Talk:Orthomolecular medicine/Archive 6

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Request for comment on the attribution of criticism in the lead

Which version do people prefer, in light of the NPOV policy? Tim Vickers (talk) 17:22, 21 March 2008 (UTC)

Version 1

Some therapies that meet the criteria Linus Pauling established to define orthomolecular medical therapies, such as the use of vitamins and nutrients to treat dyslipidemia, are also used in mainstream medicine. However, the scientific and medical consensus is that the broad claims of efficacy advanced by advocates of orthomolecular medicine are not adequately tested as drug therapies, where oppononents and partisans have even described it as a form of food faddism and quackery. Proponents of this approach to medicine note that some research investigating the therapeutic use of nutrients have been published in mainstream sources, and that vitamins are used in conventional medicine as treatments for some diseases.

Version 2

Some conventional therapies use nutrients, such as using niacin to treat dyslipidemia, and some research investigating therapeutic uses of nutrients has been published in mainstream sources. However, the scientific and medical consensus is that the broad claims of efficacy advanced by advocates of orthomolecular medicine are unsupported, with the American Medical Association saying that the idea that most diseases can be prevented by nutritional interventions is a myth. Orthomolecular medicine has even been described as a form of food faddism and quackery.

Involved editors comments

• I prefer version 2, since it directly cites a notable medical organisation and does not use the POV term "partisan" in describing the author of the review in Annual Reviews of Nutrition that described this form of alternative medicine as food faddism and quackery. Tim Vickers (talk) 17:22, 21 March 2008 (UTC)
• Version 1 provides a substantial summary notice that there is notable disagreement from various opponents and economic interests. Anymore detail, even with balancing quotes, overloads the lede and favors the critics by obscuring the basic coverage, description & definition of orthomolecular medicine, where so many, including its "expert" critics cannot even get orthomed's basic concepts, science, experimental/clinical evidence & history straight.--TheNautilus (talk) 17:32, 21 March 2008 (UTC)
• I find version 1 more appealing. Version 2, however, would be great if it were expanded to include the fact that Linus Pauling emphatically disagreed with the notion that his claims were unsupported. There are multiple WP:RS for this.--Alterrabe (talk) 17:54, 21 March 2008 (UTC) We could separate the debate over partisan from that about including the ACS in the lead.--Alterrabe (talk) 18:07, 21 March 2008 (UTC)

I've added a section on the history to the lead, which explains the role of Pauling in establishing this field and tried to remove the wordiness by condensing the rest of the text. Hopefully this will make the lead more readable and summarise the article better. Tim Vickers (talk) 20:49, 22 March 2008 (UTC)

Uninvolved editors comments

Comments by Antelan (talk · contribs)

• OK, well I'm a bit confused about the reference to food faddism in the lead if it's not in the body of the article. If someone could explain that to me I'd appreciate it, and I'll hold off on making a judgment between the two versions until then. Thanks, Antelan^talk 20:15, 21 March 2008 (UTC)

I've added an expanded definition of that term to the "Views on Safety and Efficacy" section, added a paragraph on the history of OM to the lead, and trimmed the wordiness a little. Tim Vickers (talk) 22:24, 22 March 2008 (UTC)

Thanks. I find Version 2 more useful for the following reasons: (a) it avoids the point-counterpoint argument being set up in Version 1; and (b) it points to specific, rather than general, criticisms. Antelan^talk 23:00, 22 March 2008 (UTC)

Comments by WhatamIdoing (talk · contribs)

• In terms of a well-written introduction, I don't really like either of the options. They are both wordy (for example, "opponents and partisans") and assume knowledge that the first-time reader doesn't have (like why Linus Pauling's definition matters). Furthermore, the paragraph could be accurately summarized simply as "Critics think this controversial field needs more scientific research to support its claims." I dislike option two slightly less than I dislike option one. Option one promotes the wrong standard for testing the field (you test a specific compound for a specific disease in a drug trial, not the "broad claims" of all advocates). If option one is chosen, then the word "partisans" should be struck from the first option as being POV and redundant to boot. However, I think that reading WP:LEAD and starting over entirely might be the best option. WhatamIdoing (talk) 22:41, 21 March 2008 (UTC)

Your comments on one of the recent, one paragraph lede, a previously more stable version would be appreciated. To see the wordsmithing and then some (d)evolution of the lede, it appears to start about here. I have set up the subpage for editing and comparing suggestions & changes.--TheNautilus (talk) 00:26, 22 March 2008 (UTC)

It is getting wordier and more poisonous POV pushing the lede instead of a one sentence note that there is strong disagreement to be expanded upon in the body.--TheNautilus (talk) 06:51, 23 March 2008 (UTC)

Comments by Filll (talk · contribs)

I am sort of confused since they both have criticism in the LEAD. However, I ahve to agree with Tim Vickers that I like the attribution to the AMA. I do not mind the point, counterpoint, but it might be a bit much for the LEAD. Better to save this for the body.--Filll (talk) 23:46, 24 March 2008 (UTC)

Comments by Vuo (talk · contribs)

• For reliability as a source, it is necessary to mention the American Medical Association's criticism if the title includes the word "medicine". Also, consider scenarios (1) and (2): (1) an official body (AMA, FDA, etc.) does not consider the treatment scientifically tested for efficacy, and this is the general consensus in medicine (2) there is a general state of disagreement in the medical/scientific community about the efficacy. If the situation is like (1), then it has to be written differently, with no "sides of disagreement". If it's like (2), then you can have "sides" even in the lead. The reason is that there are theories rejected as unscientific in all sciences; their proponents tend to "teach the controversy", and make an impression that there is genuine disagreement within the scientific community. It is necessary for an encyclopedia to be "shielded" against attacks like these that attempt to use the site as a soapbox / for free hosting. --Vuo (talk) 16:15, 26 March 2008 (UTC)
  • Summarizing, Version 2 is better, because it is shorter and doesn't introduce "proponents" and "opponents". Everyone can be a proponent or opponent. Everyone isn't a PhD in Medicine. --Vuo (talk) 19:07, 26 March 2008 (UTC)

• Can someone list the respective sources used by the two versions ? It will greatly help me (and possibly other uninvolved editors) judge whether the statements reflect, (1) what the cited sources say and (2) whether the sources are being properly weighted and characterized. Thanks. I am too lazy to read the version in edit mode! :) Abecedare (talk) 19:58, 2 April 2008 (UTC)

This updated, shorter version (3c), with handy references, attempts to address the text and reference issues. Because of the extremely contentious nature of this area, *and the construction of the lede* it seems RS would demand a higher quality reference for such an unbalanced quote with partisan sources, where the implied imprimatur is abused at both the AMA level (for non peer reviewed references), and here, both as OR and an attack, where there peer-reviewed counterexamples, such as mainstreamed megavitamin therapies. As a source for "A controversial field deprecated by some critics..." in (3c), it would be less problematic, but strictly speaking, IMHO, WP:OR.--TheNautilus (talk) 20:57, 2 April 2008 (UTC)

Comments by Abecedare (talk · contribs)

Having gone through the cited sources, I think version 2 is better in terms of accurate and NPOV representation of the material (remember, NPOV does not mean equal weight to all sides). Following are some more detailed observations:

• Problems with version 1
  • The "he said-she-said" formulation is unsatisfactory since it fails to provide sufficient information to the reader in the main text, about who the opponents and proponents are that would enable him/her to form an educated opinion about the credibility and authoritativeness of the two sides. Naming AMA in the second version at least partially ameliorates this concern.
  • The phrase "opponents and partisans" is clearly POV.
  • "Proponents of this approach to medicine note ..." See words to avoid
  • Aranson's "There is no evidence ..." is better characterized by the word "unsupported" in Version 2, than the "not adequately tested" in Version 1. (Minor point: The sentence in version 1 is grammatically incorrect, since it implies that the claims are "not adequately tested as drug therapies").
• I am not sure that the two sources on behavioral benefits from nutrient supplements are relevant to the sentence they are used to support, since as far as I see this is not "research investigating the therapeutic use of nutrients." Note that neither of the two sources talk about "therapy".
• The role of Linus Pauling as a "significant force in promoting 'orthomolecularism'" (Jarvis, 1983) should be mentioned somewhere in the lede, though not necessarily in this paragraph.

Abecedare (talk) 21:07, 2 April 2008 (UTC)

Thanks. Your first 3 points are an interesting guide development of the future text. The 4th point is a discussion (later).

Your 5th point has two answers. One on the BJP & Economist references, version 1 above, this OMM article used to explicitly include OMM and "optimum nutrition", not just "OM medicine". "Optimum nutrition" has tended to get lost in the scuffles over the lede. Second, is that the referenced supplements are more like OMM "optimum nutrition" in five components: GLA, DHA, EPA, chromium, and molybdenum. The multivitamins and other minerals are relatively ordinary but still more than the standard "diet alone" nutrition views.

Your sixth point about Pauling's role is fine, however other references already make the point about Pauling's effect probably better. Jarvis was a frequent contributor to (tiny, WP technically unreliable) NCAHF extremism, where WP article improvement is reference improvement for more mainstream views that are in the mainstream of science writing. I hope that you will consider Menolascino's (1988) criticism as a much more scientifically informed and balanced mainstream medical reference.--TheNautilus (talk) 23:31, 2 April 2008 (UTC)

A quick response about my Linus Pauling comment: I didn't mean to suggest the exact wording for the inclusion or that Jarvis should be used to reference this fact. I only meant to indicate that the "LP-othomolecular medicine "association seems significant enough to be mentioned in the lede somewhere. Sorry for not being clearer. Abecedare (talk) 23:57, 2 April 2008 (UTC)

This is mentioned in the current version of the lead, this RfC is only considering the final and controversial paragraph of the lead. Tim Vickers (talk) 00:35, 3 April 2008 (UTC)

Comments by EdJohnston

• I came here because of the notice at WP:RSN. I am satisfied with Version 2 of the lead. I don't believe that entire pedigree of the AMA needs to be placed in evidence before we can simply give what is almost a direct quote from their statement. Relevance to the topic of this article is clear; they might be misguided but that is what they said. They didn't use the word 'orthomolecular' but they did say the thing that is attributed to them in Version 2. Orthomolecular medicine does have something to say about nutrition, and the AMA was giving a general comment on the idea that "most diseases are caused by faulty diets and can be prevented by nutritional interventions". EdJohnston (talk) 17:00, 4 April 2008 (UTC)

The AMA quotes are obsolete from flawed sources and loaded/overqualified e.g. "most" is misleading, "prevention" only is misleading too. Simply good sources for the "skeptipedia" mainstream on orthomolecular are tough to get - which is interesting since "mainstream" sources should be easy, especially for "mainstream" WP editors with better libraries and databases. Partisan AMA committees keep pushing tobacco quality research and reporting, or AMA keeps this serving this obsolete 1997 stuff after the major changes in vitamin C & D research status, I suspect AMA is going to shrink some more just for doctors' self-preservation. We need better *summaries*, not personalized or so much factional POVish sound bites. I also notice some of the recent skeptical books have ducked criticizing orthomed "megavitamin" topics (maybe they don't want to be AMA tobacco class buffoons down the road).--TheNautilus (talk) 03:39, 5 April 2008 (UTC)

I hear you criticizing the AMA but I don't hear you disagreeing either with (1) relevance, or (2) that they were correctly quoted. EdJohnston (talk) 04:01, 5 April 2008 (UTC)

I stress date of reference a great deal because several events ca 2001, particularly with increased vitmain D, say RDA of 1000-2000iu vs 200-400iu, and IV vitamin C in the research results of mainstream medicine, form sort of a line in the sand with organizations like AMA, ACS about "science" and therapeutic nutrients, 1,000,000 BC vs 4 AD and obsolete or "tobacco buffoon" quotes. Again, I do not think it appropriate to use unrebutted material in the brief lede section, especially poorly attributed statements (without "orthomed...") from less RS & current sources. In unfamiliar nutrition areas, seemingly small surface differences noticed to the unwary often reflect indications of larger differences, so indiscriminate "nutrition" quotes as orthomed are highly suspect for RS and accuracy. I think fair summary is more appropriate anyway, across the industry, similar to this second paragraph Draft version that could use some collaborative suggestions.--TheNautilus (talk) 09:23, 5 April 2008 (UTC)

Comments by Hcberkowitz

I also came to this discussion via RSN, and, frankly, see serious problems with both leads. Yes, it is true niacin is used to treat certain dyslipidemias, and can be excellent for the right set of abnormal lipids, and, more important, that a patient can tolerate it in the doses used for dyslipidemia. While I fully understand the singular of anecdote is not data, my allopathic physician and I, after reviewing the literature and getting a second cardiologist opinion, decided niacin was an appropriate treatment. Unfortunately, while it did great things for my lipid profile, it gave me acanthosis nigricans, or leathery and bleeding skin that was disabling. As soon as the high-dose niacin was stopped, my skin came back to normal, and my lipids are just fine with other drugs. I emphasize drug, because the niacin doses that do have demonstrable effect are very high, and can induce toxicity.

Another problem I have with both leads is that I was unaware -- and I'm willing to stand corrected -- that Pauling had proved any medical benefit for anything. Disproved some studies for bad methodology, yes. Offered bypotheses that could be evaluated in a randomized clinical trial run by qualified clinicians, yes. Directly doing human experimentation, no.Howard C. Berkowitz (talk) 19:20, 4 April 2008 (UTC)

Pauling and a Scottish physician did perform some clinical trials. The results and their interpretation are still debated to this day.--Alterrabe (talk) 20:35, 4 April 2008 (UTC)

I am not sure what text the "proved" part concerns Pauling. Pauling was associated with molecular disease research and ameliorating metabolic errors in the 1950s that involved *withholding* certain nutrient substances. His degree of "credit" and "proof" - will have to work on it. Pauling worked with Scottish surgeon Ewan Cameron on ameliorating cancer in an area that had amongst the highest cancer rates in the (industrialized?) world at the time and half the US RDA on vitamin C in a closely controlled and observed hospital setting with intravenous and then oral vitamin C. Later Pauling worked to support Abram Hoffer on his clinical cancer series studies with complementary and oral vitamin C + other increased nutrients.--TheNautilus (talk) 03:20, 5 April 2008 (UTC)

It's hard to comment on proof without a better idea of the study design. If the work with Cameron was in an area where, presumably, there was a high incidence of cancer in the community, are you saying he hospitalized people without cancer, gave them IV and oral ascorbic acid, and then drew conclusions about a decrease in the incidence of cancer? How does one compare a hospitalized patient environment with a community environment? IV therapy on an outpatient basis is bleeding-edge today.

To me, the best community studies are things like the Framingham or Nurses' studies, which use large populations over a long period of time, but in their community environments. The variables indeed may be diet, or supplements, or presumably prophylactic drugs. Howard C. Berkowitz (talk) 23:10, 6 April 2008 (UTC)

The Pauling-Cameron clinical studies were done against local controls provided by other doctors' treatment of matched patients (Controversy #1). My primary point is to highlight just a little how different all aspects of testing were between Moertel and Pauling-Cameron's methodology and their patients. Bleeding edge? Historically, vitamin C deficiencies were associated with cancer related descriptions in old sources. IV vitamin C therapy is only new to the young MDs, an orthomed pioneer used it at least as early as the early 1940s, routinely reaching 30 - 150 grams IV ascorabate in the 1950s, his results repeated clinically by others in different decades and languages. As the IV amount cruises past 100 grams ascorbate per day, attention to osmolality and electrolytes balance apparently becomes important, and then crucial above 200 or 300 grams. The bleeding edge basis of human experience with IV ascorbate apparently extends, well, very high, to an osmolality limit.^{Warning: not a dbRCT based study:} A generation ago, to recover a hopeless MRSA vancomycin resistant case in an ICU, involving a family of well connected lawyers, a hospital apparently allowed the staff to try a "hail mary" treatment to save *one* of these lawyers, from near dead to walking out in 10 days. Who said lawyers are useless to medicine?--TheNautilus (talk) 00:19, 7 April 2008 (UTC)

No, you misread: IV therapy on an outpatient basis is bleeding-edge today. WhatamIdoing (talk) 03:24, 7 April 2008 (UTC)

Sorry, to clarify, most/many of the IV treatments within 150 grams/day since the 1940s (Klenner) seem to have been done on an outpatient basis, homes and dr's office. From the available papers, someone needing over 150 grams/day is in dire shape that is likely to already be in the hospital. My point was simply where OMM's (b)leading edge has already been.--TheNautilus (talk) 07:58, 7 April 2008 (UTC)

I'm confused as how the selection was done. Did one group of physicians select both controls and treatment group? That's fairly standard, with the treating physicians blinded as to why a patient was selected. Correct me if I misunderstand, but did the physicians giving the IVs know whether they were giving ascorbate or placebo? I may be wrong, but so far, it doesn't sound as if there was randomization or blinding.

I'm also not sure about your VRSA example. While, today, we have vancomycin alternatives like the streptogramins, vancomycin or methicillin resistance does not mean resistance to all combinations of conventional antibiotics. A good infectious disease specialist will also dust off some of the older drugs, rarely used, on the not totally random chance that the infecting strain has not kept the resistance to things that were many generations of natural selection back. Is it useful to the bacterium, for example, to "remember" how to defend against sulfadiazine? It's not unreasonable to suggest that there is a metabolic cost, to the bacterium, of maintaining every possible resistance factor.

Now, it is arguable whether saving lawyers is a social good. :-) Nevertheless, in quite a few years of looking at medicine, if there isn't RCT evidence, then we are at a point where I want to see some molecular pharmacological explanation of how a "hail mary" treatment is going to work. It happens that my medical surrogate has a strong interest in herbalism, but we have agreed, over her protests, that if I had terminal cancer, I want palliative measures, not a "hail mary" herbal cocktail whose inventor was too busy to have any mainstream reserchers evaluate it. I'm not opposed to all CAM, but I expect CAM practitioners to know their limitations. While I've had chiropractic treatment referred by an allopathic physician, I also lost a close relative to a chiropractor that kept insisting that what any minimally trained clinician would know was visceral pain was a backache caused by misalignment. By the time his aortic aneurysm blew completely, 100 miles from Houston, it was too late to move him.

If the orthomolecular people aren't willing do dbRCT, or give a explanation of why their approach works, within current standards of molecular pharmacology, I'm not willing to play with them on Wikipedia.Howard C. Berkowitz (talk) 03:43, 7 April 2008 (UTC)

I thought the "connected lawyers" part was interesting because it took that big of a hammer to concentrate the hospital's thought processes (there is another story of an accidentally hospital damaged lawyer, few connections, that started as $50+ million in lawsuits, settling for under half...almost a generation ago, where they sued everything (mfrs) & everyone in the area). From the doctors' pt of view (no love lost...), the thought that experimental rats usually cost, rather than pay, seemed a piquant turnabout.

Most historical orthomed clinical evidence is from clinical series or repeated, dramatic recoveries from the almost dead or dire straits, class II evidence.

Orthomed doctors have repeatedly applied & struggled for support for studies (they complain through the decades, Pauling's rebuffs were not the first), and apparently have been almost uniformly denied since ca 1937, Sabin "retesting" Jungeblut's work. Sabin "proved" Jungeblut's IV vitamin C didn't work on polio by cutting the dosage to 1/4th and increasing the severity of the infection technique, deprecating his failure as vitamin C's failure. For polio, Klenner came along ca 1948-9, increased Jungeblut's dosage with multiple treatments per day, plus thiamine for neural damage, and claimed 100% success on polio, 60/60, including already flaccid cases.

Almost no funding - in the 1990's, privately raised funds supported Riordan to investigate and document protocols similar to Klenner's in cancer, leading to the NIH studies published in CMAJ and PNAS, including pharmacology & pharmacokinetics that happen to pretty much agree with the 1930s-50s discovery era research & hypotheses mentioned by Klenner in the early 1950s. There is some NIH dbRCT study on pure IV vitamin C in progress right now. What is sad is that IV vitamin C in *large* doses has always been considered most reliable for antiviral use and most toxins, still waiting on funded support 60+ years from Klenner (70+ yrs if you count Jungeblut). Pauling represents orthomed's lowest vitamin C doses for statistical improvements and first scratchy throat. LP's recommendations have never been tested either despite dozen & dozens of tests at much lower doses & frequencies (e.g. once/day vs hourly) that are quoted to "refute" him.--TheNautilus (talk) 07:58, 7 April 2008 (UTC)

AMA discussion

In response to your concerns about the inclusion of this source, I have posted a question at the RS noticeboard so people can discuss the issue. Tim Vickers (talk) 17:16, 2 April 2008 (UTC)

I think that RS/N is premature, as I said before , since, after naming its targets, the AMA doesn't even state "orthomolecular" anywhere - that makes it Original research or offtopic. Also many editors *are* AMA members or unfamiliar with the underlying issues that especially concern orthomolecular medicine.--TheNautilus (talk) 17:44, 2 April 2008 (UTC)

...Um... do you have any evidence that editors are AMA members? Shoemaker's Holiday (talk) 11:25, 3 April 2008 (UTC)

Yes, but presenting that would get me in trouble and be improper for several reasons. See also Doctorfinder. I think that it is easier to confirm that they routinely claim here to be physicians and often have similar views. Also note the "or" part, which is largely my OR, but the Talk pages here (and elsewhere) are my evidence.--TheNautilus (talk) 14:33, 3 April 2008 (UTC)

Well, perhaps, but aren't pretty much all American doctors AMA members by default? I mean, if we're talking about them being high-ranking AMA members able to set policy, that's one thing, but I think you're presuming professional bodies have more control over their members than is reasonable if simply having membership in an organisation which almost every American in the medical profession gets membership in by default is your evidence of bias. Also Tim Vickers, who along with you is the main editor here in the last couple weeks, is Scottish, and the American Medical Assosciation is not generally considered to have power outside of America. Shoemaker's Holiday (talk) 14:49, 3 April 2008 (UTC)

My note is mostly cautionary. The doctors are in and out. Many editors I do have to invest substantial effort in education about orthomed items to carry a conversation. Tim's interests appear to me to be antithetical to most basic orthomed claims.--TheNautilus (talk) 15:27, 3 April 2008 (UTC)

Reportedly, 15–20% of practicing physicians are AMA members. While the actual number is a bit nebulous, it's almost certainly a minority. I'm not a member, though they keep sending me enticements. The AMA looms large as a bad guy in the alternative-medical world for largely historical reasons. I doubt there are editors who are here to push a "pro-AMA" POV, though I suppose it's possible. I think it's more likely that many editors simply regard the AMA's statement as a notable and reliable source describing one element of mainstream medical opinion. Familiarity with the in-universe aspects of orthomolecular medicine isn't a requirement to edit the article. MastCell ^Talk 16:15, 3 April 2008 (UTC)

Archive

I've archived the enormous talk page, using the "move page" method to preserve the edit history. Let's start over, with a clean slate. Maybe we could discuss something simple, like whether #Orthomolecular doctors and #Orthomolecular scientists could be merged, before getting back to the complications of writing a perfect lead. WhatamIdoing (talk) 05:32, 2 April 2008 (UTC)

Notable

"Notable OM Drs & Scientists" would be okay with me. I prefer the previous 3-4 column format, too.--TheNautilus (talk) 12:09, 2 April 2008 (UTC)

What do you think about "Notable supporters"? The word "doctor" makes me itch, because it can legitimately include PhDs, but is usually received as "licensed physicians." WhatamIdoing (talk) 18:30, 2 April 2008 (UTC)

Ooooh, outed my cultural assumptions. "Notable OM Physicians & Scientists"? AFAIK, most, or at least the notable non-PhD/DSc "doctors" are MDs and foreign versions.--TheNautilus (talk) 18:50, 2 April 2008 (UTC)

I can support that. On further reflection, it has the added advantage of keeping the size of the list under control. "Supporters" could have been interpreted as "anyone with a website or quoted in a magazine article." Would you like to merge the two sections? Perhaps we could alphabetize the names, and use {{div col}} or some such template to make the information more compact? WhatamIdoing (talk) 20:47, 2 April 2008 (UTC)

Lead

I also agree that leaving the lead alone for a while in the form approved by the RfC is an excellent idea. Tim Vickers (talk) 17:08, 2 April 2008 (UTC)

Thanks for your prompt attention, I said 2 days off. I thought we should try a more neutral, less injurious version on for size, we could still talk. The "faddism" and "quackery" are not acceptable lede material, they are poisonous attacks given WP:UNDUE weight often based on highly flawed allegations & distortions, even trivially obvious in the scientific senses. Because of the historical facts on major OMM areas, although I will agree that vitriolic critics are notable in the general sense, their inflammatory misrepresentions & coverage promoting distortions & scientific misconduct that scientifically & commercially interferes & unfairly deprecates others' legitimate results should be discussed where there is space for balancing quotes, references and reader's (yawn) voluntary continued interest.--TheNautilus (talk) 17:44, 2 April 2008 (UTC)

Yes, there are some concerns with the lead, but let's give it a rest for a while. Perhaps over the weekend, we can start a fresh subpage to edit the lead -- edited just like it was the real article, until we can get a reasonable compromise that we can then paste into the article.

One suggestion in the meantime: If there's something that you want to eventually be included in the lead, would you please make sure that it's present in the main body of the article? The guidelines state that the "lead section should briefly summarize the most important points covered in an article," and I'm inclined to enforce the covered in the article bit fairly strictly. So if you want any particular point in the lead, please make sure that it's appropriately represented in the article. WhatamIdoing (talk) 18:40, 2 April 2008 (UTC)

At the moment the first paragraph summarizes "basics" and "method" (those have to go first, so the reader can grasp the subject) the second paragraph deals with the material in "history" and "criticism". The section on "popularity" isn't covered in the lead, that could go as part of a new second paragraph with the "history" summary. Tim Vickers (talk) 18:53, 2 April 2008 (UTC)

Link offensive text dif and moved text to subpage. That last sentence has never been agreed on and as far as I am concerned, has all the lede legitmacy of a KKK scholar's published scholarly opinion ca 1915-1924 on various ethnicities. That kind of last sentence is material that needs to be discussed, not the default article.--TheNautilus (talk) 19:11, 2 April 2008 (UTC)

Indeed it was discussed in the RFC, with 3/4 uninvolved editors preferring this over your version. Just because you disagree with this consensus is no reason to pretend this hasn't been discussed. I've unarchived the RfC, since this was still listed as active. Perhaps more uninvolved editors will comment. Tim Vickers (talk) 19:22, 2 April 2008 (UTC)

For poorly founded, inflammatory material, it was not clearly agreed in the manner & time I have learned to expect, where less troubled, more neutrally worded versions are available. Also there are in essence three versions. I appreciate the input but I will consider facts and policies as best as I know how. Strict numbers aren't the basis of good editing on RfCs or consensus, either, especially in partisan & conflict of interest situations. I also think that the RfC proposition was too narrow and has changed.--TheNautilus (talk) 19:29, 2 April 2008 (UTC)

highly UNDUE wt on minor indirect reference (Jarvis) in lede

Move relevant part even remotely supported by quotes to body, "Guackery" not quoted. The 17 page 1983 paper, whose brief *criticism of Pauling and Bronson Pharmaceutical*, mentions "orthomolecularism" and "orthomolecular psychiatry" once each in passing while criticizing Pauling's book and Bronson Pharmaceuticals (Pauling's supplier). Note: This (un)"scientific" criticism rests on precisely zero (0) relevant tests (none remotely close to orthomed's dosage & frequency) of even Pauling's lowest [ vit C recommendation], still after 37 years, no relevant mainstream work published, at all! Jarvis: "Food faddism meets a persistent human desire. As Maple (54) says, "In the face of the great leveller, Death, we are all children listening fearfully for the footsteps of doom, and relieved only by the whisperings of hope. This is suggested in the opening of Nobel Laureate Linus Pauling’s book, Vitamin C and the Common Cold, a significant force in promoting "orthomolecularism" and widespread excessive vitamin C supplementation. Pauling states:

" The idea that I should write this book developed gradually in my mind during the last five years. In April 1966 I received a letter from Dr. [sic] Irwin Stone, a biochemist whom I had met at the Carl Neuberg Medal Award dinner the previous month. He mentioned in his letter that I had expressed a desire to live for the next fifteen or twenty years. He said he would like to see me remain in good health for the next fifty years, and that he was accordingly sending me a description of his high-level ascorbic-acid regimen. ...and second,

"Bronson Pharmaceuticals makes books available at discount prices to medical doctors that promote scientifically questionable theories on megavitamin therapy, orthomolecular psychiatry, and the use of vitamins to prevent colds, flu, cancer, allergies, and so forth. Of the 25 titles listed by Bronson in their 4-81 "Special Book Offer," not one appears on the list of nutrition references recommended by a respected professional association (10), while several appear on its "not recommended" list. Bronson may be..."

I have no idea what the above text refers to and can't understand the writing enough to work this out. Could you please rewrite this comment so that your meaning is clearer? Tim Vickers (talk) 16:32, 4 April 2008 (UTC)

Bronson sells firearms? Please read your messages carefully before you click the "save page" button. If your computer is set up for it, have it read the text back to you. Frequently it's easier to "hear" the problems than to see them. WhatamIdoing (talk) 17:59, 4 April 2008 (UTC)

That was a PDF cut and paste text error, fixed, thanks.--TheNautilus (talk) 18:12, 4 April 2008 (UTC)

Tim, ~70% was quoting Jarvis from *your* reference article

1. The quote from Jarvis' paper does not support the text. No "quackery" quoted, "faddism" on Pauling's lower dose C is implied by section title, but that is not the same as (all) "orthomolecular medicine", either for vitamin C or the rest.

2. The 17 page paper, twice, just barely mentions "ortho- anything" anywhere, never "orthomolecular medicine".

3. Jarvis' explanation retreats to psychological mumbo-jumbo, nary anything relevant biologically or biochemically based.

4. Jarvis' opinion & criticism rests upon *no* tests in the orthomolecular range of colds & flu. (after Hemila, 2006 - there is still no such testing). Sort of like pseudoscience...

5. This profound "mainstream" refusal to fund or test any part of the orthomolecular antiviral range has been going on not only since Pauling's book 37 years ago, but at least 60 yrs, after Fred R. Klenner's paper.^{oh yeah, your UWStL bud "purified" WP at AfD}--TheNautilus (talk) 18:12, 4 April 2008 (UTC)

70% of what? What on earth are you talking about? Tim Vickers (talk) 04:22, 5 April 2008 (UTC)

70% of "my" text[1], immediately above your first response here, are direct quotes from Jarvis' paper. I assumed you were familiar with your source text.--TheNautilus (talk) 08:51, 5 April 2008 (UTC)

Your comments are becoming increasingly difficult to understand. Could you please try to use complete sentences in plain English. The distinction between an "unproven alternative medicine sold for profit" and a "quack remedy" is not one based on biochemical tests, what assay would differentiate between these two forms of words? This is an opinion and a judgement mostly on the motivation of the people peddling these pills, not a scientific assessment of the efficacy of a remedy. Your comments about the lack of data in these expert's opinions therefore misses the point entirely. This source discusses the use of "quack nutrition" to treat disease and even specifically cites Linus Pauling and "orthomolecularism" as a prominent example of this. This is the opinion of the author and it is published in a unimpeachably authoritative source - The Annual Review of Nutrition, the premier scientific review journal in the field. Tim Vickers (talk) 22:34, 5 April 2008 (UTC)

Your are fabricating verbal connections, and giving greatly disproportionate, undue weight to a brief non-scientifically based opinion that discusses "quack" and/or "faddism" in different places in an old article. And I have to say any respect for ARN goes down with such a non-technical POV piece with such ambiguous, prejudicial words. Non-scientifically based criticsim: orthomed may have lower levels of evidence, its critics usually have no relevant data but are too dishonet or incompetent to admit it, especially on the vitamin C part.--TheNautilus (talk) 21:52, 6 April 2008 (UTC)

If the statement is not backed up by actual science, then its more of an expert opinion then a scientific finding, and should be expressed as such. Consider, then, that Linus Pauling also has expert opinions (or assessments, if you prefer) -- except Pauling earned a Nobel Prize and devoted his life to studying this stuff. Also, I don't see TheNautilus's comments as difficult to understand. You just need to read slowly. I'm coming into the middle of this and I'm understanding the issue fine. If this is your best source, you don't have much, Tim. Impin | {talk - contribs} 07:48, 13 May 2008 (UTC)

UNDUE wt & sentence construction on minor Jukes' reference in lede

Hardly anything there in Jukes article for the "less temperate..." slams in lede, UNDUE weight even if there were direct quotes in a few paragaphs. A few paragraphs where Jukes nitpicks details on Pauling's interview skills against a tape recorder and then makes an ass of himself, where time *has* moved the mainstream RDA (90+mg) and NIH's last recommendation (200 mg) way past Juke's flat "anyone" assertion of 60 mg vitamin C. Jukes monologue continues, pp 16-17:

QUACK REMEDIES FOR CANCER (~28 lines of text in three (3) paragraphs)

My involvement with laetrile, a name under which the cyanogenic glycoside, amygdalin, was illicitly peddled for treating cancer...laetrile...pangamic acid...[body of the 3 paragraphs] In general, legal action against quack remedies is a protracted process. By the time a court decision is reached, the defendants have moved on to other, greener pastures.^{[ end of 3 paragraphs)}

Vitamin C came into prominence as a universal remedy. Bogus claims for vitamin C were made as a result of its hyperenthusiastic promotion by Dr. Linus Pauling (49), and I appeared as a rebuttal witness against him in San Francisco and Santa Rosa, California.

Linus Pauling published the following account of a discussion with me(50):

I am reminded of an experience I had in 1984 on a radio medical program (on station KQED) in San Francisco. There was another guest on the program, a retired professor of nutrition from the University of California in Berkeley. I made a statement about the value of a high intake of vitamin C... The retired professor of nutrition said simply, "No one needs more than 60 mg of vitamin C per day," without giving any evidence to support his flat statement. I then presented some more evidence for my large intake, and he responded by saying, "Sixty mg of vitamin C per day is adequate for any person." After I had presented some more evidence, this retired professor said, "For fifty years I and other leading authorities in nutrition have been saying that 60 mg of vitamin C per day is all that any person needs !" There was just time enough left on the live radio program for me to say "Yes--that’s just the trouble: you are fifty years behind the times."

What actually happened is described on the official audiotape of the broadcast, May 7, 1984. (LP = Linus Pauling, DW = moderator, TJ = T. Jukes).

LP:Well, I failed to mention that if I am traveling and people are sneezing in my face and [I] get pretty tired and think that I may be coming down with a cold I go up to as much as 50 grams of Vitamin C in a day and that stops it.

DW: Do you think that is recommended for all people, Dr. Jukes, to take that much Vitamin C?

TJ: Well, I certainly don’t.

DW: Based upon your previous observations.

TJ: Based upon my previous observations and my studies of literature and my conversations with vitamin experts for about the last 50 years.

DW: All right.

LP: You know it’s too bad that these vitamin experts have been making the same statements for the last 50 years and haven’t caught up with the times yet.

TJ: Yes, but their statements are based on controlled observations. This shows a lack of agreement between what Pauling reported and what actually happened.

MEGAVITAMINS

The Food and Drug Administration proposed that an upper limit should be set on over-the-counter vitamins of 150% of Recommended Daily Allowances (RDAs) per tablet. This modest proposal was seen as a challenge by the megavitamin industry. The National Health Federation organized a letterwriting campaign to Congress for the support of the "Proxmire Bill" that specifically prevented FDA from making such a regulation. The Proxmire Bill was opposed by the American Institute of Nutrition and other scientific groups. It was supported by Prevention magazine, the National Health Federation, Linus Pauling, and Roger Williams. The Proxmire Bill passed the Senate by a vote of 81 to 10 in September 1974.

Another successful nutritional deception is the "organic food" industry. The term organic to describe food and a particular farming style was originated by the late Jerome Rodale, an electrical contractor who moved from... ^{(same material as Jarvis, 1983 continues on Rodale etc)}--TheNautilus (talk) 03:09, 5 April 2008 (UTC)

Apparently Tim is having trouble reading what Jukes' short mention shows, clearly and implied. This flawed reference's short blub is being POV pushed as a sweeping indictment of (all) orthomolecular medicine in the lede in a conclusory manner. What Jukes(1990) really shows, is one of Jukes' continued personal attacks on Pauling, who here appeared to mock Jukes' expertise for longstanding lack of investigative curiosity and scientific rigor (*zero* high range vitamin C data). Here Jukes vilifies Pauling with an innuendo, where Jukes, a vitriolic personality, long despised Pauling's ultraliberal politics (many WP:V observations available on Jukes' personality, politics and his anti-Pauling antipathies), especially about banning nuclear arms tests as well as their clashes over the human range of vitamin C benefits, where Jukes never shows *any* relevant data.

If one reads Jukes' & Pauling's statements closely with the transcript fragment, it seems clear that what has likely occurred is that Jukes has snipped several earlier, relevant statements from the "damning" KQED transcript to make Pauling look bad without actually uttering the implied libel. It appears to be an innuendo, where allowing for Pauling's recall of a conversation two years earlier, Jukes' version is roughly the last half of Pauling's version.

(1) This appears to be a WP:OR violation to generally claim Jukes' section title "Quack Remedies for Cancer" that positionally sweeps in Jukes' personal attack on Pauling (mentions only his vitamin C use above 60mg/day for respiratory illnesses) is WP:RS, V for all vitamin C much less orthomed, it simply is not.

(2) Jukes' 1990 statement would not reflect current mainstream research findings, either, where (Cochrane Collection vitamin C author) Harri Hemila's papers, accepted and published, have systematically reanalyzed the misstated "mainstream" analyses of earlier vitamin C papers to show a small positive therapeutic effect, increasing with dosage of vitamin C in the range ~8x to 250x under the quoted 50 grams Pauling mentioned. (see Hemila, 2006 for a collation of Hemila's vitamin C papers)

(3) It appears likely Jukes' short blub is a demonstrable example of the systematic bias, distortions and misconduct that have been used to repeatedly attack Orthomolecular medicine and its proponents. It may be more notable as such a demonstration in the body of Jules' biography depending on the exact WP:V conversation recorded, which will probably take six weeks to get. This is not current or scientific opinion, it appears to an old, scurrilous personal attack leaping two huge steps to a POV in the lede.

(4) This use of Jukes' short personal attack appears to be a WP:NPOV and WP:SOAP violations where Tim is attempting to force an obsolete view as current *medical science* with undue weight. It is not. If this were 20 years ago, I would agree that it reflected current thinking. That time has passed. Both vitamin C questions, for cancer CMAJ (2001), PNAS (2005), CMAJ (2006),ANN INTERN MED (2004), PNAS (2007) and viral respiratory illness,Hemila papers, 1991-2006, are recognized as *open* by authoritative medical science figures.--TheNautilus (talk) 20:54, 6 April 2008 (UTC)

Olson's Preface on Jukes (1990)

Part of the problems above seem to be that Tim is not quoting Jukes' paper directly. Rather Tim quotes the linkable content to editor Robert Olson's politicized comments in the Preface that *add* severe characterization and opinion onto "megavitamin therapy", far beyond Jukes' published opinion & innuendo on Pauling - the original source that I quoted, above. Rather than summarizing Jukes, Olson's editorial comments, More recently, he has come to the defense of science in the public sphere by confronting creationism, food faddism, and various forms of quackery including megavitamin therapy., are an interesting expansion on Jukes' text since even Jukes' (non-technical bio) paper did not actually say what Olson credits Jukes with. One can certainly imagine that Olson "knew" what Jukes meant or Jukes' history. But Olson's editorial swipe at megavitamin therapies, scientifically unfounded in Jukes' bio or analysis, greatly exceeds even Jukes' use of his autobiography as a platform for another attack (innuendo) on Pauling. Such brief political commentary is an unreliable source for the lede to assert potentially false light/defamatory comments in a prominent, semi-conclusory manner on active science issues,^{NIH (2001)-PNAS 2007, Cochrane author (2006)} especially where the notable & quotable scientific misconduct lies with the supposed mainstream-of-something- but-certainly-not-science.^nayo--TheNautilus (talk) 08:22, 9 April 2008 (UTC)

too wordy, inadequately supported, POVish dated lede material

In other early research in this area, orthomolecular physician Abram Hoffer was part of the group who discovered in 1955 that niacin could be used to treat dyslipidemia.[4] -- too long, too detailed, too much personality detail, and there are others from the 50s with Pauling's acknowledged *molecular medicine* that turn out to also be orthomolecular in nature.

However, the current scientific and medical consensus is that the broad claims of efficacy advanced by advocates of orthomolecular medicine are unsupported,[5][6][7] and these ideas are not accepted in mainstream clinical practice, with the American Medical Association saying that the idea that most diseases can be prevented by nutritional interventions is a myth.[8] -- 1980s QW/NCAHF type loaded statements that seriously mislead readers. Highly flawed QW/NCAHF type material from QW/NCAHF authors for the AMA references, flat earth - not current nutritional and biological science on myth, where there *are* "many" recognized diseases and conditions treatable or percentages preventable with nutrients recognized now with WP:V sources.

Less temperate critics have even classed orthomolecular medicine as food faddism or quackery.[9][10] -- not supported by text, either direct words or orthomed in general--TheNautilus (talk) 03:20, 5 April 2008 (UTC)

off topic link removal

I am moving the UK source, an off topic link, [ here] The closest approach to Orthomed was near the end the audio^~26:30. I listened to the audio, very entertaining. BenGoldacre's page and audio has nothing Orthomed, not even much there concerning orthomed. Orthomed is not about patent medicines, corn flakes, Hadacol, BG's cranks - didn't sound orthomolecular. Get this, orthomed is science based, a lot of its most effective critics have involved clear cases of scientific misconduct. This scientific misconduct might have been exposed sooner, if (1) most people weren't so experimental science illiterate, (2) medical information and media were less limited by gatekeeping before the internet.

Tim, you continually seem to confuse all "nutritionists" with orthomolecular medicine and orthomed MDs. How about we lump all Christian scientists in straight with your corporate & research scientists too.--TheNautilus (talk) 08:47, 5 April 2008 (UTC)

If you wish to remove all material from the article that does not specifically reference "orthomolecular medicine" then we would have to remove most of the references in "History and development" and all of the clinical trials for nutrients in the section on "Relation to mainstream medicine", such as those dealing with vitamin E, niacin, selenium, zinc. Insisting that a reference use the "in universe" jargon is illogical, if if a source discusses the usage in alternative medicine of megavitamins or dietary supplements than this is exactly the same as the topic covered by the jargon term "orthomolecular medicine". Tim Vickers (talk) 22:29, 5 April 2008 (UTC)

I'm with Tim on this one: we need to consider "all the facts and circumstances", not just whether or not a specific and relatively new term appears in the text. WhatamIdoing (talk) 23:11, 5 April 2008 (UTC)

Indeed, it would cause a major NPOV problem as well - imagine if an article could only use references that use the exact terminology originating from the group the article is discussing, that would be unworkable. To use a close equivalent, it would mean references discussing dilution could not be used in the article on homeopathy, only the sources that called dilution "succession". Or references that called a Nazi group's views "holocaust denial" couldn't be used if the group instead called the holocaust "The Jewish Exodus". We can't let the subjects of articles set the criteria for the inclusion of material based on their own opinions. Tim Vickers (talk) 23:24, 5 April 2008 (UTC)

If logical rigor and precision are maintained, I'm all for a liberal interpretation of what therapies make it into the orthomolecular article. But what must not happen is that therapies not endorsed as "orthomolecular" by "orthomolecular" people are used to discredit them.--Alterrabe (talk) 13:21, 6 April 2008 (UTC)

Indeed, you need to be careful about specific claims about specific treatments, it would be inappropriate to discuss herbalism here. However, when a authoritative source makes a general review of the use of nutrients in alternative medicine's attempts to treat and prevent disease, then orthomolecular medicine is part of the area covered by that review. Tim Vickers (talk) 15:23, 6 April 2008 (UTC)

You are pushing unreliable references, greatly overstating their content and currency, more on previous discussion, adding your POV into the lede. I've added another demonstration of this below.--TheNautilus (talk) 20:33, 6 April 2008 (UTC)

3 strikes and hold the mayo...another unreliable source

The brief, [13 line]^* coverage of orthomolecular medicine on Aaronson's Ch 6 of Cancer Medicine is not a technically reliable [or substantial]^* source as proposed by Tim because it is so misinformed (-ing) with several major WP:V failures on source text comparison and fact checking.

1.[Pauling's] claims that massive doses of vitamin C could cure cancer... Greatly misleading. Pauling, Cameron, Hoffer all proposed to treat cancer into longer remission periods with lifelong treatment, not a "cure".^{Vitamin C & Cancer (1979, 1993)} Orthomolecular pioneers, starting with Klenner, probably in the 50s, were often at pains to recommend receiving compatible conventional treatments with vitamin C rather than as a standalone attempt to treat or cure. Klenner, Cameron (with Pauling) and Hoffer (with Pauling) certainly followed this statement for surgery, radiation and/or many forms of chemotherapy. Both Klenner and Pauling et al, openly acknowledged that vitamin C, despite their most favorable clinical impressions of vitamin C's contribution in cancer treatment, was usually inadequate as a standalone therapy. Pauling stated that only a lucky small fraction would obtain a long term remission on Cameron's IV/oral vitamin C protocol alone.^{Vitamin C & Cancer (1979, 1993)} Three follow on points are important: (1) the vitamin C amelioration claims on both cancer and on other conventional cancer treatments themselves made vitamin C beneficial to most of patients, (2) CAM advocates are looking for alternative IV and oral chemotherapeutic adjuvant combinations, e.g. menaquinones (vitamin K₂), alpha lipoic acid, tocotrienols, tocopheryl succinates, ubiquinones (coQ series), herbal extracts, etc as well as Hoffer's complementary treatment regimen.^{Healing Cancer, Complementary & Drug Treatments, Hoffer with Pauling (2004)}
[(3) Riordan's high dose experiments (NIH, PNAS recognized) on cancer selective cytotoxicity and IV vitamin C pharmacokinetics clearly show that standalone IV vitamin C treatments in principle favor increasing IV ascorbate dosages to very high blood levels where some successors appear to be experimenting with pulsed IV (high dose, high rate IV ascorbate) instead of the usual gravity drips but synergistic adjuvants that reduce the IV C load several fold (e.g. 200 gram/d -> 50 gram/d) would be preferred. (still room for the grad students and PGY residents here)]^{* added 6 hrs later}

2. ...were disproved in clinical trials,^50,51 Said "clinical trials" were correctly long identified as highly flawed or even fraudulently misrepresented. These trials at a (in)famous small city medical center are more notable, see Vitamin C and Cancer: Medicine or Politics? (E. Richards 1991) for their failure to follow basic scientific methodology such as experimental control (inadequate residual C test frequency 1-2 orders, inadequate residual C testing of the patient population coverage by ~1 order of magnitude of patients, inadequate urinary residual test sensitivity ~2 orders of magnitude, inadequate urinary residual selectivity (interferences), medicant access control failures - available at the corner drugstore vs Cameron's confined population), multiple failures of replication (skipping the intravenous treatment phase altogether, different oral treatment chemistry, rather brief applications rather than lifetime), drastic interferences (e.g. intervening chemotherapy, cold turkey discontinuation of megadose ascorbic acid), failure to note population differences (e.g. refractory, single type cancer; Scotland vs US, genetic, environmental and nutritonal), different measures and mileposts of improvements, failure to adequately research or integrate prior literature, art, experience & advice, and failure to adequately disclose protocols, data & results. Many are not sure what the "clinical trials" (~1975-1985) really proved, but hubris, incompetence, systematic bias, scientific misconduct, breeches of social contract & specific promise seem to have had a pretty strong demonstration.--TheNautilus (talk) 20:30, 6 April 2008 (UTC)

3. There is no evidence that megavitamin or orthomolecular therapy is effective in treating any disease. At this point, mere parrot-like cant of Cassileth's sound bite, or perhaps earlier, factually challenged adversaries. Megadose niacin has long had published evidence that it treats CVD patients' dyslipidemias, with the Canner study (1986) on post heart attack survivors showing an average of two years increase in lifespan following an average of six years treatment. Also there are niacin references on rapid relief for anginal and post infarct pain. Menolascino et al (1988), pp 137 & 140-144, cites 14 "megavitamin therapies" in mainstream medicine for amino acid metabolic disorders, before he drills down to his questions & criticisms of Orthomolecular psychiatry. Further Menolascino states, This limitation of described cases [for amino acids] is not a true reflection of all the disorders in a population which are potentially treatable with specific vitamins. For example, only recently have some disorders of carbohydrate and lipid metabolism been found to respond to large dosages of specific cofactors/vitamins. (e.g. The lipid disorder, Abetalipoproteinemia, typically requires 6000^[2]-25,000^[3] iu vitamin E per day along with more A, D, K). Malabsorption syndromes are also acknowledged to require supplementation & megavitamin therapies for various forms of gastrointestinal problems.--TheNautilus (talk) 20:30, 6 April 2008 (UTC)

Rather than endlessly restating your own point of view and arguing with the conclusions of the sources, you would do better to find some general reviews of orthomolecular medicine in reliable sources, or positive statements about this form of alternative medicine by prominent medical orgaisations. Your personal opinions and arguments are not relevant and cannot be included. Tim Vickers (talk) 21:17, 6 April 2008 (UTC)

Wrong again. These points cite WP:V failures, of your nominally RS sources, when flawed sources have to yield (or modify) to facts. I've summarized and referenced a large amount of material, including whole books. Including the Cassileth/Aaronson cant - "no evidence megavitamins...[are] effective in treating any disease", a major, prejudicial statement stated absolutely that is just flat ass wrong by a dozen+ of *mainstream* megavitamin examples^{Menolascino et al 's 14 (1988), Hoffer et al(1955), ab-lipid+E} and overweight the lede with petty (short, POV), OR fabricated, or obsolete references.--TheNautilus (talk) 22:03, 6 April 2008 (UTC)

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Can you summarize briefly and specifically here what you think of as the problem with TimVickers's sources? Antelan^talk 02:50, 7 April 2008 (UTC)

Thanks, Antelan. I think that I have pretty well shown that three of the references are brief, have POV & WP:V problems, and / or are obsolete with respect to *current* medical science (with substantial references & background). A preliminary table has been started to summarize references in the lede. Although the Canadian Pediatrics (1990) paper is dated, largely rebuttable by subsequent mainstream positions (e.g Canadian Pediatrics (2007) vitamin D RDA 200-400iu -> 1000-4000iu, which equaled or exceeded previous orthomolecular recommendations of the 80s & 90s) or orthomed science points on "then conventional" clear flaws, it is a substantial paper that reasonably establishes a (rebuttable) mainstream pov ca 1990 without the vitriol, exaggerated degree of misrepresentation & error, and defamatory language of the three I've discussed so far, above (Jukes(1990); Jarvis (1983); Aaronson (2006) ).

We need to figure out fair use viewing on the Menolascino et al (1988) article. That is actually the most informed orthomed criticism that I have seen. Encyclopedic summary is the proper way to go, quotes and balancing discussions in the main body. e.g. Lede: "The ACS and AMA dontlikeit and historically have criticized it, some critics with vitriol and great deprecation." Otherwise the lede and the article are being hijacked and poisoned with prejudicial words and phrases of its most bitter, least accurate, often least qualified enemies, and even other personal disputes like Jukes' running toward defamation on Pauling, WP:OR putatively sideswiping OMM.--TheNautilus (talk) 09:25, 7 April 2008 (UTC)

OK, thanks for the summary, TheNautilus. I'm going to restate it from my own understanding so that you can let me know if I got something wrong: The sources in question do not actually address modern orthomolecular medicine. They address a previous version that is no longer practiced. I am having trouble understanding if you mean that (1) the mainstream or (2) the orthomolecular positions described in those references are outdated. (I'm ignoring for now the WP:V and POV concerns because those don't generally apply to sources, although those can inform the structure and the weight given to that material in the article itself.) Antelan^talk 20:28, 7 April 2008 (UTC)

Both have changed. Orthomed oral regimens frontload much higher on the first hour or two to reach bowel tolerance sooner (may first notice substantial drying up in ~1/2 hour, the antihistamine effect earlier even Barrett mentions as "possible benefit", then approach slower to bowel tolerance). Although the orthomed crowd will tell you vitamin suppresses colds pretty well (this is at higher frequency & dose than any conventional controlled test[4]), vitamin D & immune resistance is the other big thing here in the north. The mainstream has changed because the realization the Pauling was right about researchers generally were not analyzing & reporting their positive experimental results correctly e.g. Hemila (2006) and that NIH is publishing yearly in CMAJ or PNAS on IV vitamin C & cancer. Since 2000, papers or some acceptance on mega E for alzheimer's, the *big* vitamin D change, alpha lipoic acid for diabetes, fish oil for CVD, coQ10 for cardiomyopathy, thiamine losses of diabetics, Hemila on vitamin C & respiratory disease, IV vitamin C for cancer trmt (still need that adjuvant), more recognition of mixed arthritis formulas (higher dose MSM, glucosamine, chondroitin combos), mixed/other carotenoids like lycopene etc, seem to show a change is taking place in pharmacology & the mainstream acceptance.

To answer your question, the mainstream is starting to recognize that the C questions were never remotely tested, analyzed, or reported accurately, much less answered at all, and that significant pausibility exists. This applies as well for other (big) nutrients that are therapeutically useful.--TheNautilus (talk) 10:39, 8 April 2008 (UTC)

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As I understand it, TheNautilus' problem is that the source (a widely used, highly valued reference work for oncologists) disagrees with his convictions about OMM.

TheNautilus, I assure you that, even if every single word you say here is true, WP:RS does not actually require that the source get any of its facts right. The Chicago Tribune is still a reliable source, despite one of the most famous errors in the history of newsprint. WP:RS is about the source itself, not what the source says in any given case. If you can make a case for standard reference works being "unreliable" in general, or for this book not being a standard reference work, then let's hear it. Otherwise, you need to quit complaining about this source qua source. WhatamIdoing (talk) 05:32, 7 April 2008 (UTC)

The application of WP:V to problematic WP:RS sources in technically related articles, which this is, along with NPOV and WEIGHT require some work to avoid inaccurate and misleading statements. Proper use and interplay of policies yield accuracy, scientific priority and fairness. Basically it is non-encyclopedic to be repeating fundamental & factual errors & misrepresentations that do show the unfamiliarity, or bias, of authors outside their expertise. Then the material needs to summarized, not quoted at length or unbalanced. Unbalanced quotes and attack style statements are not good practice in the lede, rather roughly describing the totality rather than just repeating some (prominent) biased individual or groups where WP:V technical error or misrepresentation of facts, especially mainstream recognized ones, are involved. I think that we may be starting to surface the issues interaction on POV, currency, & technical accuracy to begin to resolve the disputes if some editors will focus on these technical discussions and not just assume QW-based prose reflect current or mainstream science.--TheNautilus (talk) 09:25, 7 April 2008 (UTC)

The issue isn't whether or not "reliable sources" one may not like are quoted, but rather if they are claimed to be authorative, and whether reliable countervailing voices are silenced. --Alterrabe (talk) 19:54, 7 April 2008 (UTC)

Yes, as the "quackery" and "faddism" views are notable views in the scientific and medical literature, then we need to note that these views exist and cite the literature that puts these views forwards. Our personal views on the accuracy of these views is not relevant to that fact that these views exist. Tim Vickers (talk) 19:58, 7 April 2008 (UTC)

I have never been against putting vitriolic condemnations of orthomolecular medicine into the lead. It was I, in fact who described OMM as a "controversial" branch of medicine. But if we put such vitriol into the lead, I think it's only fair to include that some of the organizations that condemn OMM, such as the AMA, have a very dubious history themselves, having promoted smoking at a time when smoking was controversial. This way, and only this way, would the first time reader know right from the start that this is a controversial topic, and that they may have to think for themselves.--Alterrabe (talk) 20:25, 7 April 2008 (UTC)

A concise, current, accurate balanced lede summarizing high quality references (e.g a calm, authoritative 15 page paper written to the subject, without ambiguous non-technical epithets) is best. So far all I is see are obsolete statements, old innuendos and misrepresentations falsely presented in an authoritative voice. The 3rd paragraph continues to violate NPOV, WP:V in the current factual sense, UNDUE weight, and *promotes* a false light with a defamatory POV.--TheNautilus (talk) 22:01, 7 April 2008 (UTC)

I would respectfully disagree. Orthomolecular medicine is so controversial that including epithets, and questioning the seriosness of those who truck in such epithets, in the lede, would contribute to our efforts to enlighten our readers. Not referencing them, or referencing them, without questioning them, would suggest that this is a topic often discussed dispassionately, or that the criticisms themselves don't merit criticisms to the unenlightened reader.--Alterrabe (talk) 22:39, 7 April 2008 (UTC)

When you say "WP:V in the current factual sense" it is very clear that you don't understand this policy. Please read it again. especially the first sentence - "The threshold for inclusion in Wikipedia is verifiability, not truth." Arguments over if that something is true or accurate is completely irrelevant to if it is verifiable. Tim Vickers (talk) 22:31, 7 April 2008 (UTC)

Tim, you are clearly misstating policies and their application. From WP:V Reliable sources: ...As a rule of thumb, the greater the degree of scrutiny involved in checking facts, analyzing legal issues, and scrutinizing the evidence and arguments of a particular work, the more reliable it is. The three sources, mere partisan or non authoritative blurbs, Jarvis(83), Jukes(90), Aaronson(2006) that I have analyzed fall far short on these three conditions: checking facts, when they contain (multiple) false (and misleading) statements; analyzing issues - there's no analysis or length in a quick [ex cathedra] bash; and have clear deficiencies in evidence and arguments; hence a less or unreliable source. You are attempting to confuse an WP:RS masthead with flawed text and literal print as WP:V with the preceeding actuality of RS and WP:V, where facts must prevail in precedence to have coherence in techncial matters. I am open to acknowledging controversy & status, past and present. You are short circuiting this with weak references, weak WP:RS, weak because of the source text and subsequent findings, not the publication.

Verification of factuality, not merely verification of printing.--TheNautilus (talk) 07:57, 8 April 2008 (UTC)

Ah...the Wikipedia:TRUTH. Jefffire (talk) 08:07, 8 April 2008 (UTC)

Now I have directly cited the policies, WP:RS on substance. I have cited hard references for the current facts and situation. The two sources, OlsonJukes(1990)amplifying fabricating Jukes' "words", Jarvis (1983) are simply old, tiny, loosely stated, individual political opinions being given UNDUE weight, obsolete on the vitamin C question, the underlying issue in those two sources, with no scientific substance and only minor historical merit to greatly mispresent the current status of the vitamin C questions, much less all orthomed.

Goodwin (1998, Arch Int Med): "Pauling...respiratory disease...idea is now a respectable hypothesis, but 20 years ago it was quackery." (Cochrane Collection author) Hemila (2006), shows Chalmers and all misanalyzed the positive data on doses much lower than orthomed (zero data on orthomed), and vitamin C appears to work with small statistical benefits at small fractions of Pauling's recomnmendation. Aaronson's (2006) statements, contradicted by real examples (and better informed doctors), simply suggest he doesn't know what he is talking about, a good reason to keep it short at three paragraphs, a trivial "reference" on a subject. This article and the lede on a technical subject are being overloaded & sabotaged with obsolete and erroneous POV in large quantity. Plase re-read NPOV: especially Undue Weight, Fairness of tone, and Balance.--TheNautilus (talk) 10:09, 8 April 2008 (UTC)

And what is the truth? is the issue isn't it? Is it what x said, or what y said. Frankly, it doesn't matter. Verify that x said z about orthomolecular medicine and it can go in. Verify that y said a about orthomoleculal medicine and it can go in. Declaring that x's statement is wrong because y said so is PoV. Of course, all that depends on the subject of x and y's discourse being about orthomolecular medicine. If they don't explicately say so, then it's OR to claim that it is. I mention this because I've started to go over some of the references, and some seem to not mention OM at all. Jefffire (talk) 10:21, 8 April 2008 (UTC)

Many of the article's references & authors are quoted, directly acknowledged as, and/or referenced by other orthomolecular publications, OM authors and orthomolecular related articles as well as reflecting upon elementary orthomolecular positions & principles.--TheNautilus (talk) 00:33, 9 April 2008 (UTC)

You may very well think that, we cannot possible comment. It's OR. Jefffire (talk) 09:14, 9 April 2008 (UTC)

No, orthomolecular acknowledged references are primary & secondary sources that provide additional material actually used in orthomolecular research, analysis & recommendations from a common body of literature.--TheNautilus (talk) 20:51, 9 April 2008 (UTC)

See Talk:Orthomolecular_medicine#off_topic_link_removal for discussion of the jargon, synonymous terms include "megavitamin therapy" and "vitamin therapy". TheNautilus insists on a very prominent use of the term "orthomolecular medicine" in critical sources, but is happy to include any clinical study that used a nutrient if it is supportive of his ideas, even if "orthomolecular medicine" is never mentioned. Tim Vickers (talk) 13:58, 8 April 2008 (UTC)

These terms are not synonymous, rather they overlap and context is important.--TheNautilus (talk) 20:51, 9 April 2008 (UTC)

Although it may sound baffling, there is some method to this. In Abram Hoffer's online writing about the orthomolecular treatment of cancer, he has some therapies which he calls "orthomolecular" and insists they be part of a regimen, and then many others that he essentially adds as optional adjuncts that probably are useful. It would be unfair to use the adjuncts to discredit the "blue-chip" orthomolecular therapies that Hoffer, Pfeiffer, and Pauling endorsed, but I suppose that we ought to make it clear when the adjunct therapies are not 100% orthomolecular. There is a lot of overlap, and the only way to avoid frustration is to be very precise.--Alterrabe (talk) 17:56, 8 April 2008 (UTC)

Those "imputed" references referred to, many/most of which I didn't add, are usually based on test & data that were generally recognized as substantially orthomolecular in nature, mostly from the lower dose optimum nutrition side, don't have "hot button" non-orthomolecular errors ( e.g. wrong molecules from "K3" to excess iron for the population subgroup or wrong quantity for specified use) and usually are claimed, used, referenced, discussed, and/or written by explicit orthomolecular sources and authors.

The three "references" ( Jukes/Olson,^{Jukes' dif} Jarvis,^dif Aaronson,^dif short, spurious opinion non-encyclopedic blurbs really) that I am objecting to, are insubstantial & highly flawed:

(1) two are relatively old for "current opinion" (1983, 1990), given important changes in published science, later references specifically and more authoritatively refuting them, the public, and the marketplace;

(2) all three blurbs are not reliable sources in the sense of RS objective criteria (e.g. (i) only ~12 lines of (sometimes vaguely) OMM related material instead of a paper with 15 focused pages; (ii) an evidence based, logically presented opinion; (iii) multiple serious errors or misrepresentations, failing WP:V for fact checking);

(3) they are being given undue weight to advance a bitterly partisan position often associated with groups whose broadly distrbuted opinions are recognized as unreliable sources at WP, from groups increasingly generally recognized as sources of (systematic) bias in legal, scholarly and scientific venues.

(4) the orthomolecular connections are indirect OR or highly specific instead of general OMM coverage (e.g. Jukes: attacking LP himself (not OMM per se), defending an obsolete RDA and incidentally, prodding LP on low range vitamin C but mostly including the Jukes' sub orthomed based dose-frequency opinions, off by 1 or more orders of magnitude in either the therapeutic or prevention categories of single OMM components. An irrelevant opinion by most scientific & academic measures.

(5) critics are seldom even talking about/using the same nutrient forms, and never(?) the current complete regimens, making them "more" irrelevant.--TheNautilus (talk) 23:26, 8 April 2008 (UTC)

Table of (possible) Lede references

see Help:Table

Ref #	link to	relevant	discussion,	Talk page
in OMM	best text	lines	summary	links
ref 5	Aaronson's Cancer Medicine (2006)	13	errors incl. "moon is green cheese" type denial, claimed "disproved" conclusion refuted by landmark series of NIH-PNAS-CMAJ papers on top of inherent flaws noted by Nobelist	[5]
ref 8	AMA (1997)	26	non-specific & distorted application of "nutrition" to OMM with partisan, tautological wording	[6]
ref 9	Jarvis (1983)	~35	assoc'd incl much *not OMM*, poor direct coverage on OMM, not Lede quality	[7]
ref 10	Jukes (1990)	~46	personal views. personal reminiscences used as a vehicle for innuendo & vitriol on vit C, Pauling; "Megavitamins": FDA & political commentary. No WP:V, RS science references to support critical "verdicts".	[8]
none	Olson, ed.Prefaceon Jukes (above)	~5	highly political ind'l stmt, anti-mega-anything boosterism. Not current science, now a slur that promotes False light or worse stmts as well as problematic edits under NPOV, Achieving neutrality. No WP:V, RS science references. Olson previously publicly rebuked in 1985 by Natl Academy of Science for attacking Food & Nutrition Board members to lower vitamin C RDA, now higher instead.	[9]
ref 7	ACS	~250	general description from ACS pov, some one sided stmts.	--
ref 13	Braganza, Ozuah(2005)	~100	current, but somewhat one sided. Mainstream complaints on paper's content, 2 of 4 criteria poor (e.g. known mainstream treatments for genetic disorders of metabolism would classify as a fad)
	possible lede reference
ref 29	Menolascino, et al (1988), no link	~600	extensive, specifically titled OM critique, detailed examples & references	access?
	Cassileth and Deng (2004)	~16	Specific, obsolete summary that still ignores Mayo-Moertel trials' severe flaws & bias, see application about OM for cancer	PMID 14755017
	ABC of complementary medicine. Unconventional approaches to nutritional medicine. Vickers and Zollman (1999)	~40	Overview of nutritional related subjects, esp naturopthy & various diets, some dated, flawed reliances (eg. Moertel & APA reports)	PMID 10574865

• As a note on Menolascino, et al, on-line access to Child Psychiatry & Human Development starts at 1993 and my university only has print holdings from 1997. Anyway, weren't you complaining above about references from the 1980s being too old? Why is this one different, or have you changed your mind? Tim Vickers (talk) 23:11, 9 April 2008 (UTC)

You've misunderstood the principles & fundamental statements[10]. I said old, vitriolic (extreme) opinions, that are unsupported within the relatively few relevant lines in their papers (or Olson's misattributed editorial that you quoted as Jukes') for support, that certainly aren't current for mainstream medical science. Where time has proven them wrong for making a number of rabidly conclusory judgments (niacin for HDL₂, triglycerides, & ApoB; vitamin Bs' uses developing, C is an active issue, megavitamin D is happening in Canada, E has evidence in claudification & Alzheimers, K₂ in cancer & osteoporosis, lipoic acid in diabetes, not to mention the long known megavitamin treatments for disorders of metabolism and maladsorption). Menolascino analyzed, presented readers with balanced work, references and facts to state his criticisms in ~600 lines (lots of supporting info & references). Older solid work? - most people, if they (can) do any physics, still use Newton's version, 300 years later. Although some of Menolascino's points are uncomfortable, they are still far more relevant, focused, knowledgeable & balanced than any other critique that I have seen here, not just cheap, internally unsupported (or even back then knowably wrong) shots under a "WP:RS" masthead.

Also another item that has been misunderstood or ignored several times, is that although I think some of these references are utter c---, I am more amenable to working balance issues in the body. Such low quality, obsolete opinion based references in a prominent & conclusory manner, appear to unencyclopic and violate NPOV in presentation, with undue weight and lack of currency among others.

I have a copy of Menolascino but need a current fair use policy (e.g. limited time, words).--TheNautilus (talk) 01:31, 10 April 2008 (UTC)

Lead as a summary

I don't find a statement in the main text about OMM being called quackery by its critics. Obviously it was, and indeed is, in some circles, but if it's not important enough to include in the body of the article, then it doesn't belong in the lead. WhatamIdoing (talk) 05:13, 7 April 2008 (UTC)

I'm sure that was there before, I've replaced it in the criticism section. Tim Vickers (talk) 16:00, 7 April 2008 (UTC)

We also failed to summarise the Prevalence section, I've added some of this data to the lead. Tim Vickers (talk) 16:27, 7 April 2008 (UTC)

POV problem at daughter article

The article Megavitamin therapy is ridiculously POV, and appears to have been written by an advocate of this concept. Tim Vickers (talk) 18:22, 7 April 2008 (UTC)

We need to finish here. You are still running around touting misattributed statements, such as that slap shot activist editorial (read ARN 1990 Preface's whole editorial, promoting Jukes' kind of polemics, not even accurately rendering Jukes' statements) of a faction that time has demonstrated, in the mainstream, were not only wrong relative to orthomolecular recommendations, but demonstrably detrimental to public health. At least in my state and Canada, spreading their dangerous "VDD" (vitamin D deficiency) promoting nonsense, as well as the other obsolete or blatant errors on A, B, C, D, E....--TheNautilus (talk) 21:35, 7 April 2008 (UTC)

I'm sorry, but if you want to attack the entire medical profession as idiots, then per WP:REDFLAG, which specifically mentions medicine, you will need superior sources. Shoemaker's Holiday (talk) 23:40, 7 April 2008 (UTC)

My answer, above, to Tim has little to do with the medical profession per se, rather it is about old (e.g. circa WWII profs, students & their "allies") nutritionist factions that are literally dying off, but leave a bitter legacy that is only slowly emerging from a dark age in preventive & therapeutic research with natural or bioequivalent compounds. The results that I refer to come from current millenium medical recommendations, research and papers, some even earlier. Some compounds were even previously acknowledged in a backhanded way by one of Pauling's biggest antagonists, Herbert. The nature of your answer suggests you might want to read these discussions, the archives, and the current nutritional & medical science literature more closely.--TheNautilus (talk) 04:01, 8 April 2008 (UTC)

"slowly emerging from a dark age" - no wonder these articles have so many problems. Shot info (talk) 06:32, 10 April 2008 (UTC)

With the belated recognition of many nutrient based therapies in the past ten years, that one is already in the rear view mirror, ca 1948 - 1998.--TheNautilus (talk) 07:58, 10 April 2008 (UTC)

Great review

Is there a metabolic basis for dietary supplementation?. Unfortunately, as is normal in modern reviews that don't address alternative medicine, "orthomolecular medicine" is not mentioned. It would probably be OR to include this, although it discusses exactly the topic of this article. Tim Vickers (talk) 18:35, 10 April 2008 (UTC)

That is an interesting article, Tim. Although it studiously avoids the "O" & "M" words, despite discussing similar concepts at length, perhaps it provides some transition for conventional opinion without any "hot button" words. I might point out that in Figure 2, Risk of deficiency vs Intake, on vitamin RDA, optimum dose, upper safe limit and toxicity, that the graph would likely represent a logarithmic scale on the x-axis of dosage (1, 10, 100 grams/day...) where positive human experience with increasing vitamin C doses covers over 6 orders of magnitude and individual's benefit-opimum-tox curve may vary substantially with time & conditions, such as any stresses and illness. The orthomolecular crowd may also express concerns about the (non)ideal shape & skewness of the curves, perhaps especially the tail. Also the curve's labelled RDA, optimum and inflection pts, allow consideration of the definitional "deficiencies" hobgoblin: (1) deficiency relative the individual's optimum point, (2) subclinically deficient relative to some population average, (3) clinically deficient by some measure, or (4) even "classic" deficiency sysptoms including death. Offhand, I am not sure how to address this article here, myself.--TheNautilus (talk) 07:52, 11 April 2008 (UTC)

The values on the X-axis depends on the substance in question, with the window between beneficial intake and toxicity in selenium, for example, being quite narrow. Tim Vickers (talk) 15:42, 11 April 2008 (UTC)

The width of the "selenium window" also greatly depends on body stores, disease, and the Se form. e.g. inorganic -ite, -ate not so wide vs some organic forms that are much better tolerated and may be more effective too. The "true" orthomolecular Se form is considered to be not yet identified.--TheNautilus (talk) 11:50, 23 April 2008 (UTC)

False light

Just FYI: you can't make a "false light" or "defamation" charge stick against an idea. Privacy rights (and freedom from false light representations is indeed a privacy right) only attain to persons. WhatamIdoing (talk) 04:18, 11 April 2008 (UTC)

I have adjusted the table entry for greater precision.--TheNautilus (talk) 07:52, 11 April 2008 (UTC)

Not really. Saying that something is a "slur that promotes defamatory statements" (to slightly paraphrase) still makes a claim of defamation against the idea of megavitamin therapy. You can defame a person or an organization; you cannot defame an idea.

Try "criticize", "denounce," "disparage" or "attack" instead. I doubt anyone would disagree with summarizing that link as "an editorial that strongly disparages megavitamin therapy as quackery". WhatamIdoing (talk) 18:54, 11 April 2008 (UTC)

The nature of the lead assertion[11] is at the point of incivility, it certainly is not NPOV, balanced, weighted, technically current or scientifically accurate as a summary. My point is an erroneous POV emanting from known unreliable sources, that are at least obsolete, has a history of fueling (expensive, losing) real world persecutions, including defamation, while drowning out more technically accurate and balanced accounts. This poisonous POV is being used *here*, at Wikipedia, to advance extreme positions & innuendos that are simply WP:V false. These old opinion pieces engage in personal and professional attacks, that were identifiable as without genuine foundation even then. Mainstream authorities of today's science and medicine have taken notice, however low key, finding scientific merit in statements previously dismissed most uncivilly without any consideration, much less according to scientific methodology. Rather than summarize and balance that there have been vitriolic critics whose views were once accorded weight far beyond their technical foundation, successive statements focus on the extreme view and accentuate, add or exaggerate the obsolete negative. Jukes vitriol -> Olson's added opinion (flames) -> Wikipedia's lead focuses on the small extreme rather than summarize and generalize. The Lead should be general summary e.g "there have been mainstream, and extreme vitriolic, critics" rather than the KKK-like whirlwind of rising epithets, poisoning the reader in the Lead, presented as if they were current or authoritative.--TheNautilus (talk) 11:13, 23 April 2008 (UTC)

Also phrases such as "ind'l stmt, anti-MV boosterism" are incomprehensible and close to gibberish. People will not respond to statements they cannot understand. Tim Vickers (talk) 19:54, 11 April 2008 (UTC)

One thing that I will note is that often new, almost alien concepts and terminology, can be difficult to understand, sound like gibberish, difficult to grasp or even remember. Here I wrestle with several sets of jargon (Wiki, conventional, CAM, and orthomed) that are important to condense concepts and material into retainable or decipherable chunks that can be be scanned at all. It's a long story. Hoffer himself noted that cleaning up after these kind of broadsides: ...your latest account of megavitamin therapy ...1975. I am sure that you realize it is impossible for any person to mop up the continual errors which are put out--TheNautilus (talk) 11:13, 23 April 2008 (UTC)

The sentence you object to is "Other critics have classed orthomolecular medicine as food faddism or quackery." What part of this sentence do you believe is factually untrue? Do you believe that no critics, however misguided they might be, have ever made such a claim? WhatamIdoing (talk) 01:09, 24 April 2008 (UTC)

The allegations themselves are based on gross misrepresentations & appear malicious in nature to those knowledgeable about the underlying facts. These are extreme, hurtful, uncivil opinions being presented as if they were authoritative. They certainly are not NPOV, BALANCED summary. That there are vitriolic critics is notable. Perhaps like the KKK on ethnic groups, their words of malice & attack are not suitable lead material. If this is the Wikipedia standard of editing, there are a lot of medicine and pharmaceutical articles leads that we should probably quote NY Times, NEJM, JAMA, etc about "scams", "fraud", cooked and crooked science[12][13][14].--TheNautilus (talk) 11:38, 24 April 2008 (UTC)

That's what I thought your concern was. You seem to have fallen into the logical fallacy of assuming that because we state a bare fact, that we support or approve of the bare fact. PLAIN FACT: Other critics used these words to describe this concept. NOTE: That's all we're saying. It doesn't say "Other critics used these words, and we think they're right" -- just "Other critics used these words."

And I assure you that there are many articles in which the words scam, fraud, etc., feature in the lead, to the disgust of supporters. See Homeopathy, for example, which is labeled as "scientifically implausible", "diametrically opposed to modern pharmaceutical knowledge", "regarded as pseudoscience", "quackery" and so more -- in the lead. Ozone therapy's second sentence names critical claims that it "is nonscientific and has no proven benefits." The bio for researcher Hwang Woo-Suk discusses "various lies and frauds". OMM's lead is by no means unusual in this respect. WhatamIdoing (talk) 15:37, 24 April 2008 (UTC)

Quite a different situation here. I also really think that "quackery" is an encyclopedically unsuitable word for brief leads, both for its lack of precision and for its hard-to-balance, derogatory emotional content. Hwang Woo-Suk is an admitted fraud. Ozone, because of its high reactivity, instability, and seemingly nonstoichimetric behaviors, even when it works well industrially, has often been extremely controversial - when I was younger, I got to swap war stories with an older Jason type physicist that had also been involved in industrially applying several major, (successful) patents, ozone related, that almost caused a riot and lynching, but whose technlogy is now deployed across a continent. Homeopathy has severe fundamental science conflicts. OMM does not, it is molecular medicine with nutrients and natural substances with a *much* wider safety margin than conventional medicine that have a lot support in convnetional literature. Virtually all modern pharmaceutical research is molecular medicine. The problem is somewhat akin to the medical societies' decades long, illicit attacks on the chiropractors, a fact now legally recognized. While OMM has had a much stronger scientific basis from the beginning (all those MD-PhD & research backgrounds), it did not have the economic and political clout, wherewithal and organization to fight back against the unrelenting multipronged political "science" attacks of dramatically larger adversaries that have resorted to much less than scrupulous methods and "science". Also OMM has been obstructed and denied funding in provisioning adequate studies in recognized venues for even the simplest, most successful demonstrations across many decades. Despite this, there is adequate scientific record that notes, exposes and even destroys the very worst supposed objections of claimants of "conventional" medicine as scientific humbug.

The two critics cited in the lead are gratuitously derogatory, *non-current* unqualified (no data after decades) *opinions* that reflect a confluence of varying degrees of bigotry (severe bias), scientific misconduct, non-scientific or economic interests, and, since we are on it as much as I dislike the the term, scientific quackery (denialism of simple facts, greater than order of magnitude exptrapolation from highly uncertain data with multiple known errors after clear recital of better, more relevant observations). They are extremists given outrageously UNDUE WEIGHT for statements *not based on valid scientific method and experiments*. The "critics" are using their editorial and industry positions to advance personal attacks (Jukes' vitriol seems to spring from a hate of Pauling's politics and then Pauling, noted by mutual academic acquaintances) and ex cathedra personal opinions (Jukes, Olson) without any real scientific discussion, reference or substance given in the paper, or anywhere else that I see. Even still, at the height of their personal influence and priviledges, they are merely executing hit and run attacks without any substansive technical discussion.

The "pseudoscience" situation at homeopathy is quite different, it proposes hypotheses that have no solid evidence of a rather uncertain theoretical basis (unknown structure of water in the mainstream vs persistent "imprinted" water structures), that otherwise contradict a physicochemical basis of action. Pauling and various OMM positions have a much more scientifically recognizable claim to be victims of fraud or scientific misrepresentation by several critics, including that spread by WP recognized unreliable sources, since the stream of NIH and PNAS papers in the last 9 years have acknowledged the scientific basis of his complaints as significant, some years after Pauling's death. The lead continues to mislead and misinform where there is undue weight given to error, vitriol and misrepresentation, contradicted on cancer by the NIH-CMAJ-PNAS series of papers, and on treatment of respiratory ills by the long series of a relevant Cochrane author.--TheNautilus (talk) 13:26, 21 May 2008 (UTC)

It doesn't matter if you agree with the critics. It doesn't matter if the critics' positions were disproven later. They used these words and it's reasonable for us to report that: It gives the reader a basic idea of the widely differing opinions and strongly (even irrationally) held positions. Later in the article, we can discuss whether Jukes hated Pauling's politics, or whether those terms are likely to be used by current critics. For the purpose of the lead, the fact that physicians and researchers took absolutely unambiguously negative views of this idea is important. I can think of no more effective, efficient, or concise way to communicate this history than to state that the critics chose to employ clearly derogatory terms like "quackery" and "food faddism". I suspect that most readers encounter this and think that the critics were rather irrational on the subject, not that OMM is quackery and a food fad just because some critics once thought that. WhatamIdoing (talk) 23:14, 31 May 2008 (UTC)

"SYNTH"

Jefffire's edits seem to frequently call things he doesn't like, "SYNTH". We would disagree as to the use of "source based research", explicitly cited by J Wales himself. Without it, we'll never get remotely current or accurate articles. The "nutritional medicine" formulation[15] is closer to the commentaries' broad scattered criticism of nutrition or to the periphery (or actual outside) of orthomolecular therapy regimes, just barely mentioning "ortho-" anything. Making a categorical assignment of all the criticism to orthomed in general has the SYNTH problem. Let's focus on improving the sentence, please.--TheNautilus (talk) 12:03, 23 April 2008 (UTC)

Nutrition is not synonymous with Orthomolecular medicine. Your choice of wording implied that it was. One cannot attribute anything to do with nutrition as being orthmoecular. If the article makes direct references to OM, then we might have something useful to work with. Jefffire (talk) 12:11, 23 April 2008 (UTC)

The sentence overstates its source base on "orthomolecular" content, that's the original SYNTH problem.--TheNautilus (talk) 12:14, 23 April 2008 (UTC)

Could you elaborate, please? If critical material is WP:SYNTH I'll look into it too. Jefffire (talk) 12:25, 23 April 2008 (UTC)

Jarvis (1983) just barely touches OM with 2 "ortho-" anything words in 17 pages, quotes linked above. Jukes (1990) attacks vitamin C with misplaced proximity to "Quack Remedies in Cancer" being the crime, where Jukes never mentions vitamin C & cancer, just vitamin C & colds with Pauling. Jukes' nutritional autobiography and (misrepresented) attack on Pauling nevers says "ortho-" anything in 23 pages, Jukes *briefly* criticizes "megavitamins" (and Congress, Pauling, Roger J. Williams, NHF, Prevention magazine...) on a failed FDA attempt to regulate vitamins over 150% of RDA in one paragraph (FDA went down in flames, 81 to 10), all in one paragraph. Jukes finishes the "Megavitamin" section with two paragraphs criticizing organic foods being pesticide-, hormone-, artificial fertilizer- free. Megavitamin, huh?

Then AJR editor, Robert Olson, starts bashing everything in sight as quackery, sort of "hey everybody, sic 'em like Jukes, sic 'em, sic 'em." All personal opinion, no technical back up, references, nada. Just pure attack. Not even one use of "ortho-" anything, just one (ab)use of ambiguous "megavitamin therapy". Misrepresented megavitamin use - the big negative examples were never orthomolecular in nature e.g. synthetic menadione (once called K₃) used by *mainstream doctors* in larger amounts on newborns (up to 50 mg documented) than orthomolecular amounts of the safe human forms of vitamin K₂ used successfully on liver metastases in Japan for terminal adults. Or even now pharmaceutical isotretinoin, a scarce interconversion form of vitamin A, used too frequently (6x?) on young females that can create severe defects or coerced abortions even several years after drug cessation. Yeah, there may be big "megavitamin" examples of quackery alright, they are just not orthomolecular.--TheNautilus (talk) 13:31, 23 April 2008 (UTC)

It's probably within the realms of reason to include criticisms aimed at the founder and megavitimins since they appear to be strongly associated with the subject. There's a lot of detail in your post above, so could we take it one at a time? Which do you think is the biggest problem at the moment? Jefffire (talk) 13:39, 23 April 2008 (UTC)

Beyond the textual summary's inaccuracy and sources' minimal coverage, these are extremist critics being given undue weight, without balance or NPOV, as well as being without a relevant scientific base or technical development on the subject. Criticism based on megavitamins should reflect clear orthomolecular examples. The supposed "bad" megadose examples that are typically presented either were fundamentally non-orthomolecular in nature or involved (long) known contraindications.

Jarvis, founder of an "activist" group that virtually sued itself into oblivion being also legally wrong too many times, has no research in the area. Jukes, a "gifted polemicist", sore at being gently needled by Pauling for being a critic with no research on high dose vitamins & C after several decades of missing opportunities, appears to deliberately create an innuendo against Pauling by selective truncation of the radio transcript - pretty non-encyclopedic for orthmed by any standard.

Deja vu. To further demonstrate what I mean about "extreme", let's listen to *the mainstream* in Science, about Robert Olson and the NAS decison to not release an RDA recommendation to drop from 45 mg to 40 mg per day for vitamin C (now 75-90 mg/day, recommended for 200 mg/day by Levine et al at NIH). Olson supported a food only RDA proposal dropping to 40 mg/day vitamin C. Robert Olson was neither a part of the panel nor party to the review process. His letter contains unverified assertions about NRC's decision, selective citations, faulty characterization of the review process, and unjustified attacks on members of the Food and Nutrition Board. - Frank Press, Office of the Chairman, National Research Council, National Academy of Science.^{Science, 20 Dec 1985} With such a public rebuke in a premier journal by an NRC/NAS official, Olson's opinions of anything, or anybody, don't sound too reliable north of 40 mg vitamin C. Especially since Dr Levine's 200 mg C/day NIH recommendation might be considered a "megavitamin" (5x) by Olson's reckoning.

Ultimately, these avowed enemies of "more than minimalist nutrition" are being used to perpetuate gross misrepresentations and misconceptions about orthomolecular medicine here at Wikipedia with weak, highly biased sources from extreme, baseless statements with *no* relevant data. Although "FF-Q" discussion in the body can be balanced and summarized, the current Lead is POV, unbalanced(-able) and frankly, uncivil, as well as false (currently experimental with plausiblity and gaining positive medical evidence) and not a summary, just a transparent attack given UNDUE WIEGHT and authority.--TheNautilus (talk) 11:15, 24 April 2008 (UTC)

Dated reference in lead used for current consensus statement.

Concerning the claim: "The current scientific and medical consensus is that the major claims of disease treatment by advocates of orthomolecular medicine are unsubstantiated by the available evidence."[9] [10][11]

Already dated reference 10 published in 1990, cited studies that were published in the 1970s and 1980s to substantiate their position, It would seem to be misleading to use it to represent current scientific and medical consensus. Ward20 (talk) 20:29, 13 May 2008 (UTC)

The other two references are from 2003 and 1997. Tim Vickers (talk) 21:44, 13 May 2008 (UTC)

Yes, I agree that those two references support the claim of current, but a 1990 viewpoint based on data from the 70s and 80s should not represent current scientific and medical consensus. If the other sources are strong enough to support the content then reference 10 is redundant and can stay or go. If references 9 and 11 will not support the content on their own, then a new reference might be found or the sentence reworded. Ward20 (talk) 23:27, 13 May 2008 (UTC)

Ward20, I think that the combination of references is okay (not ideal, but okay) here, but perhaps you would prefer to have it say "The longstanding scientific and medical consensus..." instead? WhatamIdoing (talk) 19:45, 19 May 2008 (UTC)

Yes, I believe the above wording would be more accurate to the sources used, although I have some other suggestions about these references and paragraph to try to improve it.

The source (9) Cancer Medicine Megavitamin and Orthomolecular Therapy section seems to be written by two PhD's, and as far as I can tell their primary view states, "There is no evidence that megavitamin or orthomolecular therapy is effective in treating any disease." This is contradicted by sources (10) and (11) and other studies cited in the article. I don't view that source supporting "the consensus of the scientific and medical community" very well.

Source (10) Megavitamin and megamineral therapy in childhood which I believe the most dated source, seems less negative about megavitamin and mineral therapy than source (9) saying, "Vitamins and minerals in large doses are used as primary therapy for certain medical conditions." and "A number of disease states necessitate the use of vitamins and minerals in doses exceeding the recommended nutrient intake... diseases of the liver, kidney and bone... Large doses of vitamin D, ...rickets... high doses of vitamin A analogues... acne... The rationale for use in several other conditions, however, is not as well established." Then they discuss studies that conclude there is a lack of efficacy for many conditions advocated for megavitamin and megamineral therapy. In the recommendation section they urge caution concerning the health hazards and substitution of unproven megavitamin regimens for proven safe and efficacious treatments.

Source (11) Orthomolecular Medicine by the American Cancer Society states, "Available scientific evidence does not support use of orthomolecular therapy for most of the conditions for which it is promoted. However, vitamins, minerals, and other supplements have been and continue to be studied to see if they can help or prevent many types of illness. While some supplements have been shown to help certain conditions, a few have unexpectedly proven to be harmful."

Suggestion to change the paragraph to bring more balance in the lead:

• The American Cancer Society states that current scientific evidence does not substantiate most uses of orthomolecular therapy for which it is promoted. Certain conditions have been helped by some supplements, while a few nutritional therapies have proven harmful. The American Medical Association stated in 1997 that "much of the dietary intervention stressed by alternative healers is prudent and reasonable", but described as a "myth" the idea that "most diseases are caused by faulty diets and can be prevented by nutritional interventions". Other medical literature has been very critical of orthomolecular medicine.

I changed the last sentence because it seems to be cherry picking in order to get pejorative phrases into the lead. I think the prior wording gives the pejorative phrases too much weight. This change would bring more balance to the lead, and then the primary source positive studies in the last paragraph could be moved out of the lead into a section that specifically talks about those. It would seem to me that better balance in the lead similar to this would be more encyclopedic than (perhaps overly) harsh criticism which is then followed by positive studies. Ward20 (talk) 02:01, 20 May 2008 (UTC)

And the longstanding wording per WhatamIdoing suggested, along with source (10)'s pro and con statements could be added. I still wish the paper was more recent though. Ward20 (talk) 02:35, 20 May 2008 (UTC)

The short three paragraphs in Cancer Medicine are directly contradicted by the recent NIH-PNAS-CMAJ papers on the (misrepresented) Moertel trials, nature & significance of IV vitamin C, Moertel's failure ("oversight") with cancer. The section's brevity suggest, and these clear errors show, that however authoritative the book may be on conventional treatments, it is *not* very authoritative on OMM.--TheNautilus (talk) 13:26, 21 May 2008 (UTC)

Lead Redux

I was in the middle of editing the lead when Ward20 changed it. Here's what my edit looked like:

However, recent science has begun to substantiate some of the claims of orthomolecular medicine, finding that nutritional deficiencies may play a greater role than previously thought in mental illnesses and criminal behavior. A recent review of case studies found three cancer patients whose only significant treatment was intravenous vitamin C survived much longer than expected. These results are far from conclusive as there are other possible explanations, including the conventional treatments which two of the three underwent, but further clinical trials are in motion.

I don't know if we really need to explicitly describe studies in the intro section, especially when the studies are open-access. Note that the vitamin C case study explicitly says "3 cases of patients with usually progressive malignant disease who received intravenous vitamin C therapy as their only significant cancer therapy". Thus broadly claiming that these patients' had conventional and alternative treatments is misleading. Spending time on this study makes sense given that "vitamin C cures cancer" was a major part of this discipline. Also, I may raise a RfC on the "quackery" bit, although I don't suppose it matters that much. Its ad hominem attacks don't mean anything analytic readers, but most people aren't that analytic. Still, I don't think it belongs in the opening -- the "mainstream consensus" bit covers that side much less crassly. Impin | {talk - contribs} 23:45, 13 May 2008 (UTC)

I can see the point. The amount of detail is certainly a matter for discussion. I do believe the phrases, "science has begun to substantiate" and "nutritional deficiencies may play a greater role" may be slightly synth, in that the citations talk mostly about benefits of treating nutritional deficiencies and not about substantiation of Orthomolecular medicine or the perception of nutritional deficiencies. The two papers that discuss the cancer studies cases do say that other alternative treatments besides C were used and it would be difficult to say which are important. I agree with the point that only 2 of the three patients had limited conventional treatments along with the alternative treatments. Ward20 (talk) 01:13, 14 May 2008 (UTC)

Orthomolecular medicine is about treating nutritional deficiencies. I don't see how this is synth. Impin | {talk - contribs} 18:51, 14 May 2008 (UTC)

Perhaps WP:OR is a better term because those two opinions do not appear to be stated in the citations. Ward20 (talk) 05:48, 17 May 2008 (UTC)

Using vitamins to treat diseases is what OM is about. I don't see how you're making these claims.

For the last RfC see above. To be perfectly honest, a historical account of three people over ten years who received a mix of many different treatments is not something I would have added to the lead. Furthermore describing this as Recent evidence even suggests that vitamin C delivered intravenously can shrink tumors. is unsupported by the data. Tim Vickers (talk) 15:50, 14 May 2008 (UTC)

Furthermore saying that vitamin C was their "only significant treatment" when all these people received either radiation therapy or surgery is equally misleading. Tim Vickers (talk) 15:56, 14 May 2008 (UTC)

That RfC was not focused on your quackery addition at all -- both were in the two choices. Many people said they disliked both. First, this is a study highly pertinent to this topic which is mainstream generating attention; it definitely belongs in the lead. As far as saying "only significant" treatment -- that's a quote from the paper; it's not our job to contradict researchers, no matter what our qualifications are. One of these people received no radiation or surgery. So stating that they all received some conventional treatment is patently false, beyond misleading. False statements do not belong in this encyclopedia. Impin | {talk - contribs} 18:51, 14 May 2008 (UTC)

Case 1 received nephrectomy, case 2 received transurethral resection and case 3 received radiation. As the authors note in the discussion "The cases reported here do not prove that vitamin C induced the favourable outcomes observed." I do appreciate your eagerness to improve the article, but please try to read the sources carefully. Tim Vickers (talk) 19:00, 14 May 2008 (UTC)

Sorry, I missed the nephrectomy statement on case 1. Ward20 (talk) 05:48, 17 May 2008 (UTC)

No, the conventional therapy is not very prominently presented in this paper, for some reason. Tim Vickers (talk) 15:09, 17 May 2008 (UTC)

Your observation and wording, very astute. Ward20 (talk) 05:29, 18 May 2008 (UTC)

The paper clearly says that the only significant therapy for these 3 was the vitamin C therapy. Leaving that out and putting the conventional therapies on the same level distorts the paper. I'm no specialist, but I got the impression that the chance of the conventional therapies working was very remote. I'll have to re-read it, but I recall hearing that the chance of recovery with only the conventional therapies was somewhere around 1% for at least 1 of the patients. Impin | {talk - contribs} 18:02, 20 May 2008 (UTC)

So if you treat 1,000 people with a therapy that works 1% of the time, you would expect it to work in 10 cases. Here we have 3 cases where the people were treated and had a small chance of getting better, and did they get better. What a case-report study like this can't tell you is if there are 997 cases where people treated in the same way did not get better. This is why people do clinical trials and why the authors of the study say that it doesn't prove anything. Tim Vickers (talk) 18:15, 20 May 2008 (UTC)

True. My proposed intro says that "these results are far from conclusive". That doesn't take away from the fact that the conventional treatments were considered minor by the researchers, which is not in the intro. Ultimately, I didn't put the vitamin C study in the lead; I think it belongs in the lead only because the vitamin C cures cancer is such a well-known claim of OM. Impin | {talk - contribs} 18:21, 20 May 2008 (UTC)

Instead of using an inconclusive report on 3 people who were treated with a complex mix of alternative and conventional therapies, what about using a recent review on the topic of vitamin C as a cancer therapy? Examples could be this meta-analysis or this review in an alternative medicine journal. Tim Vickers (talk) 18:34, 20 May 2008 (UTC)

Well, Tim, offhand I'd say the reason that a case report was selected is because there are no good reviews that support this particular treatment. So to represent the "maybe IV Vitamin C cures cancer" (sometimes: the first case died from cancer) idea, we're pretty much stuck with anecdotal evidence. Still, I'd rather see weak evidence like this not placed in the lead. WhatamIdoing (talk) 23:15, 31 May 2008 (UTC)

When I found this page, The Independent's article was cited in the lead as a footnote without saying anything about it. I expanded it somewhat. Considering the importance of vitamin C in this field, however, I don't think it is strange to put the new recent research in the lead. The inclusion in the lead is not meant to say anything about whether vitamin C actually works. It's just meant to highlight something rather notable for the field - much of OM has revolved around vitamin C. A paper recently found that IV vitamin C is much different than oral vitamin C and generates plasma levels of vitamin C up to 70 times higher than oral. Prior to this case study, two papers were published in the PNAS in 2005 and 2007 (see the end of the history section) demonstrating that vitamin C kills cancer in vitro and likely in vivo as well. Yet all the randomized studies of vitamin C have used oral vitamin C, when the observational studies by Pauling and Cameron used IV vitamin C as well as oral. It's something that the scientific community is paying attention to, as evidenced by the fact that two PNAS papers were published, and a CMAJ paper was published over this small case study. This is really a huge event for OM, and it deserves to be mentioned in the lead. ImpIn | (t - c) 00:42, 1 June 2008 (UTC)

poor relevance (OR), obsolete reference, 1990 CMAJ

The 1990 CMAJ Canadian Pediatrics Society paper[16] is obsolete and has been demonstrated to be in dangerous error for Canadian children in some cases (e.g. vitamin D in the high north), much less much about orthomolecular medicine. Hoffer's books on OMM deprecate the use of "megavitamin" and "megavitamin" is not synonymous with "orthomolecular", especially when "conventional" types are hunting for disparaging text with just plain old overdosages. Using the 1990 CMAJ article confabulates a connection between OMM and some large ("mega")dosage examples that are not any therapy, and/or especially are not the same as orthomolecular megavitamin therapies (e.g. pharmaceutical vitamin A isomers for acne). As for the CMAJ quote in the paper: "For certain nutrients or people toxic effects may occur at much lower levels." Well, duh, see RJ WIlliams, Biochemical Individuality, 1956. This quote misleads. OMM has a much better track record identifying this than conventional MD / RD recommendations, recommending nutrient better forms and recognizing individual conditions and contraindications to individualize any dose (e.g. see niacin comments below). Vitamin A and carotenes are an area great individualization because of the chemical (alcohol, statins) & oxidative stress (smoking, lack of vit C) and liver disease populations that also need careful handling and monitoring. In these latter cases, OMM would talk about vitamins B's, C, K, E, Se, Q10, alpha lipoic acid, N acetylcysteine, sAME, silymarin, phosphatidylcholine (lecithin) for liver support[17][18][19][20][21] as well as individual dosing of vitamin A and/or mixed carotenoids.

As for implied OMM oversupplementation with iron, vitamin D and calcium, how insulting. CPS in CMAJ 1990 et al simply missed the pediatric vitamin D requirements by a factor of 5-10, at least, according to *current* medical schools' research, where various OMM recommendations then were closer (still low) or even concordant with *current* recommendations. Iron has been a watchword of caution in orthomed-natural circles for a long time (so long I am not sure, but before the 1980s), long before conventionals caught on in the 1990s. OMM types have been concerned about magnesium - calcium ratios for a long time too, some OMM groups being very negative about current willy nilly calcium supplements without magnesium.

Niacin hepatotoxicity is grossly overstated and not relevant to OMM recommendations, pure niacin doesn't have these problems outside the most liver compromised, -ing, pre-existing conditions (see Parsons, WB (1961 a). Archives of Internal Medicine 107, 639-652 & Parsons, WB (1961 b). Archives of Internal Medicine 107, 653-667; and the Coronary Drug Project, 1966-1974); the old sllooowwww release non-orthomolecular forms were problematic. Journal papers claiming problems (e.g. JAMA 1994) include gross malpractice using triple-sized dosages (e.g. 1500 mg bid instead of 500 mg tid) of the slow release form on unacclimated patients - long known gross overdosages, greatly over *any* hard ceiling at 750 mg (or perhaps 1000 mg) per ingestion on such slow release niacin.

Multigram gram doses of B6 are not modern OMM treatments (1950s, before Pauling's definition), especially by itself and without other vitamins and minerals. Using the Table 1 (0.23 - 60 gram scale mineral toxicities) in CMAJ 1990 with cobalt, fluoride, iron and copper toxicity, again how misleadingly insulting, like Al Capone accusing someone's tea totaling virgin aunt of impropriety. I haven't noticed OMM advocate fluoride (ahem) or cobalt chloride as implied using CMAJ (1990), and OMM is much more cautious about iron and copper supplementation than most conventional recommendations or multivitamins have been.

CPS' statements about vitamin C as a respiratory antiviral treatment still *completely fail* to address the even the lowest orthomolecular treatment range (Pauling) despite 60 years since Klenner and almost 40 years since Pauling's (low but) easy-to-use recommendations. The basis of CPS' statement about the suborthomolecular vitamin C treatment range was subsequently refuted by Hemila in numerous peer reviewed papers in the 1990s and collated in 2006. Likewise CPS' statement spreading Moertel's fraudulent misrepresentations (per Pauling, now with NIH acknowlegements about significance and lack of range, route of administration & replication ) about cancer and vitamin C testing that had little to do with actual OMM recommendations.

Using the 1990 CMAJ article is pretty much inaccurate OR about orthomolecular medicine to support a POV and perpetuates several misunderstandings of orthomolecular medicine in relation to random megadose accidents and to megavitamin therapies.--TheNautilus (talk) 14:32, 20 May 2008 (UTC)

Source selection

There are three studies mentioned in the last paragraph of the lead that deal with the effects on particular conditions of nutritional supplements, rather than discussing OM or megavitamin therapy in general. What was the reason that these studies in particular were chosen from the thousands of other studies that have been done over the years? Why also are we quoting these primary sources describing specific pieces of research, rather than secondary sources such as reviews or textbooks? Tim Vickers (talk) 16:01, 20 May 2008 (UTC)

OM medicine simply is the use of vitamins to treat diseases. It overlaps with mainstream nutrition. And what do you mean? There are three main topics cited. 'The first is a 2008 review -- it literally is a review. Look at it. The second is a fairly straightforward study; there's no harm in it. And the third touches on one of the primary topics of OM, vitamin C for cancer. The rule for secondary sources is designed to avoid using extremely technical papers, which other WP users can't understand. Read WP:PSTS. I'll quote it for you just to make sure: "Primary sources that have been published by a reliable source may be used in Wikipedia, but only with care, because it is easy to misuse them. For that reason, anyone—without specialist knowledge—who reads the primary source should be able to verify that the Wikipedia passage agrees with the primary source." None of these papers are highly technical, and we aren't making any controversial interpretations -- we're describing them in a straightforward manner. Also, the vitamin C study is cited by two secondary source which agrees with our interpretation -- a newspaper and an editorial in the journal. Impin | {talk - contribs} 16:39, 20 May 2008 (UTC)

So what was the reason for the selection of these three particular publications? Tim Vickers (talk) 16:47, 20 May 2008 (UTC)

The first is a good overview, and directly relevant to OM as it talks about using vitamins to treat mental illnesses, gently chiding mainstream science for ignoring nutrition as a source of mental illness. From the abstract:

Notably, essential vitamins, minerals, and omega-3 fatty acids are often deficient in the general population in America and other developed countries; and are exceptionally deficient in patients suffering from mental disorders. Studies have shown that daily supplements of vital nutrients often effectively reduce patients' symptoms. Supplements that contain amino acids also reduce symptoms, because they are converted to neurotransmitters that alleviate depression and other mental disorders. Based on emerging scientific evidence, this form of nutritional supplement treatment may be appropriate for controlling major depression, bipolar disorder, schizophrenia and anxiety disorders, eating disorders, attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD), addiction, and autism. The aim of this manuscript is to emphasize which dietary supplements can aid the treatment of the four most common mental disorders currently affecting America and other developed countries: major depression, bipolar disorder, schizophrenia, and obsessive compulsive disorder (OCD).

The second is simply a striking individual example of the effect of omega-3 fatty acids. The third describes the contemporary mainstream research into foremost nutrient in OM, vitamin C. ImpIn | {talk - contribs} 18:57, 23 May 2008 (UTC)

If memory serves me right, I added one of the articles to the lede, as well as an article from the very reputable Economist. Such sources are indispensable if one wishes to show that the debate about orthomolecular medicine is not yet conclusively resolved, that serious people are finding its tenets to make sense, and, perhaps, that the tide is slowly turning. The article in the Economist should never have been deleted.

If we must have such highly pejorative words as "food faddism" and "quackery" in the lede, fairness and accuracy dictate that we also cite The Economist, an extremely respected publication.--Alterrabe (talk) 21:13, 23 May 2008 (UTC)

Jeffire's synth allegation

Obvious WP:SYNTH, removed. Jefffire (talk) 17:26, 24 May 2008 (UTC)

I'm sorry, you're going to have to back up your statements better than that. Look at the intro to the article, indeed. Orthomolecular medicine is defined as using nutrients "in the right amount" to treat diseases. That article is about using nutrients to treat mental illnesses, which are diseases. Thus, that article is about Orthomolecular medicine. It also includes a Journal of Orthomolecular Medicine article in its references. Your edit is analagous to, say, taking an article about the Earth out of a broader solar system article because the article on the Earth doesn't directly reference the fact that the Earth is in the solar system. Or taking an article on vitamin C out of a nutrition article because the article doesn't directly reference that vitamin C is a part of nutrition. If you don't respond within a few hours, I will revert again. ImpIn | {talk - contribs} 18:32, 24 May 2008 (UTC)

I asked Jeffire to look into the history and breadth of orthomolecular research in delinquency before denying that they are the same. I hope this will solve our problems.--Alterrabe (talk) 20:36, 24 May 2008 (UTC)

Journals of orthomolecular medicine are not reliable sources. Material that does not identify itself as "orthomolecular" can not be pegged as such by the opinions of editors. If this stuff is "orthomolecular", then find a reliable source which says it is. Jefffire (talk) 09:28, 25 May 2008 (UTC)

I beg to differ. Journals of Orthomolecular Medicine certainly are reliable sources for the beliefs of adherents of orthomolecular medicine.--Alterrabe (talk) 11:38, 25 May 2008 (UTC)

You obviously haven't taken the time to actually read this page, or the policies. Thus, you should not be editing it. First, even if JOM wasn't a RS, it is fine for views about itself. Second, it is a peer-reviewed scientific journal, it has been around for 40 years, and thus it is a RS. Its papers are vetted by people with Ph.Ds and MDs. You'll have to quote from the policies if you disagree, because, as a peer-reviewed journal, it certainly fits as a RS prima facie. As far as what OM is, you can look at Pauling's article in Science for one of its first definitions. It has been republished here. You cannot say that using nutrients to treat disease is SYNTH. Don't wikilawyer or misrepresent the policies. ImpIn | {talk - contribs} 11:49, 25 May 2008 (UTC)

One cannot claim any use of nutritions in medicine is "orthomolecular", that's PoV. This is a fringe, pseudoscientific alterative medicine, and so should be treated exactly as detailed on WP:FRINGE. "Orthomolecular" studies are those which have self defined as such. Jefffire (talk) 13:56, 25 May 2008 (UTC)

I worry that the pejorative labels you apply to orthomolecular medicine, some of which are emotionally charged, may inhibit thoughtful reflection on its claims by readers. To my mind, it is a pushing an inaccurate point of view to suggest that nutrient therapies are not "orthomolecular" in nature, given that orthomolecular medicine's definition is:

"Orthomolecular therapy is the treatment of disease by the provision of the optimal molecular constitution of the body, especially the optimal concentration of substances that are normally present in the human body and are required for life. The adjective orthornolecular is used to express the idea of the right molecules in the right con- centration. This word may be criticized as a Greek-Latin hybrid, but I have not thought of a better word."

How can nutrient therapies NOT be orthomolecular given this definition? What I can, however, understand are concerns that the reader be given to understand that there is unamity about all the claims advanced under the umbrella of "orthomolecular medicine" when many are not acknowledged by mainstream medicine.--Alterrabe (talk) 15:03, 25 May 2008 (UTC)

If a claim is not called "orthomolecular", then it is not orthomolecular. Simply claiming that any befintit found of vitimins to people is orthomolecular is no more valid than claiming the debunking of Piltdown man is creationist research. Both fall under the mainstream umbrella. Jefffire (talk) 15:10, 25 May 2008 (UTC)

Do I understand you correctly, that you claim that even if a treatment meets the definition for "orthomolecular medicine," as soon as it is accepted by mainstream medicine it no longer is "orthomolecular"?--Alterrabe (talk) 15:19, 25 May 2008 (UTC)

I don't accept that these treatments meet the definition of OM (even as wooly and meaningless as that quoted about), but that would be a glib interpration of how Wikipedia's fringe guidelines work. If a topic is fringe, it gets treated as such. Jefffire (talk) 15:25, 25 May 2008 (UTC)

1.) By what logic do you deny that these treatments meet the definition of OM?

2.) By what logic do you criticize the Pauling's definition of orthomolecular medicine? --Alterrabe (talk) 16:30, 25 May 2008 (UTC)

My reasons are irrelevant. Under wikipedia policy, the sole onus is upon the editor who wishes to include material into an article, which is yourself, to prove that the material is suitable. Prove that the material is "orthomolecular", avoiding any possible accussation of WP:SYNTH, WP:PoV or WP:OR, and it can go in. Otherwise, it can't. Jefffire (talk) 16:35, 25 May 2008 (UTC)

I'm afraid I cannot agree with you in this regard. Insofar that I am considering asking for a third opinion or comment, I am trying to understand your reasoning and thinking so as to avoid this step if possible. We cannot address the allegations you make of WP:Synth, WP:POV you make without getting our definitions straight. I am making a good faith effort to understand the reasoning behind your edits. Bear in mind that when two opinions clash, not one, but both parties have a point of view. My goal is to respect your point of view, and wikipedia's policies, and at the same time write the best possible article. You cannot insist that wikipedia policy requires that the article be the way you wish, and then refuse to explain why you believe wikipedia policy means that you are right. The discussion is not about whether the edits are suitable, but rather why you believe they are not. I believe that it is evident in my question why I believe you are mistaken in removing them, and invoking SYNTH.--Alterrabe (talk) 16:45, 25 May 2008 (UTC)

I don't care what the definition of orthomolecular medicine is. Either the studies are described as "orthomolecular" or they are not. If they are not, then it is quite clear this is legimate nutritional research that is being jumped on by pseudoscientists, and should be removed as under WP:SYNTH. Either provide some evidence that this is described as "orthomolecular medicine" or cease PoV pushing. Jefffire (talk) 16:51, 25 May 2008 (UTC)

Jefffire, I reread WP:Synth. You are right, according to it; it doesn't matter whether the research is orthomolecular or not, it must describe itself to be such. I apologize. I hope, in due time, to find a source which mentions that many treatments readily adopted by mainstream medicine fulfill the criteria meet the criteria for "orthomolecular" medicine.--Alterrabe (talk) 17:35, 25 May 2008 (UTC)

Are you kidding Alterrabe? It's so obviously not SYNTH. The SYNTH example is not remotely similar to this case. What is being reported in the article, that nutritional therapies do work for treating mental illness, is explicitly stated by the article in question. I will stand by that and go through a RfC if necessary. If using vitamins to treat diseases is SYNTH, then we might as well get rid of the entire article. Further, we might as well get rid of most articles on Wikipedia, because most of the sources that they are based on do not specifically say what field(s) their work is involved in. Whether or not the researchers even know they are practicing OM is meaningless, although I am sure they would admit that their recommendation is for an OM treatment. ImpIn | {talk - contribs} 17:50, 25 May 2008 (UTC)

I think the way to resolve these disagreements is to find a source, TheNautilus has mentioned some, that mentions that many mainstream medical therapies, meet the criteria for orthomolecular medicine, and then mention some. If we mention that "mainstream medicine" has used some of the same therapies that OM advocates have long proposed, and reporting very encouraging results, without explicitly representing themselves as "orthomolecular" we will even better do the convolutions of the politics justice. Alternately, we could mention William Walsh's work, and then explain that mainstream researchers have replicated part of his work. In so far as the British subject used a standard regimen for all its subjects, with spectacular results, it was inferior to most explicitly orthomolecular research, which uses individually customized regimens. I think Jefffire has encouraged us to write an even better article.  :)--Alterrabe (talk) 18:26, 25 May 2008 (UTC)

This review {PMID 18046879) may be helpful, "This literature review examines several supplements that have documented roles in medical therapy, including vitamins C and E, coenzyme Q10, alpha-lipoic acid, chromium, L-carnitine, and quercetin. The evidence shows benefits in diabetes, cardiovascular disease, hypertension, congestive heart failure, age-related deterioration of brain function and vision, and immune function, as well as other age-related health problems." There are others that the whole article need to be reviewed, PMID 18072818, PMID 16366737, PMID 15871343, PMID 9532818, PMID 8567594.

—This is part of a comment by Ward20 , which was interrupted by the following: I checked these sources. They all appear to be extremely fringe journals with rock-bottom impact factors (indicative of a lack of scientfic respect). None of them qualify as reliable sources. Jefffire (talk) 09:31, 26 May 2008 (UTC)

First, I don't believe "Orthomolecular" is fringe because there are many well documented effective mainstream nutritional treatments for illness or disease. I am not aware of any RS calling it pseudoscience either. There appears to be no mention of pseudoscience in the article or its sources. Per WP:FRINGE, "ideas should not be portrayed as rejected or labeled with pejoratives such as pseudoscience unless such claims can be documented in reliable sources."

Second, if we use Jefffire's criteria that the RS must specifically use the term "orthomolecular" when mentioning use of nutrition in medicine for prevention or treatment, that would seem to eliminate source the AMA Report on Alternative medicine^[15} in the lead, and possibly other sources in the article. Ward20 (talk) 20:08, 25 May 2008 (UTC)

Jefffire; If what Ward20 writes is true, i.e. tha the AMA report never mentions the word "orthomolecular" (it is) do you agree that it, too is a SNYTH, and must be removed?--Alterrabe (talk) 21:02, 25 May 2008 (UTC)

"most diseases are caused by faulty diets and can be prevented by nutritional interventions" is pretty much exactly what OM claims, and it falls under the broad title of a nutritional therapy. Thusly, the AMA report does indeed cover OM. Jefffire (talk) 09:09, 26 May 2008 (UTC)

I'm sorry, you can't have it both ways. Either sources that describe how nutrient therapies contribute to improved or sustained health without mentioning the magic word "orthomolecular" are admissible in the article on orthomolecular medicine, or articles that deny that nutrient therapies contribute to improved or sustained health without mentioning "OM" are not admissible. To claim anything else is to abuse logic and WP:NPOV. Unless you can agree with me, the time has come to obtain a third opinion, or request comment. Which will it be?--Alterrabe (talk) 10:28, 26 May 2008 (UTC)

Policy is quite clear, there is no need for evenhandedness. A broad criticism of "nutritional therapies" by the AMA quite clearly covers OM, claiming that research X is "orthomolecular" because it contains "nutrients" is clearly OR and PoV pushing. In short, I can have my cake and eat it on this one. Jefffire (talk) 13:21, 26 May 2008 (UTC)

That's WP:OWN and WP:IDONTLIKEIT, Jefffire. As to what consititutes OR, Jefffire's statements are at least hypocritical, double standards. OMM has been identified as a rubric, not a theory, by even its bitter critics. As for FRINGE, even for the new medical treatment hypotheses, that is not an appropriate description for legitimate MD and PhDs that have substantial records in science and medicine, and whose recommendations *are* being tested in the mainstream, *and are* often being grudgingly developed & accepted year-by-year. That "cake" you are baking sounds like it has lead acetate for icing and little high on mercury content for Wiki madness. Please don't start some edit war based on such a prejudicial, unreliable, ill-informed view.

The AMA's wording is overgeneralizing, non-neutral and a little amibiguous. The "alternative healers" has some risk of misattribution or specific meaning to OMM (rather a naturopath?). Using a generalizing statement like "most diseases" may also be tautological or self serving, and excludes more commonly used wording like "most chronic diseases" and "treat" or "ameliorate" rather than requiring causation or prevention. In fact that part *mischaracterizes Pauling's definition of OMM*, he didn't claim or specify causation or prevention. His definition implies OMM could treat to optimize the body's chemistry, to make something chemically out of kilter, better, closer to some optimum. The AMA statement may also define or medicalize a large number of diseases and conditions as non-nutritional in origin (e.g. aerosolized anything, ²¹⁰Po, ²⁵³Fm poisoning... ) - certainly some of OMM's other medical critics, including (former?) AMA members, play word and logic games of serious misrepresention. The AMA has something of a track record for self serving (oh, yes, that was its chartered purpose) and anticompetitve statements, it has not been a neutral party with competitors and outsiders. Further, the *mainstream* nutritionists have criticized (dismissed) medicine's familiarity of the subject (there's a really precious quote from the Am Inst Nutrition fellows/officers in the early 1960s that I'll have to dig out) and nutrition is not substantial part of the curriculum for most medical students. Given the substantial amount of experimentation, acceptance of therapeutic nutrients, and even reversal of position on some nutrient therapies, in the ~11 years since the AMA committee's statement, it is also obsolete.--TheNautilus (talk) 00:06, 27 May 2008 (UTC)

Syntheses

In the 1960s, Linus Pauling, a two time Nobel Laureate, urged that medicine move to using the building blocks of nature; e.g vitamins, minerals, aminoacids (the sort of things Americans think of as nutritional supplements) as medicines in the place of medicines that do not occur in the naturally in the human body, when this is possible. He named this approach to medicine “orthomolecular medicine.” To this day, orthomolecular medicine is quite controversial. Some uses of vitamins, minerals and the like have established themselves in mainstream medicine, others advocated by the proponents of orthomolecular medicine haven’t.

Editor Jefffire removes mentions of positive results using nutrients to cure illness from the article on orthomolecular medicine, which clearly embody orthomolecular principles, and explains his doing so as removing a “synthesis” because they do not explicitly mention that they are “orthomolecular.” I believe that this is contrary to the spirit of wikipedia’s guidelines, but that it is correct by a very strict reading of the same.

Our disagreements begin when Jefffire, insists that articles that describe nutritional therapies, but don’t mention the word “othomolecular”, he insists, cannot be included in the article when they support the claims of orthomolecular medicine’s proponents, but they can, and should be, when they disparage their claims. In other words, he insists on a double standard to advance his point of view. Our discussion.]

What do other editors have to say?--Alterrabe (talk) 15:50, 26 May 2008 (UTC)

Cue meatpuppets. If you have a problem with Wikipedia policy, don't use Wikipedia. This is not the place to overturn medical and scientific consensus, and attempting to do so is a hallmark of pseudoscience (I've seen this pattern so many times before, it's sad). Earn a medical degree, do some real research and prove the matter one way or another. Waging such a battle on Wikipedia is frankly a waste of both our time, and culimates in the eventual blocking of the anti-science alt-med promoters. Jefffire (talk) 16:51, 26 May 2008 (UTC)

The idea is to get a third opinion, and not to blather around. Yet some of the insults in the above require an answer. I am not "anti-science;" the exact opposite is true. Those who insist that scientific consensus are beyond questioning are the greatest enemies of the scientific process.--Alterrabe (talk) 19:07, 26 May 2008 (UTC)

Thank you for admitting that this is fringe. Luckily there is a whole subset of policy for this WP:FRINGE Jefffire (talk) 21:26, 26 May 2008 (UTC)

Orthomolecular medicine is based on the traditional sciences. It is not a theory but rather utilizes an idea or principle to establish preference for selecting research and treatment directions in health and medical matters, based on chemical changes, usually nutritional in nature. Individual practices or treatments may be based on hypotheses that are hotly disputed, but experimental stage treatments or developmental treatments don't make OMM a fringe science, every field has its areas of growth and exploration. OMM does use a different assumption of risk and benefit during development: that nutrients are relatively safe in the hands of a *knowledgeable* professional and that cautious, individualized use during development is desirable and likely to have net benefits.

Also the "scientific consensus" here about anything has been overclaimed by the QW inspired. Editors who depend on related sites, or perhaps more commonly, publications relying on those sites, as a quide or reference, are simply misinformed with material that is based on bias, scientific misconduct, misrepresentation and/or obsolete notions about orthomolecular medicine. Also, much of what is not yet fully medically accepted to the level of an FDA approved treatment is not "fringe" science or medicine.--TheNautilus (talk) 00:19, 27 May 2008 (UTC)

I very much dislike having to rebut the facts of your contentions in a discussion that is meant to obtain third opinions, and not rehash first or second opinions. We have done this ad nauseam, and beyond. I feel it is an insult to our readers. When research pioneered as "orthomolecular" and shunned 30 some years ago, is now published in the Canadian Medical Association Journal, which bills itself "Canada's leading medical journal," I cannot let blatant misrepresentations of what is now experimental science published in serious publications be miscategorized as "fringe" science.--Alterrabe (talk) 03:29, 27 May 2008 (UTC)

Find supportive articles in a high quality journal such as the BMJ, Clinical research or the like, and you have evidence that this is mainstream. A smattering of articles in the Canadian Medical Journal (impact factor 1.338), is not convincing. Mainstream subjects will be well represented in all sources. Fringe ones will display the pattern seen here. All you have done is prove it fringe. Jefffire (talk) 08:12, 27 May 2008 (UTC)

Deleting half the article is hardly an act of good faith when it includes, for example, the sourced claim that fish oil improves cardiovascular health.--Michael C. Price ^talk 11:28, 27 May 2008 (UTC)

Please see WP:SYNTH. Since about half the article violated Wikipedia policy, it should go. Jefffire (talk) 11:31, 27 May 2008 (UTC)

Since the fish oil claim, for example, was sourced from an OM journal (despite your edit summary claim to the contrary) it should be restored. Same goes for the other material. Please be more selective in your deletions. In fact, I suggest you follow policy and improve, don't delete. --Michael C. Price ^talk 13:33, 27 May 2008 (UTC)

You also restored a lot of material which was obviously PoV and unverified. Such material should be removed, as per Wikipedia policy. Jefffire (talk) 13:47, 27 May 2008 (UTC)

I suggest going to the Wikipedia:Reliable sources/Noticeboard whith this instead of arguing with someone that has made up their mind about it. Ward20 (talk) 04:13, 27 May 2008 (UTC)

Nutrition journal

I've been reading this article and am rather puzzled that they seem to include lithium salts and St. John's wort as nutritional therapies, eg:

In comparison to patients taking Fluoxetine, consumption of the St. John's wort extract reduced 48% of OCD patient's symptoms [70]. These results clearly depict how the use nutritional supplements can be effective treatments for mental disorders.

I've done some looking but I can't find any mention of lithium as a dietary mineral, and St John's Wort seems to be a herbal medicine to me. Are these substances regarded differently in orthomolecular medicine? Tim Vickers (talk) 15:32, 27 May 2008 (UTC)

Do they not fall under Pauling's definition of the "right molecule"? And herbs can be eaten as nutrients. --Michael C. Price ^talk 15:47, 27 May 2008 (UTC)

As before, I suggest that we go with self-identification. Regardless of logical inconsistancy (herbs are a plant, nutrients are chemicals), if OM proponents claim that "herbs" are orthomolecular then we ought to describe such herbs as being part of the pantheon of beliefs. Jefffire (talk) 15:52, 27 May 2008 (UTC)

It's simple logic: herbs/nutrients supply molecules: if they are the right molecules then it's OM. --Michael C. Price ^talk 15:58, 27 May 2008 (UTC)

I see this question has been answered before Talk:Orthomolecular_medicine/Archive_5#Are_herbs_orthomolecular.3F, and lithium certainly isn't a dietary nutrient. Even without considering SYNTH questions, this source seems to be using a far broader definition of "nutrients" than is used in orthomolecular medicine. Tim Vickers (talk) 15:59, 27 May 2008 (UTC)

No, the question was not answered before: indeed some of my points raised there were left unanswered. --Michael C. Price ^talk 16:05, 27 May 2008 (UTC)

By your logic virtually any remedy could be termed "orthomolecular". However, I have no time for semantics. If you could provide a source that verifies that the use of herbs as "orthomolecular" is in common practice, then fine. If not, then it should be left out as fringe material. Jefffire (talk) 16:09, 27 May 2008 (UTC)

I don't see how herbs can be described as nutritional therapies, and especially not as orthomolecular therapies. The use of lithium as a nerve tonic, particulary at doses far below those used to treat manic-depression, has a long and venerable history. Many baths patients visited to calm their nerves were rich in lithium, and Dr. Pepper, the soft drink, originally included a fair amount of lithium, enough to calm fraught nerves. There are advertisements in which its lithium content is mentioned as a reason to drink it. In this sense it probably would be orthomolecular, though I would argue - based on reading Pauling's writing on neurology and psychiatry - that Pauling would have much preferred nutrients that corrected specific anomalies that had been measured, rather than a variation on today's sledge-hammer aproach to treating troubled psyches.--Alterrabe (talk) 16:19, 27 May 2008 (UTC)

Equally, can anybody find a reliable source that describes lithium orotate as a nutrient? I can't. Tim Vickers (talk) 16:11, 27 May 2008 (UTC)

I have read an article in a journal like the Amer. J Psych if that that journal itself which explained in great detail how low dose lithium salts had been added to diets to calm frayed nerves long before Schou and Cade.--Alterrabe (talk) 16:20, 27 May 2008 (UTC)

Yes that is probably quite true, but lithium isn't a nutrient, and it isn't a biochemical it is a xenobiotic. I don't know if you will be able to access this, but this very cool paper does elemental analyses on people and shows lithium is not a measurable constituent of human bodies, while sodium and potassium are. Similarly, PMID 3905079 doesn't list it as a trace element needed in our diet. Lithium orotate is a drug, not a naturally-occurring compound, so it isn't part of orthomolecular medicine - however broadly you define this. Tim Vickers (talk) 16:37, 27 May 2008 (UTC)

I have not yet seen Tim's paper, I assume that it demonstrates that lithium is not an *essential* nutrient by its absence. That doesn't kick it out of OMM. The claim seems that lithium and orotate ions are naturally occurring, utilizable substances in the diet and orthomolecular substances packaged in a salt, similar to common synthetic vitamins, e.g. thiamine nitrate, vs the natural cocarboxylase (pyrophosphate). OMM is not so synthetic friendly to the alien enantiomers in synthetic oil solubles. However Lithium is most certainly a naturally occuring item in the water of many places; growing up in one place whose water source contained Li this was something of a joke about why people were so mellow. This will come up about others like strontium which are reputed to be good for the bones too, the natural versions considered OMM. Then there is strontium ranelate, a xenobiotic because of the artificial anion. OMM's relation to pharmacological herbs seems ambivalent for several reasons. One, probably, is that the largest body adopting the most (adapting from) OMM are probably the naturopaths, so if it is in the approved garden, why sweat it? Honestly though, there is the question, how do we define xenobiotic and not xenobiotic in OMM? I don't have a fast answer myself between applying Pauling's definition and the definite feeling that some plant extracts are not OMM but xenobiotics. One can probably develop a Socratic argument starting with hemlock... As for the St John's Wort, the plant contains things that are definitely nutrients. The extract is a homework assignment. This is one of the gray areas where *my impression* is that one may traverse from the orthomolecular field to the herbal part of naturopathy without necessarily encountering a clear boundary. (Sort of like the pressurized, critical path skirting, water heating experiment with no clear phase change between liquid and steam and back) One other comment is that it is "okay" if something is not OMM, OMM does not claim to be the "be all, end all" answer, or a jealous god, er, guild. OMM MDs do apply conventional drugs and surgery more sparingly, they probably just don't get as many "free" boat trips (but the Glacier cruise is nice).--TheNautilus (talk) 18:24, 27 May 2008 (UTC)[22]^{best 2ndry ref so far--03:56, 28 May 2008 (UTC)}

You have to be careful with that logic though; remember that Pauling noted that human beings were one of three animals unable to synthesize Vitamin C, nevertheless Pauling certainly thought of Vitamin C as a nutrient.--Alterrabe (talk) 18:31, 27 May 2008 (UTC)

I'd be very wary of taking a Socratic approach to hemlock! :) Tim Vickers (talk) 18:35, 27 May 2008 (UTC)

Perhaps if your wife were a Xanthippe, you would eventually succumb! [23]--Alterrabe (talk) 18:40, 27 May 2008 (UTC)

In my eyes, my wife is at least 500 millihelens (500 ships) on the Greek scale of beauty, so I'm quite content. Tim Vickers (talk) 18:43, 27 May 2008 (UTC)

Wonderful. Ad multos annos! and dare I add, and maybe muchos niños? Meanwhile my Odyssey in quest of an orthogamete continues...--Alterrabe (talk) 19:50, 27 May 2008 (UTC)

It's debateable whether they are -- under Pauling's definition, they could perhaps be included, but I think most OM practioniers would reject that these are the "right" molecules. If there are papers in the Journal of Orthomolecular Medicine saying they are, then we can go with that. In the meantime, the paper is still good for its references to EFAs, tryptophan, glycine ect. in the treatment of mental illness. ImpIn | {talk - contribs} 04:02, 28 May 2008 (UTC)

Yes, we can cite it as a general survey of the literature, but can't cite its conclusions, since these are not based on the same definition of nutrients as used in OM. Indeed, I don't see how those particular statements got past peer-review! Tim Vickers (talk) 15:39, 28 May 2008 (UTC)

Note that the paper never explicitly calls lithium a nutrient. You can gather that from the title, but I think it's unfair to put that in the researchers' mouth when it's well-known that lithium is not a nutrient. The paper is mainly focused on nutritional therapies; the lithium paragraph is a short aside on what they consider to be more effective alternative to standard lithium -- more effective because it allows the doctor to prescribe less, thus messing with the normal biology less. Incidentally, there is a quote from Pauling here where he states that OM is focused on "varying the concentrations of substances normally present in the body". ImpIn | (t - c) 02:28, 29 May 2008 (UTC)

If you have an article that reviews nutritional therapies, I'd expect it to do this, and not wander off this topic and discuss non-nutritional therapies. I'm just puzzled as to why they included these, as it doesn't make a whole lot of sense. Interesting definition, of course it would apply to most drug. Organophosphates vary the concentration of acetylcholine for example. Tim Vickers (talk) 02:54, 29 May 2008 (UTC)

I think Pauling meant that one should use substances naturally in the body. I imagine pretty all drugs work by manipulating chemicals naturally in the body, and I'm sure as a biochemist, he was aware of that. Can you think of any drugs which don't work through manipulating natural body chemicals, out of curiosity? (Well, many drugs displace natural chemicals in certain receptors, which seems somewhat different...) As for the lithium: the inclusion of lithium oroate makes perfect sense when you think of the paper as purposeful as well as topical -- the paper is directed at helping practicing doctors and psychiatrists to help their patients better, as well as to help researchers get up to speed. Thus, they included therapies were effective and less well-known. Further, lithium orotate is unregulated by the FDA and can be purchased OTC as a dietary supplement. Certainly they should have began that paragraph with "Although not a nutrient...", but I think that saying they are the only scientists in the world who think lithium is a nutrient is perverse. With that said, I agree that it is rather sloppy on their part. ImpIn | (t - c) 03:41, 29 May 2008 (UTC)

Request for Comment on TheNautilus

Some of you may not be aware that there was a RfC on TheNautilus largely regarding his behavior here. Also, I summarized some of the evidence for the "vitamin C cures cancer" controversy here. ImpIn | (t - c) 04:08, 29 May 2008 (UTC)

[24]--Alterrabe (talk) 20:14, 29 May 2008 (UTC)

Use of material from Lyle MacWilliam

This author is a paid consultant of several companies who produce nutritional supplements see (link). His article What Makes Gamma Tocopherol Superior to Alpha Tocopherol was used as a source for this statement:

Recent scientific and medical research shows gamma-tocopherol, the most common vitamer of natural vitamin E, has unique beneficial functions and "gamma tocopherol is considered an integral component of the nutrient-based recommendations in many EU member countries."

I changed this to attribute this directly and note the source.

Lyle MacWilliam, a consultant and advocate for several nutritional supplement manufacturers, has argued in Life Extension Magazine that research shows gamma-tocopherol, the most common vitamer of natural vitamin E, has unique beneficial functions and that "gamma tocopherol is considered an integral component of the nutrient-based recommendations in many EU member countries.

I consider the original formulation a serious breach of the NPOV policy that made claims based on an unreliable source with an obvious bias. In particular, the claim that it is gamma-tocopherol which is the most common form of vitamin E is misleading. Gamma-tocopherol is the most common form in the current US diet, but alpha-tocopherol is the most common form in the body (see (link) "Background" paragraph]. This is since alpha-tocopherol is taken up preferentially. Do people think we should retain the second version, or delete this sentence entirely? Tim Vickers (talk) 19:00, 29 May 2008 (UTC)

I think these concerns need to be seen in their proper context.

The link provided mentions that He has also served as a consultant with Health Canada, Environment Canada, Human Resources Development Canada, and the British Columbia Science Council; he is currently engaged as a scientific consultant for several nutritional manufacturers in the United States and Canada...A former Canadian legislator, Mr. MacWilliam served at the behest of Canada's Minister of Health to help develop the framework which led to the current Natural Health Product Directorate and regulations, which allows consumers far more choice in their health care products. In other words, he's far more than a mere shill for supplement manufacturers. It seems misleading to selectively quote qualifications and then use the chosen ones to discredit a person. I have never heard LEF be described as an unserious organization, they even fund grants in academia. I believe that LEF is in fact a non-profit, if so one could also characterize it as "a charity."

One one argue that any scientist who has consulted for pharmaceutical companies is a questionable source? Well, perhaps I answer my question.

In this day and age when blogs blog daily about scandals and frauds in academic medicine [25] [26] [27] it seems to me that it would be better to speak softly, and perhaps add a citation needed tag.

My understanding is that some studies have found significantly superior outcomes in trials that use a blend of isomers, rather than the alpha isomer. It doesn't matter how common something is in the body, it matters what it does in the body. A liter of water is one thing, a liter of hydrogen cyanide something else entirely.

I will make changes to the phrasing that we can then discuss, there are more than two ways to skin a cat.--Alterrabe (talk) 20:33, 29 May 2008 (UTC)

The Life Extension Foundation is a non-profit foundation (charity if you like). It is funded by member donations and by the Life Extension Buyer's Club, which is the for-profit privately owned company which sells supplements and pays to publish Life Extension Magazine. The Buyer's Club does indeed donate some millions of dollars a year to life extension science research projects, many of them having nothing to do with vitamins or supplements. However the magazine should be seen as political views advocated by The Buyers' Club, and contains arguments, lobbying, and advertisments. It's not a science journal. By contrast, the non-profit Life Extension Foundation exists to make science grants, and doesn't sell, advertise, publish, or lobby. Work funded by the foundation is published elsewhere, in referreed science journals. SBHarris 03:54, 30 May 2008 (UTC)

I'm not sure I'd go quite that far, but I stand informed, somewhat corrected that the LEF is intertwined with a for profit organization.--Alterrabe (talk) 07:47, 30 May 2008 (UTC)

Wouldn't go quite WHAT far? The above relationship is exactly correct: LEF is the non-profit research arm of the LEBC, which sells the supplements and publishes the newsletter. "Intertwined" isn't a good word for a relationship where one company is the non-profit branch of the other. Save for LEF membership dues, LEF is a wholely supported subsidiary of LEBC. There is nothing wrong with this, and both LEF and LEBC are very open about it (it's for tax reasons). But that is the way it is. SBHarris 20:21, 30 May 2008 (UTC)

We could say Lyle MacWilliam, an ex-politician and now a consultant and advocate for several nutritional supplement manufacturers, if you wanted. However, do you see the problem with presenting this man's opinions as facts? Tim Vickers (talk) 20:40, 29 May 2008 (UTC)

I notice that most of Mr MacWilliam's books see here have been self-published by MacWilliam Communications Inc. This is looking less and less like somebody we should be quoting. Tim Vickers (talk) 20:51, 29 May 2008 (UTC)

I agree about self-publishing authors. The notion that gamma tocopherols are important in Europe isn't sourced in the article. Given that the papers MacWilliam cites reference a scientist published in the NY Acad of Sci on Tocopherols in Colon Cancer, assuming that MacWilliam adequately does them justice, theNautilus's linking to a review article rather than the specific papers des not strike me as an egregious infraction.--Alterrabe (talk) 21:04, 29 May 2008 (UTC)

This isn't a review, it is a magazine article written by somebody who is paid to promote nutrients. We can and should do better than this. If we want to go into the details of the various types of vitamin E I'd suggest this free-access review from 1999 or this review on tocotrienols from 2006. However, to be honest I think this section is far too technical and could be greatly simplified. Tim Vickers (talk) 21:13, 29 May 2008 (UTC)

Jefffire's disruptive behavior

I've lodged a complaint on Jefffire's behavior at Wikiquette here. He recently said that he's not interested in reading articles on the subject. He needs to stop editing the subject, then. ImpIn | (t - c) 22:56, 29 May 2008 (UTC)

Editors are not required to becomes experts on the subjects they edit. I am only involved here to remove egregious violations of Wikipedia policy. As the admin commenting on your alert points out, I understand policy and how it applies to articles such as this, a specific expertise which has been sorely lacking. To build an authoritative article it is essential that these policies be followed. Jefffire (talk) 11:28, 30 May 2008 (UTC)

Response on the Wikiquette page. ImpIn | (t - c) 22:20, 30 May 2008 (UTC)

There's been another blanket deletion of much sourced material (not by Jefffire this time) which I've restored along with a pseudoscience infobox addition. If someone wants to re-add the pseudo-science infobox in the criticisms section then please discuss first -- but don't try to slip it in amongst another mass deletion because any mass deletion of sourced material will only be reverted eventually.--Michael C. Price ^talk 08:41, 3 June 2008 (UTC)

You were asked to provide citations that these were practiced by believers in orthomolecular medicine. These were not provided. wIthout them the section is original research. Do not reinsert them again, or they will be removed as original research. Jefffire (talk) 08:52, 3 June 2008 (UTC)

This is crazy and non-scienific. Science is science, OM or whatever, no matter who does the research. It doesn't have to be done by "believers".--Michael C. Price ^talk 08:57, 3 June 2008 (UTC)

That's your view, but Wikipedia requires references (see WP:V). That is why we request that this research which porportedly represents "orthomolecular medicine" is actually verifiably about "orthomolecular medince". Afterall, if this is a mainstream subject as some of it's supporters claim, finding those citations should be as easy as pie. Jefffire (talk) 09:08, 3 June 2008 (UTC)

You are being evasive. No one is questioning the need for references. And BTW, it's because so much of OM is mainstream, that so much of it is published in mainstream journals. I note you have avoided addressing the "practiced by believers" requirement you made, which is quite frankly the sort of requirement that paranormal researchers make.--Michael C. Price ^talk 11:20, 3 June 2008 (UTC)

I really don't see how I'm being evasive. What is requested are citations demonstrating that this "orthomolecular research" really is "orthomolecular", or at a pinch that these specific treatments are utilised by OM believers. At the moment you are inferring that it is based on your personal view of what orthomolecular medicine is. This is both PoV and OR. If you can provide mainstream sources (eg. BMJ reviews) which say say that this research is "orthomolecular", then we've got something to work on. Jefffire (talk) 11:35, 3 June 2008 (UTC)

Vitamin E controversy, broadly grouping all vitamins together, and synthetic forms

I'm going to try to make this short. I think much of our discussions here have been too wordy. Synthetic beta carotene needs to be pointed out -- that's the precision I was getting at, in addition to synthetic alpha-tocopherol In fact, I don't think the original version was overly complex; things should be made as simple as possible but no simpler. Since OM places such an emphasis upon different isomers, we should too (and mainstream medicine is doing so now as well). We strive to be a scholarly encyclopedia. References to studies need to include which forms they studied exactly. Synthetic beta carotene has mainly been studied rather than natural. I don't have time to do heavy research atm, but there are papers out there that we should be on the lookout for. I consider Tim's editing out of these distinctions to be very serious, and may have to revert his recent changes back to the original, which I felt was fairly clear. Please comment. ImpIn | (t - c) 23:12, 29 May 2008 (UTC)

Tim's view is a very one sided perspective, such as the citing of the con, er, controversial Miller study, much criticized for "wrong E", cherry picking negative studies, mathematically ignoring whole normal populations with benefit or w/o harm, combining (and wildly amplifying) the smokers' vitamin A & E (but not entertaining) data where the A & E combination was known to be complex or problematic back to the 1940's (nice when poor scholarship can be called "research" and probably earn outside funding too). Ditto vitamin E and a vitamin K deficiency (common, especially in aged & ill), known back to the 1940s, is a nice negative studies enhancer, when malfeasance or -practice is ignored.--TheNautilus (talk) 11:58, 30 May 2008 (UTC)

If you are going to try to explain the cis versus trans-isomers of beta-carotene, you should mention that the all trans-isomer is the main form in both food and dietary supplements. (See PMID 15453670). The cis-isomers are also produced in food during cooking and the cis and trans isomers interconvert in the body (see PMID 8694017). What basis is there to make a distinction between "natural" and "synthetic" forms of this vitamin when the same isomers are present in both sources? Tim Vickers (talk) 23:44, 29 May 2008 (UTC)

More importantly, the earlier 20th century data converted mixed carotenes to "equivalent beta carotene" by some formula of fractional values, and then the manufacturers came along with synthesized single molecule beta stuff in the 1980s, but advertised using mixed carotenoid source population data, and presumably later beta carotene data with favorable data & populations. Orthomolecular perspective likes to treat each molecule as a distinct entity, where different vitamers can have much different function and pharmacologic properties. Individual carotenoids continue to be examined for the their individual properties and benefits. Orthomed favors natural mixed carotenoid sources (e.g. high veg diet or juicing). Also the beta carotene & E study portions with non-smokers indicated benefits although not usually powered for showing this. The "deadly" A&E gag hits unaddressed liver diseases, oxidative & chemical burdens - smokers, alcohol and statins, all seriously non-orthomed habits more than normal. Turn up the noise & scare the population to tears, collect P----- dividends.--TheNautilus (talk) 11:58, 30 May 2008 (UTC)

Another serious problem with the earlier version was the statement that studies used "alpha tocopheryl esters (acetate, succinate) not in an antioxidant form." was extremely misleading. Esters are used to prevent air oxidation of the tocopherol, and these esters are hydrolysed in the gut to release the free tocopherol. (See for example PMID 8529918). This is a prodrug, not an inactive form of the vitamin. Tim Vickers (talk) 23:58, 29 May 2008 (UTC)

Nope, those are healthy people with adequate bile & enzymes. As I said, not when transport & ester conversion are problems, such as (gut)"damaged people". CF patients are not the only ones. Some trends suggest an increasing fraction with liver *and* second organ issues. Guess what kind of people frequently get dumped on OMM's doorstep from "no answers"?--TheNautilus (talk) 02:31, 31 May 2008 (UTC)

As far as the ester comment, that's fine to take out, although I think we should perhaps include what form the supplements were in. On the other point: synthetic beta carotene is what is being studied. Do you know what the concentrations are of trans in the cis ect.? It sounds like you're attempting to argue that the distinction between synthetic and natural beta carotene is artificial. Can you find a RS source which basically states that? If so, I think it would fit well in the article. If not, it sounds like OR. Those sources do not state that, from my look at them. ImpIn | (t - c) 01:25, 30 May 2008 (UTC)

The problem is that even the a-t-succinate has much different properties than a-t-acetate, even beyond tissue distribution, IV a-t-succinate having data that shows possible cancer impacts. Ditto RRR-gamma-, RRR-delta-tocotrienol and tocopherols but not a-tocopheryl acetate (a-t very worst cancer choice in several datasets). Tim's edits seem to switch and/or confuse the 8 alpha-tocopherol enantiomers (SSS- etc) with the 8 RRR-tocopherol / RRR-tocotrienol vitamers! Also in damaged people the normal hydrolase conversion and various transport assumptions may break down. Orthomed prefers RRR alpha tocopheryl succinate, and/or the mixed (natural) tocopherols, with co-factors, depending on situation. Not the common "d,l-" and acetate stuff.--TheNautilus (talk) 11:58, 30 May 2008 (UTC)

Why would "orthomed" prefer the succinate, which does not occur in nature, and would be unlikely to occur in your blood if you ate it (which is why PMID 14612885 suggests it be tried IV, but does so only on the basis of in vitro killing of cancer). Studies since that paper have given it to mice IP (interperitoneally-- bypassing the gut). I'm not aware of any cancer studies of alpha-TOS in humans at all. There are no ORAL studies in any cancer model. Why not? It's hydrolized to the free alcohol too well, as the ref shows! After that, you get merely the effect of the natural ingested vitamin, with the caveat that it's not hydrolyzed quite as well as the acetate, yet neither is it absorbed in the intact form. Which means, you excrete it.

In any case, here we have orthomed advocating delivery of an unnatural form of the vitamin by unnatural means, on the basis of mouse IP studies, and cell culture killing??? Please! I would suggest you pay more attention to Tim Vickers, who has generally been giving you the straight dope on nutrition, as currently understood, above and below. He's not trying to torpedo this article and neither am I, but that doesn't mean we're going to let nonsense slip in. SBHarris 05:50, 2 June 2008 (UTC)

I am feeling a little jaded that Tim so frequently "misunderstands" & repudiates everything I say in ways that I feel AGF is being abused after I take pains to source the points. I think I am reading closer to the source's words. e.g Horwitt did criticize esters' IU rating in the papers but focused on the racemate most, yet Tim accuses *me* of not reading the paper as well as other spurious complaints. This article is starting to look like what you earlier spoke about being (mis)defined by the opponents, a familiar, pre-bibical problem. No torps? how about the gratiutious "quack", "pseudo..." insults by notorious anti-vitamin C cranks (e.g. so extreme, *attacked* other NAS members for not supporting a lower RDA) that think 45 mg/ day is plenty high when *they* have *zero* OMM range data, say 20 - 200 g/day, divided hourly or less (persistent, loud, wrong way opinions with *zero* data = scientific quackery).--TheNautilus (talk) 10:07, 2 June 2008 (UTC)

The statement that tocopheryl ester prodrugs are not antioxidants was a serious mistake, and was probably copied from this newsletter. The esters are hydrolysed in the gut, releasing the free tocopherol. See PMID 3953477, PMID 7288289, PMID 8529918 and PMID 1186449. If you have genuine data on different cancer risks of the various esters please post links to the papers involved on this talkpage, so people can verify what you are claiming. Tim Vickers (talk) 15:39, 30 May 2008 (UTC)

I've done some checking and this paper "Vitamin E analogues as anticancer agents: lessons from studies with alpha-tocopheryl succinate." PMID 16835868 does describe specific effects of alpha-tocopheryl succinate ester (a-TOS) but says:

All the results mentioned above imply that a-TOS is effective only by intraperitoneal injection, not by oral administration, since it is efficiently hydrolysed to a-TOH when administered orally.

Similarly "Vitamin E succinate and cancer treatment: a vitamin E prototype for selective antitumour activity." PMID 14612885 states:

Although these studies show a strong promise, there are certain drawbacks that need to be solved before alpha-TOS and similar compounds its possible application to humans. These compounds are esters of vitamin E, and as such, are fully hydrolysed during the intestinal uptake following oral administration. Therefore, intravenous application is required.

Actually it is not a mistake, you missed reading/recognizing the "damaged people" part where hydrolysis cannot be assumed. People with no/limited bile, lacking pancreatic enzymes, and/or damaged intestinal mucosa suffer (toco-ester) conversion & transport problems. ...gamma-tocopherol form of vitamin E is particularly beneficial in improving oxidative stress and resultant respiratory complications associated with cystic fibrosis disease. The present invention includes a method of ameliorating the complications of cystic fibrosis, particularly oxidative stress and respiratory exacerbation,...The use of non-esterified compounds is preferred in the present composition since they would not require the same amount of enzymatic cleaving for absorbability.[28]--TheNautilus (talk) 02:31, 31 May 2008 (UTC)

You've referenced a patent application. How about using some reliable sources for a change? Tim Vickers (talk) 02:54, 31 May 2008 (UTC)

The patents carry references you can get with your database and library resources >10 times mine, that I can't. No formal RS, V requirements here Talk, the patent is from a former Eastman vitamin E specialist, where I am still trying to establish a starting point for meaningful discussion with you beyond all your dismissals and misunderstandings.

Max K Horwitt, WH Elliott, P Kanjananggulpan, CD Fitch. "Serum concentrations of a-tocopherol after ingestion of" various vitamin E preparations" Am J Clin Nutr 1984 : shows differential pharmacokinetics of 800 IU (nominal equivalent) for natural alcohol vs several esters, tocopherol hydrolyzed and absorbed from tocopherol succinate much lower...

Horwitt confirming his earlier results[29] that also show the tocopheryl esters based on animal data are in fact less than equivalent than currently stated.

Sokol RP, Bruno RS, Traber MG. "Chapter 70 - Vitamin E and Vitamin K Metabolism", Physiology of the Gastrointestinal Tract (2006, LR Johnson, KE Barrett, 4th ed)

p.1773: "These esters require hydrolysis before absorption, but this apparently occurs efficiently in the small intestine of healthy humans"

p.1774: "most esterases from the pancreas or intestinal mucosa..."

Papas A (1999) The Vitamin E Factor, HarperPerinnel, pp 76-77: Micelles ferry fatty material across the gut...To make micelles two major components are absolutely required. pancreatic enzymes (esterases)... p 81. Bile; Infections of the gut, liver damage, and medications reduce absorption.--TheNautilus (talk) 16:07, 1 June 2008 (UTC)

Page 242 of Horwitt et. al 1984 states that the differences between the absorption of the acetates and alcohol are not statistically significant and in the discussion on p244 they state that "We found the free alcohol to be at least as potent as the acetate forms". The differences they did see were between racemic mixtures and single enantiomers, not between acetates and alcohols. I would recommend that you actually read references before you cite them. Tim Vickers (talk) 18:22, 1 June 2008 (UTC)

Your answer is misleading again. The corrected Fig. 3 clearly shows the d-alpha tocopheryl succinate ester form (not the closer performing acetate), d-aT-succinate the specific component that we were discussing above, is as poor performing as the (d,l)³ racemate, a virtual overstrike in overrated performance. I suggest that your responses quit trying to categorically dismiss legitimate edits and science discussions with such seriously miscast answers or at least try harder to correctly comprehend published papers as well as my answers.--TheNautilus (talk) 02:43, 2 June 2008 (UTC)

I really don't know what to say here. I've quoted what the text of the paper says and even told you the exactly where it says this so you can check it for yourself. You've responded by telling me what you think a figure "clearly shows", while ignoring what the authors say about their data. Tim Vickers (talk) 04:47, 2 June 2008 (UTC)

I think TheNautilus is trying to make a point that alpha-TOS gives lower blood vitamin E levels. For what purpose, I have no idea. You're trying to point out that acetate and -ol are about the same, insofar as blood levels. Yes, yes, all this is true. So? The anti-cancer stuff is very specifically the alpha-TOS, not the acetate or alcohol, as delivered in provitamin form to cancer cells bypassing the gut, and it's in no sense a natural molecule. So why even discuss it in the context of this article? Nobody knows what blood alpha-TOS levels are if you took the stuff orally, but presumably they're so low nobody has even suggested giving it orally for cancer. For vitamin E supplementation, acetate or free alcohol are better. End of story, I think. Whatever effect TOS has on cancer is a redherring for this topic, since it's not found in the blood, and would have to be synthesized in a lab, then shot into a vein to be found there (and good luck making *that* emulsion-- I actually know something about that, and it's difficult enough to make IV vitamin E which isn't fatal, even using the free alcohol). So where is the argument? SBHarris 06:03, 2 June 2008 (UTC)

TOS and cancer, I agree, let it drop, it wandered from IV to oral. Interest in the RRR gamma- delta- tocols remains. The article has lost its clear sense of what is greatly different between OMM mixed tocol-vitamin E regimes and the mainstream metastudies. The metastudies don't identify other individualized conditions that affect OMM recommendations as well as (mainstream) test results. There are long recognized populations (liver disease, alkie, smokers) that need to be treated differently on retinol/beta carotene and other remedial nutrients (or at least ID'd & separately accounted) than the "one-size-fits-all-tests for vitamin E." The mainstream tests keeps grinding those bodies into the test with known contraindications in the "vitamin E" tests (some known since the 1940s - vitamin C & K deficient, vitamin A issues like liver diseases and other nutrient treatments (e.g. Lester M Morrison's 1950 choline/lecithin simlar to Charles Lieber's 2004 recommedations for liver damage, and Burton Berkson's triple antioxidant liver therapy, or addressing digestion and malabsorbed vitamins in the gut shot pts with chronic diseases.--TheNautilus (talk) 10:07, 2 June 2008 (UTC)

The cis isomer ranges from about 2% in carrots, to about 40% in some algae. The cis isomer is arguably the "unnatural" isomer since it is highest in processed foods.(link) and (link) However, as these forms are interconverted in the body the idea that processed foods could give you more of a "good" isomer of beta-carotene seems no more than an interesting hypothesis. See this alternative medicine review for a specific discussion of the points that remain unknown. For a good overview of the significance of these trials see this article. Tim Vickers (talk) 02:17, 30 May 2008 (UTC)

Suggest centering on broad or mixed carotenoids as "true" OMM.--TheNautilus (talk) 11:58, 30 May 2008 (UTC)

If you wish to add a section on β-carotene, please do so, but all we really need to note in the vitamin E section is that the cancer promotion effect is a possible confounder. Tim Vickers (talk) 15:39, 30 May 2008 (UTC)

I am not sure which way you mean confounder, there are several possible vitamin E approaches or variables.--TheNautilus (talk) 01:36, 31 May 2008 (UTC)

Emphasis upon natural vitamin E

Tim: The source that I used shows that Abram Hoffer emphasizes natural vitamin E, and even calls the manufactured "natural vitamin E" mainly synthetic. However, he does not endorse the broad mixture of gamma/delta/beta ect in that paper. The Linus Pauling Institute doesn't really come out heavily in favor of a broad mixture either in their page on vitamin E. They mention that alpha lowers gamma, and that gamma is correlated with heart disease, however (source) -- thus some OM practitioners have probably raised concerns about giving too much alpha alone. Maybe TheNautilus can find a reference, but if not, then we should probably switch the wording around as you were doing. The other source states that gamma is not well-studied, which backs up their assertion loosely. ImpIn | (t - c) 22:35, 31 May 2008 (UTC)

Addressing & understanding "Natural vitamin E" is definitional. "Natural vitamin E", the natural alcohols, includes the mixed tocopherols where pure alpha tocopherol supplements are rare, and excludes the common "natural source" d-alpha tocopheryl esters.

LPI is a voice at the lower edge of the OMM dose ranges, even lower than Pauling, trying to bridge the shortest distances with the mainstream, so LPI should not be counted as addressing the entire OMM range here. Save that for Hoffer, Pauling, J Orthomed, and OMM practitioners.

Many editors and consumers are confused on "natural" about vitamin E. Normal "mainstream" advertising practices in the past typically called "natural" what is now labeled "natural source" (usually d-alpha-tocopheryl acetate or succinate). This is in fact is not "natural", but semi-synthetic, the "natural source" raw material being esterfied and then methylated to convert all other RRR-isomers into d-alpha-tocopheryl esters. Literal "natural vitamin E", as a practical matter is a mixture that ranges d-alpha + 25% w/w other RRR isomers, the legal minimum "mixed tocopherols", to d-alpha + ca 200+% w/w other 'RRR isomers, for supplements with high potency concentrates like UniquE (1962).

Hoffer: "There are eight vitamin E isomers in nature...[use the natural form]...orthomolecular physicians have been using dosages of 400 [iu] and upward following the [Shute brothers]...VItamin E is the last of...antisenility vitamins we will discuss.... The best dose ranges from 800 - 1600 [iu] per day." A Hoffer, M Walker (2004) Smart Nutrients, Revised Ed.

Pauling, often on OMM's lower dose edges, in How To Live Longer...(1986), Ch 18, 27, discusses vitamin E, the natural tocopherols and treatments up to 3200 iu. Pauling mentioned counting rough tocopherol equivalents, (e.g. d-gamma tocopherol as 1/10 IU per wt as a same weight of d-alpha-tocopherol is the modern "TE", tocopherol equivalent). Others just use the alpha fraction IU recommendation as a part, independent of beta-, gamma-, delta-tocopherol quantity.--TheNautilus (talk) 15:24, 1 June 2008 (UTC)

Personal comments counting

I disgree strongly with what he has done to the page. It's not just one of us.--Alterrabe (talk) 02:58, 1 June 2008 (UTC)

Quite. SA's just trying to pick a fight. --Michael C. Price ^talk 06:46, 2 June 2008 (UTC)

Please comment on content and not on the contributor. Thanks. ScienceApologist (talk) 22:59, 3 June 2008 (UTC)

Follow your own advice in your edit summaries. --Michael C. Price ^talk 07:47, 4 June 2008 (UTC)

Revising the article

I'd like to reorganize the article. First, I'd like to make a Nutrients section, under which we could go in-depth on how OM views each of the different nutrients, as well as mention the mainstream study of these nutrients. Based on what I've seen so far, OM places a particular focus upon vitamin C, niacin, vitamin E, alpha lipoic acid, and fatty acids, so these need sections. ImpIn | (t - c) 09:50, 2 June 2008 (UTC)

I had been mulling suggesting the article be reorganized. I think

• longer sections should be devoted to orthomol. psychiatry and oncology and their history.

• The notable supporters of OM section could enrichingly be incorporated into the history section.

• perhaps the sections on nutrients could be hived off into a new article, "orthomolecular nutrient research." This would reduce the bloat, and separate highly technical sections from some that are closer to providing an overview. Some of the most interesting findings should, however, still be in the main article.

This is my opinion, perhaps others wish to share theirs?--Alterrabe (talk) 12:16, 2 June 2008 (UTC)

I agree that this article spends far too much time going through the mainstream medical literature trying to prove that the OM view is justified/unjustified and spends too little time describing the ideas and practice of OM. Adding descriptive material would also be less contentious, since it is describing these people's beliefs, not trying to make statements about what is actually true. Tim Vickers (talk) 17:38, 2 June 2008 (UTC)

Reinterpreting history

The begining of the history section contains a lot of material which is based upon orthomolecular.org interpratation of events. Now, not not disputing what any of the people in history did, but it is highly PoV to claim that they were "Orthomolecular". orthomolecular.org is obviously a highly biased source, and they cannot be considered a reliable source for whether or not the ancient Egypians could be neutrally described as having used "orthomolecular medicine", for example.

This is found in Wikipedia:RS#Extremist_and_fringe_sources. The pertinant part is
"The material taken from such sources should not be contentious, and it should not involve claims made about third parties, unless those claims have also been published by reliable sources. Articles should not be based primarily on such sources." (my bolding)
Since these are very definately third parties, it is required that sources other than those directly affiliated with orthomolecular medicine describe these are practicioners of "orthomolecular medicine". I suggest mainstream history books as a good example. Jefffire (talk) 14:44, 2 June 2008 (UTC)

Menolascino's extensive paper is mainstream, U Nebraska even has an award named after him. Menolascino's critique, Orthomolecular Therapy: Its History and Applicability to Psychiatric Disorders, picks up history with Lind in 1753 and vitamin responsive inborn errors of metabolism. The Gerson survivors, their books, and their Gerson Organization self identify with Orthomolecular medicine. Klenner was recognized and quoted by Pauling in his books and Irwin Stone, a close OMM/vitamin C buddy, in Klenner's lifetime. Klenner's obit immediately followed in the J Orthomolecular Medicine. Wm Kaufman and Roger Williams self-identified with OMM.--TheNautilus (talk) 16:59, 2 June 2008 (UTC)

Do you have access to these papers, TheNautilus? The Menolascino paper is here, but I can't access it. As far as the rewriting history charge, the rest of that section does say that the sources from the group "should only be used as sources about themselves or, if correctly attributed as being such, to detail the views of the proponents of that subject. Use of these sources must not obfuscate the description of the mainstream view, nor should these fringe sources be used to describe the mainstream view or the level of acceptance of the fringe theory." It's pretty clear that these are just the opinions of Orthomolecular Medicine. I think taking this out would leave the article with an incomplete picture of how OM views its own history. I can see taking the first sentence out, but give us some time to look at these papers. ImpIn | (t - c) 02:57, 3 June 2008 (UTC)

Supplements alone, or nutrients in general?

Based on Pauling's definition, and the definition over at orthomed.org, there is no mention of supplements specifically. Should we defer to the Encyclopedia of Alternative Medicine on this? I don't think so: I think OM is focused on nutrients in general. Often, they prescribe lots of supplements as the way of getting these nutrients, but that's not exclusive. OM is obviously associated with strictly supplements, as the Encyclopedia shows. ImpIn | (t - c) 03:43, 3 June 2008 (UTC)

The trouble I had with getting the definition right was that there is no consistent definition used by the first party websites. The encyclopedia of alt med had the advantage of being a 3rd party which viewed the subject in a positive light, and it used plain English. Jefffire (talk) 07:27, 3 June 2008 (UTC)

The controlling definition is Pauling's. Some references add clear distortion, others simply confuse (or ignore) OMM, "individualized optimum nutrition," with "megadoses" that aren't even OMM, but olde pharma stuff (isotretonin, D2, K3, sloowww release niacin) especially frequently on the negative websites. Supplements are theoretically not necessary or even preferred for some components. e.g. blended, multiple colored vegetables are considered far superior to any supplement on the market for mixed carotenoids. Of course, if one wanted 1600iu alpha tocopherol + 200% RRR isomers, you would have to drink a *lot* of wheat germ oil. I can't say this enough, a substantial part of OMM is reducing some nutrients/foods (excess iron, copper, fluoride, sugar, alcohol, polyunsaturates, processed transfats, allergens, etc.). I think we should concentrate on accuracy as per Pauling, Hoffer and JOM rather than play wikilawyers. Too often the "reliable sources" are patently false on OMM, they don't think that way (different paradigm), and they can't understand to apply (or write about) it on a consistent or correct basis.--TheNautilus (talk) 09:08, 3 June 2008 (UTC)

The trouble is that modern proponents of orthomolecular medicine appear to have diverged significantly from what Pauling described. Whilst his definition is historically important, it is no longer applicable to the movement as a whole. If there is a 3rd party source which you think gives an accurate definition that would be highly useful here. Jefffire (talk) 11:30, 3 June 2008 (UTC)

That looks like your OR. ISOM Europe, Hoffer still recognize Pauling's definition as the unifying concept, also Dean. Now, other groups (e.g. holistic medicine, environmental medicine, naturopathic physicians, naturopaths, other nutritionists, chiropractors, homeopaths) to varying degrees, have incorporated, adopted and/or adapted OMM to their offerings but they *do not* define Orthomolecular Medicine(OMM). Further, orthomolecular physicians do use other modalities when practical, even Abram Hoffer utilized conventional psychiatric drugs in his practice - a physician will still be "orthomolecular", just the particular intervention isn't OMM in nature. Also there are few instruments of State enforcement, so some really non-orthomolecular parties may claim themselves such, too, false branding could become a problem. Some applications of Pauling's OMM definition may not be immediately obvious, or even be debated, but his definition still stands unique. This book, Encyclopedia of Complementary Health Practice (1999) looks promising as a 3rd party source.--TheNautilus (talk) 19:01, 3 June 2008 (UTC)

That's a generally acceptable source for the "what is" question. Unfortunate that it's not written in plain English and is rather PoV, which would require both quotation and attribution, which would make the lead look quite ugly IMO. That's a stylistic view rather than content however. Jefffire (talk) 10:39, 5 June 2008 (UTC)

Jefffire:Are you sure that the definitions were not consistent? The first sentence of orthomed.org appears plenty consistent with Pauling's definition: "Orthomolecular medicine describes the practice of preventing and treating disease by providing the body with optimal amounts of substances which are natural to the body." The only thing which is not consistent with the OM practitioners themselves is the Encyclopedia of Alt. Medicine. ImpIn | (t - c) 21:01, 3 June 2008 (UTC)

Believers vary in their emphasis on "naturalness", "optimisation" and what constitutes a "nutrient". Whilst the "right molecule" mantra is oft repeated, actual plain english specifics are much more woolly given. Jefffire (talk) 07:36, 4 June 2008 (UTC)

Perhaps -- you have provided no examples -- but they don't vary in talking about nutrients, not nutrient supplements. Thus, I think you're wrong, and will change it in a day or so after you've had the chance to reply. ImpIn | (t - c) 02:31, 5 June 2008 (UTC)

You've made a section below specifically about the variation in the pantheon of OM beliefs, which is exactly what I'm discussing here. All we really need is a decent 3rd party references for "What is OM". Jefffire (talk) 07:50, 5 June 2008 (UTC)

Yes, but there's no dispute that it's over nutrients, not nutrient supplements. And I don't think that a third-party should be allowed to define what OM is -- that is up to OM. You've shown no inconsistencies among the most basic principle of OM, that is, that nutrients can be used to treat disease, and are underacknowledged. OM is about nutrients in general, not supplements. When I feel up for it, I'll rework the intro to reflect that. ImpIn | (t - c) 09:35, 5 June 2008 (UTC)

The reason I would prefer a 3rd party source is because what OM says and what OM does are not necessarily the same. Ostensibly it may be only nutrients in general, but in practice it seems to revolve around selling supplements. That said, attribution would make that concern irrelevant, but that's generally an inelegant solution. Jefffire (talk) 10:35, 5 June 2008 (UTC)

Asserting SYNTH

Jeffire is correct in this dispute. The WP:FRINGE policy is in place because articles at Wikipedia are harder on fringe sources than they are on non-fringe sources (WP:REDFLAG). The sourcing of critiques of obscure crackpot beliefs in the origin of all diseases does not need to specifically mention every belief of every stripe. However, claims that there are studies which "prove" a particular fringe theory can only be used if those studies are actually about the fringe theory explicitly. Otherwise, we'd have a free-for-all at every fringe theory page. It's highly unfair to the fringe theorists, but that's the name of the game. Wikipedia is not the place to right great wrongs. Complain about oppression elsewhere. ScienceApologist (talk) 21:13, 31 May 2008 (UTC)

First: WP:FRINGE has nothing to say on this issue. Neither does WP:REDFLAG. Please stay on topic. You need to look at WP:SYNTH. Orthomolecular medicine defines itself as using nutrients to treat diseases. It draws its methods and practices from mainstream science. Its founders were research scientists (Pauling, Horrobin, Hoffer all did groundbreaking research). Thus, articles about using nutrition to prevent and treat are about OM. The "fringe" topic defines itself broadly, thus many articles apply to this "fringe" topic. Simply because OM is not referenced directly in each article does not change that. The Linus Pauling Institute at Oregon State University writes that OM is not alternative and is rather an" adjunct to appropriate conventional medicine". As I mentioned above, your argument is analagous to taking an article about the Moon out of the Solar system article because the moon's article does not directly state that the moon is in the solar system. If you want to push this, however, note that the AMA's critique does not reference OM, but rather "nutritional therapies". Thus, it would have to be removed. I, TheNautilus, Ward20, Michael Price, and Alterrabe all agree with this. TimVickers has not commented. I've asked for some input over at the SYNTH page here. ImpIn | (t - c) 22:23, 31 May 2008 (UTC)

All you need to do to get the content included is find a source which says that those studies are known for explicitly being used by orthomolecular proponents. Right now, there is no indication that those studies are used by the people who push orthomolecular mumbo-jumbo on the general public. There is no rhyme or reason to the list: it is just a list that some editor thought was "indicative". The AMA point is simply a red herring: part of a different discussion because it is about a source that characterizes OM rather than characterizing a source as being about OM. We need to stick to the issue at hand: not a single source on that list explicitly connected the studies to OM. ScienceApologist (talk) 22:34, 31 May 2008 (UTC)

No responses to this point? The offending bulleted points were removed as POV-pushing. Please do not re-insert them without a source that explicitly links these claims with major orthomolecular proponents. 128.59.169.46 (talk) 20:01, 2 June 2008 (UTC)

User:TheNautilus has reverted the removal without commenting. I encourage this user to answer the challenge presented herein and provide appropriate sources for the text. ScienceApologist (talk) 22:57, 3 June 2008 (UTC)

Calm down. We've responded at length that your SYNTH assertion is just plain wrong. We've already shown that many people (myself, Ward20, Michael C. Price, Alterrabe, ect) just plain disagree with you on this SYNTH assertion. To us it seems as if you and Jefffire are just being disruptive. It's not a cut and dry case, because clearly OM is about nutrients in general. Further, some of the criticism is not directed at OM specifically. OM uses what research is available, and it doesn't redundantly document everything that they use from mainstream science. OM practitioners don't feel the need to say "we agree with this study"; OM people have PhDs or MDs and publish in mainstream journals anyway, and when they do so, they don't mention OM specifically because they don't feel the need to do so (see recent PNAS studies, for example).

If OM is a scientific approach to medicine using nutrieints, as its proponents claim that it is, then it moves with mainstream research when they believe such research is appropriate, and broadly categorizes all research on nutrients and disease as OM. You can see this at the Linus Pauling page on Orthomolecular Medicine -- please read it here. Most of the mainstream categorization of OM doesn't even directly reference OM -- what you're really doing is trying to claim that a particular (perhaps misunderstood) "fringe", yet major subgroup of OM is all that orthomolecular medicine is. And that seems like SYNTH. Orthomolecular medicine is a theory/philosophy of "optimum nutrition", not a group, and not necessarily a discrete set of practices. ImpIn | (t - c) 23:38, 3 June 2008 (UTC)

If there is a citation that shows these particular studies have been called studies in orthomolecular medicine, please give it. Until you do that, I claim the list to be original research. ScienceApologist (talk) 02:07, 4 June 2008 (UTC)

When there is strong disagreement it means no consensus. QuackGuru 00:09, 4 June 2008 (UTC)

These controversial changes should be reverted. We need more discussion, proper sourcing, and agreement. QuackGuru 00:21, 4 June 2008 (UTC)

I agree that there is no consensus either way. That's why I'm not trying to cut out large swaths of text. However, that edit is not really controversial; it's getting rid of the 3 controversial third parties referenced. ImpIn | (t - c) 02:01, 4 June 2008 (UTC)

ImperfectlyInformed has acknowledged there is no consensus either way. QuackGuru 02:05, 4 June 2008 (UTC)

Agreed. So let's discuss edits instead of constantly reverting them. I'm working on a Treatments section which will cite the orthomolecular perspective for specific nutrients, so please refrain from reverting until I get some basic stuff up. ImpIn | (t - c) 04:09, 4 June 2008 (UTC)

Great! I invite you to workshop them here and we'll see. Still wondering why you reinserted that list of studies that have no sources to OM proponents claiming that they are validating their beliefs. ScienceApologist (talk) 04:30, 4 June 2008 (UTC)

Stop edit warring. There are 5 people who disagree with your SYNTH assertion, and it is highly convenient to have those links in place. That section has been in place for a long time. ImpIn | (t - c) 04:36, 4 June 2008 (UTC)

Sorry, none of those arguments work here. You need to provide some evidence: the links are in the history for you to access. Please provide citations and stop skirting the issue. ScienceApologist (talk) 05:14, 4 June 2008 (UTC)

Material which has not been properly sourced should be removed. Citation tags are only to be added if you suspected it is accurate. In this case, I think it's quite clear it's a bunch of BS. Either find the citations demonstrating that this material is in fact "orthomolecular" or leave them deleted. Jefffire (talk) 07:30, 4 June 2008 (UTC)

Drafts

History

As a discipline focused upon using nutrients to treat illness, orthomolecular medicine practitioners trace the origin of the field back to the discovery of vitamins in the early 20th century. However, the word "orthomolecular" was coined by Linus Pauling in 1967. Thus orthomolecular practitioners lay claim to figures who preceded later controversies and labels, and perhaps would have rejected the controversial treatments which were later called orthomolecular medicine. Practitioners claim these figures were orthomolecular because of their emphasis on the role of nutrition in treating disease. In a paper on the history of orthomolecular medicine, Menolascino notes that there were several eras in the use of nutrition to treat disease. After the discovery of nutrients at the dawn of the 20th century, some doctors began to think that vitamins could cure many things, and nutrition was incorporated into the medical curriculum. As spectacular results were not forthcoming, in the 1950s and 1960s medical science slowly became disillusioned with nutrition and cut it from the standard curriculum, just as orthomolecular medicine was heating up. Orthomolecular medicine highlights figures from these early years. In the 1930s Dr. Max Gerson (1881 - 1959) developed Gerson therapy, a strict diet which he claimed could treat many diseases.

Point out the controversial stuff and back up with relevant policies. ImpIn | (t - c) 04:33, 4 June 2008 (UTC)

Still waiting to hear back on this. ImpIn | (t - c) 02:31, 5 June 2008 (UTC)

Strong and weak versions of Orthomolecular Medicine

I've been glancing through the archives, and this statement struck me as particularly right:

Although the Pauling definition which merely notes that orthomolecular treatment consists of optimally adjusting substances naturally found in the body (thus encompassing everything from diet therapy to megavitamin therapy), in practice we should probably note that there exist both weak and strong versions of the orthomolecular belief statement.

The weak one is controversial enough: "Medicine should pay attention to optimal nutrient levels in the treatment of every disease, lest medicine find itself actually treating subclincal malnutrition, when it thought it was treating pathology." Years ago I read an article pointing out the very high prevalence of untreated malnutrition in acute patients (it said essentially that the skeleton in the hospital closet, was too often the patient). But the "orthodox" idea of what constitutes "good nutrition" has changed a lot over those years. It's not just the RDA for ill people anymore. I've mentioned the extremely fortified enteral feedings which are becoming routine in ICU's--- they probably deserve a "bullet" in the orthomolecular claim section, and I'll get around to it eventually. Those canned feedings with with all those mono additives didn't exist just ten years ago, and anybody trying to implement them would have accused of orthomolecular quackery. Arginine?! Hmmm. And EPA used to be synonymous with snake oil. If fact, EPA is actually a large fraction of cold water snake oil, so there you go. The very idea of using it for rheumatism! Lock up those snake oil salesmen. We want Vioxx.

So what do we learn from our double blind trials? The GISSI study found no effect from vitamin E in 11,000 people with heart disease. Aha, that proves the orthomolecular quacks are wrong about vitamin E. Okay. But the same study found a drop of 30% in cardiac mortality and 20% in overall mortality, from omega-3 supplementation. This is a larger effect than any statin trial has yet found. And what does that show? Well, for too many people it shows that omega-3 supplementation can't be an orthomolecular therapy. Since it works. ;) But not to worry: when it comes to actual physician practice, fish oil is still TREATED as though it was orthomolecular (since most cardiac patients are on a statin and a minority on fish oil supplements, rather than the other way around). So I suppose it works out in the end. Fish oil will need to be made a lot more expensive and drug-ified before it's used very much. Powerful medicine needs to be expensive-- we all know that instinctively, do we not. And they're working on that. I mentioned OMECOR.

The strong version of the orthomolecular belief is the idea that most diseases have their origins in malnutrition, or at least can be managed by diet and nutritional therapy alone, if the patient cooperates (especially true for chronic conditions). These heretical ideas have their origin in studies of disease incidences in populations eating various diets, such as the China Study. And in shorter term tests of things like the DASH diet and the Mediterranean diet. In short, believers in the strong version of orthomolecular medicine are guilty of feeling about diet and nutrition, much the same way as orthodox medical people feel about their drugs. The cads. So what are we going to do about them? My suggestion is that we just remember that everybody tends to overrate the tools they're most familar with. I personally can't convince myself that there's more bad thinking on one side than the other. Too many times I've seen a grossly obese patient with 4 obesity-related diseases, 11 pill bottles, 3 polypharmacy-related problems, 1 drug reaction, and a partridge in a pear tree. And if you've done much internal medicine, so have you. In such a world, one wonders if orthomolecular thinking is really contributing the harm which its critics suggest.

So what do we do, here? If we let the orthomolecular people coopt the Mediterranean diet and fish therapy, is it not just a slippery slope from there to 50 grams of vitamin C IV? How are are we going to stop it? I dunno. How did we stop orthodox medicine from running away with itself with expensive and dangerous treatments which didn't do much good? :) I suggest we just apply those brakes to orthomolecular therapy, so that it becomes the moderate and wise practice that we all know and love in standard medical practice. Not so hard, is it?

— SBHarris (archive source)

It seems the Linus Pauling Institute, and probably some others, fall on the weak side of OM, while Hoffer and JOM are on the stronger side -- or at least willing to consider rather strong theories. It would be nice to reflect this in the article, although the reader is likely aware of this undercurrent because of the initial definition. Although this distinction may not be noted per se in their literature (it probably is if one digs deep enough), I don't think it would be original research to mention it because it is so obviously implied by LPI's statement, and practice in OM as compared to the JOM.

There seems to be a strong guilt by association happening in here. OM is not pseudoscience, and it is not concerned solely with the works of JOM. It is a philosophy. The importance of nutrition, and the lack of concern placed on it, is pointed out numerous times in mainstream literature (one example). Bruce Ames, as well as the people most associated with OM, has been at the forefront of this criticism. He does mention and cite OM in a paper (source) favorably. He calls Pauling's work "biochemical nutrition". Glance at some of his papers in ACJN (Ames search) to see more of his arguments that nutrition is neglected. ImpIn | (t - c) 06:21, 5 June 2008 (UTC)

Given that the Pauling Institute is only the 15th result on a google search for Orthomolecular, it seems pretty clear that the field is dominated by the "strong" type. Jefffire (talk) 07:27, 5 June 2008 (UTC)

Lets not jump to conclusions; Pauling was known for achieving scientific breakthroughs, and then leaving others to flesh out all the details; in any event, as a school of thought it doesn't matter. Pauling's definition holds, by definition.--Alterrabe (talk) 15:10, 5 June 2008 (UTC)

I wasn't thinking specifically about the definition. Rather, the article is weighted according to the prominence of each viewpoint, as detailed in WP:WEIGHT. If the majority of OM practitioners are the "strong type", then the article needs to reflect that. Jefffire (talk) 15:32, 5 June 2008 (UTC)

The majority of OM believers are well-outside mainstream medicine. The article must reflect this. ScienceApologist (talk) 15:53, 5 June 2008 (UTC)

Drafting some additions to the article

I'm taking some notes from the Journal of OM and other things over at User:ImperfectlyInformed/OM. Feel free to comment, contribute, and fix what I've got, although it is all tentative. ImpIn | (t - c) 05:20, 13 June 2008 (UTC)

Time and therapeutic priority

This section needs to be removed. It looks like an example of COATRACKing, as it is not focused on OM. It can perhaps be moved to the alternative medicine article, or the alternative cancer treatments article, which could perhaps be wikilinked from here. I'd like to have a "Safety concerns" section in this article directly focused on OM. II | (t - c) 17:27, 8 July 2008 (UTC)

Yes, merge any specific material to the "Views on safety and efficacy" section, this is just a sub-section. Tim Vickers (talk) 03:12, 9 July 2008 (UTC)