Talk:Acupuncture/Archive 28

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Why was "Webster's New World Medical Dictionary" replaced by "QuackWatch"?

Greetings! Why was Webster's New World Medical Dictionary replaced by QuackWatch[1] in the caption at Acupuncture#Related practices? The ES didn't even mention the change of the source. Jayaguru-Shishya (talk) 16:23, 2 June 2015 (UTC)

Probably because it's more pertinent and accurate. Guy (Help!) 16:37, 2 June 2015 (UTC)
Not for this particular change: defining "acupressure" doesn't seem like something we need to rely on QuackWatch for.—Kww(talk) 16:56, 2 June 2015 (UTC)
If we're defining something, a reputable dictionary like Webster's is the obvious choice and a better source by leaps and bounds. CorporateM (Talk) 17:23, 2 June 2015 (UTC)
Acupressure is not similar to acupuncture. Webster claim it is similar to acupuncture. But what Webster's is claiming is misleading. They are different. Acupressure is a non-invasive treatment, while acupuncture is an invasive treatment. I previously explained this in another thread before I made my edit. The long term consensus was using the QW source not Webster. QuackGuru (talk) 17:43, 2 June 2015 (UTC)
The Oxford dictionary[2] also says there is a relation between the two and this is what I remember reading in other sources I have seen so far. It doesn't make sense to me to use a weaker source to prove multiple, stronger sources wrong. On the contrary, Quackwatch's error looks like a good example of why it's not a great source and if there is consensus that it should only be used on minor topics, I don't see a place for it on this page, where multiple stronger sources exist. CorporateM (Talk) 18:06, 2 June 2015 (UTC)
For the record, I am the one who changed it from Quackwatch to a dictionary source on acupressure here. I noticed it and was concerned that sources like this might only be used for link spamming purposes by editors who might be connected with Quackwatch because it defies all reasoning to use it as a source for acupressure when we have better sources that say better things. I mentioned my concerns on the MEDRS talk page and Whatamidoing] said Wikipedia links are considered no follow by Google, but that editors might add links like this to our articles in order to increase the number of visits to a website that they may be affiliated with. I do not know who changed it from the dictionary source back to Quackwatch, but I would be curious to know who did it. The only reason I see for doing something like this would be to increase web traffic to that website. LesVegas (talk) 19:43, 2 June 2015 (UTC)

The dictionary is fine if we want a definition, but if its to give the reader more depth of presentation, something like this website would be more appropriate. Quackwatch is a source of critical opinion, not an appropriate source for defining terms.Herbxue (talk) 20:18, 2 June 2015 (UTC)

aobta.org doesn't provide an adequate definition: any definition that includes a flat statement that it "can strengthen weaknesses, relieve common ailments, prevent health disorders and restore the body's vital life force" is too ludicrous to incorporate in an encylopedia, even by reference.—Kww(talk) 20:22, 2 June 2015 (UTC)
Fair enough, it is a professional association but that phrasing does have a bit of an advocacy tone. The Quackwatch definition is pretty POV-pushy too though, so I would opt to stay with the dictionary.Herbxue (talk) 21:38, 2 June 2015 (UTC)

The problem as far as I can see is that the relationship between acupuncture and acupressure is founded on the refuted elements - meridians, qi, acupoints - but most of the article is founded on the minority, non-refuted (at least to date) elements around actual needling, which is by now reliably established to be entirely unrelated to the refuted bits. It's the classic alt-med bait and switch. Guy (Help!) 21:51, 2 June 2015 (UTC)

What is the problematic text in the article as you see it? Was it the "acupressure is non-invasive acupuncture"? I would agree that a stronger distinction should be made, I just edited it to say it is a form of bodywork instead. I can't find where the reference to acupressure using webster's is…Herbxue (talk) 23:27, 2 June 2015 (UTC)
Acupressure is described as "similar to acupuncture, but without needles."[47] The issue is that it is technically not similar. QuackGuru (talk) 00:40, 3 June 2015 (UTC)
Though one is with needles and the other is with hands?, the sources seem to suggest they are similar and we should just follow what the sources say. That being said, it would be useful to include more context on why they are considered similar and in what way, if it does not exist in the article already. CorporateM (Talk) 00:53, 3 June 2015 (UTC)
The problem comes from the attempts to find a "real" acupuncture. Based on scientific studies, any effect that acupuncture has is completely unrelated to any acupuncture "points", so to say that acupressure depends on the acupuncture points that acupuncture doesn't depend on leads to an oxymoron or two.—Kww(talk) 01:32, 3 June 2015 (UTC)
That's a pretty big over-simplification of the research. And not exactly relevant to the topic at hand. Herbxue (talk) 13:30, 3 June 2015 (UTC)
I don't see how a direct explanation of JzG's objection can be anything other than "relevant to the topic at hand".—Kww(talk) 13:50, 3 June 2015 (UTC)
I mean that the argument over the validity of point specificity is not directly relevant to a basic definition of acupressure. Acupressure is practiced with the assumption that they are affecting qi flow in the meridian system in a similar way as acupuncture. I don't see why the question of point specificity needs to be brought up here since it is brought up elsewhere, and this is not an article about acupressure. If you want to write something with a value judgement about the validity of acupressure, then do that in an acupressure article. Here its just a brief mention of a related practice. Herbxue (talk) 16:09, 3 June 2015 (UTC)
An accurate definition would be: acupressure is similar to the refuted parts of acupuncture but but differs in omitting the only element for which there is even slightly plausible mechanism.
Since the dictionary definition is pretty much the opposite of this, it is not a good source. Guy (Help!) 17:51, 3 June 2015 (UTC)
That's absurd. Are you seriously proposing the definition be written like that? Or are you just writing over-the-top to suggest the webster's definition is equally absurd? btw, I found 2 different webster's definitions, and one of them says "cure disease" which is a reach, but this one seems totally appropriate for our needs. Herbxue (talk) 21:27, 3 June 2015 (UTC)
The issue is as I stated it. People are claiming that the weak and limited evidence for acupuncture implicitly supports acupressure, even though the only part of acupuncture that survives in acupressure, is precisely the part which has been comprehensively demonstrated to be incorrect. It's like homeopaths claiming support from hormesis. Guy (Help!) 10:10, 10 June 2015 (UTC)
I just scanned (not thoroughly) but the only mention of acupressure I found is under Related Practices and says "Acupressure, a non-invasive form of bodywork, uses physical pressure applied to acupressure points by the hand, elbow, or with various devices" - is there another section that has text that implies "support" for acupressure? The quoted text is neither supportive nor critical, which is appropriately encyclopedic in tone.Herbxue (talk) 15:38, 10 June 2015 (UTC)
That's completely accurate; I don't see what the problem is. @Guy: suggest leavening your perspective with a slightly-above-homeopathic dose of WP:NOTTRUTH. Acupressure = pressing acupoints, essentially. That's enough. We don't have to recap the results of sham-controlled experiments every time we mention "acupoints" as long as we properly cover sham in the article. It gets POINT-y, the same way the homeopathy article was getting when editors were writing out all the zeroes in Avogadro's number. --Middle 8 (t • c | privacy • COI) 07:09, 12 June 2015 (UTC)
It is not an accurate description of the fourth acupuncture point. QuackGuru (talk) 04:33, 13 June 2015 (UTC)

Possible WP:IUP violation

Acupressure is described as "similar to acupuncture, but without needles."

"Acupressure is described as "similar to acupuncture, but without needles." The text is not a description of the image. We should not have controversial or misleading text in the image anyhow. QuackGuru (talk) 04:33, 13 June 2015 (UTC)

Why the text is not a description of the image? I can't see any needles. Jayaguru-Shishya (talk) 11:45, 13 June 2015 (UTC)
The image does not say it is "similar to acupuncture" or it is "without needles". The text is typically a description of the image. Therefore, something needs to change with the text. For example, the image File:Gua_Sha.jpg says "Gua Sha" for the description. The image does not use any needles but we don't say it is done without needles. See Traditional_Chinese_medicine#Gua_Sha. QuackGuru (talk) 17:20, 13 June 2015 (UTC)
How bout something like "Acupressure being applied to the Hegu / Large Intestine 4 point" Herbxue (talk) 17:34, 13 June 2015 (UTC)
"Acupressure being applied to the (Hegu) large intestine fourth acupoint." Without a wikilink it will not make sense to the reader. QuackGuru (talk) 18:30, 13 June 2015 (UTC)
QuackGuru is correct. The description of an image should only describe the image and not include commentary about the subject that belongs in the body of the article. Maybe someone will swoop in and provide a link to the Manual of Style on this - I don't know where the rule is, only that it's how I've been trained sort of speak by the community as being our norms. What is a Hegu if someone doesn't mind educating the ignorant? CorporateM (Talk) 19:51, 13 June 2015 (UTC)
Its the name of the point being pressed in the photo. I like QG's solution of linking to a definition of the point. If that's too jargon-ish, how about "Acupressure being applied to a point on the hand"? Herbxue (talk) 20:25, 13 June 2015 (UTC)
I disagree with this edit. The reader will not understand the current caption. The proposal is "Acupressure being applied to the (Hegu) large intestine fourth acupoint. There should be two wikilinks without the irrelevant source in the caption. Or "Acupressure being applied to an acupoint on the hand."QuackGuru (talk) 20:51, 13 June 2015 (UTC)
You mean acupressure being applied to the hand, obviously. There is no credible connection to the lare intestine, and different traditions have different (and inconsistent) acupoints. Of all the concepts in acupuncture I think the existence and function of the purported acupoints is the most thoroughly refuted. Guy (Help!) 14:11, 14 June 2015 (UTC)

Do you really think naming the point the person in the photo is intending to press somehow gives it inappropriate validation? I'm fine with just saying "hand" (I proposed it before you did, above) but the level of point-iness about this is disproportionate to the importance of the subject at hand.Herbxue (talk) 14:19, 15 June 2015 (UTC)

Then I propose: "Acupressure being applied to the hand." without the ref at the end of the sentence. I think this will work better. QuackGuru (talk) 16:11, 14 June 2015 (UTC)

I've copy/pasted that version into the caption. There seems to be support for it and it reduces jargon. I will point out however that the language of the caption seems to me to imply an assumption that accupoints exist, whereas I presume this is a contested claim? Not sure of a better way to fix it though. CorporateM (Talk) 21:29, 13 June 2015 (UTC)

At least it is better than the other version. "Acupressure being applied to an acupoint on the hand." The exact wording I proposed included two wikilinks (without the source that failed verification). QuackGuru (talk) 21:32, 13 June 2015 (UTC)
Technically we're only suppose to wikilink upon first reference in the article, but I don't think it really matters and have never paid close attention to it myself. I would only discourage folks from arguing about it - it's not really worth anyone's energy to argue about what to wikilink and how many times, etc.. CorporateM (Talk) 21:56, 13 June 2015 (UTC)
If that is the case then you added an WP:OVERLINK for the wikilink to acupoint[3] in the caption. QuackGuru (talk) 23:23, 13 June 2015 (UTC)

Failed verification

Acupressure being applied to an acupoint on the hand.[51][not in citation given] What is the source doing at the end of the sentence? See Acupuncture#Related practices. QuackGuru (talk) 23:23, 13 June 2015 (UTC)

or section is disputed.

1. I go to the talk page to see what the discussion is all about because someone has put a box at the top saying "The relevance of particular information in (or previously in) this article or section is disputed. The information may have been removed or included by an editor as a result. Please see discussion on the talk page considering whether its inclusion is warranted. (May 2015)"

2. I search for "or section is disputed" trying to find out where the discussion is.

3. I find nothing

4. Please explain. Why does wikipedia allow such silly boxes that don;t help?

5. Where is the discussion?

6. Are the anti-science brigade gaining the upper hand again?

122.59.105.93 (talk) 11:24, 14 June 2015 (UTC)

Most of the article is in constant dispute between true believers and the reality-based community. Which section were you looking at? Guy (Help!) 14:08, 14 June 2015 (UTC)
122.59.105.93, you can open an account. The box at the top of the article does not help the reader. It should be removed. QuackGuru (talk) 23:06, 15 June 2015 (UTC)

Source not viable due to expiration of claim

MEDDATE tells us up to date reviews, 5 years old or newer, and not use them when they are in conflict with more recent literature. Since the publication over 6 years ago of this claim in April 2009, there have been several Cochrane updates which show evidence contrary to this claim, and which we boldly make in our lede. Here are just a few examples where Cochrane has more recently differs from this one-sided statement:

"There is low to moderate-level evidence that compared with no treatment and standard therapy, acupuncture improves pain and stiffness in people with fibromyalgia."[4]

"Limited evidence suggests that acupuncture may have some antipsychotic effects as measured on global and mental state with few adverse effects."[5]

"In the previous version of this review, evidence in support of acupuncture for tension-type headache was considered insufficient. Now, with six additional trials, the authors conclude that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches."[6]

"In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care."[7]

"Acupuncture may reduce period pain, however there is a need for further well-designed randomised controlled trials."[8]

"There is moderate evidence that acupuncture relieves pain better than some sham treatments, measured at the end of the treatment."[9]

As such, the claim should be removed. LesVegas (talk) 18:00, 15 June 2015 (UTC)

You have not provided evidence that the claim is incorrect. See Acupuncture#Other_conditions that show it is not effective for a wide range of conditions. QuackGuru (talk) 18:07, 15 June 2015 (UTC)
The claim is dated (beyond the 5 year threshold) and we have newer Cochrane reviews, some of which have been modified. For instance, we have a Cochrane review which says In the previous version of this review, evidence in support of acupuncture for tension-type headache was considered insufficient. Now, with six additional trials, the authors conclude that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headache and that was published by Cochrane after the time of the Ernst source. His conclusions were based on Cochrane reviews at the time, but that was 5 years ago and we have newer reviews which were not examined at the time the statement was made. LesVegas (talk) 19:00, 15 June 2015 (UTC)
We don't have newer Cochrane reviews that contradict the claim "it is not effective for a wide range of conditions." QuackGuru (talk) 19:04, 15 June 2015 (UTC)
I provided the wide range above. Ernst made his statement before the publication of those. Kww reverted and restored saying any reliable study finds acupuncture is not effective, yet I provided several updated Cochrane reviews which say otherwise. This is about as clear-cut of an example of MEDDATE expiration of sources as it gets. In fact, it becomes original research to include a statement about what Cochrane reviews say overall once a new Cochrane review comes out that says otherwise. In this case, I provided several reviews that say something different. Plus the source is over 5 years old. The claim must go on several grounds, but if you can find a publication of Ernst saying something after the most recent Cochrane review with positive findings then we can include that instead. We have MEDDATE for a reason. LesVegas (talk) 19:12, 15 June 2015 (UTC)
I think the issue is pretty clear: we should not use reviews older than five years when we already have newer ones available. Especially when even the review itself refutes its older findings. Therefore, we should remove the older ones, as they've already been replaced by the more recent findings in the scientific literature. Jayaguru-Shishya (talk) 19:16, 15 June 2015 (UTC)
No editor provided a specific source that contradicts the claim. No recent finding contradicts the claim. QuackGuru (talk) 19:18, 15 June 2015 (UTC)
The claim "it is not effective for a wide range of conditions." dates back to 2009. We already have newer source that contradict this claim. What do you expect, a source that explicitly states that "the 2009 claim is not true"? The source already refutes its older findings. Another user just quoted a plethora of such contradicting statements above. Jayaguru-Shishya (talk) 19:28, 15 June 2015 (UTC)
What specific source do you think contradicts "it is not effective for a wide range of conditions"? QuackGuru (talk) 19:27, 15 June 2015 (UTC)
That would appear to an intentional misreading of the source: changing the status for one particular kind of pain does not even come close to contradicting a claim pertaining to "wide range of conditions".—Kww(talk) 19:33, 15 June 2015 (UTC)
Exactly: the guidance about stale sources is not a mandate to remove all old sources. No recent Cochrane reviews refute the claim that acupuncture is ineffective for a wide range of conditions. There suggested Cochrane reviews talk about a few narrow types of pain, which does not refute "ineffective for a wide range of conditions". If people want to claim that the source has been contradicted, they need to find a Cochrane review that finds that acupuncture is broadly and generally effective for numerous conditions.
I also note that of the supposed refutations, all but one include Chinese researchers on the papers: we've discussed that bias problem extensively, and there's no reason to believe it doesn't apply here.—Kww(talk) 19:33, 15 June 2015 (UTC)
When a source has been contradicted, or even refuted by itself, one does not need a source that says the exactly opposite. That's not how science works. "What we reported in our earlier review, it's not true at all", bollocks. The most recent findings are reported as they appear, and that's how we are entitled to report them. If the older sources are in conflict, e.g. stating that "not effective for a wide range of conditions" whereas the newer sources correct this claim, then we are ought to drop the older, outdated sources in favour of the new ones.
When it comes to the "Chinese names", are the authors from China? Or do they just have "Chinese names"? Just for curiosity. Jayaguru-Shishya (talk) 20:27, 15 June 2015 (UTC)
But the source hasn't been contradicted. If it has said "acupuncture is completely useless for all things", then yes, a single instance of effectiveness would refute that. It didn't say that though, it said that acupuncture isn't effective for a wide range of things it purports to treat. A single instance of effectiveness doesn't refute "wide", because "wide minus one thing" is still "wide". As for the names, yes, if that was the only objection, I would have to research actual residence before we could be certain it mattered.—Kww(talk) 20:44, 15 June 2015 (UTC)
There are Cochrane reviews published on pain and stiffness after Ernst's statement as well as Cochrane reviews showing that it may have antipsychotic effects. That's pretty wide. LesVegas (talk) 21:10, 15 June 2015 (UTC)

Manheimer the lead author clearly is not Chinese, and is a prolific researcher. While it may not be necessary to remove the statement presently in the article it is also clear that more recent acupuncture reviews show some possibilities for more research and or show some positive results. Does this article indicate this?(Littleolive oil (talk) 20:55, 15 June 2015 (UTC))

The lede says "An overview of high-quality Cochrane reviews suggests that acupuncture may alleviate certain kinds of pain.[13]" I already covered this in the lede. QuackGuru (talk) 21:04, 15 June 2015 (UTC)
From what I've seen so far, I believe the body of source material is vast enough and diverse-enough in its views that any point-of-view could be supported depending on which sources are selected. The robustness of available source materials also eliminates any viable excuse to use out-dated or low-quality sources. What I would prefer in cases like this is simply removing any un-acceptable sources and leave them with a Citation needed tag. Giving other editors an opportunity to find more current, or stronger sources, rather than just deleting it. Proposing additional content/sources to document the debate could also be done simultaneously. It's unlikely that the point-of-view that it is not effective is not represented in more updated medical literature. CorporateM (Talk) 21:08, 15 June 2015 (UTC)
The source for the general statement is update to date because no newer source has been presented. QuackGuru (talk) 21:15, 15 June 2015 (UTC)
CorporateM, do you think {{update-inline}} ([needs update]) would suffice to tag the outdated sources? The article already covers a plethora of source material, so we can just follow the sources in my opinion. Jayaguru-Shishya (talk) 21:23, 15 June 2015 (UTC)
QuackGuru, I provided these newer sources; all of the ones above are after April 2009, please don't IDHT. LesVegas (talk) 21:21, 15 June 2015 (UTC)
I actually spent time clicking on each source you provided and I did not find even one source that contradicted the claim. QuackGuru (talk) 21:36, 15 June 2015 (UTC)
LesVegas, you need to study WP:KETTLE very carefully. The sources your provided do not refute the statement present in the article. Many of them do not even make claims of effectiveness, only claims such as "policy makers and health professionals need much better evidence in order to establish if there are any potential benefits to acupuncture", "Three of the four trials in which acupuncture was compared to physiotherapy, massage or relaxation had important methodological shortcomings", "there is no evidence for an effect of 'true' acupuncture over sham interventions," and "however there is a need for further well-designed randomised controlled trials.". In short, you have cherry-picked a group of result and actively misrepresented the strength of the results of the studies to exaggerate their effectiveness.—Kww(talk) 22:21, 15 June 2015 (UTC)
Positive findings or new findings from April 2009 could hardly be construed as misrepresentation. The fact remains, Ernst came to his conclusions based on data in April of 2009 and that data has changed. One glaring example is here, "In the previous version of this review, evidence in support of acupuncture for tension-type headache was considered insufficient. Now, with six additional trials, the authors conclude that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches."[10] How is that misrepresentation? Anywho, if you can find more recent statements that encompass updated Cochrane reviews, by all means post it. Guys, seriously, I'm not against the claim being made but I am against it being made with old reviews looking at older data. We have MEDDATE for a reason. I don't know any other way to say it and I'm sorry you feel I'm cherry picking with the big basket full of a wide assortment of fruit I provided. Kww, why don't you just find an updated source like MEDDATE says for us to do? LesVegas (talk) 22:41, 15 June 2015 (UTC)
That is a single review from 2009 for just tension-type headaches that could be useful. QuackGuru (talk) 22:52, 15 June 2015 (UTC)

Littleolive oil, I don't think the article does indicate that more recent acupuncture reviews show more possibilities for more research or show some positive results. In fact, when a review says something like "Despite positive outcomes in several studies, we cannot as of yet state that acupuncture is good for X and more studies are needed," what usually makes it into the article is "We cannot state that acupuncture is good for X". And recently, I searched for reviews published within the last year on pubmed and every single one was positive other than one, something like 14 out of 15. So, yeah, our article is a bit outdated. 6 year old statements should be the first to go if we're going to have a hope at creating a neutrally up to date article. LesVegas (talk) 21:31, 15 June 2015 (UTC)

The short citation was replaced with a citation needed

This change does not make any sense. No newer source was provided to contradict the claim. QuackGuru (talk) 21:20, 15 June 2015 (UTC)

As discussed above: we have more recent Cochrane sources already in the article, so we should prefer them over the outdated ones (WP:MEDDATE). Whether it should be {{citation needed}} or {{update-inline}}, the core issue remains the same. Jayaguru-Shishya (talk) 21:28, 15 June 2015 (UTC)
I have asked before but none of the sources contradict the claim. Individual reviews do not contradict the claim that it is not effective for a wide range of conditions. QuackGuru (talk) 21:31, 15 June 2015 (UTC)
I have posted this. We have had many Cochrane reviews with positive findings for a wide range of conditions since Ernst's statement in April 2009. We have MEDDATE for a reason. LesVegas (talk) 22:02, 15 June 2015 (UTC)
You have not posted a single overview of Cochrane reviews that show positive findings for a wide range of conditions. Your personal opinion of the many Cochrane reviews to come to a new conclusion that there is positive findings for a wide range of conditions is a WP:SYN violation. QuackGuru (talk) 22:09, 15 June 2015 (UTC)
Yes there are a wide range of conditions that Cochrane has published since April of 2009, from fibromyalgia to neck pain to psychosis. But since Ernst looked at reviews prior to that time to come to his conclusions, the moment we even get one new review, it becomes original research to keep using the statement because Ernst used a different set of data to make it. But 6 years and many reviews later is far too long to leave a statement that broad on the page without an updated source. MEDDATE must be respected and I see no better use of it than here. LesVegas (talk) 22:18, 15 June 2015 (UTC)
No, there are not many Cochrane reviews with positive findings, there are Cochrane reviews with weak and limited conclusions and notations of metholodogical flaws. Please stop misrepresenting results and cherry-picking quotes. Your logic that any single review of any single treatment completely invalidates Ernst is also absurd.—Kww(talk) 22:20, 15 June 2015 (UTC)
I'm not saying it invalidates Ernst, but it invalidates the statement, sure, since it's a fairly wide claim. Could Ernst publish the same statement today? Sure, if he agreed it was still accurate and you were the publisher. But other than that, I'm not so sure the claim would still stand. Maybe it would, maybe it wouldn't but we have to follow our policies and guidelines. You aren't saying we should ignore MEDDATE, are you? LesVegas (talk) 22:47, 15 June 2015 (UTC)
According to MEDDATE the source is still good since you have not provided a newer source. QuackGuru (talk) 22:52, 15 June 2015 (UTC)
Also, LesVegas , Meddate specifically says "Cochrane Library reviews are generally of high-quality and are routinely maintained even if their initial publication dates fall outside the above window". Given that you were unable to find any contradicting sources (see detailed analysis below), there's no reason to consider removing the citation.—Kww(talk) 22:57, 15 June 2015 (UTC)
I restored the original language. The new source provided by (I'm on my smartphone; I cannot see who actually provided it) clearly does not contradict Ernst, but it could be added if a non-synthesized statement of the content could be determined. I, personally, didn't see any actual positive results, only that further study is warranted, but there may be something I've missed. — Arthur Rubin (talk) 01:55, 16 June 2015 (UTC)
I have no objection to a "better source requested" tag, but removing Ernst as a source of that statement is inappropriate. — Arthur Rubin (talk) 01:57, 16 June 2015 (UTC)
The poor source actually confirms the finding of the overview of Cochrane reviews. QuackGuru (talk) 03:50, 16 June 2015 (UTC)
  • Kww you can stop calling people liars, Sheesh. (Littleolive oil (talk) 02:39, 16 June 2015 (UTC))

The actual findings

The 2009 review that people are arguing has been "refuted" listed that following conditions

  1. Rheumatoid arthritis
  2. Epilepsy
  3. Insomnia
  4. Breech
  5. Tear of rotator cuff
  6. Chemotherapy-induced nausea or vomiting (positive)
  7. Nonspecific back pain
  8. Cocaine
  9. Enuresis (positive)
  10. Lateral elbow pain
  11. Shoulder pain
  12. Bell's palsy
  13. Nausea and vomiting in early pregnancy
  14. Oocyte retrieval
  15. Glaucoma
  16. Postoperative nausea and vomiting (positive)
  17. Irritable bowel syndrome
  18. Chronic asthma
  19. Idiopathic headache (positive result)
  20. Carpal tunnel syndrome
  21. Vascular dementia
  22. Pelvic and back pain in pregnancy (positive result)
  23. Primary dysmenorrhea
  24. Schizophrenia
  25. Depression
  26. Induction of labor
  27. Labor pain (Inconclusive, leaning positive)
  28. Neck disorders
  29. Whiplash injury
  30. Smoking cessation
  31. Stroke rehabilitation
  32. Acute stroke

In short, of 32 conditions, positive evidence was found for variations of nausea and pain, including headaches. LesVegas's "refuting" studies actually support the earlier review's headache conclusions, studies two new items (neck pain and schizophrenia), and does not refute the dysmenorrhea conclusion, only suggesting that "there is a need for further well-designed randomised controlled trials." There's no "refutation" here, nor has their been any evidence provided that there is any drift away from Ernst's conclusions.—Kww(talk) 22:57, 15 June 2015 (UTC)

Yes, there have been positive changes. I never claimed Ernst has been refuted. It's not if I believe the statement still holds true or if you believe it, it's if the same claim could be published 6 years and changed evidence later, and I don't see that it has. Given that there are positive findings for multiple conditions which Ernst did not address as well as some other small changes toward the positive end, the claim is outdated. Seriously, why not find something newer? If the claim could still be made, you wouldn't have to look very long. Anywho, I am glad you are starting to see that the evidence base is changing somewhat and hopefully your editing style will reflect this. LesVegas (talk) 23:13, 15 June 2015 (UTC)
But given that WP:MEDDATE states that your reasoning is inapplicable and the studies you are quoting don't support your position, you are going to edit war anyway?—Kww(talk) 23:23, 15 June 2015 (UTC)
What, one revert to your three and I'm edit warring? Weren't you the one who just told me to read Wikipedia:KETTLE? And here we have every editor saying it needs to go or needs an update tag, except you and QuackGuru and you're saying that I'm ignoring consensus? Seriously, we can leave the sentence in there for now, just find a source that passes the MEDDATE test is all we are asking. LesVegas (talk) 23:43, 15 June 2015 (UTC)
LesVegas, how many times do you need to be shown the words in WP:MEDDATE that say "Cochrane Library reviews are generally of high-quality and are routinely maintained even if their initial publication dates fall outside the above window" before you acknowledge them? Jayaguru-Shishya is relying on an argument based on WP:MEDDATE when it explicitly says it doesn't apply. He, at least, has not continued after having been shown that he was wrong. You, on the other hand, have continued to falsely claim that it applies and to distort the auxiliary evidence that you have provided.—Kww(talk) 23:51, 15 June 2015 (UTC)
Yes, the Cochrane reviews are well maintained, which is why some of them have changed. But what you aren't hearing is that Ernst's statement was on old Cochrane reviews. But unlike Cochrane reviews, Ernst's statement has not been maintained and we shouldn't put dinosaur bones into the lede just to watch them decay while the modern world zooms by. MEDDATE is applicable in that instance. LesVegas (talk) 00:24, 16 June 2015 (UTC)
LesVegas, I listed the thirty-two things that Ernst studied and pointed out that precisely none of it was refuted by the articles you listed, and you find that irrelevant? So you are relying solely on your personal opinion (which you can't substantiate) that the world is zooming towards the conclusion that acupuncture is good? And as a result you can read WP:MEDDATE to say things that it explicitly doesn't? There's no source out there refuting Ernst, and there aren't Cochrane reviews on the twenty-eight things he found acupuncture to be ineffective for that suddenly began to report effectiveness.—Kww(talk) 00:34, 16 June 2015 (UTC)
That's not true, there have been changes and new reviews since April 2009, and I have pointed some of these out. LesVegas (talk) 00:42, 16 June 2015 (UTC)
It's absolutely true, LesVegas: you have not pointed out a single new study that refuted the material in the Ernst study you are arguing about. The closest was dysmenorrhea, and that didn't actually draw a conclusion about effectiveness. Go over the list of thirty-two fields from Ernst, go over your list of newer studies, and demonstrate a case where Ernst said it was ineffective and your newer material says it's effective. You won't be able to find one, because you haven't provided any. Your argumentation today has been based on reviews that don't support your conclusions and a guideline that doesn't support removing the review as a source.—Kww(talk) 01:01, 16 June 2015 (UTC)
What, did you not see tension type headaches, amongst others I pointed out? It's a moot point, anyway, I found a source that's better, more respected and newer and have updated it so everyone should be happy. LesVegas (talk) 01:18, 16 June 2015 (UTC)
I corrected your correction for you. As to whether an organization that still funds homeopathy is more respected than Ernst, I think that's demonstrably false.—Kww(talk) 01:25, 16 June 2015 (UTC)
Incidentally, continuing to write blatant falsehoods while arguing only helps trick people that aren't reading closely,LesVegas. Ernst didn't mention "tension headaches", and all forms of headaches that he did list came under the context of "positive results", so your review couldn't possibly meet the standard of demonstrating a case where "Ernst said it was ineffective and your newer material says it's effective". Combine that with the fact that you are using a 2009 study to argue that a 2009 study is too old to include, and the quality of your logic drops so low it isn't even credible.—Kww(talk) 01:32, 16 June 2015 (UTC)
No, Kww, with regard to tension headaches Ernst didn't mention them curiously enough. Later, Cochrane updated their findings on tension headaches to show a positive result, where they didn't have enough evidence before. Regarding your next statement, I've also seen some falsehoods on your part, but I wouldn't ever claim you are blatantly lying because that's uncivil. And to the point of respectability, maybe you want to try removing the NHS from the reputable organizations list on MEDRS if you find them so repugnant? Ernst having written books for the skeptic community and having had claims made against him that he doesn't release details of his methods for his reviews and that he seems to use reviews as opportunities for ad-homiem attacks should speak for itself. But anyway, despite this, I wouldn't suggest removing all of Ernst, just as I hope you wouldn't suggest removing NHS. I think the occasional prune is necessary, though, and we should always remove outdated material when we find it's done better. Glad we can come to some middle ground here. LesVegas (talk) 01:45, 16 June 2015 (UTC)
LesVegas, you've managed to spend the day making arguments without having a single one of them be true. You've misrepresented guidelines, you've misrepresented sources in discussions, you've misrepresented sources in the article, and you've misrepresented your own statements. WP:CIVIL is not a suicide pact: you intentionally made false statements in an effort to win a debate. If you don't want people pointing that out, then don't do it.—Kww(talk) 02:27, 16 June 2015 (UTC)
You did not address tension headaches yet again. It is uncivil to say that Im intentionally lying and then ignore evidence to the contrary. Is IDHT not a suicide pact either? LesVegas (talk) 02:32, 16 June 2015 (UTC)
Ernst did not mention tension headaches. Therefore, it is impossible for them to fall in the category of "Ernst said it was ineffective and your newer material says it's effective". I did address that. I've addressed it twice. When I asked you to provide a statement where "Ernst said it was ineffective and your newer material says it's effective", and you provided "tension headaches", you were intentionally making a statement with false implications. I hear everything you say, I'm just not particularly gullible.—Kww(talk) 02:36, 16 June 2015 (UTC)
Aha, so my point exactly. Ernst didn't mention tension headaches but newer Cochrane reviews did. Please don't tell me what my intentions are behind my statements. You've been warned for civility issues before here and I suggest you back off and start being civil. LesVegas (talk) 02:46, 16 June 2015 (UTC)
Asked to provide any source that found evidence of effectiveness for any of the twenty-eight points that Ernst found ineffective, you brought up something that didn't address the issue and implied that it did. If your point was that you won't answer direct questions with applicable answers or support your edits with true arguments, you did quite well.—Kww(talk) 02:56, 16 June 2015 (UTC)
Sorry I think I didn't see what you were even asking since it was covered in blood and bile. Neck pain is another such condition. LesVegas (talk) 03:35, 16 June 2015 (UTC)
And, again, a point that can't possibly address the question asked. Am I to assume that you will concede that for all the conditions that Ernst specifically stated acupuncture was ineffective for, there is no more recent Cochrane review that contradicts that conclusion?—Kww(talk) 03:41, 16 June 2015 (UTC)

No, I will not concede to such a statement. Ernst claimed it was ineffective for neck conditions but more recent reviews show it is effective for neck pain. Aside from "refutations" we also have new Cochrane evidence Ernst didn't examine, such as tension headaches and psychosis. But a lot of this is beside the point anyway because it's a synthesis violation. LesVegas (talk) 04:02, 16 June 2015 (UTC)

So, if I spot you "neck pain" for "neck disorders", the most charitable possible conclusion that one could come to, you've demonstrated that the ratio should not have been 28/32, it should have been 27/32. Hardly a refutation or even a significant disagreement. My point stands: you didn't come with sources or good faith argumentation, you came with distortions, falsehoods, and intentional misrepresentations in an effort to remove a sentence that you dislike. And now you expect people to view your arguments about WP:SYNTH in good faith?—Kww(talk) 05:26, 16 June 2015 (UTC)
I pointed out the neck pain before but you were too busy calling me a liar to notice this. I pointed out other differences in the meta data as well, like additional conditions which would make your 32's into higher numbers than 32, and I have pointed out that the conditions are now a wide range by all accounts. We can only assume that there have been other changes as well and we really shouldn't have to look into them once we see significant changes in Cochrane reviews 6 years after the fact when we have newer sources available, as we should be doing per MEDDATE. I'm getting tired of being attacked, so I won't engage in this discussion any further. I've made my point and made it many times and have shown the policy and that's all I can do. Going forward, can I ask that you start assuming good faith so that we can engage in a real dialogue on Wikipedia? I have asked you over and over again to stop being uncivil, and feel uncomfortable to have to ask this of an administrator who knows better. LesVegas (talk) 14:13, 16 June 2015 (UTC)
There is no reason to believe that you have been editing in good faith, Les, and I think that's apparent to anyone that makes any form of careful review of your contributions. I have no reason to believe that that will change in the future. You are the one that led off this discussion by misrepresenting the contents of a series of Cochrane reviews, distorted the possible impact of the contents even if they were true, and even now continue to reference WP:MEDDATE after it has been pointed out to you that it contains language that clearly makes it inapplicable, and then provided deceptive answers to straightforward questions.—Kww(talk) 14:29, 16 June 2015 (UTC)
As Karl Popper promoted. One can't prove a theory only disprove it. Read Falsifiability. Acupuncture has not yet been disproved. As an encyclopedia we should strive to follow scientific protocols -even if it ruffles some editors feathers up the wrong way. "Belief" should not enter into this discussion. --Aspro (talk) 23:29, 15 June 2015 (UTC)

Synthesis

The NHS statement and source were removed for synthesis reasons and I think Arthur Rubin has a point there, but it's being overlooked that the Ernst supported statement is also a synthesis issue. To state that "Cochrane reviews found acupuncture is not effective for a wide range of conditions" is an even greater synthesis issue since some reviews have found the contrary, and other reviews have found evidence is just limited, and we're lumping all these into an inaccurate statement supported by an old source. So what suggestions does anyone have to offer for how we can get past these synthesis issues? Should we list individual conditions or can we summarize more accurately? LesVegas (talk) 02:42, 16 June 2015 (UTC)

There is no syntheses with the text of the overview of Cochrane reviews according to V. It is not what editors think it was what reliable sources state. The source you added is a very poor source compared to the overview of Cochrane reviews. You also added misleading text. We have numerous higher quality review available. The source does not improve the article. It is a weight violation to include a poor source.
"However, there is less clear scientific evidence about the benefits of acupuncture in the majority of conditions it is often used for."[11] The poor but newer source makes it clear that what it is most used for is not effective. QuackGuru (talk) 04:11, 16 June 2015 (UTC)

Discussion of correcting WP:Lead, WP:NPOV, and WP:Weasel problems in lead first paragraph.

There is discussion of correcting WP:Lead, WP:NPOV, and WP:Weasel problems in lead first paragraph of the acupuncture article here[12]. Please participate in the discussion. FloraWilde (talk) 17:16, 16 June 2015 (UTC)

Source does not support that "It is rarely used alone but rather as an adjunct to other forms of treatment"

The lead says, "It is rarely used alone but rather as an adjunct to other forms of treatment". The source does not support this statement. FloraWilde (talk) 12:22, 16 June 2015 (UTC)

"In practice, acupuncture is rarely used in isolation but rather as an adjunct to other therapy modalities and this limited evidence supports this", directly from the source. Similar statements are made throughout the sourcing, so the lead could probably get by without a citation. Note Acupuncture#Medical_organization_guidelines, where all the clinical guidelines referenced countenance its use only as an adjunct.—Kww(talk) 13:56, 16 June 2015 (UTC)
That quote is taken completely out of its context. It is false that most corner strip mall acupuncturists provide it only as an adjunct to biomedicine. FloraWilde (talk) 15:27, 16 June 2015 (UTC)
And what is your source for that assumption? Acupuncture is taught as a complimentary therapy in the schools in the US. Recognizing emergencies and knowing when to refer out are a major focus of acupuncture training and certification exams. Also, I don't think biomedicine is even what the quote is explicitly about, I think it refers to the fact that acupuncturists typically employ multiple modalities in their practice. Herbxue (talk) 15:46, 16 June 2015 (UTC)
The quote is about the 82 pain studies the authors looked at, of which 3 found significance when compared to a minimal sham treatment, and of which ZERO found significance when compared to an actual, double blinded, sham treatment. FloraWilde (talk) 15:49, 16 June 2015 (UTC)

Just re-read the study, it does seem to suggest acu is typically used as adjunct to other types of therapy, not just other modalities within TCM/CAM practice. Source supports the statement in the lede just fine. I don't see how the results of the different types of trials has bearing on the way we use this particular quote? Herbxue (talk) 16:48, 16 June 2015 (UTC)

An editor's perception of a "suggestion" by a narrowly focused source is not a basis the lead first paragraph on a well-defined topic like acupuncture. Discussion of this and other problems with the lead first paragraph are being consolidated here.[13] Please participate in the discussion. FloraWilde (talk) 17:35, 16 June 2015 (UTC)

WP:Undue for lead - "It can be associated with the application of heat, pressure, or laser light to these same points"

The sentence, "It can be associated with the application of heat, pressure, or laser light to these same points" is in the lead first paragraph, which violates WP:MOS and WP:UNDUE. The lead first paragraph is full of WP:Undue sentences. 15:46, 16 June 2015 (UTC) — Preceding unsigned comment added by FloraWilde (talk • contribs)

We get it, Flora. However, while we strive to portray a scientific POV relative to its effectiveness and merit, it isn't undue weight to attempt to describe it. Moxibustion, acupressure, and laser acupuncture all exist and are all practiced, even in those strip malls across America.—Kww(talk) 17:00, 16 June 2015 (UTC)
Discussion of this and other problems with the lead are being consolidated here[14]. Please participate in the discussion. FloraWilde (talk) 17:38, 16 June 2015 (UTC)

Not disputed

It is not disputed and it is a 2014 Nature Reviews Cancer review article. It is poor writing to use the author's last name to the write the text. QuackGuru (talk) 01:59, 19 June 2015 (UTC)

Sources do not support "Acupuncture is most commonly used for pain relief"

The lead says, "Acupuncture is most commonly used for pain relief", with two sources cited. The sources do not say the most common use of acupuncture is for pain relief. FloraWilde (talk) 12:15, 16 June 2015 (UTC)

This one may go a bit beyond its sourcing: the two sources certainly say that acupuncture is commonly used for pain relief, but don't explicitly support the "most", even though that's likely to be a true statement. We could take the "most" out, or someone could find a source that explicitly states it.—Kww(talk) 14:02, 16 June 2015 (UTC)
"Go a bit beyond its sourcing" is WP:Weasel. The source does not support the statement. Most of acupuncture results from looking at a person's tongue in order to treat things other than pain. Under WP:UNDUE, this would preclude mention of treatment of pain before discussion of the vast majority of conditions it purports to treat. FloraWilde (talk) 15:22, 16 June 2015 (UTC)
Brings up a recurring discussion about whether this article is about the modality of acupuncture, which is practiced using varied theories/rationale, even by a single practitioner, or whether it is about TCM theory as reflected in acupuncture practice. The article is kind of a hybrid of the two approaches right now, which is fine. But kww's solution to take out "most" seems fine to me. Herbxue (talk) 15:34, 16 June 2015 (UTC)
You did not respond to how that still violates WP:Undue. FloraWilde (talk) 15:40, 16 June 2015 (UTC)
Can you explain why "acu is commonly used for pain relief" is undue? Its both sourced and common knowledge.Herbxue (talk) 15:52, 16 June 2015 (UTC)
Acupuncture is used to treat almost all disease. Picking out the most vaguely measurable things it claims to treat, e.g., psychological states such as pain, which on a tiny percentage of human illness conditions, then bringing that to the top of the lead, is WP:UNDUE. Under WP:MOS, a reader should be able to read the lead first paragraph and go away with an understanding of what acupuncture is. There is not a mention of how the tongue is used in diagnosis, nor any mention of the vast majority of human illness acupuncture is used to treat. That is a violation of MOS and UNDUE. FloraWilde (talk) 16:02, 16 June 2015 (UTC)
I share your pain, Flora, but that isn't a requirement of the first paragraph. Anyone that sticks to read the whole lead (four paragraphs), will see that acupuncture is generally ineffective for most things, and there's controversy over its effectiveness for pain and nausea. I've sought in vain for a reliable source that points out that the more subjective an illness is, the more likely it is that studies will find acupuncture is effective. If you can find one, bring it up, but with the sources we have, the lead is nearly as balanced as it can be.—Kww(talk) 16:13, 16 June 2015 (UTC)

Citation of requirements for the lead first paragraph, and discussion of a proposal to fix the deficiencies, is here.[15] FloraWilde (talk) 17:27, 16 June 2015 (UTC)

The Mayo Clinic website says "acupuncture is most commonly used to treat pain." [16] Perhaps we could use that as a source instead of what is being used now. Everymorning talk 19:07, 21 June 2015 (UTC)
The Mayo Clinic is talking about most Mayo Clinic acupuncture being for pain, not acupuncture worldwide. FloraWilde (talk) 17:20, 22 June 2015 (UTC)
Perhaps it could be changed to "chronic pain" and sourced to this review. It states that "The most common indication is for chronic pain unresponsive to standard therapy..." Everymorning talk 20:42, 22 June 2015 (UTC)
That is a misleading statement. Just removing the word "most" from the lede and body will work. QuackGuru (talk) 20:46, 22 June 2015 (UTC)
Sounds reasonable to me. Seems like a strong source we have as well. Jayaguru-Shishya (talk) 21:03, 22 June 2015 (UTC)
Selecting one thing that is purportedly treated, pain (which happens to be among the least testable), to put in the lead, is WP:UNDUE. FloraWilde (talk) 20:57, 22 June 2015 (UTC)
OK so to be clear, we have moved past what the sources support -- we all now agree that the sources support "commonly used" for pain, right? What is WP:DUE to include in the lead is another question. Something sources describe as a "common" use I'd think would be a good candidate for the lead. Zad68 21:02, 22 June 2015 (UTC)
I tagged the word that should be removed. Just removing one word will resolve the issue with the text failing V. There is also a source that should be removed from a caption.[17] QuackGuru (talk) 21:52, 22 June 2015 (UTC)

Another fringe journal?

Not sure the journal is good. QuackGuru (talk) 19:38, 21 June 2015 (UTC)

Probably not reliable, but it seems notable. The Wikipedia text says "it is argued", not "it is credibly argued". — Arthur Rubin (talk) 21:53, 21 June 2015 (UTC)
I'm not particularly comfortable with the journal, but it isn't a surprising claim and doesn't need some kind of overwhelmingly reliable source. The struggle to provide truly blinded studies has been noted numerous times, and that blade has two edges: both that the patient or practitioner may be able to detect what side of the study he is on, and that if acupuncture actually has an effect, the "sham" version used may accidentally replicate the effect.—Kww(talk) 22:09, 21 June 2015 (UTC)
There is also this meta-analysis which says that "Sham acupuncture was treated as a separate comparator because of evidence suggesting it is more active than an inert ‘placebo'." Perhaps that would be better as the journal (Osteoarthritis and Cartilage) has an IF of 4.165, [18] which is a lot higher than Complementary Therapies in Medicine (1.545). [19] Everymorning talk 16:41, 22 June 2015 (UTC)
The text is clearly redundant too. See " Brain imaging studies have shown that traditional acupuncture and sham acupuncture differ in their effect on limbic structures, while at the same time showed equivalent analgesic effects.[2]" See Acupuncture#cite_ref-Berman2010_2-9. The effectiveness section is repetitive. We are repeating basically the same thing over and over again. QuackGuru (talk) 17:12, 22 June 2015 (UTC)

The journal in question is not fringe. It is published by Elvesier, which is an excellent publisher. We can't exclude journals that meet all concievable standards we have. LesVegas (talk) 13:22, 24 June 2015 (UTC)

I previous explained the text is also redundant. The entire effectiveness section can be trimmed. It would take just a few minutes. QuackGuru (talk) 17:59, 24 June 2015 (UTC)

An officially "reasonable" option?

The United States National Institutes of Health says "acupuncture appears to be a reasonable option".[20] Here is some of the history[21]. Wikipedia has an article on reason. Please comment and contribute. FloraWilde (talk) 16:19, 26 June 2015 (UTC)

Wikipedia has articles on many things. None of them are relevant to our article on acupuncture however, since we don't cite Wikipedia as a source. AndyTheGrump (talk) 16:27, 26 June 2015 (UTC)
NIH uses the word "reason" in a way inconsistent with the Wiki article. What I am not understanding is use of the word "reasonable", in that each of the NIH "systematic reviews" showing some mysterious new "energy" source or proposed "biomechanism" for the "effects" (which TCM practitioners just happened to have come across by application of incorrect traditional Chinese anatomy, Chinese Astrology, and numerology, to start sticking needles in people to fight disease), notes that there was not a single truly double blinded study included in the systematic review, yet they went ahead and published the review as if there were such studies, and got the "efficacy" conclusion published in the abstract, without mention that the review included zero double blind studies, as if there were real double blinded studies being reviewed. FloraWilde (talk) 17:15, 26 June 2015 (UTC)
The article says: "Results from a number of studies suggest that acupuncture may help ease types of pain that are often chronic such as low-back pain, neck pain, and osteoarthritis/knee pain. It also may help reduce the frequency of tension headaches and prevent migraine headaches. Therefore, acupuncture appears to be a reasonable option for people with chronic pain to consider." The article doesn't contain the word "reason". What would you like to suggest? Jayaguru-Shishya (talk) 17:39, 26 June 2015 (UTC)
It seems to me that if the other organizations cited under the Organization Guidelines section are considered acceptable sources, than this one should be as well. Certainly different organizations have different opinions, which would allow us to document different perspectives. CorporateM (Talk) 18:20, 26 June 2015 (UTC)
Flora, WP:NOTTRUTH is an essay that might shed some light here. What we as editors must strive for is verifiability, what the sources say, not what the truth is. Now, weight is always up to us as editors to determine, but never what the truth is. LesVegas (talk) 03:05, 27 June 2015 (UTC)
This comes under the general controversy of whether it is ethical to prescribe placebos. If a patient believes acupuncture will help him, requests a referral from a doctor, and then receives acupuncture, it is actually quite likely that he will feel better, even if the result comes entirely from self-delusion. Is it "reasonable" to recommend acupuncture in that case? Some think so, and the NIH apparently falls in that camp.—Kww(talk) 00:39, 6 July 2015 (UTC)

Sources for history

Just dredging this out of the archives as I may be using it soon. The local public library just obtained an inter-library loan for the Needham book that is probably the best historical source available, which is what I was waiting for. CorporateM (Talk) 23:39, 23 June 2015 (UTC)

  • Gwei-Djen Lu; Joseph Needham (October 25, 2002). Celestial Lancets: A History and Rationale of Acupuncture and Moxa. ISBN 0700714588.  Done
Argh, I was all excited to finally obtain that book, but then I lost it somewhere around my house. I should be able to actually work on this section if I can find it. CorporateM (Talk) 22:31, 13 July 2015 (UTC)
I've substantially expanded, re-written, and re-worked the History section. It still needs a lot more work, but I'm all teetered out for now and need to get back to some other stuff. Comments/input/help are still welcome. The third source above is actually very good, even though it's a tertiary source. I believe it accurately represents which theories about the history of acupuncture are generally accepted and has an NPOV tone, more than any other source I have found. Still need to mine the rest of its contents. CorporateM (Talk) 23:56, 14 July 2015 (UTC)

Safety and Cost-effectiveness / Safety#Adverse events

The current lede (Safety and Cost-Effectiveness) and the Acupuncture#Adverse events section say:

When not delivered properly by a qualified practitioner it can cause potentially serious adverse effects.

What the source[22] actually says is that:

Serious adverse effects of acupuncture are rare. Reported accidents and infections appear to be related to violations of sterile procedure, negligence of the practitioner, or both. A systematic review of case reports on the safety of acupuncture, involving 98 papers published in the English language from 22 countries during the period from 1965 to 1999, found only 202 incidents. The number of incidents appeared to decline as training standards and licensure requirements were enhanced.

The current text isn't supported by the source. Jayaguru-Shishya (talk) 10:34, 16 July 2015 (UTC)

Feel free to suggest an alternative summary. Guy (Help!) 11:26, 16 July 2015 (UTC)
In my opinion, any summaries of this information should indicate the rarity of these incidents if we think this is notable enough for the lede. The body should include most of the statement above, if it doesn't already. LesVegas (talk) 14:32, 16 July 2015 (UTC)
In this edit, the added sentence (3) seems to be the logical inverse of sentences 2 and 1. ~Adjwilley (talk) 15:40, 16 July 2015 (UTC)
I agree, and it's not supported by the source so I don't see any reasons to include it to the article. In fact, the source emphasizes the rarity of adverse effects, and it has already been covered along with the proper delivery. Jayaguru-Shishya (talk) 15:31, 17 July 2015 (UTC)
Perhaps you are reading the wrong page. I updated the ref. QuackGuru (talk) 17:43, 17 July 2015 (UTC)
  • I fixed the ref. The ref was going to the wrong page. QuackGuru (talk) 16:19, 16 July 2015 (UTC)
LesVegas, from your statement you clearly have access to systematic adverse event reporting data that I have not seen in the literature, would you care to point out where it's published? Guy (Help!) 08:13, 24 July 2015 (UTC)

"but when not delivered properly it can cause potentially serious adverse effects." I recommend it be shortened. QuackGuru (talk) 16:31, 16 July 2015 (UTC)

that works. good summary. --Middle 8 (t • c | privacy • COI) 07:39, 17 July 2015 (UTC)
"but when delivered by an unqualified practitioner it can cause potentially serious adverse effects.[18]" To condense the prose. QuackGuru (talk) 21:01, 17 July 2015 (UTC)
To clarify, where is the exact wording supporting your summary? --Middle 8 (t • c | privacy • COI) 05:24, 18 July 2015 (UTC)
See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616356/#sec4title QuackGuru (talk) 05:34, 18 July 2015 (UTC)

Here is the conclusion of that paper; per WEIGHT and STICKTOSOURCES we need to make sure we don't overplay the risk:

In conclusion, although serious AEs associated with acupuncture are rare, acupuncture practice is not risk-free. Adequate regulation can even further minimize any risk. We recommend that not only adequate training in biomedical knowledge, such as anatomy and microbiology, but also safe and clean practice guidelines are necessary requirements and should continue to be enforced in countries such as the United States where they exist, and that countries without such guidelines should consider developing them in order to minimize acupuncture AEs.

Note e.g. that they say guidelines "should continue to be enforced" in e.g. the US, not that said guidelines aren't being enforced. --Middle 8 (t • c | privacy • COI) 13:35, 18 July 2015 (UTC)

On a logical level, the "qualifications" of the practitioner don't matter much: jabbing someone in harmless places with sterile needles won't cause trouble and jabbing them with dirty needles or in sensitive places will, and neither the place stabbed nor the dirt on the needle cares a whit about what piece of paper is hanging on the wall of the office. I prefer a summary like "Improperly delivered acupuncture can cause adverse effects". No need to editorialise about the severity or credentials.—Kww(talk) 15:23, 18 July 2015 (UTC)
The source makes the association between decreasing incidents and increasing training and licensure. Its a pretty important piece of information.Herbxue (talk) 19:52, 22 July 2015 (UTC)
Yes -- I understand that Kww doesn't think training & licensure matter if it doesn't matter where or whether you needle. But as long as society thinks training and licensure matter, and sources discuss these things, they're encyclopedic. --Middle 8 (t • c | privacy • COI) 00:56, 23 July 2015 (UTC)

Aseptic technique

"Acupuncture is generally safe when done by an appropriately trained practitioner using clean technique and single-use needles".

The WHO says: "In competent hands, acupuncture is generally a safe procedure with few contraindications or complications. Its most commonly used form involves needle penetration of the skin and may be compared to a subcutaneous or intramuscular injection. Nevertheless, there is always a potential risk, however slight, of transmitting infection from one patient to another (e.g. HIV or hepatitis) or of introducing pathogenic organisms. Safety in acupuncture therefore requires constant vigilance in maintaining high standards of cleanliness, sterilization and aseptic technique."

I have never seen a photograph of an acupuncturist using proper aseptic technique. The illustration to the right of this very text is a case in point: the practitioner is not using gloves. Do you think he followed these guidelines? A 2012 study asserts that acupuncturists generally lack awareness of good sterile technique. It does seem a bit questionable for us to assert, in Wikipedia's voice, that acupuncture is generally safe when practices in an idealised way, without noting the extent of evidence for adherence to this idealised model. I think that some editors with access to the full text of journals could materially help here by looking for review articles that address this point. Guy (Help!) 14:41, 14 July 2015 (UTC)

In the U.S. we follow the Clean Needle Technique manual published by the Council of Colleges of AOM. Herbxue (talk) 15:05, 14 July 2015 (UTC)
Specifically see pp. 181-2. Per the WHO, subcutaneous, intradermal and intramuscular injection administration doesn't require gloves as long as the health worker's skin is intact. Bleeding is rare in these cases, as it is with acupuncture needling, which is considered similar. --Middle 8 (t • c | privacy • COI) 02:57, 15 July 2015 (UTC)
No evidence of use of alcohol swabs in most cases, certainly when I had acupuncture this was not done. As to adherence to guidelines, I think this is unlikely to be widespread among TCM practitioners. Guy (Help!) 10:51, 16 July 2015 (UTC)
If you can find a source that improper hand washing is frequently done, post it here and let's discuss it. But Wikipedia:NOTTRUTH talks about this well. I have regular acupuncture performed on myself many times and usually always they put alcohol on the points, and my regular acupuncturist even has a sink in her office so she washes her hands in front of me. But if a source existed that said contrary to my experience, we would have to consider using it because we're after verifiability, even if I don't feel it's true. Ultimately, we just follow sources. Everything else is OR, or is OR applied to credible sources while proposing to delete them, perhaps without justification. LesVegas (talk) 14:15, 16 July 2015 (UTC)

Guy, wondering what evidence you have or are you just making assumptions? Are you suggesting your anecdotal experience is a reliable source?Herbxue (talk) 16:21, 16 July 2015 (UTC)

Guy, I clarified this in the lede and body. QuackGuru (talk) 02:18, 17 July 2015 (UTC)
FWIW (and this means no more than anybody else's anecdote) I've received acupuncture from several dozen different people and have observed dozens more. Alcohol swabs every time. That's part of CNT, which we use in the US, cf. Herbxue above. Different in UK? There's no licensure there, right? But whatever, STICKTOSOURCES. "No evidence of use of alcohol swabs in most cases" -- which source is that, then? --Middle 8 (t • c | privacy • COI) 07:56, 17 July 2015 (UTC)

@ JzGuy, from Ernst's 2011 review of reviews [23] on safety and efficacy-for-pain, touching on awareness of guidelines: Serious complications after acupuncture continue to be reported. Many are not intrinsic to acupuncture, but caused by malpractice of acupuncturists. This might explain why surveys of adequately trained therapists failed to yield such complications [28,147,149]. Most of the case reports originated from Asia (Tables 2–4), possibly reflecting the fact that, in Asia, acupuncture is more widely practised than elsewhere. Alternatively, it might be due to more Asian therapists being poorly trained [113]. (2nd para, p. 762) --Middle 8 (t • c | privacy • COI) 08:51, 17 July 2015 (UTC)

What's the problem here? That JzG has gone to an acupuncturist and made his own observations that conflict with the sources? Sorry [User:JzG|JzG]], but we have to WP:STICKTOSOURCES. This is the wrong place for WP:FORUM discussions. Cheers! Jayaguru-Shishya (talk) 01:30, 18 July 2015 (UTC)

No, the issue is that this is a problem consistently raised by some critics, and I have observed precisely this in a "properly trained" acupuncturist so I believe it to be valid. The sources on chiropractic say it's safe when properly practiced, but there's a metric fuckton of evidence to show that the 99% of charlatans let the 1% of diligent practitioners down. I do not know what the position is with acupuncture and I can't find any actual evidence it's been systematically studied, so to say that an idealised form is acceptably safe without any context to show how widespread that idealised for actually is seems to me to be problematic, that's all. Guy (Help!) 08:11, 24 July 2015 (UTC)
Well, the available evidence shows that acupuncture is safe, and that infectious disease being spread by acupuncture is rare, and has been decreasing as training and licensure requirements increase, so it would be reasonable to assume most practitioners are following clean needle technique guidelines. It would be very interesting to see a study on actual practice habits, but I imagine we don't see studies like this because most L.Acs are in private practice and if they knew they were being evaluated for CNT of course they would follow it closely. The only way really would be to do a wide scale "shopping" of practitioners, but the ethical issues associated with such a study would be complex to say the least.Herbxue (talk) 16:40, 24 July 2015 (UTC)
How could I put this really nicely... JzG, we don't care what you "have observed", we care what the reliable sources say. If you have some appropriate sources, please share those with us and tell us what you'd like to suggest. Thanks. Jayaguru-Shishya (talk) 18:48, 24 July 2015 (UTC)

Ernst '11, real and sham (revisited, again, one more time)

I just mentioned p. 762 of Ernst's 2011 review [24] above re "Aseptic technique", and there's something else we need to fix from that same page. If you look at the first para (p. 762), you'll see the sentence -- "Real and sham acupuncture were both more effective in reducing pain than no acupuncture at all, but real acupuncture was no better than sham" -- which is being taken out of context and represented as a conclusion of the review. That sentence is actually Ernst's summary of a high-quality trial to which he's contrasting his dataset.

Kww and LesVegas and Alexbrn and J-S and 2/0 and Herbxue and most other editors who have carefully read the paper have all agreed on the above. (QuackGuru has either not understood or pretended not to understand.) The reason the wording has been stable is that the sentence also happens to be a correct summary of much of the literature today, and I think Ernst would likely agree. Still it is — as a matter of fact — not what he was saying in the paper. That's because his dataset was reviews spanning 2000-2009, and those reviews covered studies going back into the '90's that weren't very well controlled and thus showed false positives -- simple as that. Just see the para under §4 Discussion, on p. 761.

We should fix this -- if WP:ENC means anything, it means not misstating what a source says -- while being sure to summarize Ernst '11 properly and report the current state of research. We also might do a better job of explaining sham in the lede. I'll be happy to propose wording, but first I want to reaffirm general agreement that we've reading the source correctly (we've had consensus before). Per WP:OGTW, I am fully confident QuackGuru will not go full-on IDHT and disingenuous as he has in past discussions of this issue. --Middle 8 (t • c | privacy • COI) 08:51, 17 July 2015 (UTC)

Actually, it's referring to two different studies; [14] declaring little difference between individualized, formula, and "sham" (non-penatrating toothpicks), and [128] comparing "real" and "sham" (the study being designed as a single-blind study to measure the effect of the practitioner's statements). I don't know if we can combine the statements without declaring it as synthesis. I agree it's not a "conclusion". — Arthur Rubin (talk) 09:41, 17 July 2015 (UTC)
I wouldn't say it was contrasting with his dataset, though. — Arthur Rubin (talk) 09:47, 17 July 2015 (UTC)
Agree pretty much on both your points, Arthur. Yes, the sentence correctly describes the conclusions of both ref 128 (Suarez-Almazor) and ref 14 (Cherkin, the "toothpick" study); grammatically its antecedent is the former, but in any case, right, it's not a "conclusion". And instead of "contrasting" let's say he's "comparing" the dataset with the newer, better-controlled trials: he's caveating the positive findings of the former. Glad you commented; good to clarify and settle this. --Middle 8 (t • c | privacy • COI) 11:01, 17 July 2015 (UTC)
See Talk:Acupuncture/Archive_24#Ernst.27s_review_of_reviews. User:Dominus Vobisdu,[25] User:McSly,[26] User:Jim1138,[27] User:Roxy the dog,[28] and User:Bobrayner[29] preferred the more concise wording. We should not re-add overly detailed wording to the lede. User:Yobol stated that it does seem to be a conclusion Ernst is making and therefore citable as a source for that conclusion.[30] The wording in the lede is clearly sourced and is the long term consensus text. User:Middle 8, you are overanalyzing the source and coming to your own SYN conclusion IMO. QuackGuru (talk) 17:49, 17 July 2015 (UTC)
When the objection is "I don't like it" we can't give that any weight at all. Anyone failing to engage in meaningful discussion and not addressing the issue that it's extremely misleading to state something as a conclusion of a review when it was only the conclusion of a couple of studies, amongst many in the review, are given no weight in their argument since they are ignoring the issue widely acknowledged. Simplified wording isn't an excuse for wrongful wording. In my opinion, we should tackle this issue first before doing anything else. This source has been wrongfully characterized for far too long. It's now 2015 and it's a 2011 source! In another year it might even be outdated, so let's get it right while it's still on the page! LesVegas (talk) 16:38, 18 July 2015 (UTC)

I agree, even if we need an extra sentence, let's be clear about what Ernst's conclusions are. QG I can't believe you are still trying to subtly misrepresent this source. We took it to project med and multiple neutral editors disagreed with your reading of "conclusions". Not even gonna find it and link it because we all remember.Herbxue (talk) 14:39, 20 July 2015 (UTC)

We are citing a review of reviews not a primary source. After over a year I am surprised editors are still debating the verified non-controversial fact. Condensing the prose is better for the lede. QuackGuru (talk) 02:43, 21 July 2015 (UTC)
It is absolutely controversial because it is a primary study that concludes with the finding that you are using the systematic review to support (justifying it by saying it is mentioned in the discussion section of the review). It is not the finding or conclusion of the systematic review, it is one study that Ernst uses to crystal-ball what he thinks is likely to happen in future reviews. I know this is not a competence issue (I think you know the difference between a conclusion and a discussion), so what is it? I recommend that you stop encouraging wording that misrepresents the source.Herbxue (talk) 15:49, 21 July 2015 (UTC)
You claim " it is one study that Ernst uses to crystal-ball what he thinks is likely to happen in future reviews." You acknowledged it was what Ernst thinks. That means the text is sourced. Furthermore, it is not about a crystal-ball of the future. The specific sourced text is not speculating about the future.
Editors should not be concerned what sources a MEDRS compliant review used to verify the claim or what sources they did not use to verify the claim. QuackGuru (talk) 18:19, 21 July 2015 (UTC)
The specific sourced text is speculating about the future. Instead of including Ernst's gut feelings about what the future will bring, we can include something more concrete, such as (emphasis added): " A systematic review of case reports on the safety of acupuncture, involving 98 papers published in the English language from 22 countries during the period from 1965 to 1999, found only 202 incidents. The number of incidents appeared to decline as training standards and licensure requirements were enhanced."[31]
Here we have a concrete trend against the gut feelings of Ernst. Cheers! Jayaguru-Shishya (talk) 19:10, 23 July 2015 (UTC)

I don't see any point debating this further with QuackGuru: it's a simple matter of reading a sentence in context. QG has stated his position repeatedly, is wrong on the merits, and is alone among editors who have recently discussed this. He is also under indefinite sanction at this article due to a long history of tendentious editing. Situations like this are why consensus ≠ unanimity.

Here are Ernst '11's conclusions about efficacy:

  • In conclusion, numerous systematic reviews have generated little truly convincing evidence that acupuncture is effective in reducing pain. -- from the abstract, p.755.
  • In conclusion, many systematic reviews of acupuncture for pain management are available. Yet they only support few indications, and contradictions abound. -- end of paper, p.762.

Additionally, in the same paragraph where he mentions the trials that found real = sham, Ernst makes this prediction:

  • Adequately controlling for nonspecific effects in future is likely to demonstrate that acupuncture has no or few specific effects on pain [89]. -- end of first para, p.762.

That prediction is pretty much consistent with Vickers' findings that specific effects are small. Vickers (the field's only IPD meta-analysis) and Ernst '11 (a systematic review of systematic reviews, perhaps the only recent-ish one) are AFAIK still our best sources for pain. Is there anything else comparable?

All we have to do, then, is summarize Ernst '11 and Vickers (and whatever else) and do so with reference to sham acupuncture. The footnote on sham acu looks fine as is. More later; ideas? --Middle 8 (t • c | privacy • COI) 07:04, 22 July 2015 (UTC)

Great thoughts, Middle 8 While we are still in the gestational stages of figuring out what to do, I would like to point out this essay on Ernst's website. As I understand it, Ernst used to be the lead researcher at Exeter, correct? But he was asked to step down, and according to him this was possibly influenced by Prince Charles trying to put pressure on him. So since Ernst is no longer in academia he hasn't been able to answer the hypothesis he once had regarding adequate controls. Ernst knew that sham acupuncture wasn't a true placebo, but assumed that if a real control was available it would show identical results between real and sham. However, as you can read on his website, a meta-analysis was released for laser acupuncture and Ernst found it to be very interesting since laser acupuncture is an excellent control, much better than sham devices. However, the results of the meta-analysis was that it was clearly different, with laser acupuncture being superior to sham laser acupuncture.
Since Ernst proposed a hypothesis that was never answered while he was in academia, should we mention this hypothesis about adequate sham controls without supplying the answer that came much later in the form of laser acupuncture? I know we don't typically cite emeritus statements from websites, but given that this is a unique situation and given the disservice that we do readers in leaving questions like this unanswered forever when it has, in fact, been answered, I propose that we state Ernst's hypothesis from Ernst '11, then cite Ernst (clearly attributing it to his website) and his comments re laser acupuncture controls in the body to keep with the spirit of MEDDATE. All of this information is far, far too complex for the lede, but perhaps we could rewrite the statement in the lede, summarizing it in some way in the opening paragraphs, then go into greater detail in the body? LesVegas (talk) 00:21, 23 July 2015 (UTC)
LesVegas - Honestly, I think we should wait till later on that, and first make the obvious fix to Ernst '11 (the out-of-context sentence, cited both in body and lede). I think there could be WEIGHT problem with the issue you mention, but in any case it's going to muddy the waters. It's been hard enough just to explain Ernst '11 until now. --Middle 8 (t • c | privacy • COI) 02:15, 23 July 2015 (UTC)
By weight problem, do you mean that Ernst '11 possibly lacks weight because it's an older and obsolete hypothesis Ernst once proposed, or is it a weight issue because it's a website and statements published there aren't peer reviewed and published by journals? If the latter, should we write the sentence keeping in mind that the science is ongoing and might have already answered the question without directly alluding to the website itself? In other words, qualify it with something like, "At the time of publication, Ernst believed X would say Y?" or something of that nature? LesVegas (talk) 03:16, 23 July 2015 (UTC)
LesVegas - I think the prediction part of Ernst '11 is less important (certainly less encylopedic) than what he finds from his dataset, plus the website is a lesser RS: the source itself is what weighs, and not that much given the journal. If you want to get into the question of whether sham is a valid control, we need good MEDRS for that; AFAIK sham is pretty well-accepted, although there's room for improvement in some cases. While objections are often registered in letters to journals, sham keeps on passing peer review and keeps being accepted by good sec and tert sources. And here's the thing, whether inert or not (and I know it's not), sham does control for insertion and location, and you have to admit the evidence for point specificity is really slim. Maybe the small margins Vickers sees for verum above sham are due to activity of major points like PC6 and LI4 and St36, or maybe it's just bias. I don't honestly know. --Middle 8 (t • c | privacy • COI) 11:58, 23 July 2015 (UTC) edited 02:08, 24 July 2015 (UTC)
It is you who has been disagreeing with the concisely worded claim for over a year now (Revision as of 13:16, 8 July 2014). A number of editors disagreed with you. You claim it is "out-of-context", yet you provided verification it is sourced. QuackGuru (talk) 02:09, 24 July 2015 (UTC)
I think that it is misleading to say that Ernst found that "for reducing pain, real acupuncture was no better than sham acupuncture." In fact his results were inconsistent, and we should say instead that he found little convincing evidence that acupuncture is truly effective for reducing pain, which is his real overall conclusion as stated in the abstract. Everymorning talk 12:45, 25 July 2015 (UTC)
Where did it say the results were inconsistent in respect to real acupuncture versus sham acupuncture? QuackGuru (talk) 21:49, 25 July 2015 (UTC)
He talks a lot about contradictions (e.g. "Numerous contradictions and caveats emerged." and on page 762, "many systematic reviews of acupuncture for pain management are available. Yet they only support few indications, and contradictions abound.") Perhaps we could say "A systematic review of systematic reviews found numerous contradictions in the evidence regarding acupuncture's effectiveness for treating pain." Everymorning talk 03:10, 26 July 2015 (UTC)
Your comment is not relevant to my question.
Your proposal is ambiguous and does not improve the page. The articles already says "Contraindications to acupuncture are conditions that should not be treated with acupuncture; these contraindications include coagulopathy disorders (e.g. haemophilia and advanced liver disease), warfarin use, severe psychiatric disorders (e.g. psychosis), and skin infections or skin trauma (e.g. burns).[2]" QuackGuru (talk) 03:17, 26 July 2015 (UTC)

It is true that the word "inconsistent" is not used in Ernst's paper. But he does, as I noted above, say the evidence is contradictory, which seems to have a similar meaning. Everymorning talk 03:28, 26 July 2015 (UTC)

Where did it say the results was contradictory in respect to real acupuncture versus sham acupuncture? QuackGuru (talk) 03:35, 26 July 2015 (UTC)
As Ernst assesses the evidence in the abstract he stated, "Numerous caveats and contradictions emerged", in results he states, "in areas where multiple reviews were available, a substantial degree of contradiction emerged" (p. 759) and then we have the statement about contradiction in "The majority of the early reviews arrived at negative conclusions [85], while the majority of the 57 recent reviews were positive." I think Everymorning's suggestion is not only well supported, but is the best suggestion thus far. If there are no objections (other than QuackGuru who objects to us even having this discussion) I will add Everymorning's suggestion, which was "A systematic review of systematic reviews found numerous contradictions in the evidence regarding acupuncture's effectiveness for treating pain." LesVegas (talk) 12:41, 26 July 2015 (UTC)
Sounds good, Everymorning. I think that's a good improvement to the article. Cheers! Jayaguru-Shishya (talk) 16:30, 26 July 2015 (UTC)
The proposal makes absolutely no sense and adds nothing to the article. QuackGuru (talk) 16:08, 27 July 2015 (UTC)

History

I think I'm "done" with the history section. Not sure if we have any images that might be better-suited for the section though. Any thoughts/feedback from subject-matter experts is welcome. Initially I had planned on making a separate article History of Acupuncture like I did for History of public relations, but I think it's short enough to remain as a section. I would like to suggest that this section be represented in the Lead prominently. As an encyclopedia, history is one of the most important aspects of most articles and currently the Lead doesn't say anything about the history of acupuncture at all. In most articles I write, about a third or a half of the Lead is devoted to history. CorporateM (Talk) 06:30, 22 July 2015 (UTC)

This is such a big, big part of WP:ENC, a major improvement to the article. ★ Much appreciation! ★ Yes, agree wholeheartedly re lead. It's worth its own paragraph. --Middle 8 (t • c | privacy • COI) 07:22, 22 July 2015 (UTC)
Yes, agreed as well! Many thanks to CorporateM for much hard work! As for including the information in the lede, what historical facts should be added? I definitely think Bian Stones could be a good beginning, anyone else? LesVegas (talk) 03:25, 23 July 2015 (UTC)
"Historical fact" just makes me cringe, because history gets so muddled with time. I got the impression the Bien Stones was more of a minority viewpoint. They were most probably used for bloodletting and popping puss-filled growths. The Yellow Emperor's Classic of Internal Medicine from 100BC seems to be widely regarded as when acupuncture began. CorporateM (Talk) 04:49, 23 July 2015 (UTC)

This section seems to favor very critical sources and gives undue weight to things like Mao and the Nixon visit, so to me it comes across as a little ethnocentric. It is certainly well-sourced and well-written, and I'm sure it was a lot of work, so thank you for doing it. I would like to see some mention of the 20th century standardization of "TCM" which revolves around figures like Zhang Xichun and Qin Bowei and their roles in academia (note this was BEFORE Mao). Also, there is a weight issue with the "Modern Era" section covering an account of a bogus acupuncture anesthesia claim - why? You could alternatively cover the use of Qing Dynasty Warm Disease theory in the treatment of SARS patients in 2003, but again, how do we decide what anecdotes to include and what to exclude? Herbxue (talk) 21:56, 23 July 2015 (UTC)

That particular anecdote was only included after I spotted it in multiple sources, which also indicated that it was just one example of a rife of similar stories in the 70s. That being said, do you have some sources regarding the other subject-matter you discussed? The Modern History could use a bit more expansion. CorporateM (Talk) 01:39, 24 July 2015 (UTC)
The Mao visit is identified in many, many sources as pivotal tot he spread of acupuncture to the West just about the time that the Chinese authorities realised it was actually bunk. Guy (Help!) 08:05, 24 July 2015 (UTC)
I agree that we should add some information about TCM's development as well as the time before that. Many scholars were imprisoned at various times in China's history for either knowing too much or not going along with party lines. Qin Bowei, whom Herbxue mentioned, was forced out of his position for standing up to the Communist party as they tried developing TCM. Things like that are always interesting.
In response to CorporateM, I agree about the Huang Di Neijing being a great starting point, mostly at least. But Bian Stones are mentioned in the Neijing, so what would you think about using the Neijing as a source for that? I wasn't aware that these stones were controversial, so we could always cite the controversy of the bian stone if you think that's a good idea. And I have a copy of the Neijing at my office library so I wouldn't mind sifting through it to pull quotes about bian stones from it. The problem is that my copy is in Chinese, so wouldn't I be doing original research if I am the one translating it?
But there are decent translations out there. One of the more widely known translations is by Paul Unschuld and I wouldn't mind investing in a copy of his books (Ling Shu and Su Wen) if other editors here would like to expand some of that classical history. Thoughts? LesVegas (talk) 19:30, 24 July 2015 (UTC)
Something about tapping into the Yellow Emperor's Classic itself doesn't sit right with me. I think it would probably be a primary source. CorporateM (Talk) 08:18, 27 July 2015 (UTC)

You are right, it would be a primary source. However, a lot of these translations have commentaries so anything listed in the commentary would be secondary. That settles it, I've been on the fence about whether or not to order some translations but something with great commentary would really be useful on this page. LesVegas (talk) 13:27, 27 July 2015 (UTC)

This needs removing from the lede:
In the 1900s as it spread to the United States and Western countries, the spiritual elements of acupuncture that conflict with Western belief systems, such as the premise of tapping channels of life force energy in the body, were abandoned in favor of the premise of tapping into special nerve locations.
It may be true that some acupuncturists in the west use nerve locations (and hence risk nerve damage so I hope their knowledge of anatomy is as vague as that of their "traditional" counterparts) but it cannot be stated as a general fact. Guy (Help!) 13:02, 27 July 2015 (UTC)
You are right, the passage is problematic for a few reasons. The increased emphasis on neuroanatomy in acupuncture really developed in China, especially in the 1950's and 60's. As early as the Huangdi Neijing beliefs in "spiritual" causes of disease were de-emphasized in favor of natural phenomena (which is why we often assess in terms of hot and cold, dry and damp, etc.) and balanced emotions were always considered to play an important role in maintaining health, some people refer to this as the "spiritual" aspects of the medicine, which muddies the water IMO. The word "spirit" is a translation of 神, shen, which could mean spirit, but is most often used to mean consciousness, affect, emotions, etc. in medical texts. Contemporary practitioners study both the traditional theories and bioscience (and yes Guy, we do study neuroanatomy. Its one of the many reasons we have so few adverse effects:)).Herbxue (talk) 16:06, 27 July 2015 (UTC)
I am sure some of you do. God alone knows why, since the entire practice remains unconnected to reality-based physiology, but yes, I believe that at least some of you do undertake this study; these folks remind me of Sam Homola, who discarded all the pseudoscience around chiropractic and ended up basically performing deep-tissue massage - I have no idea what's left after the mumbo-jumbo is stripped out of needling, but the objective evidence suggests it's very little if anything at all.
However, I think that most TCM practitioners (especially those outside the influence of reality-based medical establishments) have few reported adverse events because (a) there is no systematic recording of adverse events and (b) the body is a big place and if you randomly stick short needles in you'll usually miss anything important. Cardiac tamponade, a well-documented complication, would never happen if every acupuncturist had anatomical knowledge.
Regardless, the statement in the lede is not supportable as a general summary statement.
I do think that the Nixon visit should be included because it is so widely identified as pivotal in the birth of quackademic study of acupuncture in the US. Guy (Help!) 16:30, 27 July 2015 (UTC)
Does this fix the problematic sentence? "In the 1900s as it spread to the United States and Western countries, the spiritual elements of acupuncture that conflict with Western beliefs were abandoned in favor of anatomical rationalizations."
Regarding the Lead being too long now, I think we can trim a bit of the other content that is redundant or excessively detailed. History is the most important part of an article and deserves a significant place in the Lead. CorporateM (Talk) 19:11, 27 July 2015 (UTC)
The lead should not be five bloated paragraphs. QuackGuru (talk) 19:25, 27 July 2015 (UTC)
I agree with your proposal, CorporateM. And yes QuackGuru, that's why we can trim some of the other content. Cheers! Jayaguru-Shishya (talk) 20:10, 27 July 2015 (UTC)
I also agree with CorporateM regarding the weight of history.Herbxue (talk) 20:29, 27 July 2015 (UTC)

So the pro-needling editors want to trim some of the reality-based content from the lede in order to inflate the fallacy of appeal to tradition? Tell me again why that would be a good idea? Guy (Help!) 21:52, 27 July 2015 (UTC)

Because that's how we write most medical articles. Compared to any other medical article, we devote far too much space to controversial material, and when we try giving equal airtime to every viewpoint, we end up with an extremely long lede. We also devote far too much space in the lede for things like side effects and deaths. Compare that to Aspirin which cause far more deaths in one year than acupuncture has in its recorded history. I'm not saying these things shouldn't be mentioned, but that's what we have a body for. We should model our lede after other medical articles. SSRI's have been in both the professional and popular literature quite a bit lately because of meta-analyses showing that for most people they are equivalent to placebos. Yet our lede on SSRI's reads like this:
Selective serotonin re-uptake inhibitors or serotonin-specific reuptake inhibitors[1] (SSRIs) are a class of compounds typically used as antidepressants in the treatment of major depressive disorder and anxiety disorders.
SSRIs are believed to increase the extracellular level of the neurotransmitter serotonin by limiting its reabsorption into the presynaptic cell, increasing the level of serotonin in the synaptic cleft available to bind to the postsynaptic receptor. They have varying degrees of selectivity for the other monoamine transporters, with pure SSRIs having only weak affinity for the norepinephrine and dopamine transporters.
SSRIs are the most widely prescribed antidepressants in many countries.[2] The efficacy of SSRIs in mild or moderate cases of depression has been disputed.[3][4][5]
That's how we should model our lede. Describe what acupuncture is, give the history, talk about its mechanism of action, and if there is something worth disputing, don't take sides in it, but briefly summarize and signal to the reader that there is more to the story and you can read more about it in the body. LesVegas (talk) 00:07, 28 July 2015 (UTC)
That's medical articles. This is about something that's about 5% medicine and 95% religion. Guy (Help!) 17:30, 28 July 2015 (UTC)
Well, that might be disputed, but for the sake of argument let's assume it's actually 100% religion. If we model the lede after Christianity it comes out exactly the same as I suggested earlier. LesVegas (talk) 17:57, 28 July 2015 (UTC)
LesVegas wasn't there discussion about reporting the death incidents already one year ago?[32] If I remember it right, even Kww opposed inclusion of such mention, saying that there's "a death rate associated with nearly any procedure". Please correct if I am wrong though, Les :-) Jayaguru-Shishya (talk) 21:51, 28 July 2015 (UTC)
That's interesting. That information should likely be the first to go in any rewrite of the lede. LesVegas (talk) 22:20, 28 July 2015 (UTC)
I think the analogy with religion is a reasonable one. Many religions include stories of healing miracles. In the East, religion is replaced with spirituality and for 18 out of 20 centuries of acupuncture's existence, it's been focused on releasing demons, aligning with lunar cycles, celestial bodies and similar spiritual beliefs. There is an important difference that in this case the spirituality is entwined with a form of medical treatment, so both elements are important. CorporateM (Talk) 18:24, 30 July 2015 (UTC)

History summary

CorporateM, could you specify which sources support "In the 1900s...early belief systems"? A couple of parts are surprising to me, e.g. it seems a bit off that all but the last 50-100 years of acupuncture's history should be considered "early." If we could break things down by source, it would also be easier to verify and to incorporate other material like the histology/physiology statement. Thanks, Sunrise (talk) 20:53, 30 July 2015 (UTC)

I actually prefer Leads that do not have sources, since they are summarizing the body of the article, which is sourced. However, both formats are considered acceptable. Those sources are all for the sentence that starts with "For example" and they are a carry-over from the prior version of the Lead that was maintained. I have not reviewed the sources, but merely assumed the original content was properly sourced. I may get to it eventually though if nobody else does. CorporateM (Talk) 12:08, 31 July 2015 (UTC)
I see, my apologies then - I thought it was something you had written. I'm aware that both formats are acceptable, though on controversial articles I think the benefits of precisely linking references to content (including in the lead) are greater. Sunrise (talk) 20:09, 31 July 2015 (UTC)

Conceptual basis

Working my way up the article, I just started poking around the Conceptual Basis section. I apologize that I've left it in a mess for the moment, but it's 8:30 a.m. in my time zone and I still haven't gone to bed yet. Before I turn in, I wanted to share some comments/notes to get any reactions before I work on it again later.

My first-glance suggestion is that we can probably summarize this in just two sub-sections, maybe called "traditional" and "Western" or "traditional" and "modern". This avoids using the term "Scientific", since whether it is scientific is a contested claim.

A lot of the content can be trimmed, because we have separate articles devoted to these subjects. For example, I don't think we need so much detail about the history of "A-shi" points, since there is a separate article on acupuncture points. On this page, we just need a concise WP:SUMMARY of the sub-pages.

The two bottom sections I would probably move to an efficacy-type section, but I think they will need some culling. One of the statements for example that raised an eyebrow for me was "Acupuncture may improve cognitive function by modulating signaling pathways that regulate neuronal survival and function.[273]" Haven't checked the source yet, but sounds fishy.

CorporateM (Talk) 12:54, 31 July 2015 (UTC)

I've made a few changes, so there are now only four subsections. I haven't addressed any of the issues you describe here - I just wanted to mention that the first paragraph of "Qi, meridians and acupuncture points" is ungrammatical and the source is in Chinese, so it would be great if someone could infer or write out the intended meanings. Sunrise (talk) 20:56, 31 July 2015 (UTC)

Gastrointestinal stuff

JzG just reverted my addition of information about gastrointestinal dysfunction to this article, claiming that this content derived from a "primary source" and fails MEDRS. [33] However, the source [34] is actually a review, meaning it does meet MEDRS. Accordingly, I think the deleted content should be restored. Everymorning talk 14:48, 31 July 2015 (UTC)

I restored it. Guy, see this page from the publisher you can see that this is a secondary source and the peer review process is transparent. Herbxue (talk) 15:41, 31 July 2015 (UTC)

It is a WP:PRIMARY source for the speculated mechanism.

In China, acupuncture has been considered an effective method for treating gastrointestinal (GI) dysfunction diseases for thousands of years. In fact, acupuncture has gained progressive acceptance from both practitioners and patients worldwide. However, the therapeutic effects and underlying mechanisms in treating GI dysfunction have not yet been established due to a lack of systematic and comprehensive review articles. Therefore, the aim of this review is to discuss the efficacy of acupuncture as a treatment for GI dysfunction and the associated underlying mechanisms. A search of PubMed was conducted for articles that were published over the past 10 years using the terms "acupuncture", "gastrointestine", and other relevant keywords. In the following review, we describe the effect and underlying mechanisms of acupuncture on GI function from the perspectives of GI motility, visceral sensitivity, the GI barrier, and the brain-gut axis. The dual regulatory effects of acupuncture may manifest by promoting gastric peristalsis in subjects with low initial gastric motility, and suppressing peristalsis in subjects with active initial motility. In addition, the regulation of acupuncture on gastric motility may be intensity-dependent. Our findings suggest that further studies are needed to investigate the effects and more systematic mechanisms in treating GI dysfunction, and to promote the application of acupuncture for the treatment of GI diseases.

So, Chinese authors, starts with a fallacious appeal, speculative - standard problems of the uncritical approach of believers in alternative medicine. Guy (Help!) 16:19, 31 July 2015 (UTC)

Did you read the paper? We can discuss the validity of their methods, but the proposed mechanisms come from the primary sources cited in the review. And it is not speculation, they are mechanisms discovered through experimental research. There is no question this is a secondary source. Btw, you discounting it because the authors are Chinese is definitely nonsense and possibly racist.Herbxue (talk) 18:12, 31 July 2015 (UTC)
It remains speculative, and identified as such. I guess the authors, who clearly identify themselves as True Believers, were very likely mining for whatever they could find. How many mutually contradictory speculative mechanisms do we need in the article anyway? Not so long ago it was asserted that purinergic signalling is the mechanism of action, based again on speculative reports. Obviously the reality-based community also have an explanation, but needlers tend not to like it. Guy (Help!) 21:38, 31 July 2015 (UTC)
Regarding the accusation of racism, this was my initial reaction as well, but it turns out there are quite a few sources that discuss less rigorous scientific standards in China and a strong bias in favor of acupuncture. I don't think that means we should dismiss Asian sources alltogether; it's just an interesting dilemma that we should be able to discuss openly and handle thoughtfully. CorporateM (Talk) 22:14, 31 July 2015 (UTC)
The discussion should not be about whether the authors are Chinese (as suggested above by GUY) and to be suspect of authors with Asian names is certainly racist! The literature has plenty suggesting that some journals from Asia might be suspect, but I have never seen a study suggest that authors from Asia, publishing in a reputable journal, should be suspect. — Preceding unsigned comment added by 75.152.109.249 (talk) 23:31, 31 July 2015 (UTC)

Whoa, whoa, whoa. There are WP:TIGERS afoot, Guy's in particular. Sec sources speculate about mechanisms and prevalance and causes and study design and stuff all the time. That's what the "Discussion" section is for, and I'd love to see where PAG says that such discussion somehow makes a sec source primary.

We don't omit reviews just because an editor disparages them as "religious". The question is whether they're fringe, and the idea that acu works for certain things like pain is not fringe. When acu is used in mainstream settings (academic centers), and mainstream sources say acu is a reasonable option, that's obviously a sig view. Sci consensus here is that of a spectrum of views. Yes, maybe that will change; Vickers' observed margins may turn out to be due to bias (unblinding). But in the meantime, STICKTOSOURCES. Scientists writing about acupuncture are as much part of the sci community as anyone else, to be weighted alongside other MEDRS. --Middle 8 (t • c | privacy • COI) 00:55, 1 August 2015 (UTC)

See WP:MEDINDY: "Whenever writing about medical claims not supported by mainstream research, it is vital that third-party, independent sources be used." QuackGuru (talk) 00:58, 1 August 2015 (UTC)
See also William Shakespeare ... ""The Foole doth thinke he is wise, but the wiseman knowes himselfe to be a Foole" -Roxy the non edible dog™ (resonate) 07:03, 1 August 2015 (UTC)
@Roxy [35] --Middle 8 (t • c | privacy • COI) 14:53, 1 August 2015 (UTC)
Are the claims in question about possible gastrointestinal mechanisms "not supported by mainstream research"? Also, what, if anything is non-third party or independent about the source in question? Everymorning talk 14:23, 1 August 2015 (UTC)
MEDINDY doesn't exclude this. Chinese research is caveated, yes, but there is mainstream interest in this outside China: the source [36] is in a reasonable journal, and its focus is the subject of e.g. a study at Johns Hopkins [37]. Beware the circular logic that those interested in acupuncture are true believers because acu is fringe because the only people interested in it are true believers. --Middle 8 (t • c | privacy • COI) 14:53, 1 August 2015 (UTC)

Lede input

In order to make the Acupuncture lede more like that of other articles, some have proposed new formatting for the lede. I'm proposing an outline that looks something like this:

1) Describe what acupuncture is: this should be self explanatory
2) History of Acupuncture We could talk about the ice-man, the Neijing, acupuncture practiced throughout various dynasties and especially Nixon's visit which brought it to the US. Like CorporateM said, the history should be the most prominent part to make it in line with other Wikipedia articles.
3) Mechanism of Action: Start with traditional views of acupuncture's mechanism, then change to modern views, with everything from immune reactions to brain imaging research.
4) Scientific Overview: Since this is the lede, we want the best statements from the most reputable organizations. Scientific statements from Cochrane, NIH, NHS, and any other medical bodies on par with these sorts of orgs, as well as general statements about the state of research, what has been discovered, where it's heading.

That is four paragraphs and these seem to be the more essential to me. These also seem to be the most natural order of the paragraphs. Does anyone else have suggestions? LesVegas (talk) 22:41, 28 July 2015 (UTC)

... and yet you've just boldly removed a significant part of the scientific overview from the lead. This seems quite contradictory. -Roxy the non edible dog™ (resonate) 06:14, 31 July 2015 (UTC) aaaaaaand it's back. Well done -Roxy the non edible dog™ (resonate) 09:55, 31 July 2015 (UTC)
Roxy, thank you for participating here and responding to the section I created. If you notice, I suggested things like Cochrane and consensus statements would be better for scientific overview than systematic reviews and meta analyses, since there are many more of those, sometimes with contradictory findings depending on the methods used. LesVegas (talk) 15:58, 1 August 2015 (UTC)
But alas, no explanation for your proposal, and the edit you made counter to it? Can't say I'm surprised. -Roxy the dog™ (Talk to the dog who doesn't know when her owner is coming home) 17:52, 1 August 2015 (UTC)
the edit I made was merely supporting an edit Corporate M made earlier, as I thought it went along nicely with what I said here, but thanks for noticing all of that. It would be nice to see you add something of substance sometime to a talk page rather than engage in grumblings and "I don't like its", but if you choose to keep engaging in low level discourse, editors can just choose to give low level weight to your opinions. of course, it's your choice, Roxy. LesVegas (talk) 21:27, 1 August 2015 (UTC)

Relevance tag

I want to know why the relevance tag has not been removed after at least 2 months. What exactly is the material that is allegedly irrelevant, and which led to the tag being placed? Everymorning talk 15:47, 31 July 2015 (UTC)

If I remember correctly, we placed the relevance tag on the article as a compromise of sorts. I placed a NPOV tag on the article and QuackGuru objected to it, as he did with all tags. In my opinion, we desperately need more neutral editors, such as yourself, actively editing this article and our guidelines call on us to use an NPOV tag to help make that happen. Perhaps we should replace it now with the more appropriate tag? LesVegas (talk) 15:54, 1 August 2015 (UTC)
Sounds like NPOV = the proper tag. Reasons to use it are at the top of Template:POV and it appears valid in this case. Editors who have argued we need consensus for the tag are mistaken; if that were true, highly contentious articles would never get tagged! And the tag is exactly what such articles need: to attract more editors (and hopefully less entrenched ones). We should specify the areas of concern here: can someone recap them? --Middle 8 (t • c | privacy • COI) 23:07, 1 August 2015 (UTC)
Sure. Here were a couple of the unresolved issues from the past which warranted a tag then, and since they're still unresolved warrant the tag still. Talk:Acupuncture/Archive_26#POV_on_Lede and Talk:Acupuncture/Archive_10#Neutrality_Tag. Additionally, there was a long list of issues I posted many months ago, and few of those issues have been resolved. I'll start a new section below and add two tags, while removing the relevance tag, and I'll keep the neutrality issues down to the two biggest areas that I think can resolve most of the NPOV disputes forever on this page, if we can hash out a consensus on them. And hopefully we can now. LesVegas (talk) 17:14, 2 August 2015 (UTC)

MASS violation of MEDRS and LEDE

This change deleted a rare overview of Cochrane reviews and replaced it with a poor source that is not even a review in the lede. The change did not improve the lede. QuackGuru (talk) 00:35, 6 July 2015 (UTC)

There is duplication in the lede. See "but there is some evidence that it may have a beneficial effect for chronic lower back pain, tension-type headaches, migraines, nausea and vomiting, osteoarthritis, neck pain, irritable bowel syndrome.[13] as well as several other conditions where there is not enough evidence to draw any clear conclusions over its relative effectiveness compared with other treatments.[14]" The following is sourced to a better source" An overview of high-quality Cochrane reviews suggests that acupuncture may alleviate certain kinds of pain.[15]" We should delete ref 13 and 14 and keep the overview of high-quality Cochrane reviews. QuackGuru (talk) 00:45, 6 July 2015 (UTC)

This change is obviously original research. QuackGuru (talk) 00:57, 6 July 2015 (UTC)

I've made a couple of adjustments without removing (at least not yet). I also have concerns about about source quality - this is a MEDRS but is the lowest level of acceptable source (e.g. see Peer-reviewed medical information resources...are usually acceptable sources for uncontroversial information; however, as much as possible Wikipedia articles should cite the more established literature directly.) As written, it also currently appears to be used to rebut the higher-quality source that precedes it, which needs to be avoided. Sunrise (talk) 05:45, 6 July 2015 (UTC)
Greetings Sunrise! I am not totally sure if I could catch the intention behind these edits[38] (ex. ref work), but now the text says (emphasis added): "Cochrane Reviews found acupuncture is not effective for a wide range of conditions, but there is some evidence that it may have a beneficial effect for several conditions, and there are other conditions where there is not enough high-quality evidence to draw any clear conclusions about efficacy."
So conditions, conditions, conditions ... Any suggestions how to rephrase the text in order to avoid the repetition? :-P Jayaguru-Shishya (talk) 14:35, 6 July 2015 (UTC)
Yes this makes sense to me Jayaguru. Regarding source quality, the NHS is different. MEDRS considers statements by bodies such as the NHS to be very high quality. What is actually considered unreliable are outdated statements and given that the Ernst statement is now 6 years old, it falls outside MEDDATE's window since some new (and wider) conditions have been favorably reviewed by Cochrane in that period of time and since the evidence overall has shifted in the positive direction. Not positive yet, but what I'm saying is that some reviews have stayed negative, some have gone from negative to null and some from null to positive. So I suppose the outdated statement can stay for now until we can find an updated source. I will put a tag on it. LesVegas (talk) 18:33, 6 July 2015 (UTC)
I also agree with Jayaguru's revert, listing the individual conditions because it avoids synthesis. LesVegas (talk) 18:36, 6 July 2015 (UTC)
I tried explaining this before. We have much higher quality sources available. If editors want more details in the lede we should use the higher quality sources. QuackGuru (talk) 18:38, 6 July 2015 (UTC)
I don't understand why you claim it is low quality because per MEDRS, the NHS is very high quality. It isn't about having more details in the lede, it's about having accurate, updated statements that are non-synthesized. Regarding the Ernst statement, it was high quality in 2009 but since we have new reviews to contend with it is no longer even reliable. Yes, I added an update tag to the old source as we should. You're very good at finding new sources, QuackGuru, so please helps us find an updated source that backs up the statement. LesVegas (talk) 18:50, 6 July 2015 (UTC)
NHS is not a review and it is a lower quality source than an overview of Cochrane reviews. We are using the best available research except for the NHS source. QuackGuru (talk) 18:57, 6 July 2015 (UTC)
LesVegas: I quoted the relevant part of MEDRS in my previous comment. The source is an information page, not a position statement, so it should only be used for uncontroversial information. Also, summarizing a list of six as "several" is not WP:SYNTH; you need two sources for synthesis to be possible. Either way, on second glance, specifying the exact number is probably better.
Jayaguru-Shishya: Greetings. :-) I've made a different edit which removes one of the "conditions" much more easily: "other conditions" -> "others." How does that look? This maintains the version without the undue weight issue as well as the other changes for concision etc. (Please don't revert several changes if you're only providing objections to one of them. Was anything unclear from the edit summaries and/or do you have objections to the other parts? Also, either of the remaining "conditions" could be replaced by "uses," "circumstances," or a number of other terms if you prefer.) Keep in mind that the source is still being contested so it's not worth much to discuss the wording in detail yet. The reference change was just to make two identical references appear as the same number in the page's rendered text. Sunrise (talk) 02:50, 7 July 2015 (UTC)
Hello there, Sunrise! Looks a lot better now. Cheers! Jayaguru-Shishya (talk) 16:04, 7 July 2015 (UTC)

A tag was added to the review again. The edit summary claims it was an update? QuackGuru (talk) 18:42, 6 July 2015 (UTC)

A good tag, well-described in the "reason" section. We should definitely urge editors to seek for a better source to replace this one. Jayaguru-Shishya (talk) 18:55, 6 July 2015 (UTC)
It should not be tagged when it is an extremely high-quality source. QuackGuru (talk) 18:57, 6 July 2015 (UTC)
QuackGuru, please don't IDHT. I said it was a high quality source in 2009, but now that some of the Cochrane reviews are different it's not even reliable for such a statement. If you have an objection to the tag, please try to find us an updated source. You can post it here to the talk page and I will add it in. LesVegas (talk) 19:12, 6 July 2015 (UTC)
You have not presented a better source than the overview of Cochrane reviews. Therefore, there is no need to tag. QuackGuru (talk) 19:37, 6 July 2015 (UTC)
LesVegas, you have never managed to demonstrate any meaningful shift in the results of the Cochrane reviews, and there isn't any support for tagging it. Remember what John said about not reverting to troublesome behaviour? Edit-warring a tag into place when you know that other editors virulently and violently object is troublesome behaviour.—Kww(talk) 19:47, 6 July 2015 (UTC)
I did demonstrate a shift. I and several others believed it was meaningful enough to remove the source, but obviously you did not. After all, we had multiple new positive reviews in a wide range that a 6 year old source hadn't seen. It would be a different story if all the reviews had stayed the same over 6 years with no change in the data at all, but clearly that was not the case. LesVegas (talk) 22:56, 6 July 2015 (UTC)
Yes, from 28/32 to 27/32 or 27/33, depending on how one counts. Your definition of "meaningful" is a bit stretched, LesVegas. Not certain who you thought agreed with you, either.—Kww(talk) 04:22, 7 July 2015 (UTC)

We should go back to this version before the poor source was added to the lede. QuackGuru (talk) 19:37, 6 July 2015 (UTC)

Those diffs are the same. What's the point? Jayaguru-Shishya (talk) 20:14, 6 July 2015 (UTC)
Why did you restore the tag to one of the highest quality sources. This is the best available evidence. QuackGuru (talk) 20:27, 6 July 2015 (UTC)
Jayaguru-Shishya, please self-revert. You know the tag is controversial, and you should also know that LesVegas has been edit-warring for weeks over that particular cite ([39][40][41][42]). Constantly replacing and tagging the same text is just a form of edit-warring. Once tagging that reference was rejected by multiple editors, a tag shouldn't have been reinserted until there was consensus.—Kww(talk) 20:40, 6 July 2015 (UTC)
In my opinion, it would help if editors understood Wikipedia policies and guidelines better such as NPOV, MEDRS and BLP and we would see less edit warring all over the encyclopedia. I don't mind listing the relevant policy here if editors are confused or simply are unaware. Tags are necessary in some cases and our guidelines say that outdated sources need tags. I assumed it would be welcomed to tag an obviously outdated source rather than simply removing it again. LesVegas (talk) 22:49, 6 July 2015 (UTC)
Your opinion is your opinion, LesVegas. You do, however, know as certain fact that multiple other editors object to the tag, and, in fact, you are well aware that the material presented by the source has not changed in any significant fashion since its publication. That means that you are intentionally changing material without consensus and are edit-warring in relation to that particular source.—Kww(talk) 23:42, 6 July 2015 (UTC)
Actually I know as a certain fact that only you and QuackGuru object to the reasonable tag. I see no other editors thus far who are willing to stick their neck out to combat guidelines and reasonable editing standards by objecting to a date tag for an outdated claim. But QuackGuru objects to anything that doesn't denigrate acupuncture, and I am surprised that you are objecting so strongly given the fact that you have an Arbcom case against you at the moment, part of which called into question your understanding of policies. But let the record show that, unlike you, I haven't reverted material so I'm not so sure I understand the edit warring accusation either. LesVegas (talk) 03:04, 7 July 2015 (UTC)
"Haven't reverted material" is pure sophistry, LesVegas, and, unfortunately, this edit shows that it isn't simply sophistry, it's blatantly false. You've attacked the exact same link with multiple tags and removals ([43][44][45][46]), and have been unwilling to acknowledge that you actively misrepresented material in your last effort to remove it. Oh, and by the way, remember Arthur Rubin and this edit? It wouldn't be so painful arguing with you if you would maintain a consistent story that had some semblance of reality. I don't think Arthur is either QG or myself, and you obviously have been engaged in edit-warring over that citation. —Kww(talk) 03:45, 7 July 2015 (UTC)
An inaccurate statement from Les. "Actually I know as a certain fact that only you and QuackGuru object to the reasonable tag." Worth noting. -Roxy the non edible dog™ (resonate) 04:20, 7 July 2015 (UTC)
If the "pro-acupuncture" editors had been paying attention, they would know that Roxy and I were opposed to the tag the last time it was added. My smartphone has an aggressive autocorrect. I'm not going to try to name names. — Arthur Rubin (talk) 04:47, 7 July 2015 (UTC)
Actually, there wasn't a tag added last time. I decided to tag the source instead of removing it per MEDDATE since we found a new one. Arthur, you were only opposed to that update because it was synthesis and I agreed, which is why I modified it. Please take a look and if you feel unsure about what I'm saying, I'm more than happy to provide some diffs. LesVegas (talk) 17:44, 7 July 2015 (UTC)

Interesting: the six conditions in that NHS source compared to the actual Cochrane reviews:

  1. Irritable Bowel syndrome: Sham-controlled RCTs have found no benefits of acupuncture relative to a credible sham acupuncture control for IBS symptom severity or IBS-related quality of life.
  2. Migraine: There is no evidence for an effect of 'true' acupuncture over sham interventions
  3. Osteoarthrities: benefits were small, did not meet pre-defined thresholds for clinical relevance, and were probably due at least partially to placebo effects from incomplete blinding

Looks like someone has been doing some cherry-picking of the words from these reviews again.—Kww(talk) 06:05, 7 July 2015 (UTC)

Kww, I already pointed out on John's talk page that you trying to bust me as a cherry picker has been to pick the cherries first and claim I did it. Here's just one example, migraines, where you left out a slew of material: In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of 'true' acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment. LesVegas (talk) 17:40, 7 July 2015 (UTC)
It's the NHS that cherry-picked, not you, LesVegas. That's the problem with using a political body as a source in a scientific article.—Kww(talk) 22:20, 7 July 2015 (UTC)
Well, I'm not opposed to quoting in more detail directly from Cochrane. If there is a way to summarize caveats in the lede to your liking, which I see is part of your objection, would you then compromise with me and delete the dated Ernst citation? In other words, we'll apply MEDDATE to Ernst and find something that gives greater parity to the NHS summary. I'll look and see if I can find something that works for you and get back to you, if you're on board with this. My purpose in making this change was to summarize the most recent evidence and if we need another source to summarize all the more recent evidence more fully, that's what we need to be doing anyway. And thank you for your explanation above, I appreciate it. LesVegas (talk) 23:22, 7 July 2015 (UTC)
My first step is going to be to look up all 32 areas that Ernst reviews and doublecheck that there has been no shift in the results. If there has been no shift in the results, there's no reason to consider the source outdated. There's nothing about a statement that says "it isn't effective for a wide range of conditions"(Ernst) that actually contradicts "there's evidence of effectiveness for these other conditions" (NHS), which seems to be the root of your logic. The only reason to remove the Ernst citation would be if it truly is outdated: a source that found contradictory results to Ernst. The NHS source says what it says, and I am primarily concerned that it is a source that knowingly recommends placebo treatments. Review of the 32 conditions will take a few days.—Kww(talk) 23:35, 7 July 2015 (UTC)

Lede has been updated

Current wording: "An overview of Cochrane reviews found that acupuncture is not effective for a wide range of conditions, and they suggest it may be effective for only chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache.[12]"

Now that the lede has been updated we can delete the followed (including the tag): "[needs update] but there is some evidence that it may have a beneficial effect for six conditions,[13] and there are others where there is not enough high-quality evidence to draw any clear conclusions about efficacy.[13] Similar text was deleted before. We can do the same again. QuackGuru (talk) 05:13, 7 July 2015 (UTC)

That was a clear-cut violation of your editing restrictions, which were to not make controversial edits. Since Cochrane reviews have now been updated to include more than just those few conditions, it is misleading to expand an outdated source like this, as I have pointed out. Anywho, I removed this expansion. LesVegas (talk) 17:30, 7 July 2015 (UTC)
This was not a controversial edit in any way. The overview of Cochrane reviews is an update to date source and MEDRS compliant. QuackGuru (talk) 17:48, 7 July 2015 (UTC)

Why was this source given additional weight[47], even it's outdated per WP:MEDDATE and we already have a newer source? We should use the more recent source instead. Cheers! Jayaguru-Shishya (talk) 21:01, 7 July 2015 (UTC)

Have you actually read both sources, Jayaguru-Shishya? Ernst evaluates 32 separate topics and finds that for 28 of them, there's no evidence of effectiveness. The "newer" NHS source does not provide any information that contradicts Ernst on 27 of those 28 conditions.—Kww(talk) 22:18, 7 July 2015 (UTC)
One of the points that I have been trying to make is that we have more conditions overall, now, with 7 conditions that have enough evidence to support effectiveness, compared with only 4 back in 2009. Additionally, the range has grown, with Cochrane reviews now showing evidence for other types of headaches, fibromyalgia, and even anti-psychotic effects. That's a wide range of conditions. Based on that, I don't know if Ernst would be able to publish the same statement in 2015 as he did in 2009, or if he would have to temper it some. There's been other changes too, with summaries of the evidence shifting from negative to null and two shifting from null to positive. I really have a larger point I'm trying to make other than the number of flipped studies, which, on their own should suffice to remove a quote that looks at broad data and makes a conclusion about it. When one of those pieces of underlying data change, a conclusion might also change. When several pieces of underlying data change, and the data set of conditions widens, and it's beyond MEDDATE's expiration date, what are we supposed to do? Wait until 10 conditions are positive? If 10 is too low then what about 15? 20? 28? Really, as editors we have to respect MEDDATE's 5 year window because otherwise there's no hard and set rules about when to discard a source and we'll have citations decaying and rotting all over the encyclopedia. LesVegas (talk) 23:47, 7 July 2015 (UTC)
But you are trying to treat WP:MEDDATE as if it is some bright-line rule. It's not, as it includes such caveats as "While the most-recent reviews include later research results, do not automatically give more weight to the review that happens to have been published most recently, as this is recentism." What you need to find is a source that reviews similar things and makes a differing conclusion. Your NHS report is close, but not really the same, as they did not report the items they evaluated and found negative results: they reported only positive and inconclusive results.—Kww(talk) 00:07, 8 July 2015 (UTC)
If MEDDATE isn't a bright line rule whenever it's past 5 years and we have a change in the overall evidence compared to 2009, where do we stop? The World Health Organization conducted a review back in the early 2000's and found evidence for 40 conditions! Should we quote that? Absolutely not, for several reasons, one being that it's past the threshold and we have different studies sometimes showing more robust evidence for many of those conditions. This is why we have cutoffs on MEDRS once new evidence is reviewed. Anywho, I am glad that despite our differences in how we see this, you are at least open to compromising on this. LesVegas (talk) 00:26, 8 July 2015 (UTC)
That study was widely denounced, so it wouldn't matter how recent it was. I wouldn't describe any of the evidence in favor of acupuncture as "robust". That's why all of the Cochrane reviews have so many qualifiers and hedges.—Kww(talk) 01:25, 8 July 2015 (UTC)
The NHS source is not a high quality source. It does not measure up to the other high quality sources. An overview of Cochrane reviews is very clearly a much higher quality source. QuackGuru (talk) 19:32, 8 July 2015 (UTC)
I think LesVegas is making a point here. We should use the most up-to-date sources that best reflect the current state of medical literature. Besides, we should be very careful not to be conducting a second peer-review of our own: "Editors should not perform a detailed academic peer review. Do not reject a high-quality type of study due to personal objections to the study's inclusion criteria, references, funding sources, or conclusions." as per WP:MEDASSESS. Cheers! Jayaguru-Shishya (talk) 19:09, 8 July 2015 (UTC)
I'm not arguing to remove the NHS source, simply that it doesn't refute or replace Ernst. Both "it doesn't work for a lot of things" and "there's evidence that it does work for this handful of things" can be simultaneously true and represent the latest state of research. They don't contradict each other.—Kww(talk) 20:24, 8 July 2015 (UTC)

Text should be restored to the lede

An overview of Cochrane reviews found that acupuncture is not effective for a wide range of conditions, and they suggest it may be effective for only chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache.<ref name=Ernst2009/> The part and they suggest it may be effective for only chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache is sourced to a very high-quality source. QuackGuru (talk) 19:30, 15 July 2015 (UTC)

The tag in the lede has no consensus

The tag that says "[needs update]" is not appropriate. It does not need updating. We are using a very high-quality source. QuackGuru (talk) 19:30, 15 July 2015 (UTC)

The tag added to the high-quality source against consensus has not been removed. QuackGuru (talk) 03:42, 3 August 2015 (UTC)

No consensus for using a lower quality source in lede to argue against a higher quality source

"but there is some evidence that it may have a beneficial effect for six conditions,[13] and there are others where there is not enough high-quality evidence to draw any clear conclusions about efficacy.[13]" This text has no consensus to keep. QuackGuru (talk) 19:31, 15 July 2015 (UTC)

Weight violation

See diff. QuackGuru (talk) 01:53, 19 July 2015 (UTC)

Why is that a weight violation?Herbxue (talk) 19:45, 22 July 2015 (UTC)
Well, the journal in question, Neural Regeneration Research, has one of the lowest impact factors I've ever seen (.180). Perhaps that could be the problem. Everymorning talk 12:15, 23 July 2015 (UTC)
Kinda off topic but could someone point out the WP guideline that discusses impact factor?Herbxue (talk) 16:02, 23 July 2015 (UTC)
I assume that you're not suggesting that we can (or should) only ever consider factors specifically enumerated in Wikipedia's (ever-evolving, deliberately flexible) guidelines in evaluating the quality or reliability of a publication—nor that we should stick our fingers in our ears and shout "la la la I can't hear you!" if anyone mentions a relevant red flag that didn't happen to appear in a guideline document....
Ultimately, it doesn't matter if a particular criterion appears on a guideline page—it matters if the criterion is relevant. TenOfAllTrades(talk) 04:29, 24 July 2015 (UTC)
Another problem is that the sentence is unreadable. "A 2015 systematic review analyzing a particular needling method found that it elicited a better effect than control treatment in reducing disability rate in ischemic stroke patients and that the long-term effects were better than that of control groups." The sentence makes no sense. QuackGuru (talk) 01:19, 24 July 2015 (UTC)
That source should not be included. We have many better sources that essentially contradict its basic claims. Guy (Help!) 08:07, 24 July 2015 (UTC)
TenOfAllTrades, I appreciate the flexibility of WP guidelines, but in many cases sources are excluded here because we have "better" sources, or because an editor labels them as "fringe journals" with no objective or even verifiable way to determine that. I certainly understand that a review in the Lancet or BMJ is more notable than a review in the World Journal of Gastroenterology, but the latter is a peer reviewed journal with a robust editorial structure and is absolutely MEDRS compliant, but I guarantee you if I cite a review from that journal it will get shot down. We need to decide do we really follow MEDRS or do we just include what we like and disregard what we don't like? Impact factor is not directly a measure of the quality control of a journal, so I don't see that as a justifiable reason to include or exclude a source.Herbxue (talk) 18:49, 24 July 2015 (UTC)
That is a good point, Herbxue. What editors at MEDRS talk have agreed on in the past is that we don't delete sources because of impact factor, but what we might want to do is consider impact factor in where we place a source. For instance, we wouldn't put a low impact factor source in the lede. This source was from a good journal and publisher that Jeffrey Beall went out of his way to say was reputable. LesVegas (talk) 18:59, 24 July 2015 (UTC)
This is not about the impact factor or MEDRS. The content itself is not about acupuncture in general. It is about a specific technique. The current wording is poor writing. QuackGuru (talk) 19:21, 24 July 2015 (UTC)
It's a specific acupuncture technique, so it is appropriate for the acupuncture page. If you feel the current wording is poor writing, would you mind suggesting an alternative here for us to discuss? LesVegas (talk) 20:19, 24 July 2015 (UTC)
It is a specific acupuncture technique but the text does not say what is the technique or how the technique differs from a regular acupuncture technique. The specific section you added it is about acupuncture in general. It does not belong in that section. QuackGuru (talk) 21:55, 25 July 2015 (UTC)
It is a specific technique, a distal technique that stimulates the brain, that doesn't merit having its own Wikipedia page. We shouldn't create pages for individual acupuncture techniques, although I think it might be a good idea to consider creating a section for individual acupuncture techniques. Still, since this is an assessment of the evidence for stroke, it belongs in that section. LesVegas (talk) 12:45, 26 July 2015 (UTC)
The text is not a description of a specific technique. The writing is very poor and it is still not about acupuncture in general. QuackGuru (talk) 03:44, 3 August 2015 (UTC)

Safety

This is what I mean when I say that the assumption of safety is based on an idealised model that does not necessarily match actual practice.

The problem of course is that some US states have licensed acupuncture, so safety is assessed by co-religionists and may not conform tot he standards required by reality-based practice. Guy (Help!) 10:11, 3 August 2015 (UTC)

An anecdote is your evidence for your assumption that acceptable safety standards are not widely upheld by acupuncturists, despite the excellent safety data we have? How about this - name any medical procedure in the "reality based" world and then see if we can find any anecdotal evidence that someone is doing it wrong. Would that indicate a trend or a norm to you? If so we should probably include a paragraph on the rape threat of seeing a dentist at the dentistry article. Here's another anecdote for you - my malpractice insurance is $600 USD per YEAR - do you think people in the insurance business take chances? No, to them its easy low-risk money because the percentage of people experiencing adverse events with acupuncture is ridiculously low compared to other invasive medical procedures. Until you get "reality based" and provide us with a real study of acupuncturists adherence to CNT, your posts about this belong more on Facebook than they do here. Herbxue (talk) 12:58, 3 August 2015 (UTC)
No, it's not an anecdote, it's an example. As a long time watcher of anecdote-based medicine (especially homeopathy, chiropractic and TCM) I do know the difference.
And here's another example: bee sting therapy.
My issue is, as I've stated before, that while I accept there are practitioners who understand the germ theory of disease and appreciate the importance of proper hygiene and so on, the entire field of TCM seems to me to be infested with people who have no concept of reality-based medicine, infection control, anatomy and other really rather important fields of knowledge (especially important if you're going to start sticking needles into people).
I do see it as a positive sign that acupuncturists in Ottawa are actually part of the process of shutting down the sub-standard shop.
The thing is, the world of acupuncture is only really taking its first steps into the whole evidence thing. I don't see any evidence of adverse event reporting, albeit that unlike chiropractors the acupuncturists are at least not in denial about them. And systematic reporting of adverse events is a necessary first step to being able to claim that an invasive procedure is actually safe.
Insurance rates are not relevant in a community that is normally treating the worried well. There will be rare cases where there is a delay in reality-based treatment, but people rarely admit that their bad judgment in seeing someone who has nothing to say about a disease, is a component of their bad outcome. We know that users of alt med who get cancer, present later, with more advanced disease, and fare worse, even allowing for that. Guy (Help!) 13:40, 3 August 2015 (UTC)
e/cAlternatively, Herb, you could name any practise in the Magical acu based world, and show us some convincing evidence that Acu works in the reality based world. The insurers know a good thing when they see it, obviously. The only risks they have are that practitioners injure people, or infect them, or advise them badly. We know that nothing can happen from the "treatment" -Roxy the dog™ (Talk to the dog who doesn't know when her owner is coming home) 13:42, 3 August 2015 (UTC)
Guy, you're still speculating based on your limited experience. Please try to get more informed. Look at the curricula taught at acupuncture schools. Look at the outline for the Biomedicine portion of the NCCAOM board exam. People in any profession present with a wide range of skill and competence, but I assure you things like universal precautions, safe needle handling and disposal, signs indicating the need for referral to a physician or red flags indicating emergency, and appropriately stating the benefits, limitations, and risks of acupuncture are all essential parts of acupuncture training. But don't take my word for it, investigate some reliable sources. Herbxue (talk) 16:36, 3 August 2015 (UTC)

There are definitely acupuncturists who are performing medical malpractice. This is made more complicated by the fact that the entire industry may be based on malpractice. But there are cases which are uncontroversially malpractices such as the instance from Ottawa. I'd be interested to see if the percentages of acupuncture clinics closed due to malpractice in various locations is the same as medical clinics. The statistics on this are somewhat hard to come by. jps (talk) 17:23, 3 August 2015 (UTC)

As with Guy, you are speculating, but yes, there are definitely incompetent or lazy acupuncturists out there, as there are in any profession. I've seen nurses do blood draws that looked like a scene from the Saw movies. See my comment above on the risk of getting groped by a dentist - its probably higher than the risk of having a serious side effect of acupuncture. But like you, I am speculating, so it is meaningless in terms of editing WP. I too would be interested in seeing real data comparing acupuncturists to other healthcare professionals in terms of safety, malpractice allegations, and cost of care. Herbxue (talk) 17:56, 3 August 2015 (UTC)
None of what I wrote was speculation. jps (talk) 18:06, 3 August 2015 (UTC)
Except this: "This is made more complicated by the fact that the entire industry may be based on malpractice." --Middle 8 (t • c | privacy • COI) 00:22, 4 August 2015 (UTC)
That's not speculation either. That's just pointing out that since acupuncture lacks an evidence basis, it can be considered malpractice. jps (talk) 12:24, 4 August 2015 (UTC)

Yes -- malpractice exists. It is bad. Regulation and training undoubtedly figure. And unless we can get some kind of RS with an incidence rate, I don't see what we can use these examples for.

I do think the analogy with chiropractic is flawed: the "idealized form" of chiropractic is, IIRC, based on one or more chiropractor's attempts to establish an EBM-congruent form of practice. That sets the bar pretty high relative to how students are actually trained, since they keep learning the same old vert-sub stuff. With acupuncture, we're talking about using alcohol swabs and not needling the wrong places, really basic stuff that is taught everywhere there is regulation. The rate of SAE's from acu is of course very low [48] to the best of our knowledge, arguments from ignorance notwithstanding. At any rate I don't see what chiropractors' adherence to certain EBM standards has to do with acupuncturists' safety and hygiene.

some FWIW comments about that story [49]

It's actually hard to tell from this story what dangers existed to patients.

  • Proper disposal of needles: Throwing them out with the trash, or just the wrong colored (but otherwise OK) container?
  • Improper hand hygiene: Not washing hands? Or not using gloves, which per the WHO [50] you don't need to do when giving someone a shot?
  • Expired products: old alcohol swabs have been known to dry up, but expired alcohol hand gel (which they cited) is about as problematic as expired table salt, if properly stored.

Just saying -- even as anecdotes go, this one is vague and "proves" little.

Idiots exist; what we need are RS indicating how common they are, not RS that furnish only examples or speculation. --Middle 8 (t • c | privacy • COI) 05:50, 4 August 2015 (UTC)

Better source needed

This information: De qi is more important in Chinese acupuncture, while Western and Japanese patients may not consider it a necessary part of the treatment.[1] uses Complementary Medicine for Dummies as the source. Could a better source be provided? Thanks. Gandydancer (talk) 11:20, 5 August 2015 (UTC)

That would be good, although the source isn't very bad. The statement is, FWIW, accurate per all the sources I've read (and inevitably can't remember at the moment). --Middle 8 (t • c | privacy • COI) 10:17, 7 August 2015 (UTC)

References

  1. ^ Cite error: The named reference Dummies was invoked but never defined (see the help page).

Conceptual Basis

I'm working my way up to the "Conceptual basis" section and am getting to a point where I'll have to spend some focused time doing research before I can make further thoughtful contributions to the section. That may take a while before I have a spare block of time that big available. I see that under the "Traditional" header we have a lot of sub-articles devoted to specific concepts, allowing us to just summarize them here, but I was wondering if anyone knew of relevant sub-articles for the "Modern" sub-section.

In other words, are there any Wikipedia articles devoted to concepts related to the modern scientific rationalization of acupuncture? CorporateM (Talk) 15:34, 6 August 2015 (UTC)

The German acupuncture trials are the only ones that come immediately to mind. I haven't looked at that article for a while, but I know that the set of trials had some particularly onerous flaws in claims of outcomes according to Edzard Ernst. jps (talk) 16:39, 8 August 2015 (UTC)
The fact that no clear benefit over sham acupuncture was established for any condition, is the telling point. Commercial providers don't accept that it works, but the public sphere, where politics and letter-writing campaigns often trump evidence, is a different matter. That's why there is still a small (albeit shrinking) residue of homeopathy in the NHS: the minister does not want to have to field all the green-ink letters. Guy (Help!) 13:06, 10 August 2015 (UTC)
Guy, would you mind staying on topic? This thread wasn't about the benefits of acupuncture, this was asking about Wikipedia articles that talked about modern acupuncture research. For some reason, it seems you enjoy trolling on the talk pages, and while it's amusing to see how angry you get, it's distracting. But back to Corporate M's question. We used to have an article called the Primo Vascular System, but several editors had it deleted (Guy one of them) so all that remains is an article on that scientist, Kim Bong Han. LesVegas (talk) 13:39, 10 August 2015 (UTC)

Tags

I placed an NPOV tag as well as a systemic bias tag, whilst removing the relevance tag per discussion in the section above.

Regarding the NPOV tag, I feel that while there are many issues lending undue weight and non neutral POV throughout the page, what can likely remedy it is for us to come up with a working rule on which sources are reliable and which ones are not. In the past, we have had issues with adding seemingly reliable sources from peer-reviewed publications which seem to meet every aspect of MEDRS, yet these are sometimes rejected as "fringe sources"almost arbitrarily. At the same time, sources such as Quackwatch which may not be reliable at all per WP:SPS are given great prominence and weight throughout the article and lede and this seems to be a source of constant dispute. So if we are able to come up with some clearer criteria for what sources, specific to this topic, are allowed according to our guidelines and which ones are not, it would help all editors working here.

Regarding the systemic bias tag, we have had much discussion about Chinese and Asian sources in the past. I have even seen US published sources rejected because the authors have Chinese names. While it can be healthy to be suspicious of some Chinese sources, given the possibility of publication bias, an outright rejection of them does our readers a disservice. So maybe what we need to work out here is a checklist of sorts, where if a source shows certain qualities (determined by us) then we can use it. If not, it's either rejected or subject to further scrutinization.

I think that if we are able to resolve issues regarding source reliability, most of the other issues here will probably resolve themselves in due time. LesVegas (talk) 17:41, 2 August 2015 (UTC)

As per the previous discussion, Chinese publications and authors have published as close to zero percent negative or inconclusive results as makes no difference, it's as bad as Indian studies of homeopathy - it's a giant red flag and it's not going to change until we have reliable evidence from the real world to show that the scientific community has noted a meaningful improvement in this.
Quackwatch is one of the most widely cited sources for critical analysis of quackery. For this reason, believers in unverifiable health claims, be it qi, therapeutic touch, chiropractic subluxations or homeopathy, have consistently tried to exclude it from Wikipedia. It is a reliable source for the content in which it specialises, and if you find that Quackwatch says things you don't want to hear then the problem is almost certainly your end.
I'm fine with an NPOV tag as I think it's way to supportive of the quackery in acupuncture, but a "systemic bias" towards "Western scientific sources"? Bullshit. There is no "Western science"< there's just science, and Wikipedia is absolutely intentional in having a bias towards scientific sources in areas of medicine and science. If you want to rewrite the article to make it clear that acupuncture is a religion, then fine, you can dispute the relevance of science, but not until. Guy (Help!) 20:24, 2 August 2015 (UTC)
Guy, please understand that we don't require consensus to add the tag, but once reasons are listed here on talk and a case is made, we require consensus to remove it. Part of the reason for the tag in the first place is your continual removal of all-sources-China, including non-Chinese publications that merely have Chinese authors. Instead of complaining, why don't you engage in discourse on the criteria for inclusion and exclusion of Chinese sources. Certainly you don't think all Chinese sources are unreliable? Or maybe you do. Ok, maybe we should start with something else. How about, surely you don't find non-Chinese publications whose authors are Chinese automatically unreliable, do you? LesVegas (talk) 22:55, 2 August 2015 (UTC)
Most of the sources are Western and they are of high-quality. That is not the issue. The issue is clearly the Chinese bias sources in this article. QuackGuru (talk) 03:40, 3 August 2015 (UTC)
Les, please understand that one person not understanding the relevance of WP:MEDRS, WP:RS and WP:FRINGE does not excuse adding a fatuous tag to an article. There is no such thing as Western science, there is just science. If you want to admit that acupuncture is a religion then you can argue about the inclusion of scientific sources, but you're arguing that it's a form of medicine, and as such Wikipedia policy and practice means that scientific sources are where we source the majority of content. We already addressed this issue when talking about the bias in Chinese sources (and yes, they are the ones that are biased, not "Western" scientific sources). Guy (Help!) 06:37, 3 August 2015 (UTC)
e/c The "western science" tag is pure pointy bullshit, and should be removed. I would not object to the tag if instead of western science it said "real science". - -Roxy the dog™ (Talk to the dog who doesn't know when her owner is coming home) 06:40, 3 August 2015 (UTC)
Exactly. We don't do 'fair and balanced' we do things using proper sources. There really isn't a problem here. Dbrodbeck (talk) 12:34, 3 August 2015 (UTC)
Please establish that there is a problem before attempting to tag the article. Why does it need tags? If there is an insufficient number of editors available here to discuss the matter, mention it at a noticeboard. Articles are bound by WP:RS, not by a desire to balance science sources with the views of practitioners. What text in the article suggests there is a NPOV problem? Why? What source supports the claimed NPOV problem? Johnuniq (talk) 07:03, 3 August 2015 (UTC)
I support the NPOV tag on the basis that we have a hard time agreeing on the validity of certain sources and the weight given to other sources. When we have people rejecting sources because of Chinese authorship, we have a problem. Now, I do understand the issue with SOME Chinese research, I saw first hand students in a Chengdu hospital working on master's theses that were basically designed to prove their teacher's hypotheses, but I have no idea how widespread these practices are. In Shanghai Shuguang hospital I saw the opposite, they were very proud of their review processes and their outcomes were less unbelievably positive. So, how do we know which research was properly conducted? How do we know that in ANY field? Right now we have people believing "science from America or UK is good, science from Asia is bad" but we do not have a reliable policy or guideline on this. As a workaround people have proposed impact factor as a gauge, which also is not a reliable metric for the quality of a journal. Unless we can all agree to acceptable inclusion / exclusion criteria, we will see editors rejecting sources that don't agree with their preconceived notions, which is an NPOV issue.Herbxue (talk) 21:35, 3 August 2015 (UTC)
Articles should not be used to express vague feelings via tags. The first step is to demonstrate that there is an NPOV problem in the current text, then tag the article if discussion with available editors is unable to resolve the issue. What text is a problem? Why? Trotting out complaints about Quackwatch is not going to fly because hundreds of discussions on a range of topics have established that WP:REDFLAG applies and gold-plated scientific studies are not required to refute unproven claims that contradict mainstream medical views. Johnuniq (talk) 23:06, 3 August 2015 (UTC)
Agree there is only science, not Western science. That said, Chinese research is caveated but still part of science, and some examples weigh more than others, e.g. stuff in adequate journals. Even outside of China, the jury is still out for some, re efficacy. NPOV tag: We don't need editorial consensus to have one, but we do need specific issues, specific passages of concern, not vague or poorly-founded objections. --Middle 8 (t • c | privacy • COI) 00:43, 4 August 2015 (UTC)
OK, I pulled up a short list of diffs to illustrate the problem I'm talking about, where it seems like its a free-for-all when it comes to denying sources.
  • Here is one and another where a journal from an excellent publisher, Elsevier, is removed because it happens to be about "acupuncture", and therefore promotes acupuncture, as if we have the same standard for journals that study "knee surgery".
  • Here is one where a citation from the prestigious BMJ is removed for being a "fringe journal".
  • Here is an example where, yes, a misleading edit summary is used. However, the publication is Elsevier and we clearly use sources much worse than that in the same paragraph, so I think we should discuss what the problem, specifically, with the source is. And if there is a problem, perhaps we should remove sources not up to par with it, found elsewhere in the article?
  • Removal of reliable sources goes on both sides of "party lines", if you will, as seen in this edit. While it's a historical claim and the most reliable source for that would be a historical source, I don't think it's a tertiary source, since it comes from the prestigious Lancet. This is an example of removing sources because of what it "says" rather than who says it. We cannot question highly reliable sources, no matter what they say, so long as they are appropriate for the article.
  • In this revert, we have a study from eCAM reverted, and it highlights a double standard here. We use eCAM in the article, elsewhere, yet new updated reviews and meta-analyses are constantly reverted. Specifically regarding this journal, we should discuss if it's allowable or not and be consistent with our application of it.
  • Here is an example where we all seem to have confusion about sources like Quackwatch, which applied to Acupuncture, seem to make it a Wikipedia:SPS. While Quackwatch is recognized as an expert source on quackery, it is not an expert source on acupuncture Acupuncture is not within the field of it's editor's expertise, and it's really a slippery slope if we say that anything a self-published source gets general credit for we can apply to specific subjects on Wikipedia. If a blogger gets recognized as an expert on Hollywood celebrities by some mainstream publication, then writes on his blog "Tom Cruise is gay" can you imagine how long it would be up on Cruise's page? I know, BLP requires an even higher threshold, but it doesn't even meet reliability standards to make ANY claim, contentious or not, about Tom Cruise. It's a SPS. In essence, per SPS, Quackwatch could be used on the quackery page, but not every page it calls quackery because it's not expert in all those fields.
Anywho, those are a few of the examples I'm talking about to suffice in illustrating the problem that we don't follow clear guidelines for what constitutes a reliable journal versus an unreliable one, and since journals are being left off the article for various reasons, and low quality SPS's are given a prominent position throughout, the article is not neutral. My hope is that this dialogue can help to resolve the issue, and that the tag can attract new perspectives. LesVegas (talk) 22:09, 4 August 2015 (UTC)
The most reliable source for a historical claim is the most current research on that historical period, not outdated historical perspectives. -- TRPoD aka The Red Pen of Doom 22:22, 4 August 2015 (UTC)

OK, how about we re-start the discussion with talk about the BMJ? Is it indeed a fringe journal, as it was stated to be in the diff above? LesVegas (talk) 13:53, 10 August 2015 (UTC)

  • I looked at the diff to which you are referring, LesVegas, and it appears the journal that you are talking about was not the BMJ but Acupuncture in Medicine, which is a different journal published by the same publisher (BMJ Publishing Group). Its impact factor, FWIW, is 1.5 [51]. Everymorning talk 13:59, 10 August 2015 (UTC)

Thank you, Everymorning. So it's an acupuncture specific journal published by the BMJ then, an excellent publisher, and it's peer-reviewed and should be an excellent source. Is there anyone who disagrees with that statement? LesVegas (talk) 17:07, 10 August 2015 (UTC)

Chinese Source Idea

I'll leave the systemic bias tag off the article for now, because I have an idea that might be acceptable to all parties involving Chinese research. We know publication bias exists everywhere and it may be worse in China. The extent of the problem can't be known, but we can't say that all publications from China are disallowed because we know that some good research gets done there. And if we were to make it a "hard rule" that a particular country-of-origin's research isn't allowed on the article, it would have to come from the policy or guideline level because the issue of publication bias goes beyond China and certainly beyond acupuncture. If we are to exclude Chinese studies, it can't be decided here. And I'm not aware of a single analysis that states publication bias is the definite issue anyway, only a possible issue. But since it is a possible issue, just one that we don't know how widespread, we need to deal with it in some way. So my proposal is this: as long as Chinese authored or published research meets every other requirement of MEDRS, such as peer-review, we can use the sources where appropriate but they must be attributed. So, for instance, we begin it by saying something like "In a 2014 Chinese meta-analysis," and we do that with the studies. I think this is the only way we can do this. After all, MEDRS states, "editors should not perform a detailed academic peer review. Do not reject a high-quality type of study due to personal objections to the study's inclusion criteria, references, funding sources, or conclusions." Anywho, for now, let's try to work this out amongst ourselves. I will leave the systemic bias tag off right now because I think this is a compromise we can all agree on, and my guess is that we won't need to bring more editors to help us out here on this. LesVegas (talk) 22:09, 4 August 2015 (UTC)

We do know that it is worse in China, at least in respect of acupuncture, because we have reliable independent sources that have analysed that specific question and found that, to all intents and purposes, Chinese research on acupuncture is uncritical and therefore unscientific. Yes, we can decide here that Chinese studies can be excluded, because we have much better sources that are not Chinese. And the reason we should exclude Chinese sources is precisely because of that quote you ined: we are not qualified to judge which are good and which bad, so we look at the WP:RS that say Chinese research exhibits systemic bias and we can exclude all of it with no detriment to the article because we have non-Chinese sources that provide all significant facts. Guy (Help!) 23:28, 4 August 2015 (UTC)
You said reliable independent sources have analyzed it. Since this is the basis for your objection, would you mind providing these so we can discuss this more in-depth?
Also, I'm curious if we question sources on other medical articles such as industry-funded studies versus government studies where industry-funded studies show overwhelmingly positive results compared to government studies? By the way, WP:MEDRS says we shouldn't conduct a second peer review. It also says we shouldn't exclude a source based on a second peer review, not refuse to include it, as you suggest. Big difference. We simply analyze if a source meets MEDRS requirements, and if so we add it if it adds new info to the article. A month or two ago, some editors tried amending MEDRS to exclude Chinese studies and they overwhelmingly failed at their attempt. As I see it, we don't even need to attribute studies or sources and say they are Chinese. I'm simply suggesting it to all editors here as a compromise, hoping to resolve the constant edit warring on this article anytime editors add a Chinese source. LesVegas (talk) 17:01, 5 August 2015 (UTC)
It is really as simple as this: you want to include Chinese sources, because they are always positive and you are a believer. I want to exclude them because they are always positive and I am not a believer. We can both cite MEDRS until we're blue in the face, the fact remains that reliable independent sources have pointed out an acute systemic bias towards acupuncture in Chinese-authored papers, and we have an abundance of non-Chinese papers, some of which are disgracefully credulous, so there is no need to even argue about it. Guy (Help!) 17:24, 5 August 2015 (UTC)
But Guy, I can cite MEDRS till I'm blue in the face, but you can't, I'm afraid, unless you want to pretend words like exclude actually mean include. Anywho, I asked you for these sources before. Again would you please mind providing them so that we can have a more in-depth discussion? LesVegas (talk) 18:43, 5 August 2015 (UTC)
Las vegas you are all alone in that tagging. it is malarky. Jytdog (talk) 01:27, 10 August 2015 (UTC)
The tagging being "malarky" is not a reason for removing the tag until consensus is obtained. Unfortunately. — Arthur Rubin (talk) 03:40, 10 August 2015 (UTC)
I don't think its malarky. We need a serious discussion about standards for journal inclusion/exclusion - and I am open to reasonable standards that are consistent, but I am not open to "Chinese authors means its suspect" or "the study supports acupuncture therefore it is a fringe journal". Until that nonsense stops, we have an NPOV issue. Still waiting for an actual source about the problems with some Chinese research (which again, I've seen firsthand, but cannot generalize to all "Chinese research"). Saying "Chinese research" is biased is like saying Jews are overly concerned with money. Yes, it is racist in the same way. Herbxue (talk) 06:57, 10 August 2015 (UTC)

Thanks Herbxue. I formatted the talk page discussion into two parts, one being all about having a better standard for regular sources, and this one about Chinese sources, even though I had taken the systemic bias tag off for now. This is an example of a source that was removed and highly contested and argued all because of the fact that it's Chinese. This is a big problem with some editors even arguing that authors being Chinese make a source unreliable (and in this case it was a Cochrane Review with Chinese authors!) Here was another example where Guy argued the source was primary (which it wasn't) then argued it was speculative (and the statement was framed as such, not as something definitive, so it's okay), then came here to the talk page and argued it's invalid because the authors are Chinese, an argument he has repeated in this thread. While I didn't re-add the systemic bias tag, going forward it would benefit us to establish a consensus about the use of these sources so as to avoid edit wars. MEDRS is clear that we can't deny sources based on things like funding sources, so that makes Chinese sources the same. But, out of the spirit of compromise, we should allow all Chinese research as long as it is peer-reviewed and the journals aren't on Beall's list, and the like, but we should attribute, i.e., "A 2013 Chinese review of the literature, stated X". We should not attribute in the case of publications outside China that happen to have Chinese authors. So, for instance, the Cochrane review with Chinese authors should just state that it was a Cochrane review. Can you imagine how racist it would sound if we attributed that? "A 2015 Cochrane review with authors who were Chinese stated X". Wow, that wouldn't fly with the Wikipedia community at all. LesVegas (talk) 13:21, 10 August 2015 (UTC)

While we're on the topic and we have plenty of editors here, this source, which was contested on the grounds of having Chinese authors, looks like an excellent source. Is there anyone who objects? LesVegas (talk) 17:18, 10 August 2015 (UTC)

Interesting recent review

I don't have access to the full text, so I don't know to what extent the authors believe acupuncture points really exist or not. Perhaps someone with a subscription could add content from this review to the article. Everymorning talk 16:29, 7 August 2015 (UTC)

I'm not sure they know themselves. They say that there is "no persuasive evidence" for the existence of acupoints, but they also use language that apparently assumes they exist, like "[s]ufficient evidence exists to suggest that acupoints may have distinct physical properties." Sunrise (talk) 18:26, 7 August 2015 (UTC)
Didn't we previously look at another source that was also funded by the "National Natural Science Foundation for Excellent Young Scholars of China"? Or am I just losing my mind? (both are a very strong possibility, especially at 2 a.m.) At the time it sounded kosher to have a government funded study, but since then I wrote the History section and found out that China is known for supporting or attacking acupuncture/TCM based on the political climate (and China is known for information manipulation in general anyway), so now I'm not quite so sure how to look at it. CorporateM (Talk) 06:00, 8 August 2015 (UTC)
I really don't think it's relevant. We have ample evidence already that acupoints don't exist, there's no need to add a questionable source. Guy (Help!) 13:45, 8 August 2015 (UTC)
Looks quite relevant and is also very recent. Guy, do you have a source that concludes that acupoints "don't exist"?Herbxue (talk) 19:43, 10 August 2015 (UTC)

Recently added review

As if foretold by my comment in the above thread, this review was just added to the article. The paper makes clear that it is assessing what happens in response to "inserting needles into the body" without regard to specific acupoints. Indeed it says there isn't evidence to support the hypothesis that acupoint specificity matters, and taken as a whole the paper may be disaffirming acupuncture more than affirming it. (After all, the brain responds to anything that happens to the body, with needling being one such thing.) Thus it doesn't seem appropriate to enlist this review as showing a "purported scientific basis" of acupuncture. One might try to save it by including a bunch of caveats, but it would be difficult to avoid being misleading. Manul ~ talk 00:04, 11 August 2015 (UTC)

Yeah, you're right, the whole analysis was even designed around the fact they were more concerned with needling response rather than acupuncture point needling response. Scientifically, it is useful to explain how sham acupuncture might not be all that inert after all, since the brain still elicits some sort of response. Wikipedially, it is a good source and contains interesting information, so I'm for salvaging it with caveats, but we would need to be specific about how it measured brain changes in response to needling anywhere rather than on acupuncture points, specifically. Everymorning, since you added this meta-analysis, do you have any ideas on how we should caveat it, or if we should even have it on the article at all? LesVegas (talk) 05:01, 11 August 2015 (UTC)
Perhaps I was being too subtle, but my comment about adding caveats was proscriptive, not prescriptive. A paper that denies a fundamental tenet of acupuncture should not be used to show the "scientific basis" of acupuncture. Let's not turn the article into a kettle defense, please.
It doesn't appear the paper is saying that needling is therapeutic, so that can't be implied in the article. The paper is looking at brain responses, and as I said, the brain responds to all kinds of stimuli, needling included. One can find a specific and measurable brain response to the forehead being slapped. That doesn't mean that slapping is therapeutic, or that a mechanism for Slapping Therapy has been discovered. Manul ~ talk 12:37, 11 August 2015 (UTC)

History section in lead

I am concerned that most of the part of the lead dedicated to history is not sourced. While this seems to be OK at first due to WP:CITELEAD it really seems like a no-no to me because the rest of the lead is sourced like you would expect the body of an article to be. I think the second paragraph of the lead should have references at the end of each sentence. Everymorning (talk) 14:46, 19 August 2015 (UTC)

I agree that we need some consistency in the lede. Ledes on Wikipedia are either sourced or unsourced and I prefer unsourced ledes myself because it greatly improves readability. It's much better for the body to have the sources. If readers want to look into something deeply, they can there. LesVegas (talk) 17:48, 20 August 2015 (UTC)

Removed this content

This journal has an impact factor of zero [52]. This indicates that they do not have a history of publishing high quality content. By the way anyway can start a journal. Our in house journal is here [53] and is not suitable as a Wikipedia reference either. Doc James (talk · contribs · email) 05:10, 22 August 2015 (UTC)

  • I recently asked Randykitty about whether Researchgate is a reliable source for impact factors of journals here. His response was that "Apparently, that's not reliable info, because that particular journal (according to the TR master journal list) is not even in any of their databases, so it has no IF." So it's not in any Thomson Reuters databases, but is is in Medline. [54] Everymorning (talk) 11:56, 22 August 2015 (UTC)
Exactly. It's a Chinese language journal that's MEDLINE indexed, peer-reviewed, and has been around for 35 years. There's a reason IF has no bearing on whether we can use a source or not, and this shows yet another reason: because the TR rating system is naturally biased against foreign language journals specifying in non-traditional medical techniques. LesVegas (talk) 16:09, 22 August 2015 (UTC)
Being around for a long time does not make something necessarily reliable. Its SJR is also very low [55]. Basically I am see no indications that this is a reputable source. Doc James (talk · contribs · email) 16:36, 22 August 2015 (UTC)
Is there anything in MEDRS that disqualifies it? Please show me something in MEDRS and I'll change my mind. LesVegas (talk) 17:26, 22 August 2015 (UTC)
I quoted it to you. It is not a realiable source and that disqualifies it. Doc James (talk · contribs · email) 22:22, 22 August 2015 (UTC)
No IF and being Chinese is two red flags. That's enough for me. We already know that Chinese journals are essentially uncritical of acupuncture claims, and that may be why this journal has a low IF, but we don't need to speculate because the low IF in and of itself indicates that we should not include it for anything that it remotely controversial. Their belief is touching but not to be taken at face value. Guy (Help!) 22:38, 22 August 2015 (UTC)

Multiple Tags

In order to gain an outside point of view by more neutral, third-party Wikipedians, I have added tags outlining multiple issues on the article. Since there are multiple issues, you might choose to highlight each tag when commenting on it instead of, say, individual sources, because it's much easier to follow.

  • POV tag

Throughout the article there are many issues with undue weight given to contentious sources. For instance, this source by Edzard Ernst is given placement 9 times in the article, whereas an NIH consensus statement is only mentioned twice. Another review on safety is mentioned 16 times. Compounding the issue is that numerous editors feel it is an unreliable source when it shows positive findings on acupuncture, yet when it has a negative finding it can be used excessively. Additionally, there are unresolved disputes regarding reliability of sources. Often sources with no reliability issues according to our policies and guidelines are removed, and this creates WP:BALANCE and WP:IMPARTIAL issues. Here are a few of the incidents:

  • Here is one and another where a journal from an excellent publisher, Elsevier, is removed because it happens to be about "acupuncture", and therefore promotes acupuncture, as if we have the same standard for journals that study "knee surgery".
  • Here is one where a citation from the prestigious BMJ is removed for being a "fringe journal".
  • Here is an example where, yes, a misleading edit summary is used. However, the publication is Elsevier and we clearly use sources much worse than that in the same paragraph, so I think we should discuss what the problem, specifically, with the source is. And if there is a problem, perhaps we should remove sources not up to par with it, found elsewhere in the article?
  • Removal of reliable sources goes on both sides of "party lines", if you will, as seen in this edit. While it's a historical claim and the most reliable source for that would be a historical source, I don't think it's a tertiary source, since it comes from the prestigious Lancet. This is an example of removing sources because of what it "says" rather than who says it. We cannot question highly reliable sources, no matter what they say, so long as they are appropriate for the article.
  • In this revert, we have a study from eCAM reverted, and, again, this highlights a double standard here. We use eCAM in the article, elsewhere, yet new updated reviews and meta-analyses are constantly reverted. Specifically regarding this journal, we should discuss if it's allowable or not and be consistent with our application of it.
  • POV Lede:

TCM theory and practice are not based upon scientific knowledge, and acupuncture is described by some as a type of pseudoscience. This statement has many problems. First, we are using a self-published source, Quackwatch, a website that has never been deemed an expert in acupuncture or TCM. By including it in the lede, we are giving a self-published source that is not a reliable source for statements on acupuncture and the like, massive WP: UNDUE weight. The statement, "acupuncture is described by some as a type of pseudoscience" is also contentious. While true, because some do describe it this way, it only shows one side of the issue. We should add a source that provides this parity. An edit like this one would fix this problem.

The statement, "Scientific investigation has not found any histological or physiological evidence for traditional Chinese concepts such as qi, meridians, and acupuncture points" is problematic because it's only one side of the issue. The research that supports this statement never reviewed literature that shows evidence that fascial planes and some blood vessels closely corresponding to the “meridian lines”, for instance. To remedy this, I think it would be an excellent idea to either state: “However, evidence has been proposed that meridians could be X, Y or Z.”

Third paragraph of lede: Cochrane reviews are higher level evidence so these are good to show here, but when we get into systematic reviews it becomes far too one sided. We overuse Ernst’s systematic reviews and leave out plenty of others that have equal weight. Ideally, for NPOV, we should use several other systematic reviews here. If not, then we should delete all systematic reviews and use the highest level evidence such as consensus statements and Cochrane Reviews.

In the lede, there is a statement, "Some research results suggest acupuncture can alleviate pain, though other research suggests that acupuncture's effects are mainly due to placebo.” The source for the statement was a 2006 publication, and since then we have had research that shows a contradictory result, such as [this one here]. To use a 2006 source in 2015 is a violation of MEDDATE. To use it prominently in the lede, is a violation of weight.

"A 2013 review stated that the reports of infection transmission increased significantly in the prior decade” is wrong. The source looked at data between 2001 and 2011, which was last decade’s decade, not the prior decade which would be 2005 to 2015. This should be amended, stating "A 2013 review stated that the reports of infection transmission increased significantly between 2001 and 2011.” But then is it prominent enough for the lede?

  • Weasel

We have several issues with weasel words throughout the article. Upon quick scan, here are two I attempted to fix:

Some research results suggest acupuncture can alleviate pain but others consistently suggest that acupuncture's effects are mainly due to placebo. The source never uses the word consistently, so this not only is a problem with misrepresenting a source, but is a rather unnecessary addition of a weasel word.

Under the section Conceptual Basis we have two subsections, Traditional and Purported Scientific Basis The title is a weasel phrase since Modern as in Modern Conceptual Basis is the idea which contrasts Traditional Conceptual Basis and I attempted to fix this before being reverted.

  • Self Published Source

We have several violations, namely Quackwatch and Acuwatch, which are self-published sources in violation of our policy on it. The fact that these are given undue weight creates not only unreliability, but non-neutral POV. Additionally, these are violations of WP:BIASED so it's a gross and egregious violation of multiple policies for these sources to exist on the article, much less be given prominence (see POV lede). LesVegas (talk) 06:35, 22 August 2015 (UTC)

  • Systemic Bias

These Chinese sources, amongst many others in the past, were removed. In this instance, the argument was that they lacked impact factor. Nowhere in MEDRS is impact factor mentioned as having any bearing on reliability, and for good reason. Impact factor would naturally be low to nonexistent for acupuncture articles written in Chinese, since these would need to be read and translated first by Western publishers before receiving an IF. The journal in question is in its 35th year and is MEDLINE indexed, peer-reviewed and has no reason according to our guidelines to be excluded. Classic case of systemic bias. LesVegas (talk) 06:11, 22 August 2015 (UTC)

Some details have been omitted from the above. Taking "Systemic Bias" for example, the removed sources were used to support a section titled "Cardiovascular Conditions" with text referring to "statistically significant outcomes" regarding the medical treatment of angina. That is standard WP:MEDRS which requires known-good sources for such claims. The meme about Quackwatch has been rebutted on WP:RSN many times, starting with WP:REDFLAG. Johnuniq (talk) 06:44, 22 August 2015 (UTC)
The source, having been in publication for 35 years is a known good source. On the RSN, Quackwatch was argued to be reliable for claims about pseudoscience, not acupuncture. LesVegas (talk) 06:49, 22 August 2015 (UTC)
Your tagging of the article is pointy User:LesVegas. That you see nothing wrong with the use of a source with an impact factor of zero / 0 raising concerns for me. This is one strong indication that a source is not a "reputable medical journal" Doc James (talk · contribs · email) 16:34, 22 August 2015 (UTC)
Sorry to be so disagreeable here, but where in our policies or guidelines is IF a factor on reliability? Frankly, your inability to see anything wrong with IF ratings when journals are peer-reviewed, Medline-indexed and 35 years old concerns me. LesVegas (talk) 17:12, 22 August 2015 (UTC)
Sure you are welcome to request further opinions. Doc James (talk · contribs · email) 17:18, 22 August 2015 (UTC)
Well, I thought POV was justified until you wrote all this, but basically you just said that the article is written in accordance with WP:FRINGE so, I now withdraw my support for an NPOV tag. Guy (Help!) 22:39, 22 August 2015 (UTC)

Proposal: truce conditions

I've thought for a long time, that if everybody working here could:

  • a) agree to limit discussion in the article to uses of acu that are accepted in the mainstream (adjuvant care for pain/nausea relief in cancer and a few chronic pain conditions) (in other words, declare a zone in the middle) These are uses taught in medical textbooks and practiced at major medical centers
    • a1) agree to a minimal and reasonable discussion of the underlying theory as being based on pre-scientific traditional medicine and having no basis in science (not belabored, just simple)
    • a2) agree to a minimal and reasonable discussion of the difficulties of obtaining good evidence (problems with placebo arm; lack of funding for big trials) (not belabored, just simple)
  • b) agree to self-police - if an acu-proponent shows up and adds some woo content positive about acu outside of that, pro-acu editors here would agree to remove that themselves (and not contest it if an acu-skeptic gets there first) and if some acu-skeptic shows up and adds skeptical/negative content, acu-skeptics would agree to themselves remove it (and not argue if an acu-proponent beats them to it). This is really essential to building up trust that the zone will be honored. A lot of the arguments on this page are about taking long-term stances against relentless pushing from the other side.
  • c) Enlarging or shrinking the zone -- in other words - adding new content or removing existing content, positive or negative, stays out, unless there is significant consensus

It is .. silly and somewhat embarrassing, that the article actually talks about things like using acu to improve sperm motility. All that kind of garbage should be taken out of the article. I understand why it is here - everybody here is following source/evidence-based editing and there is indeed a systematic review on that. But the junk-pile of an article that we currently have is the result of that process. A higher-agreement could produce a more useful article.

What do you all say? Jytdog (talk) 13:14, 10 August 2015 (UTC) (added breaks to make structure more clear Jytdog (talk) 13:14, 12 August 2015 (UTC))

We follow sources and policies. While I have witnessed acupuncture work for conditions other than pain or nausea in China, if all the sources said otherwise, I would have to respect them. Wikipedia:NOTTRUTH is a good read on this. LesVegas (talk) 13:43, 10 August 2015 (UTC)
Oh JD. You are an idealist, and its a great but doomed idea. You only have to read Les' response to see why. -Roxy the dog™ (Resonate) 13:53, 10 August 2015 (UTC)

I think Jytdog should be commended for attempting to create a collaborative situation. I do believe though, that we have no business judging whether editors are pro or con anything. Unfortunately many incivilities on Wikipedia, and I mean the real incivilities come out of the tendency to pigeon hole people, to assume they hold positions which they may or may or not and then to assume those positions gives us the right to condemn . Look at the edits not the editor and use the policies seems useful. When we start to talk about sides we are in territory that judges. Simplify don't judge. Deal with the content, discuss the content. If you have to discuss a long time so be it. There are no right answers here, no right content in my opinion. We are trying to describe a traditional health care system that has made its way into the 21st century. From beginning to end that must be described whether we like the system or not. I may sound preachy. If so I apologize, but frankly I myself have been the subject to the most astounding lies on and off Wikipedia created buy some of our in- appearance, most respected editors. Les has a point, too. Follow the sources whatever we may think. (Littleolive oil (talk) 15:49, 10 August 2015 (UTC))

I see all that Olive, and we don't really disagree on the substantive point you make, that we should AGF. Also, I've been looking at the edits not the editors here for a reasonable time. My comments are based on watching Les and others edit here. I am judging his edits - not him.
I note with some dismay that you missed a bit in the following sentence, to my mind the most important bit ... "We are trying to describe a traditional health care system that has made its way into the 21st century" This should have been what (I think) you meant ... We are trying to describe a traditional health care system that doesn't work, that has made its way into the 21st century" That is very important. -Roxy the dog™ (Resonate) 16:35, 10 August 2015 (UTC)
No. Not my business or yours, that is, to declare or deal with what works or doesn't. Just write the dang article as if you don't know or care... and then maybe the article would be neutral. I do note that you do have a good sense of humour though.(Littleolive oil (talk) 16:42, 10 August 2015 (UTC))
  • I've noticed a trend, here and in altmed articles generally, of adding text and source(s) with little consideration of weight, proportion, and overall context. I would welcome an informal agreement that such additions (or deletions) should gain consensus first. Just because a review exists doesn't necessarily mean that it should be mentioned in the Wikipedia article. I recently created the WP:BESTSOURCES shortcut because I think that part of NPOV is often overlooked. We should be seeking the best sources and prefer those. Quibbling over lots of lesser sources not only wastes time but can lead to contradictory conclusions, causing more quibbling. Contradictions can usually be resolved by preferring higher quality sources. Manul ~ talk 20:58, 10 August 2015 (UTC)
Especially since the article is contentious, consensus is a good step. However, this way of dealing with content additions has to be adhered to by all. I'd note that weight, proportion, context are subjectively identified so there is no objectively right content. I'd also suggest that consensus is not gained by numbers but by the logic of the arguments. Otherwise, the page could be flooded with editors called in to support positions. (Littleolive oil (talk) 23:20, 10 August 2015 (UTC))

What I proposed above is an agreement on the scope of the article, which is something set by consensus of the editors working on it. It is unusual to have an informal agreement that would limit the scope in this way, but the long term BATTLEGROUND around this topic is something that calls for creative solutions. Jytdog (talk) 13:17, 12 August 2015 (UTC)

  • Again, I ask you all editing here to consider the proposal above. The drama today was entirely un-necessary - there is no way in hell that this edit would ever stick and it is terrible to me that the more acu-proponent folks have not been saying so. That is so far outside the medical mainstream. So far. Jytdog (talk) 20:54, 22 August 2015 (UTC)
Jytdog. Please consider your position. You have appeared in three different threads attacking editors both who commented there and editors who do not agree with your position while crying for Les Vegas to be sanctioned. Why do you think your proposal here should be trusted? Why not let Doc and LesVegas work this out in a more peaceful way between them. The drama is truly unnecessary. (Littleolive oil (talk) 21:13, 22 August 2015 (UTC))
Littleolive oil. I stand in the middle. I tried hard to get LesVegas to back away from the cliff edge and come to the middle - you did nothing. Now he is blocked. In any case, the invitation remains open. In my view the acu-proponents have way more to gain from my proposal than the acu-skeptics, who hate it that acu has become mainstream in certain uses. You are spiting yourself. But whatever. I ado also want to point out that this article is under discretionary sanctions. Aggressive editing is not welcome. There is a box at the top of this Talk page notifiying editors of the DS (already a warning to edit cautiously) and yet another box warning editors explicitly ~not~ to be too bold. Jytdog (talk) 01:27, 23 August 2015 (UTC)
Jytdog. We all do what we can as best we can. There was no cliff edge until it was created. You stood in the perceived middle as did I. We have different "middles": the error is in thinking one middle is better than another (and I didn't say neutral). I actually have no position on acupuncture. What I care about is the procession of editors, hurt, damaged, and going out the door. I have seen this sanctioning process multiple times, same process, same ending, and often with good admins as Drmies is. I was not in the least surprised, only sorry. I'm also sorry you see fit to blame me for not helping in the way you think is appropriate. I sincerely wish you the best; I think you are a well-meaning person.(Littleolive oil (talk) 03:37, 23 August 2015 (UTC))
I see it slightly differently to Olive, but having seen this sanctioning process multiple times, same process, same ending, same disruptive intent from true believers. To me this is an indication that DS, when used properly, can be useful in keeping such editors within PAG. -Roxy the dog™ (Resonate) 07:30, 23 August 2015 (UTC)

The Chinese question

I think we have a real dilemma with the Chinese research. One one hand there seems to be a lot of it and I don't see how we can ignore it. On the other, comments have been made about the integrity of the researchers and the research. I wonder if a solution might be to have a section on Chinese research which first describes concerns with the research per sources which discuss this problem, then second, research is added in this section. Acupuncture comes out of a Chinese tradition so it makes sense to add research from the tradition which created the modality. Just a suggestion and thought in attempts to reach a compromise.(Littleolive oil (talk) 23:26, 10 August 2015 (UTC))

That's an interesting idea, Littleolive oil. We know there was once a problem documented many years ago where Chinese studies were more positive than others on acupuncture, and that publication bias may have been an issue, although other possibilities (like conducting experiments very differently than other countries) may have acted as a confounding factor. We don't know how extensive the problem was, is, or even if it exists today, so how do we proceed? Or do we proceed with anything? Your idea is an interesting one worth us thinking about, and I also like my idea of attribution. Surely there's a way to make this work. And perhaps there is still yet another option already being used on Wikipedia that we're not even aware of yet. There have been issues within the pharmaceutical industry where "industry funded" studies are also overwhelmingly positive (almost never negative, that is) compared to government-funded studies. Since that is a problem that dwarfs the Chinese one substantially, surely a precedent has been set somewhere on Wikipedia about how to source industry funded pharmaceutical studies? Perhaps we could just pattern the way we cite our sources after however that's done? At least it could give us ideas. Are you or anyone else aware of what we do with how we're supposed to present industry funded studies on pharmaceutical articles? LesVegas (talk) 04:51, 11 August 2015 (UTC)
We don't base any content on PRIMARY sources describing pharma-funded clincial trials. You don't understand MEDRS after all this time.
In any case, there is no way the community will agree to lower source quality on a controversial article. Per the very useful essay on controversial articles. we need to raise source quality. Not lower it. The effort to add content based on low quality sources that was never going to be accepted, and then tag-bombing the article because that edit was reverted, was transparent and doomed to fail and to bring trouble on the one who executed that strategy. That is what this and the subsequent tag-bombing were all about. It is not going to happen. That is advocating for a FRINGE position instead of aiming for the middle - for what is supported by high quality sources that everyone can accept. Jytdog (talk) 01:33, 23 August 2015 (UTC)
Jytdog please let this go. At some point the fact that you bring up a sanction again and again becomes tedious. Second, perhaps you don't understand what I was suggesting. I am not suggesting or talking about the sourcing for MEDRS content. I am suggesting actually adding content. There is a vast difference between using sources to support content and or claims, and for example noting what the history of the research in a field is, as content for an article. For example, in such a section, the concerns about Chinese research could be noted as long as we source it, as well as what some of the research was and is again R sourced. This is Chinese traditional medicine and as I said before how the Chinese deal with their traditional medicine and how they research it is significant. However, this is only a suggestion for dealing with contention, for dealing with content we don't seem to know what to do with. (Littleolive oil (talk) 21:22, 23 August 2015 (UTC))
LesVegas just got blocked for a week for tendentious editing, and if he keeps it up it will be a topic ban. As to "how the Chinese deal with their traditional medicine", we already know: they are uncritical. China has a strong cultural reluctance to challenging orthodoxy, and thanks to Mao, acupuncture is part of Chinese orthodoxy. Guy (Help!) 21:55, 23 August 2015 (UTC)
China has pro-TCM bias enshrined in its Constitution and there dissent isn't handled lightly. Tgeorgescu (talk) 22:06, 23 August 2015 (UT

And so we see why Wikipedia cannot hold on to its newer editors. My point about the research was that if this is how China deals with research that should be in the article RSourced. But hey, just an idea to deal with contention. (Littleolive oil (talk) 22:53, 23 August 2015 (UTC))

True believers do not last long in WP, and that is their problem, not WP's. We have policies against advocacy. In any case, when the institutions that support science in China become independent and mature, their journals will become valuable sources. They are not there yet. Jytdog (talk) 23:24, 23 August 2015 (UTC)
Again, think about what you are saying specifically when you say "Chinese research". Editors here are using a tiny piece of evidence (one CHINESE systematic review cited by Ernst) to make very broad assumptions, going so far as to say that articles in mainstream medical journals authored by people with Chinese names are unreliable. Advocacy creates certain types of problems, but when advocates are clear and transparent about their reasoning, at least you can have an intelligent debate about quality of sources. This debate does not seem intelligent to me, it seems to too easily generalize, and borders on racism, and I think its outrageous. You want to exclude a journal published in China because it is weak and uncritical? Fine. But if you want to label all Chinese researchers as compromised and unreliable, that's unacceptable.Herbxue (talk) 00:18, 24 August 2015 (UTC)
    • As I've said before I agree. These are the issues as I understand them.

Research coming out of China may be poor.

Can we discount all research where the researcher/s have a Chinese name.

Can we ever discount per WP: RS any research en masse when our policies state that sources are reliable only and specifically per the content they support or should each source be scrutinized per the content it is purported to support.

Is a single voice, Ernst's, enough to discount both Chinese research and research where names of the researchers are Chinese.

Is using Ernst to discount all Chinese research and research where names of the researchers are Chinese, undue weight per Ernst's position.

And finally, can we add a section, and is such content significant, which describes China's research on its traditonial medicine, while also noting western response to that research. (Littleolive oil (talk) 00:51, 24 August 2015 (UTC))

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