students up to speed on orthomed issues, with several lines missing. I will have to review that area (been meaning to).--TheNautilus (talk) 14:26, 15 February 2008 (UTC)

Natural / coevolved etc

I tried to describe the list of vitamins, dietary minerals, proteins, antioxidants, amino acids, ω-3 fatty acids, ω-6 fatty acids, lipotropes, prohormones, dietary fiber and short and long chain fatty acidsas "natural", which has been reverted. Does anyone have a better description? "Coevolved with" ws rejected because "evolution" is apparently too radical a concept to introduce in the lead (I would have thought a simple link wwould do).--Michael C. Price ^talk 16:14, 17 March 2008 (UTC)

Do you have some sources that state the substances used in Ortho medicine are compounds that the human body has coevolved with? Do you realize by the way, that the classic examples of co-evolution in the literature are those of predators co-evolving with toxic prey (eg snakes evolving resistance to tetrodotoxin), and that the definition requires the interaction to be between two separate species. Saying that the humans "co-evolved" with a substance that is usually present in the human body is therefore incorrect. Tim Vickers (talk) 16:21, 17 March 2008 (UTC)

Not incorrect: with the exception of minerals they are complex molecules which are synthesized (mostly by plants and microbes) lower down the food chain. Plenty of interaction there. --Michael C. Price ^talk 16:25, 17 March 2008 (UTC)

Amino acids? proteins? antioxidants? fatty acids? You realise these are all normal body constituents? Tim Vickers (talk) 16:29, 17 March 2008 (UTC)

That is the whole point, so I am struggling to see what your point is? Vitamins, essential amino acids and essential fatty acids are all externally synthesized and require dietary input. --Michael C. Price ^talk 16:33, 17 March 2008 (UTC)

An animal can't co-evolve with alanine, since that is a normal part of its own body. An animal can however co-evolve with tetrodotoxin, since this is a xenobiotic. Tim Vickers (talk) 16:39, 17 March 2008 (UTC)

The point is that since they are naturally occurring we have evolved to tolerate many of their otherwise detrimental effects -- something which is not true of recent "artificial" substances. This is a situation where the term "natural" has a clear and relevant meaning -- just as you seem to think that "normal" has.--Michael C. Price ^talk 16:46, 17 March 2008 (UTC)

I'm glad you now agree that, as this list includes substances that are not xenobiotics, saying "co-evolve" was wrong. However, I'm still puzzled as to what you are saying. Are you arguing that Orto medicine only uses substances that have harmful effects? What are the detrimental effects of dietary fiber, proteins, or amino acids? Tim Vickers (talk) 16:52, 17 March 2008 (UTC)

I said otherwise detrimental. Anyway, what is the objection the word "natural"? --Michael C. Price ^talk 17:05, 17 March 2008 (UTC)

What do you mean "otherwise detrimental"? What harmful effects might amino acids possibly have? The problem, for me, with the word "natural" is that not all of these supplements are isolated from living organisms, and are instead synthetic compounds (ascorbic acid for example). These may in some cases be chemically-identical with substances that are found in nature, and might therefore be argued to be "natural" synthetic compounds, but as the Vitamin E controversy shows, not all the supplements used are identical to the forms found in the body. This word therefore has an ill-defined and nebulous meaning. It is best to avoid such peacock terms and simply list the substances used. Tim Vickers (talk) 17:15, 17 March 2008 (UTC)

All substances have detrimental effects, but most natural substances in normal doses have minimal negative side effects for evolutionary reasons. Amino acids => kidney damage, for example.

Natural has quite a simple definition, it is not a peacock term: if it is produced in nature it is natural. That there exist modern alternative sources does not stop the compound being natural, as with ascorbic acid, as you say, since there is no "vital elan". The vitamin E analogy is irrelevant, since that is an example of where the synthetic versions are not always identical to the natural versions.--Michael C. Price ^talk 17:44, 17 March 2008 (UTC)

See natural product versus IANPP Definition of Natural Ingestible Ingredients Natural food/supplement ingredients and this news story, your definition is simple, but as it certainly isn't the only definition used, the term is ambiguous - that's the problem. Tim Vickers (talk) 17:48, 17 March 2008 (UTC)

"Natural" in this context is vague and largely meaningless. Is taxol "natural"? It's produced in nature, but its side effects are hardly minimal. The same might be said for belladona, arsenic, or any other "natural" poison. The problem with "natural" is that it's often used to suggest that "natural" products are more useful or less dangerous than "synthetic" products, when in reality there is no blanket rule to that effect and the opposite is often true. MastCell ^Talk 17:51, 17 March 2008 (UTC)

It is amusing that some people equate "natural" with "healthy", ricin is entirely "natural", but it is one of the most poisonous substances known to man. Tim Vickers (talk) 17:55, 17 March 2008 (UTC)

Of course there are natural toxins, but that doesn't invalidate the use of natural as an adjective. There is no valid reason for blocking the use of the term here. If you are all so insistent that this is such a taboo word, then find another suitable adjective we can all agree on. --Michael C. Price ^talk 17:58, 17 March 2008 (UTC)

How about "biologically-active substances" Tim Vickers (talk) 18:04, 17 March 2008 (UTC)

No, on second thoughts, bacteria and yeast can't really be described as "substances" Tim Vickers (talk) 18:06, 17 March 2008 (UTC)

(ec) I wouldn't call it "taboo" - it's just poorly defined and not particularly meaningful here, particularly as its use seemed to be predicated on a non-standard interpretation of coevolution. The approaches listed above could be more accurately characterized as "dietary", "non-pharmaceutical", etc. MastCell ^Talk 18:07, 17 March 2008 (UTC)

Coevolution was a 2ndary resort after natural was rejected. I suggest "natural agents". --Michael C. Price ^talk 18:11, 17 March 2008 (UTC)

Agents is good, and I've defined exactly what you mean, rather than using the word "natural", with all its associated confusion. Tim Vickers (talk) 18:40, 17 March 2008 (UTC)

There was nothing confused about the term "naturally occurring" which you've removed. --Michael C. Price ^talk 22:14, 17 March 2008 (UTC)

Well, a lot of people would disagree with describing a synthetic chemical as "naturally-occurring", as the links I added above will have shown you. this article also discusses the various legal meanings of the term. Tim Vickers (talk) 22:56, 17 March 2008 (UTC)

The links do not define "naturally occurring". I think most people would define ascorbic acid as naturally occurring. --Michael C. Price ^talk 23:44, 17 March 2008 (UTC)

Naturally occurring, *especially in the human body or human diet*, is an important theme because so many of the attacks and supposed problems ennunciated by critics and pseudoskeptics concern clearly (non-orthomed) unnnatural, xenobiotic, or even dangerous nutrient forms (e.g. D₂, K₃, (synthetic) "vitamin E", isotretinoin (a highly unnatural fraction), retinoids, brightly sugar coated iron supplements in bulk). Unnatural forms that have even been *defined* in pharma marketing coups as the *vitamin standard* (e.g. 2-ambo-alpha-tocopheryl acetate ca 1942, and when that wasn't cheap enough, all-rac-alpha-tocopheryl acetates as "E") whereas orthomed clearly prefers the naturally occurring mixed R,R,R-tocopherols, along with the co-factors & other oil soluble nutrients (K, CoQ₁₀, Se,) and various other antioxidants (C, R-alpha-lipoic acid, NAC etc). The historical fact of pharmas & mainstream medicine passing off IM mega-menadione (formerly known as "K₃, an unnatural & incomplete precursor of K) as vitamin K in the 1950s on neonates, repudiated by allopathic MDs ca 1953 & never matching orthomed specifications (nor advocated), is yet still repeatedly used to criticize orthomed related topics here at WP as well as by some governmentally sponsored (state supported terrorism?) websites that grossly fail WP:V fact checking.

At this point in time, naturally occurring has meaningful and practical importance for bioequivalency, where industrial sources will probably improve on bioequivalent single components with proper technical & market developments. The best combinations, currently often related to natural mixtures used in clinical combinations, long anticipate individual optimization to be defined by nutrigenetics & nutrigenomics (see Roger J. Williams in his 1956 book, Biochemical Individuality: The Basis for the Genetotrophic Concept) and metabolomics (originated by 1960s orthomed research!).--TheNautilus (talk) 10:35, 19 March 2008 (UTC)

Agreed. I have restored "naturally occurring" to the article since it is the factually correct description that applies to all the members of the following list. Also specified "molecule", to avoid all the unnecessary squabble about substance vs agent etc. Note that I have removed "probiotic" from the list since they can't be classified as molecules, and hence fall outside Pauling's defintion. --Michael C. Price ^talk 11:09, 19 March 2008 (UTC)

Frequent, conventional misconceptions

A number of edits here demonstrate substantial confusion about what is, or defines, orthomolecular.

One common error is the confusion that orthomolecular necessarily means mega-something, it does not. Orthomolecular nutrition is particluarly about individual optimization, including supplements with a zero amount (free of) of particular nutrient components for individuals in different subgroups. Orthomlecular advocates, in agreement with current conventional medical science, often expressely advocate zero supplementation of certain components for many individuals, such as with iron, where the policital, "population averaged intake + 50%" RDA is an outright dangerous mistake for many individual cases and effectively "poisons" many indiscriminately marketed "conventional" supplements, with iron probably being the most common "conventional, RDA-centric" and dangerous example for otherwise non-anemic persons.

Also "hypothesized" is at best partially correct (incomplete). Orthomolecular types appear much more likely to consider and measure for nutrient deficiencies and related metabolite levels that are recognized in conventional medicine and/or nutrition as grossly deficient or nutritionally problematic but are frequently medically unnoticed and unattended.

Third, again, the naturally occurring and bioequivalency part above.--TheNautilus (talk) 10:45, 19 March 2008 (UTC)

A fourth misconception is that the 1973 APA report or the mislabelled QW article (about first orthomolecular psychiatry 1952 obsolete treatment, mistested and results misstated by APA) are current, neutral and/or reliable technical sources, they are not.--TheNautilus (talk) 18:34, 19 March 2008 (UTC)

I found a medical textbook that mentions orthomolecular medicine, it was quite hard to find sources on this though, since it is almost unknown in mainstream publications. There was also this specialised review on nutritional claims in alternative medicine, but even this only mentioned the topic in passing. Tim Vickers (talk) 19:11, 19 March 2008 (UTC)

An article by Andrew Vickers, eh? COI? :) MastCell ^Talk 19:13, 19 March 2008 (UTC)

I only have cats, no kids! Tim Vickers (talk) 19:27, 19 March 2008 (UTC)

Orthomed is a name many doctors, and especially pharma employees, dare not speak, where conventional educational and indexing materials typically religiously avoid mentioning or crediting it.--TheNautilus (talk) 19:23, 19 March 2008 (UTC)

Fifth are statements, similar to partisan Cassileth's earlier statements, no evidence that megavitamin or orthomolecular therapy is effective in treating any disease is a blatantly false statement since the Canner study (1986) of Hoffer's 1956 discovery and nearly immediate medical acceptance of niacin for dyslipidemias. Those are really POV pushing lies, pretending to be tortured legalistic weaseling and not reliable sources (flunked WP:V fact checking, badly).--TheNautilus (talk) 19:23, 19 March 2008 (UTC)

If you can find a medical textbook that mentions orthomolecular medicine as an effective treatment for disease, then we could add that as an equally-authoritative balancing source. Tim Vickers (talk) 19:27, 19 March 2008 (UTC)

Many reference books have cited Altschul (Hoffer's advisor), Hoffer (orthomed founder), Stevens (1955) on megadose niacin for CVD (pure, *immediate release* form, 2 - 9 grams per day divided doses). I am looking at Goodman & Gilman's The Pharmacological Basis of Therapeutics, 9th ed. You should delete that source (especially for the lede), it has failed WP:V badly, and is someone's partisan attack (may be a repetition of Cassileth et al). Pharma and conventional medical publishers' blockade on citing, crediting orthomed or its pioneers, is so severe, even Wm Parsons (then Mayo resident, first American expert on niacin) who owes his entire 50+ year cardiology career based on niacin to Hoffer, and still appears to be on friendly terms, only obiliquely refers to them as "the Canadians", for decades.--TheNautilus (talk) 19:59, 19 March 2008 (UTC)

If you think this medical textbook is not a reliable source, you should raise this issue at Wikipedia:Reliable sources/Noticeboard. However, a self-published website by a proponent of this alternative medicine isn't a reliable source for Wikipedia by any stretch of the imagination. Could you quote the section of that pharmacology textbook that mentions the words "orthomolecular medicine"? Tim Vickers (talk) 20:34, 19 March 2008 (UTC)

That greatly miscontrues my answer. You surely know Goodman & Gilman's is an authoritative, professional reference to source Hoffer and his megadose niacin results. Hoffer's historical note, conveniently linked at DYS, is simply background for 3rd parties, is published, and is a reliable source about himself, his historical actions on, and what is orthomolecular medicine, corroborated with his papers in mainstream venues. Your answers resist acknowledging a simple WP:V failure that relates to an ongoing systematic bias and clear falsehood, very similar in nature to Wilk et al but with lots more science. The most charitable interpretation that I can even make of that "never...effective" assertion is that the author is either totally ignorant of megadose niacin therapy and its origins (heh, some "authority"), or confusing "alternative medicine" as synonymous with "orthomolecular medicine" and thinking that megadose niacin isn't orthomolecular anymore (completely false, Pauling's definition controls). Despite your spurious sources' misinterpretations, orthomolecular medicine often overlaps conventional medicine, especially where conventional medicine partly catches up (niacin, fish oil, folic acid, transfats, vitamin D, very slightly on vitamin C, coQ10, iron-free, ad nauseam) and is based on a more complete database of medical science (including older class II and historical evidence) and history. Pls see one previous discussion about this altmed-orthomed-mainstream point, Orthomolecular medicine is not the same as alternative medicine, by SB Harris, MD.--TheNautilus 21:31, 19 March 2008 (UTC)

Does the pharmacology textbook mention the phrase "orthomolecular medicine"? I'd like you to be clear on that point please. Tim Vickers (talk) 21:55, 19 March 2008 (UTC)

The pharmacolgy niacin text is a bare, first cite of Altschul, Hoffer, Stephens (1955), they of course avoid "orthomolecular". That is the standard (mis)treatment of mavericks, "separating the man [his credit] and his medicine". It is mostly Hoffer's articles and bibliography that show the detailed history, corroborated by others (e.g. Wm Parsons) in bits and pieces.--TheNautilus (talk) 17:26, 20 March 2008 (UTC)

I think that may be where the disconnect comes into play. Most physicians who prescribe niacin for dyslipidemia don't consider it "megadose vitamin therapy" or "orthomolecular medicine", rightly or wrongly. Niacin in this setting is a recognized and tested drug, whereas megadose and orthomolecular medicine are generally construed as referring to less mainstream treatments. Check out PMID 17620858, a 2007 review by John Guyton - he explicitly cites Hoffer and Altschul's 1955 paper as the first demonstration that a compound could favorably affect plasma lipids, but it was not until the Coronary Drug Project (JAMA, 1975) that niacin was shown to reduce atherosclerotic cardiac events. I don't see a denial of Hoffer's role - if anything, he's given credit for kicking things off - but niacin has been studied extensively outside the orthomolecular world and is no longer perceived by physicians as an "orthomolecular" treatment, if it ever was. MastCell ^Talk 22:02, 19 March 2008 (UTC)

Yes, giving a kid growth hormone, injecting somebody with anaphylactic shock with epinephrine, or giving pregnant women folate to prevent spina bifida are all recognised medical treatments, where these conventional treatments and "orthomolecular medicine" diverge are the sweeping claims of these alternative medicine practitioners, based on slim or non-existent evidence. There is good evidence that biochemicals can treat some diseases, but there is poor to no evidence for the inflated claims that make the use of biochemicals a universal panacea. Tim Vickers (talk) 22:16, 19 March 2008 (UTC)

You make excellent points. A good 95% of medical practice that fits Linus Pauling's definition of "orthomolecular medicine" is so well-accepted and uncontroversial that practitioners generally don't even realize they are "acting orthomolecular." This fact really does not get the mention it merits in the article. The controversial parts are controversial, often because they have never been adequately tested, a deficiency which ought be corrected. In this day and age when professors of medicine publicly, and I believe convincingly, question such ideas as the notion that cholesterol causes cardiovascular disease and that statins are helpful in oft-frequented web fora, [18], a notion that Broda Barnes MD, PhD already propounded decades ago[19], I think it sells wikipedia short to insist that all medical opinions must be encapsulated in the approved editions of mainstream medicine's holy scriptures. What is extremely important is that there be no room for confusion between what is generally accepted and what is rumored, for better or worse.--Alterrabe (talk) 23:04, 19 March 2008 (UTC)

Removing a direct quote of a reliable source isn't acceptable. However, if you wish to add a balancing quote from an equally-reliable source then do so. Please find a medical journal or textbook that states orthomolecular medicine is effective in treating disease. Tim Vickers (talk) 22:38, 19 March 2008 (UTC)

Besides "no megavitamin...effective" is literally false (unless 2-9 grams per day of niacin is not a megadose), the quote takes undue Lede space, is one sided contentious POV, and gives undue weight to distorted or counterfactual material. This article is about orthomolecular medicine not the random opinions of every partisan, anti-competitive echo repeater of Cassileth's deprecating, stmt used lower in the article. We should NOT (re)fight the "reactionary mainstream" - orthomed details and one sided quotes in the Lede. *Summary* is the purpose of the lede. I suggest small improvements around the "avers" sentence.--TheNautilus (talk) 17:26, 20 March 2008 (UTC)

The converse to the statement "no evidence that megavitamin or orthomolecular therapy is effective in treating any disease" is any reliably sourced published study that shows the effectiveness of any megavitamin or orthomolecular therapy. And there are plenty of those. The statement, whilst published, is so absurdly false that mentioning it in the lead is blatant POV-pushing. It should be mentioned in the bulk of the article where there is sufficient space to examine the statement more carefully and explain the contrary viewpoint. --Michael C. Price ^talk 02:24, 20 March 2008 (UTC)

The thing is that orthomolecular medicine has kind of defined itself as outside mainstream medical practice. I don't get the sense that orthomolecular medicine proponents are out there banging the drum about niacin for dyslipidemia and ATRA for acute promyelocytic leukemia. It seems, from perusing the Journal at least, that OM is largely concerned with advocating the manipulation of vitamins and other nutrients in ways that are not accepted by mainstream medicine. So focusing on niacin as evidence that OM is mainstream or widely accepted seems a bit off. MastCell ^Talk 03:20, 20 March 2008 (UTC)

Niacin's development is one simple historical, factual example that WP:V punctures such an absolute generalization, and distortion. Hoffer's niacin is on the "drug" end of OMM recommendations, where OMM proponents offer a spectrum of biochemically based nutritional strategies and nutrient formulas with various degrees of scientific & clinical studies, even published in mainstream journals.

Orthomed newsletters and books typically *mention* niacin at some point in a relatively saturated publishing market. Robert Kowalski, author of the books, The 8 Week Cholesterol Cure... has pretty much captured the consumer how-to market since 20 yrs ago, probably for both conventionally and orthmed oriented patients (Kowalski references Althschul, Hoffer, Stephens 1955 also). Hoffer (with Andrew Saul, an editor at JOM) of course narrates OMM niacin CVD use (for free) frequently, but niacin gets broader mention just not lengthy indepently written instructions where some letters may focus on answers more associated with naturopathy, e.g. gugalipid, and have lots of other orthomed cardio nutrition to cover e.g. fish oil, vitamin C/lysine/proline/etc, (L acetyl-)carnitine, mixed tocopherols (E), coQ10, betaine-B6-9-12 antihomocysteine, lecithin, lipotropes (e.g. choline), magnesium, chromium polynicotinate and so on. Also the assessed benefits of course diverge between different players, studies over various effects on morbidity, mortality, HDL, triglycerides, ApoB, fibrinogen, VLDL, LDL vs inflammation, insulin.--TheNautilus (talk) 17:26, 20 March 2008 (UTC)

My impression is that the major difference is that OM rejects any use of drugs that are not part of normal biochemistry, so while conventional chemotherapy uses folate and aspirin, OM would only use folate and would not use aspirin. Tim Vickers (talk) 03:23, 20 March 2008 (UTC)

I'm afraid you're mistaken. The "opinion leaders" in "orthomolecular medicine" have never hesitated to prescribe conventional patented medications if and when needed. They are even on the record as saying that in some circumstances it is imperative that conventional medications be used to stabilize the patient, before the slower-acting orthomolecular preparations be employed. The goal, however, is to eventually adduce healing without the need for conventional medicines and their often myriad side-effects. Pfeiffer even described which medications were best used in which syndromes he and others had identified. Phenytoin, for instance, is particularly useful in certain histamine problems.--Alterrabe (talk) 11:16, 20 March 2008 (UTC)

Incorrect, Tim. Even the most ardent orthomolecular medicine MDs, say Klenner, Cathcart and Hoffer, specifically used many ordinary therapies like antibiotics, initial anti-psychotics and conventional cancer therapies alongside their OMM/OMP therapies when either appeared appropriate for a portion of the treatment. They developed orthomolecular therapies with specific molecules and protocols, for specific conditions where the orthomolecular part addressed a specific condition or cause (oxidative attack, viremia, many (bio)chemical toxicities). A lot of OMM is complementary, perhaps you haven't read, or noticed, Pauling (1986) or Hoffer's (most recent) books[20] since you (and I think the source you reference) are still pushing everything as "alternative" where the NCAM version separates alternative and complementary.--TheNautilus (talk) 17:26, 20 March 2008 (UTC)

I don't accept that OM is defined outside the mainstream. The definition is the right molecule. Irrespective of where the molecule is sourced from. So aspirin is perfectly acceptable. Obviously people argue/debate about the disputed stuff, and not the overlap areas -- but that doesn't mean that there isn't a large overlap with conventional medicine. --Michael C. Price ^talk 10:43, 20 March 2008 (UTC)

But look at the laundry list of conditions for which OM claims prevention or cure, in this very article. For virtually all of those conditions, there is no convincing evidence (that is, convincing to a mainstream physician) that "orthomolecular" manipulation of "naturally occurring" substances is effective. It would seem, from that list at least, that OM operates well outside the medical mainstream. MastCell ^Talk 16:57, 20 March 2008 (UTC)

There are several issues. One is that nutrition grading into medicine is being held strictly to the FDA type drug approval. Second is that physicians seem much less trained in nutrition areas than before, certainly their textbooks (Cecil's and Harrison's) have been chopping it out, edition by edition, the 50s & before totally forgotten. Third is that the very exclusive definition of science & EBM being dictated to the medical students, first by the pharmas (ca 1970s-80s they went around and "educated" the existing MDs and students in seminars) now in the med schools, as a holy grail & sole brightline threshhold (but unequally applied) is hotly disputed by others on a variety of ethical, scientific and economic issues, especially for safer substances with much longer, larger experience bases. Fourth is that their overlap is de-emphasized for a variety of reasons including need to focus on the salient differences, the difficulty to identify, document and agree on the history of acceptance/"catch up" parts as well as boat rocking concerns, but may be so large as to justify a separate, difficult article. Both can trace their family lineage to Pauling's "molecular medicine".--TheNautilus (talk) 17:56, 20 March 2008 (UTC)

We could probably argue the "why" questions endlessly, but the more directly addressable content issue is that, whatever the reasons and historical context, OM is currently outside the medical mainstream. Or so it seems to me. MastCell ^Talk 17:59, 20 March 2008 (UTC)

It is classified by all the reliable sources I can find as a form of alternative and complementary medicine, so that is how we must also describe it. Tim Vickers (talk) 20:57, 20 March 2008 (UTC)

As a system, a totality, of course *any single* "heresy" makes it such. The substantial CAM (-suspect) part(s) are identified and discussed as well as largely self evident in the lede. Minor wording may be *improved* with small, less sweeping assertions and errors. Such a narrow presentation as you are pushing inaccurately obscures the fact that many OMM originated treatments, or were first OMM used & accepted, treatments have common scientific roots, even are now fully accepted in medical practice, and even more agreement in current medical research where the pharma detail men aren't exactly spreading the word, where they need to develop products that can be twisted to provide a fig leaf over the harsh market realities of cheap, less proprietary, off patent competition and patients' studied self preservation.--TheNautilus (talk) 23:33, 20 March 2008 (UTC)

Which treatments are you referring to, just so we're on the same page? MastCell ^Talk 23:37, 20 March 2008 (UTC)

Niacin and fish oil are cheap OMM staples, say $3-4/mo, that were used by the OMM influenced public in the 60s and 80s, respectively (I don't think the pharma detail people still like to acknowledge these, at least the fish oil recommendation is only starting to barely show up in the past year from some local cardiologists to my more aged acquaintances). Hoffer is barely formally acknowledged as a reference on "niacin" in the mainstream, never on the orthomed part by the mainstream, otherwise a medical "nonperson". OMM types headed for ~1000+ ug prenatal folate supplement a dozen or more years before the FDA threw in the towel on "diet" & recommended 800ug instead of the internal technical recommendation of 2000ug, as well as before MDs & despite RDs. The OMM types have been offering "iron free" multivitamins for 25+ years for non-anemic, non-menstruating females, only recently taken up wholesale by the conventional vitamin providers with really high iron still sometimes being "tested" (that 2007 paper) in BPH/PSA+ old men by MD/RDs instead of (long) contraindicated or specifically iron managed based on accepted science, where on balance, multis do provide study supported benefits *despite* the lack of adequate individual technical support on selection. Basically orthomed has been on a nutrigenomics approach by inferences (individualization or a least subgroups by limited measurements, theory, trial & observation), decades before the current medical/pharma researchers got funding to support the nutrigenomic concepts with high volume data and facualty. OMM type books did recommended vitamin D3 (over D2), 20+ yrs ago, much closer to the emerging medical school research on 1000-4000iu with a surprising breadth of benefits, even though not remotely optimized for vitamin K or deficiencies.--TheNautilus (talk) 03:59, 21 March 2008 (UTC)

If you can find some modern reliable sources that describe orthomolecular medicine as anything apart from CAM then please add them to the article. Your and my opinions on this subject are irrelevant, the article has to simply report what the sources say. Tim Vickers (talk) 23:38, 20 March 2008 (UTC)

I completely agree that orthomolecular practically inherently carries with it the distinction, perhaps stigma, of being CAM. But I also believe that a lot of orthomolecular research has been done in mainstream settings, here's an example. Could we agree that it is both CAM and part of experimental medicine? Doing so would not attribute the legitimacy that mainstream medicine enjoys, but would also make it clear that orthomolecular medicine is a more serious endeavor than urine therapy and similar approaches.--Alterrabe (talk) 13:18, 21 March 2008 (UTC)

The lead already notes that some valid research is done with biochemicals, more primary sources such as research papers don't add anything to that statement. You need a source specifically discussing "orthomolecular medicine", the 1994 BBA paper you link to does not even mention this type of medicine. In order to state that orthomolecular medicine is anything but alternative medicine, we need to find a reliable secondary source (such as a review or textbook) that discusses orthomolecular medicine as a part of mainstream medicine. Tim Vickers (talk) 15:43, 21 March 2008 (UTC)

There are some problems with your assumptions and implementation on WP:V and WP:RS where there are widely acknowledged systematic biases and even corruption involved in related publishing sources, much less the competing organizations. Also the non-summarized higly selective, partisan quotes are not appropriate in the lede, take it downstairs please.--TheNautilus (talk) 16:17, 21 March 2008 (UTC)

The closest I can come at short notice is this site from the University of Kansas, which describes the endowed chair for orthomolecular medicine, and by implication the orthomolecular research performed there, as part of "[integrative medicine]". Integrative medicine, Wikipedia notes "according to the NCCAM, integrative medicine, or integrated medicine, "combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness...." If these are WP:RS and accurate, then orthomolecular medicine isn't mainstream medicine, but neither is it quite CAM, but rather a hybrid of some sort. When the recipient of an "Endowed Chair for Orthomolecular Medicine and Research" publishes on topics generally considered part of orthomolecular medicine and gets published on medline, [21] it's indisputable that there is an effort underway to meld orthomolecular and mainstream medicine. How would you do this justice?--Alterrabe (talk) 16:23, 21 March 2008 (UTC)

That's all your interpretation I'm afraid. We need a clear statement in a secondary source such as a textbook or review article. I've cited a medical textbook and Annual Reviews in Nutrition as secondary sources, and the American Cancer Society as a prominent medical organisation. Similar sources are needed if we are to give these views equal weight. Tim Vickers (talk) 16:55, 21 March 2008 (UTC)

(Over)loading up and poisoning the Lede is a problem that is not a reference problem, it violates NPOV and SOAP. We are having difficulty on WP:RS and WP:V where you are preferentially quoting major hatchet grinders, with either zealous or economic conflicts, that have suffered notable criticism and even court losses on nutrition related activism. Also, I am going to suggest that you review WP:COI.--TheNautilus (talk) 17:16, 21 March 2008 (UTC)

By such standards, you're correct that WP:RS would have OM be part of CAM.--Alterrabe (talk) 17:26, 21 March 2008 (UTC)

Frequent misconceptions (cont'd) & V RS text

The above statements[22][23] show that more V RS, precise text is needed to help clarify rampant misinformation & distortions, decades long, being repeated here. These underlying distortions, misrepresentations and erroneous "factoids" often derive from WP recognized unreliable sources, that are also V RS noted to have severe "systematic bias". I have added the V RS direct quote to show Pauling's intro of orthomolecular medicine in 1967. LP's 1967 introduction ties mainstream accepted "molecular medicine", that LP pioneered, to his evolution & definition of the "orthomolecular" category. Also the confusion over various (over &) megadosage (including non-OMM) related topics being synonymous with OMM continues, including with the historical dates. I have added orthomolecular type examples, related to OMM topics of interest, dating to earlier 1906 & 1909 scientific and medical publications.--TheNautilus (talk) 21:03, 27 March 2008 (UTC)

I realise English may not be your first language, but could you possibly rewrite this comment so that your meaning is a little clearer? Tim Vickers (talk) 21:22, 27 March 2008 (UTC)

Thank you, that's a bit clearer, I assume when you say "the V RS direct quote", you mean a "direct quote from a reliable source"? I do sometimes find the meaning of your talk page comments very hard to grasp, this may have contributed to the misunderstandings between us in the past. Tim Vickers (talk) 22:17, 27 March 2008 (UTC)

The "Cancer Medicine" p. 76 Dekker reference is not available and will not be easily available to me and, probably, most editors. Could you excerpt the p. 76 paragraphs that refer to OMM to the new subpage that I've created, please? Thanks.--TheNautilus (talk) 16:22, 29 March 2008 (UTC)

Actually I chose that one since it is freely-available on-line through the NCBI (Link). Tim Vickers (talk) 18:54, 30 March 2008 (UTC)

Thank you for the linking to the section of the book. Linking it at the first instance would be even more appreciated. You asked what I meant by V RS. In short, the usual with more emphasis on fact checking. What are often presupposed as RS sources about CAM, especially orthomolecular medicine, despite the obvious economic conflicts of interests of many of the supposed authorities, is that their statements are often flatly contradicted by WP:V facts. Often fact checking is needed to weed out, at least, the most blatant forms of bias and error by these supposed authorities or authoritative statements on orthomolecular medicine. Especially when the "expert sources" distort, insinuate, omit, misstate, etc the OMM definitions, practices and hypotheses so badly, or that they generalize about their own "mistakes", while they seem to trend heavily into scientific misconduct. WP:V & Science cuts both ways, and we need to discuss some of the recent references that you've given in this vein.--TheNautilus (talk) 09:03, 31 March 2008 (UTC)

With all due respect, this seems to cross the boundary into WP:SYNTH of WP:OR.--Filll (talk) 18:06, 31 March 2008 (UTC)

Whose? Which part? There are lots of issues here. The clear bias & error discussions immediately above are traceable to sources where their complaints are also WP:V (e.g. "experts" WP:V sandbagged experiments in 2-3 serious, hard to AGF or remain RS, ways). As I said, including the AMA ref and the verbiage, especially in the lede, appears SYNTH or OR (or off topic). You might consider reviewing the Talk page and archives, por favor.--TheNautilus (talk) 18:58, 31 March 2008 (UTC)

I'm afraid your comment here is almost indecipherable, please try to express your ideas more clearly, or we will be unable to consider your arguments. Tim Vickers (talk) 19:33, 31 March 2008 (UTC)

I am asking Fill to clarify his previous comment, consider confounded "mainstream" sources' bias, and review the OMM Talk archives on V, RS & "science" issues that bedevil this article. Although I may need to precede long sentences with shorter summaries, you seem to have difficulty with complex subjects & sentences in this unfamiliar area.--TheNautilus (talk) 20:05, 31 March 2008 (UTC)

I honestly do my best with your comments, but what you might mean by phrases such as e.g. "experts" WP:V sandbagged experiments in 2-3 serious, hard to AGF or remain RS, ways is very hard to discern. I could try to guess, but that will only lead to misunderstandings. Tim Vickers (talk) 20:12, 31 March 2008 (UTC)

Inborn errors

Besides the two references that I gave, Inborn 1, Inborn 2, that discuss Stone's and Pauling's position on the subject, you should consider the following. From a mainstream reference, "Orthomolecular Therapy: Its History and Applicability to Psychiatric Disorders", pp 140-141, the section, "Vitamin responsive Inborn Errors of Metabolism": ..a number of the genetically determined inborn errors of metabolism were further delineated as treatable disorders. It was noted that in these disorders an increase in individual vitamin requirements (by a factor of 10 or more), was necessary. [...] Hillman[1976] summarized fourteen such vitamin-dependent amino acid disorders. [...]their responsiveness to treatment does underscore the possibilities of megavitamin treatment [...] All of these disorders must be treated with amounts of vitamins far above those required for normal maintenance (i.e. megavitamin dosages)--TheNautilus (talk) 09:12, 31 March 2008 (UTC)

The fact that all humans lack a step in the ascorbate biosynthesis pathway is what makes this compound a vitamin. Describing that as an "inborn error of metabolism" is simply absurd, since this is a biochemical peculiarity shared by all of members this species - are you arguing that all humans are ill? The pyroluria "diagnosis" is not a human genetic disease since this is an entirely hypothetical condition that isn't accepted by mainstream medicine: no studies have confirmed its existence, so no studies have shown it to be inherited, and consequently no studies have identified any genetic locus associated with the diagnosis. This is an abandoned hypothesis from medical history, not a human genetic disorder. Tim Vickers (talk) 16:33, 31 March 2008 (UTC)

I said their "position". Try not to miss Stone's points: (1) daily quantities of vitamin C for normal (often not so great) human health, orthomolecular usage would not be a micronutrient anymore, but rather an essential (macroscopic) nutrient when vitamin C is used as an exogenous nutrient at daily quantities roughly weight proportionate to endogenous production of most mammals (~ 3 - 20 grams continuous across the day depending on species and human body weight). (2) our lack of an unscrambled version the final genetic step to convert glucose into ascorbate could be viewed as a genetic disease, as well as an evolutionary result.

We classify sickle cell syndromes as disease when in fact they too are evolutionary artifacts that help prevent one kind of mortality but cause another. In any case, the Menolascino paper moots any mainstream question that inborn errors concern, or are treatable by, orthomolecular medicine.--TheNautilus (talk) 17:50, 31 March 2008 (UTC)

Even if orthomolecular medical proponents do seriously describe a universal human trait as a "genetic disease" it would be completely unbalanced to present this argument as a factual assertion in the lead. We could examine this strange claim that all humans suffer from a genetic disease in a later section, but this must be presented as an opinion, not as a fact. Tim Vickers (talk) 17:57, 31 March 2008 (UTC)

The "individual biochemical variation, inborn error of metabolism, and exogenous supply" phrase at "History and development", much less in the lede, doesn't assert "C-less genetic disease". Rather Stone's hypothesis is part of several OMM discussions in Magner's reference [24] on a historically notable OMM related hypothesis (and still largely unaddressed) on the topic of inborn errors related to orthomolecular medicine. Relative benefit of genes *can* dramatically change with the environment, from an advantage to a liability. Modern medicine simply has not scientifically addressed the various issues, either - e.g. for just one issue, show me *any* medical work on daily use of 2+ grams C/day at a frequency of 5x or more (to approximate continuous higher blood levels). Various OMM pioneers on this one subject have expended part of their meager resources to find and develop the hypotheses more fully into useful, working hypotheses that even high school dropouts can apply in a technically consistent manner with good results.--TheNautilus (talk) 18:58, 31 March 2008 (UTC)

The working hypotheses of high-school dropouts must not be presented as facts in the lead sections of encyclopedia articles. We can discuss these creative and provocative ideas in the text of the article, but such speculations do not belong in the summary, and cannot be presented as factual information. Tim Vickers (talk) 19:31, 31 March 2008 (UTC)

You just totally misstated my comment about vitamin C & Stone (I said, "working hypotheses...even HS dropouts can apply") on the 1st paragraph of the "History and development" section, and continue to POV push biased drivel in the lede with undue weight. No such speculation of mine or Stone's in the lede summary - however the trade union's anticompetitve blurb, and a known extremist partisan, get a free pass on such loaded statements & speculation that fail WP:V factchecking, NPOV, COI? Again I am going to suggest that you (all) take a hard look at WhatamIdoing's suggestion that I consider most neutral: ...Furthermore, the [critical] paragraph could be accurately summarized simply as "Critics think this controversial field needs more scientific research to support its claims."--TheNautilus (talk) 20:19, 31 March 2008 (UTC)

Claiming that there is a conspiracy to suppress a view that is regarded as a fringe viewpoint by reliable sources is not an approach that will get a great deal of traction with other editors. I suggest you confine yourself to reporting what reputable and notable medical organisations and high-quality peer-reviewed journals have published on this topic. Tim Vickers (talk) 21:04, 31 March 2008 (UTC)

I am not alleging "Conspiracy theories", where in fact the said trade union has been legally found, multiple times, to engage in anti-competitive behaviors with less science based healing arts, e.g. see the Wilk et al cases. However that trade group's journal papers have been repeatedly criticized by mainstream medical researchers, other medical journal editors, and mainstream physicians for bias and poor content control, as well as being heavily financially beholden to certain kinds of advertisers.

I have been using fact checked WP:V & RS sources, OMM & mainstream (e.g. BMJ) to qualify my edits, most recent refs, 22-26. You need to honor WP policies on several aspects. Your reference (an opinionated blurb) and the WP articlespace text is not even a personally signed/attributed article, much less an independently peer reviewed paper. It is some committee's webpage by a known economic competing organization citing the extremist, technically-unreliable-at-WP-organizations' authors (e.g. Renner, Jarvis, Sampson, Barrett) en masse; rather it is a short, sweeping blurb with loaded statements that does not mention orthomolecular medicine but that you have generalized (OR) to include orthomed. See also NPOV, and again, [25].

Very simply, the most balanced, scientifically based criticism of OMM I have seen is the Menolascino, et alpaper even though they tend to acknowledge an OMM point's concrete existence or its plausibility, drop it, and drill on toward the negative in the more difficult OMP area and present OMM uncertainties in a *somewhat* unduly negative light.

A number of the points that I am engaging you over are not "fringe science" and have hard, long medically accepted examples such as megavitamin therapies for cystanthiourea, homocystinuria, classical maple syrup disease ^{Menolascino et al} and at least a dozen others. Other points that you are either missing or tendentiously pushing derive from extremists who ignore concrete examples, definitionally distort or heavily load statements in grossly unscientific ways. These include items that are V RS categorically stated by orthomed sources, also sometimes by mainstream sources, and frequently *are* fact checkable to see which version is factually correct, not just your pov, QW / NCAHF POV, or AMA COI opinions & distortions.--TheNautilus (talk) 23:24, 31 March 2008 (UTC)

Take a break

I think this talk page needs to have no more posts today. We're making no progress. Can we agree to leave the article alone for a day or two, and then try again from a fresh perspective? If so, post here, and I'll archive this 175 kb talk page tomorrow. WhatamIdoing (talk) 02:44, 1 April 2008 (UTC)

I'll try to be off here for two days.--TheNautilus (talk) 03:55, 1 April 2008 (UTC)