Talk:Functional medicine/Archive 2

Page contents not supported in other languages.
From Wikipedia, the free encyclopedia
Archive 1 Archive 2

Proposed rewrite on 21st June 2021

Hi, I noticed that a major rewrite was submitted yesterday (21st June) by Alpacacandle, and immediately reverted.

I took the time to read through the submission and concluded that it was well written and referenced; it looks like the author took a lot of time to try to improve this article.

Was there any particular issue which led to the immediate reversion? Llamabeast (talk) 08:38, 22 June 2021 (UTC)

Dreadful sources & WP:PROFRINGE throughout. Alexbrn (talk) 11:42, 22 June 2021 (UTC)

Can you clarify for me why they were dreadful sources? Mostly they were peer-reviewed papers from mainstream journals. Apologies if this an uninformed question, understanding this would be really helpful for me to make better contributions.

Personally I didn't find it to be pro-fringe, although I accept that this is subjective (I come from a very mainstream scientific background myself and am also allergic to fringe theories). I think the quality of the writing was good. If the whole rewrite won't be accepted then I'd like to try to adapt and incorporate some of the more informative parts of the contribution, but obviously want to do that in a way which will achieve consensus. I think there is some room for carefully considered improvement to the current article. Llamabeast (talk) 12:57, 22 June 2021 (UTC)

A lot of the initial sources were from functional medicine promotional sites, site by definition not WP:FRIND. Peer-review is not enough on Wikipedia; biomedical claims need WP:MEDRS sourcing and it needs to be relevant (not riffing around the periphery of functional medicine, a fraud which tries to legitimize itself by embracing some common sense to mix in with the woo). Dodgy stuff like PMID:25324467 in a predatory journal is particularly despicable. The current sourcing (what "personal blogs"?) seems very good for a fringe topic, per WP:PARITY. Finally, could you clarify what connection you have to the edit and/or editor under discussion? Alexbrn (talk) 13:10, 22 June 2021 (UTC)
Alexbrn is correct - I didn't look through every source, but the ones I did look at appeared to be 'in-universe', not mainstream scholarship. Girth Summit (blether) 13:16, 22 June 2021 (UTC)

Thank you both for the feedback, that's very helpful. I'll try to answer your questions in turn which will make my post slightly long; thanks for your time.

My assumption when discussing a fringe theory is that the structure might first state that it's a fringe theory, then explain the claims of the proponents, then explain the criticisms. When explaining the claims of the proponents, is it not reasonable to give sources from the proponents themselves? Thanks for the clarification either way.

I think the key learning for me is that secondary rather than primary sources are needed, which makes sense. As an aside I don't believe that PMID 25324467 is in a predatory journal; it is on PubMed, and it's my understanding that PubMed screens for predatory journals.

Re the "personal blogs", I'm referring to refences 1, 2, 6, 8 and 11, which so far as I can tell are just somebody's opinion. (Apologies by the way for editing away my reference above to personal blogs; I was trying to simplify my comment.)

Great question on my relation to the article and I'm sorry for not being clearer from the beginning. I'm a PhD physicist but I've made an unusual career switch and have just completed an MSc in Personalised Nutrition in the UK. One of the other finishing students just shared that she'd taken a week to research and write this updated article as she'd felt it could be improved. For her own part she's extremely on the ball (a Cambridge-educated vet) and, as it happens, quite vehemently anti-pseudoscience, but not familiar with wikipedia editing. I don't think she'll return to this discussion but I thought there was value to be salvaged here.

I understand the need for extreme care in these fringe medical topics. I would like to comment though that the claims of functional medicine are not in fact especially fringe, certainly compared to the rest of the "alternative medicine" category. Many (perhaps most) practitioners are MDs. Essentially the claims come down to "Nutrition and lifestyle can underlie the development of chronic disease", and "Understanding and modifying these root causes can improve disease progression". Functional medicine presents a framework for clinicians to try to identify root causes and in doing so it uses a bunch of jargon which I would agree is at times obfuscatory and problematic. Criticism and skepticism is appropriate. But we're not talking homeopathy here. It's essentially a different branding of lifestyle medicine. Llamabeast (talk) 13:46, 22 June 2021 (UTC)

Okay, so there's a WP:MEAT issue here. As to the other points:
  • No, Wikipedia does not include fringe theories other than as described in mainstream sources (which we do here now). See WP:GEVAL.
  • PUBMED does not screen for predatory journals, and Aging (journal) is dodgy as hell.
  • Science-Based Medicine is not a "personal blog", though WP:PROFRINGE editors have often tried to brand it as such, leading to many discussions over the years (see the entry at WP:RSP)
If you want somebody to tell you "Nutrition and lifestyle can underlie the development of chronic disease", you can go to a normal doctor and/or read Healthy diet etc. This is not something unique to Functional Medicine, which in all the things where it is unique, is essentially a health fraud. Wikipedia isn't going to be a brochure for it. Alexbrn (talk) 13:55, 22 June 2021 (UTC)

Hmm, I see that there is indeed a WP:MEAT issue. I'm not sure what to say about that other than to apologise for the context of my arrival and to promise to work in good faith. There is, at least, only one of me.

Thanks for the clarifications above, they are all helpful, and sorry for unwittingly retreading old ground.

Clearly I'm at least somewhat pro-Functional Medicine (I think aspects of it have merit), and clearly the majority of the editors here are of the opinion that it has no merit. How do we make improvements in a situation like this? I'm not an experienced editor, but otherwise am well qualified to make contributions, including the fact that I am very happy to follow wikipedia procedure. I would hope that it would be possible to make collaborative improvements to the article in good faith. I'm hope it's clear that I'm not proposing it should be a "brochure", but being reasonably factually accurate about the claims of and evidence for functional medicine would be good, even if everyone else here thinks the claims are false.Llamabeast (talk) 15:52, 22 June 2021 (UTC)

WP:GEVAL. tgeorgescu (talk) 15:40, 22 June 2021 (UTC)

I see - thanks, that makes sense. I was just thinking about it and had come to the conclusion that that would be the only reasonable policy. I guess I am in the nightmare position here where so far as you guys are concerned, I'm the climate change skeptic or the homeopath. Obviously you would not want to equally present both sides of the argument where one side of the argument is judged to be as mad as a fish.

There are a number of factual problems with the article which I hope I can fix while not changing the overall tone of the article, which I now understand and accept even if I disagree. How can I propose small changes? Is it best just to make the edit, or should I draft it or discuss it here first instead? Llamabeast (talk) 20:47, 23 June 2021 (UTC)

Llamabeast - please sign your posts, and indent your messages. See WP:THREAD for discussion of this.
You are permitted to make WP:BOLD changes to the article, but if they are reverted you need to come back here to discuss. Given the nature of the content that you were supporting above, you might prefer to propose them here first. You can format them as edit requests if you like. Best Girth Summit (blether) 11:12, 23 June 2021 (UTC)
That's really helpful, thanks. Llamabeast (talk) 20:48, 23 June 2021 (UTC)

“ Many (perhaps most) practitioners are MDs. Essentially the claims come down to "Nutrition and lifestyle can underlie the development of chronic disease", and "Understanding and modifying these root causes can improve disease progression". Functional medicine presents a framework for clinicians to try to identify root causes and in doing so it uses a bunch of jargon which I would agree is at times obfuscatory and problematic. Criticism and skepticism is appropriate. But we're not talking homeopathy here. It's essentially a different branding of lifestyle medicine.”

I agree with this. The criticism of functional medicine can often be summarised to a claim that practitioners trade in fringe or quackery, which is probably true, but the exact same assertion could be made about mainstream doctors. Maybe less frequently but still.

And if anything, medicine is itself trying to unearth more and more fundamental causes of diseases, you could in fact argue that the entirety of medical history has centered around identifying them. The issue with the article right now, is that it is wrong, it doesn’t explain what functional medicine is, or the framework behind it.

Also bear in mind, that intrinsic to functional medicine is a critique of how current clinical trial and research is conducted, critique, which I would say is definitely not fringe, and hence using such arguments to “debunk” it make no sense.

It would be better if the article said what functional medicine is (finding root causes of chronic conditions) and then critiquing the remedies prescribed (say “curing” aging with resveratrol). But bear in mind that David Sinclair has a Harvard lab, and the average doctor is not going to take away your glass of red wine Godal (talk) 17:11, 21 February 2022 (UTC)

finding root causes of chronic conditions, I don't think that's what functional medicine is. Anyway, you have communicated vague suggestions. You mentioned no WP:RS and no specific (concrete) change of the article. tgeorgescu (talk) 19:24, 21 February 2022 (UTC)

I don’t know what all the various Wikipedia rules are, and I don’t think I would be able get through.

I am just point out that lamabeast is basically right, and that the article as it stands is misinformative. Functional medicine is neither fringe nor pseudoscience, even if practitioners trade in such ideas. It’s just the age old idea of treating the ultimate cause. Which we often do not know, hence people are attracted to ideas such as the Mediterranean diet, ostensibly on an epidemiological basis.

As someone pointed out “if it works, it’s no longer alternative medicine, it’s just medicine”. Similarly, if non-functional medicine would discover some cause or treatment for a condition it would be readily absorbed. Godal (talk) 21:40, 21 February 2022 (UTC)

Potential additions to article

Just noticed that this article doesn't mention the top marketers of "Functional medicine", such as Mark Hyman, Jeffrey Bland, and the Institute for Functional Medicine. It might be a good idea to discuss them, if there are supporting reliable sources. ScienceFlyer (talk) 23:31, 28 March 2022 (UTC)

Detox

@Daniel Santos: People who endorse detox quackery are absolutely unworthy of being called "scientists". Yup, one can be a brilliant mathematician, yet speak batshit crazy stuff about medical sciences. tgeorgescu (talk) 23:00, 8 March 2023 (UTC)

Hello @Tgeorgescu! Look, I really don't care about your opinion of who is worthy or not of some title, I care about facts. Just because there is quackery in some area doesn't give license to abandon objective reality and FACTS. The FACT is that some (maybe "most", or "almost all") scientists think it's BS. It's my opinion that most of it *is* BS. But this is an encyclopedia so lets be accurate. Science doesn't know everything and fringe medicine will inevitably stumble into things that work prior to there being reasonable studies to discover that they got something right. One example is guanfacine + N-acetylcysteine though it has no citations yet and needs follow up studies with larger sample, etc.
So maybe quackery is a trigger for you and sets you off. We all have to deal with them. But one of *my* triggers is the propagation of cognitive distortions and logic fallacies. I feel it's more helpful to tear down something stupid in an accurate fashion. This invariably reveals any nuggets of truth within them -- whose existence is NOT a rationalization for the husk of BS that surrounded it. So please calm down and let's tear down BS constructively. <3 Daniel Santos (talk) 01:41, 13 March 2023 (UTC)
@Daniel Santos: I have never understood WP:PROFRINGE people who think they are more logical than rational skeptics and than debunkers of pseudoscience. You should know that WP:AE is just around the corner. tgeorgescu (talk) 02:05, 13 March 2023 (UTC)
@Tgeorgescu Yes, we should definitely initiate arbitration. My original edit was just to mitigate the problem. The sentence needs to be re-written and probably based on something other than a news article that, it's self, doesn't include any names or references.
And in the interest of devil's advocacy, medical science has clearly identified detox methods that work, such as desisting exposure to the toxin.
I think that there are also many areas of the functional medicine "ecosystem" that deserve to be examined. I learned (through verbal communication with a practitioner) that the supplement companies (e.g., Apex Energetics) only sell through these distributors like Fullscript (parent company HGGC?), who themselves will only show you prices for supplements once a practitioner has recommended one. The reason for this is that when the practitioner creates their account, they tell the distributor how large of a kickback they want -- which dictates the price you see! If we can find WP:RS on this, I think it needs a section! Daniel Santos (talk) 22:19, 13 March 2023 (UTC)

Article does not discuss what functional medicine is. Should it be deleted?

At the absolute bare minimum, an article on a given subject should define said subject as it is typically understood. This article does not do either, plunging immediately into criticism and only briefly surfacing to list, but not define, a few terms supposedly associated with functional medicine.

This isn't to say readers shouldn't be presented with the scientific consensus on a pseudoscientific practice in the lead. By all means, tell readers that functional medicine is bad. But not before telling them what it is. That's just lazy.

Someone will likely argue that this isn't possible. I think that's tantamount to saying the topic isn't notable. If it's so poorly defined that we can't discuss it, does it really exist? 2603:7081:1603:A300:E091:E8CF:A13:50E7 (talk) 09:40, 29 May 2023 (UTC)

"Functional medicine" is a marketing brand rather than a coherent and science-based approach to medicine. tgeorgescu (talk) 10:56, 29 May 2023 (UTC)
Do you have reliable sources that define it "as it is typically understood", as opposed to "a form of alternative medicine that encompasses a number of unproven and disproven methods and treatments" that "focuses on the 'root causes' of diseases based on interactions between the environment and the gastrointestinal, endocrine, and immune systems to develop 'individualized treatment plans.'", as the article seems to define it? --tronvillain (talk) 21:44, 30 May 2023 (UTC)
I concur that article is completely inadequate and does not describe what functional medicine actually is, and any effort that has been made so far to help define what functional medicine has NOT been admitted into this article.
I can't see how any improvements to this page can be made, if in the end, the only content that is permitted through by the Wikipedia gatekeepers is what is considered kosher in the name reductionism and scientism.
"You can't get the right answers if you ask the wrong questions."
The whole point of functional medicine is that it typically asks different questions about the root causes of dysfunction (we have germs; they make us up; what do they do for us?) than what Western allopathic medicine has traditionally asked (what causes disease? microbes!! kill the germs!! ALL OF THEM!!). Medicine is evolving, in paradigm, in its scientific approach, and its practice. Guess where all that is happening? Yes, you got that right, at the fringes, and with fringe ideas. There can be quackery, but, by focussing myopically on quackery, you're throwing the baby out of the bathwater, every time.
As the article currently stands, it baffles me how the opinions of an institution like American Academy of Family Physicians or one oncologist (David Gorski) should be considered valid and authoritative (well, I suspect it is precisely because they are anti-alternative medicine figures), while the large strategic investment decision made by the Cleveland Clinic Foundation is brushed off in a single sentence by a statement made by an arbitrarily chosen university (as 'unfortunate', 'quackery').
I can see this problem also in the page about Alternative Medicine. Gorski is given airtime, front and centre. For no particular reason that I can see, either.
This makes no sense. Completely divorced from reality.
Welcome to Wikipedia on medicine. Wokspoon (talk) 12:00, 7 June 2023 (UTC)
Nope, the SCAM industry is Completely divorced from reality. Not every new scientific idea is WP:FRINGE, and the proof is in the puding, i.e. in evidence-based medicine. tgeorgescu (talk) 12:40, 7 June 2023 (UTC)

recent edits

I recently found this article and made some edits, including after reviewing the article talk page, and had thought I had helped sharpen the article according to WP:FRINGE and WP:NPOV, but all of the edits were reverted [1]. Anyway, I had also thought there is more that could be done to enhance the article according to WP:FRINGE, e.g. state that Bland has a PhD, remove or incorporate what may be a promotional-seeming EL despite its source, and expand on the lack of scientific evidence based on some preliminary research I started yesterday [2] (the phrase "a first-of-its-kind study" in the press release stood out to me as an opportunity to find and add WP:MEDRS). But I think there are more productive places to focus my attention.

As a side note, there may be some potential WP:CLOP/WP:COPYVIO issues in need review, e.g. added in 2019 [3] (which appeared to have a possible origin at [4] - the phrase 'root causes' does not appear in source cited when I viewed and worked on the article, but on closer examination, the appearance of possible CLOP/COPYVIO may be related to the amount of back-and-forth editing this article has undergone and a source getting lost in the midst of that); and text added in 2015 [5], which could be compared to the source. Thank you, Beccaynr (talk) 16:09, 28 October 2023 (UTC)

There was an issue with attributing WP:SBM, which made many knowledgeable statement appear to be 'just' an opinion, which is problematic per WP:YESPOV. But yes, eradicating any copyvio-ish content would useful & necessary. Bon courage (talk) 16:18, 28 October 2023 (UTC)
From my view, I was thinking about readers, and how the tone and presentation of e.g. the SBM Quackademia update source (cited twice in one sentence in the lead) seems to undermine its credibility (such as the frequency of exclamation points, as well as references to Nazism, New Coke, etc). So from my view, as a basic way to strengthen this source, attribution and blue-linking the author seemed helpful. Also from my view, just because a source is green-lit at WP:RSP, this does not mean we should use what seems to be classic weasel wording through vague attribution for its descriptive secondary evaluation, e.g. "quackery." My intention with the attribution was more to help readers recognize that despite the presentation of the website, the author is notable, and to provide more direct access to their Wikipedia article, which I think helps strengthen the source - we're familiar with WP:RSP, but our readers likely are not. Beccaynr (talk) 00:01, 29 October 2023 (UTC)
I think it weakens things. Per WP:PSCI we are required to be upfront about pseudoscience and make sure it's prominent and clear when something is pseudoscientific. If you want to call FM quackery directly rather than indirectly, go ahead, but I find editors resist that formulation as having an odd tone for wikivoice. Bon courage (talk) 01:42, 29 October 2023 (UTC)
I think the editorial difference in perspective may be well-addressed by adding further sourcing - for example, peer-reviewed studies from reliable journals could help directly demonstrate the pseudoscience. I haven't taken a look at GScholar or the Wikipedia Library, but if I find sources I'll add them to the talk page. Beccaynr (talk) 02:49, 29 October 2023 (UTC)
Really this is just a brand for the usual altmed scamming. There's something in
  • Nunan D, Blane DN, McCartney M (May 2021). "Exemplary medical care or Trojan horse? An analysis of the 'lifestyle medicine' movement". Br J Gen Pract. 71 (706): 229–232. doi:10.3399/bjgp21X715721. PMC 8087320. PMID 33926883.
which makes the point this is just another name for something familiar. Bon courage (talk) 03:12, 29 October 2023 (UTC)
I would like to see this article expanded to follow the first line of the lead, e.g. perhaps with a section for unproven methods and a section for disproven methods. I think this article has the capacity to be a more specific educational resource than it currently is, and when I refer to 'editorial difference in perspective,' I am thinking about how to most effectively present content to readers. More emphasis on red-flag aspects might be helpful (e.g. as noted in the source above, "The affiliation between lifestyle medicine and non-evidence-based, fringe, and alternative tests, diagnoses, and interventions in many areas risks disrepute, conflict, and confusion for patients") and adding broader commentary, such as from the above source about public health and economic disparities, might also be worthwhile to include. Beccaynr (talk) 12:13, 29 October 2023 (UTC)
Not sure 'disproven' features much in medicine, as a very tiny number of things are amenable to disproof. The problem here is that FM is a vaguely-define brand (intentionally so), so will resist efforts to explain just what it is. It's really just another name for Integrative medicine with a couple of extra gimmicks (the matrix thing e.g.). It may, yes, be worth adding something on how this adversely affects its customers though. Bon courage (talk) 12:22, 29 October 2023 (UTC)
The lead currently says 'disproven,' and I was thinking about content currently in the article, such as adrenal fatigue, but this seems amenable to a slight rephrasing. Also, I started reviewing studies and I figure there are sources available to help explain how limiting various limitations can be, e.g. in "Functional Medicine Approach to Patient Care Improves Sleep, Fatigue, and Quality of Life in Patients With Inflammatory Bowel Disease" Crohn's & Colitis 360, 4 (3) July 2022, https://doi.org/10.1093/crocol/otac032 such as a lack of a placebo control, the existence of sampling bias, etc. Beccaynr (talk) 14:13, 29 October 2023 (UTC)
Retrieved from "https://en.wikipedia.org/w/index.php?title=Talk:Functional_medicine/Archive_2&oldid=1221510121"