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This is an old revision of this page, as edited by Lowercase sigmabot III (talk | contribs) at 17:50, 8 March 2024 (Archiving 1 discussion(s) to Talk:Functional medicine/Archive 2) (bot). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Does this article rely too heavily on SBM?

I fully understand that the blog Science-Based Medicine is considered generally reliable, though not peer-reviewed. However currently 8 out of the 13 references (62%) (9 if you count External links) are from SBM, as are 14 of 22 inline citations (64%). I realize the FUTON bias makes it easy to immediately view and cite whatever diatribe du jour an esteemed researcher has decided to gripe about. My concerns are whether views of the SBM writers are granted disproportionate weight. SBM blogger David Gorksi is the only named attributed author in this article (named twice), which makes this resemble "Functional medicine from the view of Gorski". Considering WP:WEIGHT and WP:NPOV, out of everything ever written about functional medicine by reliable sources, does SBM and Gorski really comprise the majority views? Or to put it another way: is this article a neutral encyclopedic summary of Functional medicine, or a vehicle selectively broadcasting the views of SBM authors? I think a broader diversity of sources are needed. --Animalparty! (talk) 00:34, 5 January 2022 (UTC)[reply]

And for those readying to beat me with a WP:PROFRINGE cudgel, let me point out that I would have similar questions with an article about rocks with >60% of citations being from the New York Times or the same geology magazine. I recognize the standing of this topic in broader medical consensus. I'm neither pro- nor anti-functional medicine, but critical examination of how heavily we cite and present a source is healthy. Here are some potential additional sources. --Animalparty! (talk) 03:05, 5 January 2022 (UTC)[reply]
  • Luke, Jesse W. (July 2017). "Functional medicine: New name, old ideas". Australasian Science. doi:10.3316/informit.268531139808641.
  • Khan, Wajid I. (2020). "The current evidence behind functional medicine" (PDF). University of British Columbia Medical Journal. 12 (1): 35–36.
  • Khayal, Inas S.; Farid, Amro M. (January 2017). "The Need for Systems Tools in the Practice of Clinical Medicine". Systems Engineering. 20 (1): 3–20. doi:10.1002/sys.21374.
Agreed, almost this entire post is referenced on David Gorski and Science Based Medicine. This is not a "consensus viewpoint" on the subject. The page says that Functional Medicine doctors treat and diagnose a number of disease entities found not to exist. OK, some of the conditioned purportedly identified and treated do not have mainstream acceptance, but the vast majority of what functional medicine doctors are diagnosing and treating are well known, established conditions like diabetes, obesity, depression, etc, and they are often being treated with healthy lifestyle interventions for which there is good data, but none of this is mentioned because nearly all sources cited having nothing but vitriol for functional medicine. Xitomatl (talk) 15:39, 20 October 2022 (UTC)[reply]
Yup, physical exercise and a healthy diet are good for health. But we did not need functional medicine to tell us that, that was already known and broadly accepted. Of course, that isn't quackery. Its quackery lies in what distinguishes it from mainstream medicine. Also, while dieting helps patients with diabetes, it can never heal them, so expecting to be healed from diabetes through dieting is vain hope, and even a scam, i.e. a felony. Also, while running or walking helps with depression, it isn't a silver bullet. Dieting helps those suffering from obesity, but according to prof. dr. Martijn B. Katan, one of the most cited scientists in the field of nutrition, long-term weight loss through dieting is less probable than long-term recovery from heroin addiction. So, yes, diet helps those with obesity, but in 80%-90% of the cases weight loss is only temporary, and then the subject comes back to their obesity weight. tgeorgescu (talk) 12:15, 9 March 2023 (UTC)[reply]
"Expecting to be healed from diabetes through dieting is...a felony" is a pretty bizarre linguistic construction. 2603:7081:1603:A300:E091:E8CF:A13:50E7 (talk) 08:48, 29 May 2023 (UTC)[reply]
Meaning that people who pretend that diet heals diabetes are felons. tgeorgescu (talk) 03:19, 27 February 2024 (UTC)[reply]
Yes, @Animalpartyalmost every source comes from basically one organization. Gorski is an editor/writer at Science Based Medicine and so is Harriet Hall who wrote via skeptic.com, which is also referenced on this Functional Medicine page. Gorski even pops up in The Atlantic here: https://www.theatlantic.com/health/archive/2011/06/whats-eating-the-small-loud-band-of-alt-med-critics/240860/
Here are some of the other voices that could be referenced:
Dr. Mark Hyman, the leading proponent of functional medicine field, is covered in the New York Times because he advises the Clintons: Source: ​​https://www.nytimes.com/2014/04/13/fashion/dr-mark-hyman-clintons-health.html
The Cleveland Clinic has a functional medicine practice.
https://my.clevelandclinic.org/departments/functional-medicine
The ACCME provides accreditation for functional medicine:
https://www.accme.org/find-cme-provider/institute-for-functional-medicine
This Stanford MD
https://multiplesclerosisnewstoday.com/expert-voices/2022/09/14/expert-voices-functional-medicine-ms/
You can also do a Google search for functional medicine in any major city and you will probably find dozens of MDs who spent time and money to get additional training in this field. 96.241.32.156 (talk) 02:51, 19 September 2023 (UTC)[reply]
@Animalparty @Xitomatl I agree that the article should be more neutral and represent different perspectives on functional medicine. This can be done in proportion to the mainstream view according to WP:DUE. This article also presents opinions as facts. In addition to the existing references, I would add the following sources.
•Beidelschies, M., Alejandro-Rodriguez, M., Guo, N., Postan, A., Jones, T., Bradley, E., Hyman, M., & Rothberg, M. B. (2021). Patient outcomes and costs associated with functional medicine-based care in a shared versus individual setting for patients with chronic conditions: a retrospective cohort study. BMJ Open, 11(4), e048294. https://doi.org/10.1136/bmjopen-2020-048294
•Beidelschies, M., Alejandro-Rodriguez, M., Ji, X., Lapin, B., Hanaway, P., & Rothberg, M. B. (2019). Association of the Functional Medicine Model of Care With Patient-Reported Health-Related Quality-of-Life Outcomes. JAMA network open, 2(10), e1914017. https://doi.org/10.1001/jamanetworkopen.2019.14017
•Beidelschies, M., Cella, D., Katzan, I., & D'Adamo, C. R. (2022). Patient-Reported Outcomes and the Patient-Reported Outcome Measurement Information System of Functional Medicine Care and Research. Physical medicine and rehabilitation clinics of North America, 33(3), 679–697. https://doi.org/10.1016/j.pmr.2022.04.008
•Bland J. (2017). Defining Function in the Functional Medicine Model. Integrative medicine (Encinitas, Calif.), 16(1), 22–25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312741/
•Bland J. S. (2022). Functional Medicine Past, Present, and Future. Integrative medicine, 21(2), 22–26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9173848/
•Bland J. S. (2018). The Natural Roots of Functional Medicine. Integrative medicine, 17(1), 12–17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380987/
•Bland J. S. (2019). What is Evidence-Based Functional Medicine in the 21st Century?. Integrative Medicine, 18(3), 14–18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7217393/
•Droz, N., Hanaway, P., Hyman, M., Jin, Y., Beidelschies, M., & Husni, M. E. (2020). The impact of functional medicine on patient-reported outcomes in inflammatory arthritis: A retrospective study. PloS one, 15(10), e0240416. https://doi.org/10.1371/journal.pone.0240416
•Hanaway P. (2016). Form Follows Function: A Functional Medicine Overview. The Permanente journal, 20(4), 16–109. https://doi.org/10.7812/TPP/16-109
•Hickner J. (2022). Keeping an open mind about functional medicine. The Journal of Family Practice, 71(1), 6–7. https://doi.org/10.12788/jfp.0343
•Hyman, M., & Bradley, E. (2022). Food, Medicine, and Function: Food Is Medicine Part 1. Physical medicine and rehabilitation clinics of North America, 33(3), 553–570. https://doi.org/10.1016/j.pmr.2022.04.001
•Hyman, M., & Bradley, E. (2022). Food, Medicine, and Function: Food is Medicine Part 2. Physical medicine and rehabilitation clinics of North America, 33(3), 571–586. https://doi.org/10.1016/j.pmr.2022.04.002
•Orlando, F. A., Chang, K. L., & Estores, I. M. (2021). Functional medicine: Focusing on imbalances in core metabolic processes. The Journal of Family Practice, 70(10), 482–498. https://doi.org/10.12788/jfp.0307
•Simkin, D. R., & Arnold, L. E. (2023). Complementary and Integrative Medicine/Functional Medicine in Child and Adolescent Psychiatric Disorders: Should It Be Taken Seriously?. Child and adolescent psychiatric clinics of North America, 32(2), xiii–xxiv. https://doi.org/10.1016/j.chc.2022.09.001
•Strobel, T. M., Nguyen, C., Riggs, T., Horst, S. N., Motley, A., Upadhyaya, S., Campbell, S., Spring, E., Dalal, R. L., Scoville, E., Pabla, B., Schwartz, D. A., & Beaulieu, D. B. (2022). 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), otac032. https://doi.org/10.1093/crocol/otac032 4whirledpeas (talk) 01:55, 27 February 2024 (UTC)[reply]
@4whirledpeas: I don't want to give you false hope. In order to learn how the ball is played, please read WP:LUNATICS. tgeorgescu (talk) 02:15, 27 February 2024 (UTC)[reply]
That's a good start but:
Levivich (talk) 02:20, 27 February 2024 (UTC)[reply]
I'm afraid "holistic approach" is empty verbiage, it is described at not even wrong. If you're seeking to define "holistic approach" scientifically (as in medical science): don't bother, it has no meaning at all. tgeorgescu (talk) 03:15, 27 February 2024 (UTC)[reply]

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)[reply]

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)[reply]
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)[reply]
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)[reply]
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)[reply]
Really this is just a brand for the usual altmed scamming. There's something in
which makes the point this is just another name for something familiar. Bon courage (talk) 03:12, 29 October 2023 (UTC)[reply]
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)[reply]
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)[reply]
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)[reply]

Article was in violation of principle of "Wikipedia is written from a neutral point of view."

Wikipedia:Five pillars

I understand that someone who is editing this takes great issue with functional medicine, but this is an inappropriate use of Wikipedia. I attempted to edit the article to contain neutral and factual information.

Wikiwriter43103840 (talk) 20:21, 13 February 2024 (UTC)[reply]

Hi, Wikiwriter43103840, I suggest that you read what WP:NPOV actually says instead of pontificating about what it might say. WP:NPOV does include WP:PSCI, WP:GEVAL, WP:REDFLAG, and actually entails WP:FRINGE and WP:MEDRS. tgeorgescu (talk) 22:31, 13 February 2024 (UTC)[reply]
Hi there, I’m unclear about why you are taking this abrasive tone with me. We’re all trying to improve Wikipedia. I stand by what I said. Wikiwriter43103840 (talk) 04:24, 14 February 2024 (UTC)[reply]
@Wikiwriter43103840: I'm not seeking to be rude, but saying Article was in violation of principle of "Wikipedia is written from a neutral point of view." means that you have understood nothing from the real WP:NPOV. tgeorgescu (talk) 04:40, 14 February 2024 (UTC)[reply]
what don't I understand? I am trying to help the article avoid stating opinions as facts and to avoid using judgemental language. I also want it to "present opinions and conflicting findings in a disinterested tone." Wikiwriter43103840 (talk) 13:26, 19 February 2024 (UTC)[reply]
Note: I reverted back the version that avoids stating opinions as facts. In my view, your continued insistence that your way is the only correct way and continuing to remove other people's edits is becoming vandalism. Wikiwriter43103840 (talk) 13:33, 19 February 2024 (UTC)[reply]
{{subst:uw-disruptive2}} Wikiwriter43103840 (talk) 13:35, 19 February 2024 (UTC)[reply]
You do not make the WP:RULES. You have to obey our rules, just like everybody else.
You cannot warn a talk page, and see WP:DNTR. tgeorgescu (talk) 13:38, 19 February 2024 (UTC)[reply]
Then you should ignore the tone and pay attention to the content. Read the pages tgeorgescu linked. WP:IDHT is also a good page. --Hob Gadling (talk) 08:13, 20 February 2024 (UTC)[reply]

Sources

I agree with the gist of the threads started on this page over the last couple years by Animalparty (#Does this article rely too heavily on SBM?), Beccaynr (#recent edits), and Wikiwriter43103840 (#Article was in violation of principle of "Wikipedia is written from a neutral point of view."), that this article relies too much on Science-Based Medicine and generally would benefit by being expanded with more sources. Towards that end, here are some more sources that could be used for expanding the article:

Hope this helps, Levivich (talk) 01:07, 23 February 2024 (UTC)[reply]

The Gorski chapter looks fine; good find! The articles in Physical Medicine and Rehabilitation Clinics of North America are in a "special issue" with a guest editor, which is suspicious. The next three are primary sources so not usable for WP:BMI. Bon courage (talk) 03:18, 23 February 2024 (UTC)[reply]
If you're curious about the guest editor, you can look her up: Elizabeth Bradley. She teaches at the Yale School of Public Health. None of her research has anything to do with functional health. What specific concerns do you have about the issue having a guest editor, specifically this guest editor? edit: She is also highly connected to functional medicine. Significa liberdade (she/her) (talk) 03:50, 7 March 2024 (UTC) Significa liberdade (she/her) (talk) 01:06, 8 March 2024 (UTC)[reply]
Err, she's "Medical Director for Cleveland Clinic's Center for Functional Medicine". Bon courage (talk) 20:51, 7 March 2024 (UTC)[reply]
Thanks for pointing that out, @Bon courage. I was just coming back to this reply to make an amendment given that she co-authored articled with Hyman. Significa liberdade (she/her) (talk) 01:05, 8 March 2024 (UTC)[reply]
4whirledpeas, you may find these sources - particularly the Gorski one - helpful in your editing. Your edits appear to be quite pro-functional medicine, so please remember to keep a neutral point of view especially when editing in contentious topics like alternative medicine. You can keep a balanced view without skewing too far to one side. Hope this helps. Schrödinger's jellyfish ✉ 05:58, 26 February 2024 (UTC)[reply]
The article as it is written does not maintain a neutral point of view. To describe functional medicine, one can go several sources that provide a definition and description that do not only present a negative perspective.
The first sentence is an example: "Functional medicine is a form of alternative medicine that encompasses a number of unproven and disproven methods and treatments." This presents functional medicine in a negative light only. A neutral point of view would describe functional medicine objectively, without implying that its methods and treatments are inherently ineffective or unsupported by evidence. There are methods used in functional medicine that are well supported by evidence (e.g., diet, exercise, sleep, stress management).
There are individual's opinions in the article; however, they only present one side and not the other. An example: "The opening of centers for functional medicine at the Cleveland Clinic Foundation and at the George Washington University was described by Gorski as an "unfortunate" example of quackery infiltrating academic medical centers." A more neutral point of view would also present the opinions of those who have positive opinions of these centers opening.
Also, since this is a discussion on sources, I agree that there is a need to diversify the sources for a more neutral point of view. Some references are outdated, and some of the information is outdated and inaccurate as well. "In the United States, functional medicine practices have been ruled ineligible for course credits by the American Academy of Family Physicians because of concerns they may be harmful." The AAFP began approving functional medicine topics focused on the scope and techniques in 2018. "Functional medicine practitioners claim to diagnose and treat conditions that have been found by research studies to not exist, such as adrenal fatigue and numerous imbalances in body chemistry." Functional medicine practitioners diagnose and treat a number of conditions that do exist, such as diabetes, heart disease, hypertension, and digestive issues.
I see various references listed above, but they do not seem to be included. How does one proceed to edit the article to present a more neutral point of view? 4whirledpeas (talk) 21:09, 26 February 2024 (UTC)[reply]
A more neutral point of view would also present the opinions of those who have positive opinions of these centers opening ← no, Wikipedia doesn't do 'both sides' for fringe topics. See WP:FALSEBALANCE. Bon courage (talk) 01:11, 27 February 2024 (UTC)[reply]
IMO, the problem with this edit is that it didn't present a more neutral point of view, it just replaced one not-very-neutral (negative) POV with the opposite not-very-neutral (positive) POV. Functional medicine is not whatever Bland says it is, but it's not whatever SBM/Gorski says it is, either. Neither of those two have a monopoly on this field, there are more sources out there about this, and an WP:NPOV summary will summarize the body of reliable, published material on the subject, not just any one or two authors. Levivich (talk) 01:49, 27 February 2024 (UTC)[reply]
WP:FRIND is a key consideration. Bland should be excluded except where discussed in third-party sources. The Knott source is quite good for what FM "is". Bon courage (talk) 02:29, 27 February 2024 (UTC)[reply]
A quick aside - thank you so much to everyone far more familiar with WP:FRINGE topics & editing around this area. I saw the edits in recent changes and wasn't sure the best approach aside from trying to get the other editor involved in discussion. Hopefully it's been productive in getting the article away from the "not-very-neutral (negative)" without skewing too far to the, quite obviously to someone otherwise unfamiliar with the subject, not-very-neutral (positive) POV. Schrödinger's jellyfish ✉ 23:26, 7 March 2024 (UTC)[reply]

Removal of content

Hi, Zefr: Could you explain the recent removal of content? At present, the lead sentence indicates that FM refers to "unproven and disproven methods and treatments". This statement is backed by three sources, the most recent of which is 15 years old. However, when I searched for "functional medicine" on PubMed, the first three articles I found discussing outcomes indicated that FM had statistically significant positive outcomes for three conditions. This seems in contrast with the entirety of this article, which primarily cites SBM. Are there recent literature reviews in more reputable publications that we can find and include instead?

Additionally, can you tell me what POV issues the following paragraph contains:

To allegedly treat and prevent illness, FM practitioners use systems biology to identify negative triggers that could be addressed (such as stress or poor diet), as well as improving factors known to improve health (such as sleep and relationships). After building a relationship with the patient, FM practioners developed individualized plans that include lifestyle and behavioral interventions to improve their health.{source included}

This was in the section describing what FM is. This information is provided in several peer-reviewed articles in medical journals that describe FM. While this could be considered as "promotional" (as you stated in your edit summary), I would argue that the use of words and phrases such as "according to FM proponents" and "allegedly" address such concerns.

Similarly, I'm curious why the following sentence is irrelevant for the lead: "Proponents emphasize a holistic approach and developing a relationship between the patient and practitioner." Again, this is repeated in multiple peer-reviewed articles in medical journals as a core component of FM. Given WP:LEAD, it feels like that would be important to include.

Lastly, you removed a source that you indicated was a "patient advocacy source" (and therefore, not reliable, I would guess). However, you removed the Knott source, which Bon courage indicated was a good source above. Is there a specific issue in the way it was used, or do you disagree with Bon courage?

I swear I'm not trying to cause drama. I'm here to create a good open educational resource. When I initially stumbled upon this article, I had no idea what FM is based on this page, which is contrary to its purpose. It makes far more sense to provide information about the thing and provide good sources that showcase whether it's valuable or not. Significa liberdade (she/her) (talk) 03:33, 7 March 2024 (UTC)[reply]

Reasons:
  1. WP:MEDRS strongly dissuades claims based solely upon WP:PRIMARY medical studies;
  2. WP:PARITY says that for WP:FRINGE topics, WP:RS of lesser prestige are allowed, so long as they're written by debunkers;
  3. WP:FRINGE, WP:PSCI, WP:GEVAL, and WP:REDFLAG;
  4. as well as noticing that some basic concepts of FM are not empirically operationalizable, so they are not even wrong. tgeorgescu (talk) 03:54, 7 March 2024 (UTC)[reply]
Most of what I've said above isn't trying to add sources or even claims to the article that would provide undue weight. Rather, I'm just trying to get a sense of what FM even is, which wasn't described here when I arrived. However, many reputable sources provide descriptions of FM--even those that discredit it. If we look at another alternative medicine article, such as acupuncture, we can get a sense of what acupuncture is. Same thing for acupressure, alkaline diet, anthroposophic medicine, and zero balancing, among many other articles listed as alternative medicine. I would say alkaline diet might be a great example of explaining what it is (even though it's not entirely clear), then explaining that it's not back by science. However, it seems like attempts to even explain what FM are according to the practitioners and others are being removed. There also doesn't seem to be consensus about what makes a source valuable among those invested in this article, given that Bon courage indicated the Knott source is good, but then Zefr discredited it. Significa liberdade (she/her) (talk) 05:20, 7 March 2024 (UTC)[reply]
I think the Knott source is useful for debunking per WP:PARITY. It's one of the few sources that attempts to describe what this particular species of bollocks actually "is"! Bon courage (talk) 05:29, 7 March 2024 (UTC)[reply]
And the Knott source was used to describe what FM is, though it was removed as a "non-secondary Patient advocacy source". The sentence read, "After understanding these mechanisms [i.e., triggers, etc.], FM practitioners develop an individualized treatment plan for the patient." If there are issues with the phrasing of the sentence, I get that, but that wasn't the stated concern. Significa liberdade (she/her) (talk) 05:30, 7 March 2024 (UTC)[reply]
The following sentence, stated in the Knott piece, was also removed: "Proponents emphasize a holistic approach and developing a relationship between the patient and practitioner". Again, this is part of the explanation of what FM is, which is helpful to understand the core concepts. Significa liberdade (she/her) (talk) 05:36, 7 March 2024 (UTC)[reply]
Yuck, that sounds airy-fairy. A while back, Knott was used for this description, which is more concrete and useful:

Proponents of functional medicine oppose established medical knowledge and reject its models, instead adopting a model of disease based on the notion of "antecedents", "triggers", and "mediators". These are meant to correspond to the underlying causes of health issues, the immediate causes, and the particular characteristics of a person's illness. A functional medicine practitioner devises a "matrix" from these factors to serve as the basis for treatment.

Bon courage (talk) 05:40, 7 March 2024 (UTC)[reply]
Wouldn't it be helpful then to have an edit summary that critiques the phrasing of Knott's work, rather than indicating the removal of a "non-secondary Patient advocacy source"? This makes it sound like the source is bad, not that the phrasing of the source's information is problematic. Significa liberdade (she/her) (talk) 05:48, 7 March 2024 (UTC)[reply]
It's a secondary source. I would prefer to see the description above than Bland's woo. WP:FRIND applies. Bon courage (talk) 05:50, 7 March 2024 (UTC)[reply]
As other editors stated, FM is just integrative medicine with the matrix and some other tricks added to it. tgeorgescu (talk) 06:08, 7 March 2024 (UTC)[reply]
Well, this has been unhelpful. I'm going back to my corner of Wikipedia. Significa liberdade (she/her) (talk) 06:26, 7 March 2024 (UTC)[reply]
If you want to expand the description section, you can use this article at the Skeptic magazine [7]. It's only used once on the article currently. Psychologist Guy (talk) 12:03, 7 March 2024 (UTC)[reply]
How does Skeptic magazine meet MEDRS? Levivich (talk) 16:13, 7 March 2024 (UTC)[reply]
It doesn't; but a description of what FM purports to be is not WP:BMI, so it's actually a pretty good source for that. Bon courage (talk) 16:17, 7 March 2024 (UTC)[reply]
It's OK to use non-MEDRS sources for a description of what functional medicine is? Levivich (talk) 17:34, 7 March 2024 (UTC)[reply]
Yup, so long as WP:BMI is avoided. Bon courage (talk) 17:38, 7 March 2024 (UTC)[reply]
That doesn't make sense to me. Saying that FM is "effective" or "ineffective" is definitely BMI, isn't it? Levivich (talk) 17:58, 7 March 2024 (UTC)[reply]
Well you were talking about using a source for "a description of what functional medicine is", ratther than whether "it" is effective or not. Bon courage (talk) 18:05, 7 March 2024 (UTC)[reply]
The first sentence is "Functional medicine (FM) is a form of alternative medicine that encompasses a number of unproven and disproven methods and treatments."
If the efficacy of FM is BMI, then saying FM is ineffective is BMI ("unproven," "disproven").
Do you disagree and if so why? Levivich (talk) 18:07, 7 March 2024 (UTC)[reply]
The word "ineffective" is not in the article. But for woo, pretty much any respectable scientific source is WP:MEDRS if you wanted to go there, I should think. Bon courage (talk) 18:16, 7 March 2024 (UTC)[reply]
That makes me even more confused. What do you mean any respectable scientific source is MEDRS for woo? MEDRS doesn't have different rules for woo and non-woo. MEDRS is what we use to determine what is and what is not woo, so it wouldn't make sense for MEDRS to treat "woo" as an antecedent rather than a consequent.
Also, "ineffective" is not in the article, but the article defines FM as encompassing "unproven" and "disproven" methods. So that means the same thing as "ineffective." We are saying in the opening sentence that FM does not work. That's BMI. We cite it to many non-BMI sources.
This version of the lead sentence just written by Significa liberdade, cites a 2013 survey article in a peer-reviewed index journal for a definition. It was reverted back to this version that cites in the lead sentence two SBM blog posts and a 22-year-old review article in a peer-reviewed journal which is also indexed (but not on PubMed AFAICT, for whatever that means).
I'm having a really hard time understanding why that reversion was made, or why the SBM blog posts are MEDRS-compliant when the 2013 survey article is not. Levivich (talk) 18:24, 7 March 2024 (UTC)[reply]
MEDRS is what we use to determine what is and what is not woo ← no, that is really a categorization question.
MEDRS doesn't have different rules for woo and non-woo ← of course it does. You don't need a strong source to say drinking bleach won't cure cancer. Read MEDRS again and look for the spinning plate! Bon courage (talk) 18:29, 7 March 2024 (UTC)[reply]
Where does MEDRS differentiate between fringe and non-fringe topics? I don't see the word "fringe" in MEDRS anywhere. The spinning plate caption says "Reliable sources must be strong enough to support the claim. A lightweight source may be acceptable for a lightweight claim, but never for an extraordinary claim."
The definition of FM is not a "lightweight claim." In fact, it's controversial, as demonstrated by the various high-quality MEDRS sources that have different definitions of the term.
This a textbook WP:NPOV issue: there are multiple significant viewpoints in reliable sources. But this article takes one of them and presents it as the mainstream view, based on shoddy sourcing like SBM blog posts, and editors seem to be removing any and all attempts to include the other view. In doing so, editors are asserting that the other view is "woo" but in doing so are ignoring, discounting, and removing from the article, the RSes, even MEDRSes, that say it's something other than woo. Levivich (talk) 18:37, 7 March 2024 (UTC)[reply]
As an outsider on this topic and looking at the conversations on this page, I think it would be beneficial to point to specific language in MEDRS when users are uncertain what guidelines you're referring to. I see many restatements saying, "Look at this guideline!" Clearly, people aren't sure which part of the guideline is being violated. Significa liberdade (she/her) (talk) 18:38, 7 March 2024 (UTC)[reply]
Levivich, look on MEDRS at WP:MEDASSESS, also read the article on evidence-based medicine. Functional medicine is not evidence-based it is pseudoscience, therefore the papers you have suggested on this article which are supportive of functional medicine are not reliable, they are indeed pro-woo. Psychologist Guy (talk) 18:42, 7 March 2024 (UTC)[reply]
Why don't you quote the part of MEDASSESS you think applies here?
Saying that because it's woo, anything that says it's not woo is not an RS, is not what our policies say.
The RS is how you decide whether it's woo or not.
High-quality RS ... at the top of that pyramid, including review articles in indexed, peer-reviewed journals, have been removed from the article. I've posted a bunch of those on this page in the other threads above.
Whereas the SBM blog, because it's not peer reviewed, is on the lower part of that MEDASSESS pyramid.
My whole point is that we're rejecting sources high on the pyramid in favor of sources low on the pyramid.
Y'all please stop telling me in so many words to RTFM. I've RTFM'd. Quote the policy if you want to say something violates the policy. Levivich (talk) 18:49, 7 March 2024 (UTC)[reply]
This all seems very confused. WP:SBM is a golden source for fringe stuff. Knott is a good WP:FRIND source for describing FM. If somebody has a specific recommendation, perhaps they could specify that as the vague hand-waving is getting dizzying! Bon courage (talk) 18:42, 7 March 2024 (UTC)[reply]
As a concrete example, what is your opinion of the following sentence: "Functional medicine proponents stress the importance of an holistic approach and of establishing a therapeutic partnership between the patient and the doctor"? Significa liberdade (she/her) (talk) 18:46, 7 March 2024 (UTC)[reply]
it's waffly and rather WP:PROFRINGE. That's what you get when you pluck words from Knott out of context. Bon courage (talk) 18:58, 7 March 2024 (UTC)[reply]
And this is where it can be confusing for people. You say that a source does a good job of describing what FM is, but when that source is used word-for-word to describe what FM is, you still don't like it. I understand contextualizing, but there's a difference between being "pro-FM" and providing a description of what proponents say it is. Again, this gets to my point about other alternative medicine pages. Significa liberdade (she/her) (talk) 22:13, 7 March 2024 (UTC)[reply]
And as I stated before, other alternative medicine pages have descriptions of the intervention, even when it's not entirely clear what the intervention is. Language such as "Proponents advocate for..." helps clarify that this is someone's opinion and shouldn't be taken as fact. Similarly, if we look at a page like Holocaust denial, we see detailed explanations of the associated beliefs, as well as evidence to show that the beliefs are ridiculous. I'm not sure why this page is an outlier. Significa liberdade (she/her) (talk) 18:43, 7 March 2024 (UTC)[reply]
OK here's my thought: I'm going to gather up some of the sources that are in the article, have recently been added and removed from the article, or posted on this talk page, and I'm going to rank them per the WP:MEDASSESS pyramid, and we'll see if we're on the same page up to that point. Levivich (talk) 18:53, 7 March 2024 (UTC)[reply]

Source review

Top tier: secondary/filtered

See above. 01:11, 8 March 2024 (UTC)

Middle tier: primary/unfiltered

Bottom tier: expert opinion etc.

Discussion

These sources are from the article (first paragraph), recent edits to the article, or this talk page (copied and pasted, which is why the citation format is all over the place), sorted into three tiers per WP:MEDASSESS pyramid, and listed in descending chronological order (newest first).

Are any sources above in the wrong category? Are there other sources, especially in the top tier, that should be added? Levivich (talk) 20:24, 7 March 2024 (UTC)[reply]

WP:MEDASSESS is about health effects and evidence levels, and a lot of the material in these sources is other than that, so there is a lot of not-even-wrong category error here. Bon courage (talk) 20:32, 7 March 2024 (UTC)[reply]
Let's just focus on the top tier: what material in which sources listed in the top tier above, is about something other than health effects? Also, what does "not even wrong category error" mean in this context? Bottom line, are you saying WP:MEDASSESS does not apply to the lead sentence of Functional medicine, which defines the term? Levivich (talk) 21:01, 7 March 2024 (UTC)[reply]
It doesn't apply to general discussion of (e.g.) the marketing tactics of health fraudsters. I'm not sure what you're wanting to ask: are you wanting to have some actual biomedicine in the article? As with most pseudoscience, the opening should probably focus on why it's a pseudoscience. I've just read the Gorski/MIT chapter; hardly any of it is about "health effects", the "effects" are more on the bank accounts of the people falling victim to the fraud. Bon courage (talk) 21:03, 7 March 2024 (UTC)[reply]
I'm saying what's listed above in the "top tier" section are the best sources put forward so far about functional medicine, particularly for the lead of the article, for the definition of the term.
Gorski/MIT 2018, pp. 311-312:

Functional medicine is a poorly defined branch of integrative medicine that claims, as does integrative medicine itself, to “address the under­lying ­causes” of diseases, particularly chronic diseases. On the surface, functional medicine sounds harmless enough, but if one digs deeper, one finds a vaguely defined “discipline” in which it is claimed that mea­sur­ing a ­whole laundry list of metabolic ­factors and other lab values ­will lead to a “holistic” approach to disease ... Unfortunately, the specific recommendations made by functional medicine prac­ti­tion­ers are rarely rooted in strong science.

Is this not about the health effects of functional medicine? Is it not content that is covered by MEDRS?
Gorski/MIT 2018 only has like one paragraph about functional medicine specifically (it's mostly about pseudoscience more generally). So I don't understand saying that Gorski/MIT 2018 is mostly about non-health-effects of functional medicine, when it's entirely about functional medicine health claims being pseudoscience.
The lead sentence of the functional medicine article, which defines what it is, should be sourced to WP:MEDRS-compliant sourcing, such as what I've listed here. Surely you don't disagree with this?? Levivich (talk) 21:13, 7 March 2024 (UTC)[reply]
I don't see any "health effects" in the passage you quote. A health effect would be a change in a person/population between state A and state B attributed to some cause. So far as I'm aware the only accepted health effects of FM are adverse effects from unnecessary testing; these might be worth mentioning somewhere. We don't need MEDRS for the opening sentence, no. Bon courage (talk) 21:23, 7 March 2024 (UTC)[reply]
To quote WP:BMI, Biomedical information is information that relates to (or could reasonably be perceived as relating to) human health.
These statements I quoted above:
  • "it is claimed that mea­sur­ing a ­whole laundry list of metabolic ­factors and other lab values ­will lead to a “holistic” approach to disease"
  • "the specific recommendations made by functional medicine prac­ti­tion­ers are rarely rooted in strong science"
relate to or could reasonably be perceived as relating to human health.
"specific recommendations made by functional medicine" are without a doubt related to human health, and so saying that those claims "are rarely rooted in strong science" is also biomedical information.
If someone argues in favor of X, and that's BMI, then the argument against X is also BMI. Claims that FM has beneficial health effects is BMI. Claims that FM does not have beneficial health effects is also BMI.
Claims regarding FM's effectiveness is, per BMI, about "attributes of a disease or condition," "attributes of a treatment or drug," "medical decisions," "health effects," and/or "biomedical research". Claims regarding FM's effectiveness is not any of the things listed at WP:NOTBMI: "commercial or business information", "economics," "religious or spiritual beliefs," "history," "society and culture," "legal issues," "notable cases," "popular culture," "etymology and definitions," "training," "regulatory status," or "medical ethics." Levivich (talk) 21:38, 7 March 2024 (UTC)[reply]
We're describing the beliefs/marketing schtick and general irrationality and unscientific nature of FM. I don't think there's any need to discuss effectiveness - I suppose it's taken as read that homeopathy etc. don't work. Care should be taken not to WP:CRYMEDRS. This is all horrifyingly reminiscent of the attempt to extend MEDRS to all 'COVID origin' questions because it was health-y.[8] If in doubt, check at WT:MED. Bon courage (talk) 21:47, 7 March 2024 (UTC)[reply]
Levivich, just look up the main spokes people for functional medicine. 1. Mark Hyman. 2. David Perlmutter. 3. Steven Gundry. 4. Jeffrey Bland. It's also endorsed by Dave Asprey. You can look each of these people up, how can I put this politely? They are basically peddling pseudoscience. Bland has been in trouble with the FDA [9]. Apologies if I have misunderstood your position but are you arguing in favour of this functional medicine nonsense? Psychologist Guy (talk) 23:07, 7 March 2024 (UTC)[reply]
@Significa liberdade: I'd be interested in your thoughts on the rest of that 2022 Physical medicine and rehabilitation clinics of North America 33(3) series (Beidelschies, Kharrazian, or Bharmal) or the journal in general, and whether it's independent/reliable or not? Levivich (talk) 14:33, 8 March 2024 (UTC)[reply]
I would question the articles that came out of the special issue guest-edited by Elizabeth Bradley, given that she's the Medical Director for Cleveland Clinic's Center for Functional Medicine and has published articles with Mark Hyman, a huge advocate for FM. Significa liberdade (she/her) (talk) 14:56, 8 March 2024 (UTC)[reply]
I agree and have struck the others from that issue. Not sure what to make of the Hudson 2020 article in the same journal. Levivich (talk) 15:07, 8 March 2024 (UTC)[reply]
The appropriateness of the other articles in the secondary/filtered list is questionable and would need more analyses. They're not clinical guidelines or systematic reviews, so they would not be considered in Proctor & Gamble's list of secondary/filtered sources. From my understanding, a lot of those articles are saying, "What if we apply FM to XYZ?", which is also not secondary/filtered. I'm coming from the social sciences, so my radar for medical articles would need some tuning. Significa liberdade (she/her) (talk) 15:10, 8 March 2024 (UTC)[reply]
Same here about tuning. I listed them there because either PubMed categorized them as "review" or the articles described themselves as a "review," not sure how much either of those are worth. Levivich (talk) 15:13, 8 March 2024 (UTC)[reply]
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