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Missing sources

I, along with others, have been accused of not acknowledging that acupuncture is effective for a variety of conditions. If this is true, it needs to be addressed. Accordingly, I assume there are reliable, secondary sources that exist that establish the effectiveness of acupuncture that are not currently used. Please list them below and we can discuss how to best use them in the page. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:17, 17 February 2012 (UTC)

Teasing apart quality and validity in systematic reviews: an example from acupuncture trials in chronic neck and back pain looks to me as applying particularly sophisticated statistical analysis to the question of acupuncture effectiveness. Perhaps "Re-analysis using our conclusions showed a significant relationship between OPVS* score and trial finding, with higher validity scores associated with negative findings." could even be a pull quote.--Elvey (talk) 00:49, 4 March 2012 (UTC)

*OPVS is used to measure validity of findings from randomized controlled trials

It appears to be quite old, 2000 [1]. An update would be nice. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:13, 5 March 2012 (UTC)

Non-supporting source

This sentence from the Scientific basis section:"Research on acupuncture points and meridians has not demonstrated their existence or properties" is not supported by its source. If someone can find a support, please feel free to reinstate it. BTW the url seems to be wrong; try [2]. --Mallexikon (talk) 10:49, 24 February 2012 (UTC)

Eh, it's a reasonable-to-poor summary of the sentence "The anatomical and physiologic nature of the acupuncture point/meridian remains elusive" on page 862. A fairer summary would point out there is suggestive research but conclude that there's nothing definitive. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:54, 24 February 2012 (UTC)

Quite a difference in POV implications. The original statement implies that points/meridians may well exist in some sense, the claim in the article implies they probably don't. --Mindjuicer (talk) 22:53, 24 February 2012 (UTC)

I think WLU's right: this most likely is the work of PPdd. Never mind. He's gone now. --Mallexikon (talk) 02:38, 25 February 2012 (UTC)

Thanks for doing the review, the alternative would be reverting to the version from January 2011 then trying to sort out any positive additions. Ugh, a mess. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:48, 25 February 2012 (UTC)

(de-indent) I'm glad that Mallexikon flagged this; I'd been meaning to. At the moment, it looks like Napadow et. al. (2008) is no longer cited in the lead, nor anywhere in the article. Why? It's a perfectly good source, and wording like WLU's just above to summarize it is obvious and accurate. --Middle 8 (talk) 05:18, 28 February 2012 (UTC)

Dunno. What do you want to include it for? --Mallexikon (talk) 06:25, 28 February 2012 (UTC)

What do you mean? Are you asking why include a good source, or under which subtopic it should go, or what? --Middle 8 (talk) 06:43, 28 February 2012 (UTC)

Well, which sentence should it support (if you want to include it)? --Mallexikon (talk) 07:06, 28 February 2012 (UTC)

Something like WLU's above, as I mentioned, which we would add to reflect the source. First I'd like to make sure we agree on the general idea; please see my comment below[3]. thanks, Middle 8 (talk) 07:54, 28 February 2012 (UTC)

Same problem again

Ahn et. al., 2008 [4] (reference 4 in current version). From abstract: "(blah blah blah not conclusive but suggestive)". This is used to cite a statement in the article that says, predictably, "...science has not found any (evidence)...". It's the exact situation as Napadow et. al. (2008) above, and we should have the (cart-)text following the (horse-)sources rather than the other way around. Any disagreement on this? --Middle 8 (talk) 06:43, 28 February 2012 (UTC)

Not sure what you mean. "The evidence does not conclusively support" means "no evidence" ('cause suggestions are not evidence). --Mallexikon (talk) 07:13, 28 February 2012 (UTC)

Yes, but that phrase is qualified by the immediately following sentence saying "however, the preliminary findings are suggestive...", which we also need to mention. There is such a thing as "suggestive but not conclusive findings", and to highlight one side over the other is inaccurate: it would be true, but not the whole truth, and obviously not the author's intentions. I'm simply asking for a summary for both papers along the lines of WLU's summary early in the thread. --Middle 8 (talk) 07:51, 28 February 2012 (UTC)

The sentence as it is ("science has not found any evidence...") is supported by this source ("findings are suggestive" doesn't count as evidence, which in turn means that no evidence has yet been found). If you want to rather use the source for a different kind of sentence (quote comes to mind) - let's hear it. --Mallexikon (talk) 08:25, 28 February 2012 (UTC)

Middle8, could you please read the discussions we've already had (several times) regarding Ahn et al's use of "suggestive". Especially, this section. Ahn do not say of what the findings are "suggestive" - it's just a throwaway remark in what is actually a fairly negative and inconclusive review. Famousdog (talk) 10:21, 28 February 2012 (UTC)

@ Famousdog and Mallexicon: On Wikipedia, unlike Believerpedia or Skeptopedia, we don't summarize only one side (or aspect) of a source's conclusions. Ahn is specific about what "suggestive" means: some of the studies (albeit of low quality) showed positive association between acupoints/meridians and impedance (etc.), and "suggestive" refers to those associations. Ahn also says that these suggestive results can guide research that scientists may do in the future, a statement that is, of course, true in any field. These are specific antecedents of "specific", hardly "throwaway".

Research into acupuncture is way more active than, e.g., homeopathy because there are all sorts of findings that, while not conclusive, are suggestive enough to justify further research. The article should make this clear, which is easy enough when sources are summarized adequately. --Middle 8 (talk) 12:37, 28 February 2012 (UTC)

Holy hell. I give up. You're dead wrong, Middle8, but I'm so exhausted from trying to patiently explain to Mindjuicer why you can't say vague sh*t like "X is suggestive" that I cannot be bothered going through it all again. Just search this page for all instances of the word "suggestive" and you will see (assuming you want to) that there is a fairly compelling argument not to even bother mentioning this in the article. Famousdog (talk) 15:15, 28 February 2012 (UTC)

Point of information The Ahn review is currently used to support the following statements:

• "...scientific research has not found any histological or physiological correlates for qi, meridians and acupuncture points"
• "No contemporary research has supported the existence of qi or meridians."
• "Qi, yin, yang and meridians have no counterpart in modern studies of chemistry, biology, physics, or human physiology and to date scientists have been unable to find evidence that supports their existence."
• "...no research has established any consistent anatomical structure or function for either acupuncture points or meridians."
• "The electrical resistance of acupuncture points and meridians have also been studied, with conflicting results.

Famousdog (talk) 15:33, 28 February 2012 (UTC)

Single studies might claim to have found some correlate, but due to the conflicting results and inconsistencies (pointed out in reviews by researchers such as Ahn et al) this means that the weight of evidence is that scientific investigation has not found physical/physiological correlates that support the existence of qi/points/meridians. I am actually going to change the second one to: "Contemporary research has not supported the existence of qi or meridians." To clarify that it is the weight of evidence that matters not single studies. Famousdog (talk) 15:33, 28 February 2012 (UTC)

We're talking about summarizing -- accurately -- secondary sources, not synthesizing primary ones. WP:WEASEL applies to editors, not to authors of sources. Re-read the abstract of Ahn et. al. (2008). It says that certain papers met the article's inclusion criteria, that 5 of 9 point studies showed positive association between meridians and bioelectrical measurements, and that 7 out of 9 meridian studies did. It goes on to say that the studies were generally of poor quality. Based on these findings, the review says (a) that evidence does not conclusively support the hypothesis that acupoints or meridians are electrically distinguishable, but that (b) the preliminary findings are suggestive and offer directions for further research.

That is obvious enough, but for some reason, you want to summarize the article by mentioning (a) but not (b). I'd bet that consensus at RSN would disagree.

Perhaps editors editors «can't say vague sh*t like "X is suggestive"», but secondary sources certainly can, and frequently do. See Scientific_opinion_on_climate_change, for example, which uses it three times. Global warming, a featured article, uses it once (in the lede, no less). A lot of scientists have edited those articles. And of course it is important that people everywhere take data on global warming seriously, even if much of it is suggestive and not rock-certain.

The future of mankind won't be at stake if we fail to do the same in acupuncture, but we would be failing to summarize things correctly. I suggest, without malice, that editors consider whether their arguments in this topic area may be biased. Unlike established "woo", acupuncture's efficacy and mechanisms are unclear. The jury is out, and one or another single scientist is not the arbiter. Cochrane and other reviews should be the basis of the article, not something like Ernst and Singh (a plainly weaker MEDRS, cited as fact, in the lede: that would never fly in most articles). Saying there's no conclusive evidence may be a partial truth, but it doesn't correctly portray the whole picture. After all, there are virtually no double-blinded placebo-controlled studies for most surgeries, but editors don't get in a twist about that. Data that are suggestive are very obviously a relevant part of the picture, and sources that say so should not be rationalized away. It's time to make sure that we're not using double standards across WP. regards, Middle 8 (talk) 10:33, 1 March 2012 (UTC)

Okay - Let's talk specifics because this is going nowhere. Exactly what do you want to add to / change in the article? Because adding a statement like: "Ahn et al think that the literature on electical conductance is suggestive (full stop)" would be meaningless. I say again: "Suggestive" of what? Pretty much all studies say things like "further research might be a good idea" because they're the people doing the research! But come on, what exactly do you want added to the article? Famousdog (talk) 11:18, 1 March 2012 (UTC)

(e/c)::::Quick note -- and I answered this already[5] -- but if you're still not clear on "suggestive" (Ahn, 2008, abstract), just read the last sentence in light of the preceding one. Even better, read the whole thing. Ahn is simply saying that the findings are suggestive that the hypothesis the paper was examining may be true. He stated the hypothesis explicitly in the previous sentence -- that acupoints or meridians are electrically distinguishable -- and he didn't need to repeat it in the following sentence. Obvious enough, eh? Please tell me whether you agree.

I'll get back to you with specific wording, but the whole point of this thread is to see if we can agree on a few particular questions. If we have, then the specific wording is easy. So please answer these: in light of my immediately preceding post, do you agree (and if not, why) that we should cover both of Ahn's statements: that (a) that evidence does not conclusively support the hypothesis that acupoints or meridians are electrically distinguishable, but that (b) the preliminary findings are suggestive and offer directions for further research? And in general, do you agree that our using a word like "suggestive" is fine as long we're quoting or closely paraphrasing a source that also used the word? Thank you! I have to admit that this stuff strikes me as frustratingly elementary. We do seem to be on different wavelengths sometimes but I think we'll sync up. --Middle 8 (talk) 13:40, 1 March 2012 (UTC)

No, no you have not "answered this already" the comment you link to above is you arguing the semantics of "suggestive" and asserting that things should be "made clear" in the article. I repeat: what exactly do you want to do? Famousdog (talk) 16:42, 1 March 2012 (UTC)

@FD - "Semantics" is a pejorative way of referring to my advise to "read in context." It would be easier to collaborate if you'd just answer my questions. But that's fine. I'll get back to you soon w/ wording that is faithful to the source. --Middle 8 (talk) 07:03, 4 March 2012 (UTC)

We've discussed this already, here. The very, very best thing we could say is that there is no conclusive evidence for acupuncture points or meridians, only preliminary data from poorly designed studies that suggest future research. Yes, you could cherry-pick the raw numbers of studies, but only by ignoring their poor quality. False comparisons to climate change aren't helping anything since it is a modern theory developed in the 20th century with unarguable evidence based on empirical results and not a prescientific theory based on principles that contradict what we know about biology. The comparison with surgery is actually quite telling - because surgery has indeed demonstrated the existence of organs like the liver and gall bladder, but also the lymphatic system, arteries, veins, arterioles and in combination with microscopy, capilliaries (the latter too fine to be seen with the naked eye). Surgery has been incredibly successful at identifying and treating disorders of gross anatomy. Double-blind placebo controlled trials are only needed to demonstrate the effectiveness of medical interventions and phenomena that might exist at a barely detectable threshold. They're not needed to verify that the liver exists and everyone has one. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:27, 1 March 2012 (UTC)

@WLU - I'm not sure why you cite this; it's just a thread that ended up with my wanting to stick close to a source (of the "no proof but suggestive" type) and your disagreeing (& wanting to cite only the "no proof" parts). I argue for the same in the present thread. Your wording strays far from the source and even in the lede would be too close to an original synthesis. Your argument against cherry-picking primary sources is a straw man, since Ahn, Napadow and Langevin are all secondary.

You misunderstand my comparison with climate change; it only has to do citing "suggestive" results obtained by modern scientists.

You also misunderstand my comparison to surgery and EBM. The gold standard for demonstration of efficacy in EBM is systematic reviews of double-blinded RCT's. This is true for anything: drugs, procedures, whatever. See here and here. Not much point in further discussion of this apart from discussing possible edits. The point of research into efficacy of surgical techniques isn't to prove the existence of organs (straw man). Your statement "Double-blind placebo controlled trials are only needed to demonstrate the effectiveness of medical interventions and phenomena that might exist at a barely detectable threshold" is not at all consistent with the principles of EBM.

Anyway, threads do tend to drift, don't they. More later with specific suggestions of edits that closely follow sources. --Middle 8 (talk) 08:11, 4 March 2012 (UTC)

Middle8, your strategy of "... to see if we can agree on a few particular questions. If we have, then the specific wording is easy..." in my experience is not fruitful. Those particular questions almost always lead to the discussions of general world views (which in turn never lead to anything). I think the only way to solve this problem here is if you come forward with the concrete wording you have in mind regarding how to include Ahn's source. Cheers, --Mallexikon (talk) 09:07, 2 March 2012 (UTC)

@Mallexikon: As they say in Raising Arizona -- "OK, then". No problemo. --Middle 8 (talk) 07:03, 4 March 2012 (UTC)

References

Lede: retractable needles

This sentence here, " The recent development of retracting needles as a form of placebo control has resulted in a new wave of studies, the weight of evidence from which suggests acupuncture's effects are due to placebo.[15][16]", should IMO be removed from the lede. 1.) We already stated that "other reviews have concluded that positive results reported for acupuncture ... can be explained by placebo effects" just two sentences earlier. 2.) new is very debatable since the sources are from 2006 and 2008 (our newest source finding evidence pro acupuncture efficacy is from 2011). Comments? --Mallexikon (talk) 11:01, 28 February 2012 (UTC)

I was going to bring this up too, actually. Yes. --Middle 8 (talk) 12:38, 28 February 2012 (UTC)

I actually made this change in an attempt to correct an issue raised by Randomnonsense. The phrase "a new wave" doesn't in this context mean "a recent wave", it simply means that the development of retracting needles stimulated several new studies in the (relatively) recent past. However, you're quite right, this probably doesn't belong in the lead, so the refs could just be used for the comment about placebo two sentences earlier. I'll do that now. Famousdog (talk) 15:46, 28 February 2012 (UTC)

I'd suggest rephrasing to avoid reference to time - rephrase it as "studies published since the development of a new form of placebo, retracting needles that do not penetrate the skin, have suggested that acupuncture's effects are due to placebo". WLU (t) (c) Wikipedia's rules:^simple/_complex 09:32, 1 March 2012 (UTC)

Sounds good to me. Famousdog (talk) 11:19, 1 March 2012 (UTC)

I don't like it. There are other studies not using retractable needles who suggest the same thing. Also, as far as I know not all studies with retractable needles suggest placebo effects. --Mallexikon (talk) 01:49, 2 March 2012 (UTC)

Me too, it sounds like original research to me to take an inferred trend from a source and apply causality.Herbxue (talk) 16:33, 2 March 2012 (UTC)

@ Mallexicon (01:49, 2 March 2012): Yeah, I agree. And those studies are just as susceptible to some of the caveats (stated in several sources cited) about controls in acu research. That said, I was going to express concern about how that issue was handled in the lede, but I think that the current version[6] is fine in that regard. (Not yet sure about pertinent wording in the article body.) --Middle 8 (talk) 06:44, 4 March 2012 (UTC)

Tweaks to lede

This edit restores a sentence lost in complex partial reverts, namely, a better sentence about adverse events than the previous one (better in terms of weight, since adverse events are exceedingly rare, and better sourced because three sources are used compared to Ernst's single source which didn't even give a rare rate (i.e., per N treatments) for adverse events). Also, it removes "tentatively" from endorsements by various org's because "for certain conditions" is sufficient qualification. Finally, it says who criticized the various orgs' statements: certain scientists, not other org's (WP requires attribution, specifically WP:WEIGHT). These a minor tweaks, and the assertion (expressed in one ES) that these edits are "anti-science" is Wikipedian hyperbole at its best. regards, Middle 8 (talk) 07:48, 29 April 2012 (UTC)

I see that my edit above was reverted by User:Sgerbic with the edit summary (ES) "No the lede before was better", which does not advance the discussion at all. Explaining our reasoning in ES's worked OK for the first few rounds, but now I think we need to discuss in detail, i.e. here. best regards, Middle 8 (talk) 21:31, 29 April 2012 (UTC)

A late comment, but anyway - I agree with Sgerbic's revert. That part of the lead already noted that acupuncture is generally safe with trained practitioners, and that edit removed the fact that adverse effects are rare - but do occur. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:06, 9 May 2012 (UTC)

Pseudoscience

I recently reverted an edit calling acupuncture a pseudoscience. MEDRS is part of it as it is a forbes claim, and we have much, much higher quality sources (Cochrane reviews) that don't refer to it as a pseudoscience. I think that giving the forbes claim any weight when we have such high quality sources is WP:UNDUE. Secondly, "pseudoscience" on WP generally applies to method, i.e. something is pseudoscientific if it doesn't hold to the scientific method. While acupuncture may be indistinguishable from a placebo, it is in fact studied scientifically. Whether it has an actual effect or not is not what would make it a pseudoscience. I could see that Qi or meridians can be referred to as psuedoscientific, but acupuncture does not need those to be acupuncture, which is the act of inserting needles. Doctors who also practice acupuncture do not generally talk about esoteric energy. SÆdon^talk 07:43, 29 April 2012 (UTC)

Agree that WP forbids categorizing acupuncture as pseudoscience given sources at hand. Your comments are helpful, but I think there are some reasons that are even better because they are deeply rooted in WP policy and the development of scientific consensus itself. See WP:FRINGE/PS & WP:RS/AC: editors who wish to add the category have the burden of proof to provide evidence of sci consensus that acupuncture is pseudoscience. Statements by individual scientists, or signed petitions, obviously don't meet that threshold; what would be needed is a statement by a scientific academy where there is a cross-range of views, adequate review and no selection bias. Pragmatically, it's better for WP to restrict the category of pseudoscience for the whoppers like creation science; otherwise, it dilutes the message. And from the standpoint of being faithful to scientific consensus, it's simply inaccurate to use the category. Now, we can certainly use good MEDRS's giving the considered opinion of scientists, but that would go in the article body, not in the category space. regards, Middle 8 (talk) 07:57, 29 April 2012 (UTC)

The edit I'm referring to was not a category edit. See [7]. SÆdon^talk 08:07, 29 April 2012 (UTC)

Whoops, I see. Thanks. Yes, Forbes is about as far from a MEDRS as can be. And the amount of research going on certainly indicates scientific interest in mechanism and efficacy, something that is absent with pseudosciences. Sci consensus is nascent. --Middle 8 (talk) 08:24, 29 April 2012 (UTC)

You both make some good points, but the matter becomes confused because of a mixture of content that:

• (1) "mentions" that someone has called it pseudoscience (non-MEDRS sources are okay for such statements because they are part of the controversies surrounding the subject, and not strictly and solely about biomedical claims);

• (2) "categorizes" (the use of the category tag, as well as declaring in the Wikipedia voice, that the subject is pseudoscience) the subject as pseudoscience. Per the ArbCom ruling, we are allowed to document that individuals and groups have called acupuncture pseudoscience, but acupuncture (as a whole) isn't really eligible for categorization as PS. I hope that the distinction is now clear. We need to restore documentation that it's been called PS (including in Forbes), but keep the category tag off the article -- Brangifer (talk) 22:09, 29 April 2012 (UTC)

(outdent) @Brangifer, 22:09: quite right re categories (as usual, we agree on the criteria for those). Re Forbes, that source is an article by a well-credentialed scientist giving his considered opinion that ear acupuncture used on the battlefield is pseudoscientific and a waste of resources. Forbes is indeed a reliable source for quoting that, although we obviously wouldn't use it for any kind of thing that would require scientific peer review. So I agree that we can use the source, with attribution, to say what he says; I added it here to the article body, with appropriate wording.

But --and I'm saying a lot of this for other editors, not you, because I believe you grok it -- we can't use the source as a statement of fact, i.e. "acupuncture is pseudoscientific". And we certainly can't put it in the lede straight away; we first need to discuss whether the weight of sources altogether justify talking about pseudoscience in the lede.

BTW, please share your thoughts, if you wish, on the discussion under the preceding header; and/or let me know if I should clarify the issue further. thanks, Middle 8 (talk) 00:07, 30 April 2012 (UTC)

Exactly. You also added it to a logical section. It doesn't deserve mention in the lede. -- Brangifer (talk) 00:12, 30 April 2012 (UTC)

Cool. I wonder what on earth this was about? Thanks for fixing. --Middle 8 (talk) 03:06, 30 April 2012 (UTC)

Agreed, I don't think the page can be put into Category:Pseudoscience on the basis of that article, the current mention in the body is adequate. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:13, 9 May 2012 (UTC)

Criticisms of Acupuncture

There is so much controversial information on this page, and so many people who want to use it as a soap box, that I suggest creating a separate criticisms section to clean up the main article. — Preceding unsigned comment added by CoulterTM (talk • contribs) 14:31, 6 May 2012 (UTC)

It would be much better if the lead stated: "Acupuncture doesn't work as shown by these studies. Pro-acupuncture pushers rely on these two laughable articles. Incompetent acupuncture pushers have killed people. There is no reliable information that supports the existence of the pseudoscientific crap that is the foundation of Acupuncture. If you want to read the pro-acupuncture propaganda, go ahead and read this article, but just know that there is no supporting science except if you're really good at research mining for the one or two articles that really don't show anything, but the acupuncture-pushers think they do. Acupuncture is only shown to be useful in Wikipedia, because this project has no clue what constitutes science." SkepticalRaptor (talk) 21:03, 6 May 2012 (UTC)

CoulterTM, see WP:STRUCTURE. A topic that has reliable sources criticizing it should include those criticisms in the parent article. We shouldn't ghettoize them into a separate article.

SkepticalRaptor, your statement is unacceptably partisan. Though acupuncture is based on a prescientific mode of thought and lacks conclusive evidence it works the way it is described to work, there is considerable evidence supporting its limited use. Though I personally think that eventually the topic will become discarded and considered pseudoscience at some point in the future, it is undue weight on the skeptical point of view to make such a claim in the lead. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:16, 9 May 2012 (UTC)

WTF cares if it's partisan. I didn't change the article, so I'm stating a well-based scientific opinion. Prescientific? Are you serious? Acupuncture is not plausible, yet this article makes it appear to be. It is absolutely pseudoscientific, since it is based on poorly designed primary articles that have not been repeated in real science. Without a plausible mechanism, it is pure pseudoscientific crap. And you use skepticism in the most pejorative sense possible, the paradigm used by the pseudo skeptics. In fact, I present a scientific skepticism that demands real evidence, because Acupuncture is junk science. It makes extraordinary claims without extraordinary evidence. Speaking of undue weight, we're giving vast amounts of undue weight to weak studies. But hey, if you want to accept the crap level of this article, so be it. Acupuncture is just one of several crap medical articles on Wikipedia, because it's overrun by pseudoscience believers. So, good for you in reverting reasonable edits and lecturing me on the sanctity of a pseudoscience article, just because I'm not a delusional anti-science jerk. I get to rip this article amongst real science and medicine fans, and we laugh on how you all pat yourself on the back by providing unscientific junk science to the world. I'll stand up for real neutral science, but if you've got some good evidence that acupuncture is anything more than a failure (placebos are complete failures in medicine). Let me go work on water memory and homeopathy. Oh wait, you probably think that works too, or it's "pre-scientific." Damn, this is too funny to even imagine. LOL. SkepticalRaptor (talk) 23:58, 9 May 2012 (UTC)

If you don't like the rules, you are not obliged to edit - but if you don't follow them you'll end up blocked and your contributions won't last very long. If discussions aren't aimed at improving the page, then they shouldn't be occurring as wikipedia is not a forum - for skeptical debunking or pro-acupuncture boosterism. If it makes you feel any better, pro-acupuncturists argue the page is hopelessly biased toward the skeptical side.

Anyway, per WP:NPOV we must represent things in proportion to the degree and weight of attention given in reliable sources. Despite acupuncture being implausible in both its original magical form and it's more modern "counter-irritant" form, it's still an active source of discussion and serious (albeit credulous) research - so we can't simply portray it as debunked. You are free to add reliable sources that address the missing skeptical information, as they are required to verify any information on the page. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:52, 10 May 2012 (UTC)

I understand SR's frustration over this article. I am looking at this one sentence in the lede that really worries me. "There is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles" Yes there are citations that are listed but don't you think that poking sterile needles into someone is just someone poking sterile needles into a body and then taking money for it. How can we with a good conscience allow this statement and then allow the next sentence "but does carry small but serious risks and adverse effects including death"? Sometimes acupuncture is harmless, unless it results in death? I'm sure that acupuncture supporters think that this page is too skeptical, because there is some skepticism on the page. IMO we need clean up the page to say, "this is acupuncture defined", "here is its history", "there is no scientific evidence that shows that acupuncture works, but there are real cases of people who have died because of it". http://whatstheharm.net/acupuncture.html We must remember that Wikipedia is a powerful resource for people who are relying on it to know if there is anything to it. It should be a clean lede stating the facts and not glossing over some obscure studies that "might" show some effect. Be Bold. My two cents. Sgerbic (talk) 01:27, 10 May 2012 (UTC)

Thanks for you two cents. However, WLU already said everything there is to say in this regard. --Mallexikon (talk) 03:14, 10 May 2012 (UTC)

Sgerbic, if you have reliable sources that can be used to verify these points without having to engage in a synthesis, then have at thee. I'm middling familiar with the sources and have yet to see anything that would support such a stance - not that they aren't out there, perhaps I just haven't seen them. But sources always come first.

Re: the lead, perhaps the sentence could be reworked but the essence of the point is there - acupuncture generally results in very few adverse effects when clean needles are used by sterile practitioners. The fact that it may have no main effects is a point that would require addressing using a different set of sources, expanded upon elsewhere in the page. But again - sources come first. WLU (t) (c) Wikipedia's rules:^simple/_complex 03:22, 10 May 2012 (UTC)

(outdent) Agree with WLU on sources. Regarding the death soundbites: This study looked at 12 prospective surveys over one million treatments and found that the risk of "serious adverse events" was five in one million treatments. That means that the risk of death is much lower: probably about two orders of magnitude lower given that only 12* of the 715* serious adverse events were deaths. (*Note that these numbers were from every source they looked at, not just the prospective surveys used to quantify the risk as a rate). It's incredibly unscientific to make a big deal out of anecdotes or raw numbers without a rate (and the lede currently makes the latter error -- other articles on far more lethal treatments don't, for good reason). How could a "skeptic", a degreed scientist, abandon science in favor of advocacy?--Middle 8 (talk) 15:22, 20 May 2012 (UTC)

I think the risk of serious adverse events including death, not normally one anticipated in acupuncture, is worth keeping. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:15, 21 May 2012 (UTC)

NPOV re efficacy in lede

Just made a tweak to lede [8]. The ES suffices, but am starting a thread here anyway in case there is debate: We need to qualify both assertions ("tentative" -- per editors' reading, and by whom, e.g. NIH) and rebuttals (by whom - in this case, not scientific bodies, but individuals). See WP:WEIGHT and WP:VNT. regards, Middle 8 (talk) 02:10, 19 May 2012 (UTC)

Well, I anticipated some objection, but nothing like this from USer:SkepticalRaptor, whose ES distorts my history of editing (and tends to assume bad faith), fails to address the rationale I provided, and misrepresents sources -- all this from an editor who's rarely if ever discussed anything with me. The ES says:

Reverted to revision 492664200 (...): Per WP:WEASEL. Editor continues attempt to POV the article by making it seem only "certain" scientists think acupuncture is junk medicine.

There is no evidence that I "POV the article"; see my preceding edit, for example, which is not atypical. Show me a single disingenuous edit. And please use this page to refute my logic, or just ask if it's not clear. The "pro" opinions by groups carry more weight than the "con" rebuttals that are not by groups; that's just the way WP works, even if it makes some skeptics sad. Provide sources indicating what percentage of scientists think acupuncture is junk medicine, if you want to slant the article that way. In fact, Cochrane-type reviews vary depending on which condition is treated, and basic questions about study design (e.g. controls) remain unsettled. See this re increasing medical acceptance, which does not always weight for gold-standard EBM evidence if costs and risks are low.

Anyone else want to weigh in? I'll revert in a couple of days if no rebuttal. regards, Middle 8 (talk) 08:09, 19 May 2012 (UTC)

I prefer the version reverted to by SR. "Certain scientists" marginalizes the opinion unduly, and the change is unclear (as well as having a grammatical error). There are no percentages for how many scientists accept versus criticize acupuncture that I'm aware of, a popular article doesn't merit inclusion or rewriting of the page. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:11, 21 May 2012 (UTC)

I'm not trying to marginalize the opinion, but rather accurately source the comments: these are different things. An attempt to imply that the criticisms represent some larger view is OR unless we can find other sources indicating a larger swath of opinion. The sources we have are large, prestigious groups have giving qualified endorsements of acupuncture efficacy, and individuals and maybe Quackwatch refuting. None of the rebuttals are in the same league, MEDRS-wise, as the other groups. How to fix this?

Moreover, the passive voice ("have been criticized") is weaselly, and the prose ("however", followed by critics' rationale) makes it sound like the groups are wrong and the critics are right. The critics get more space than the endorsers despite the latter carrying less weight. Needs to be fixed. --Middle 8 (talk) 22:19, 21 May 2012 (UTC)

Neutrality Tag

I have sufficient concern about the article that I think it's time to bring in more editors, and one of the best ways to do that is to POV-tag it. Please leave the tag there -- there is no good reason to remove a good-faith tag added for nontrivial reasons. My concerns include undue weight to the skeptical side, e.g. the lede's mention of large organizations that have given acu qualified endorsements, followed by an imbalanced mention that these endorsements "have been criticized" (by whom?) and then going into some detail for the criticisms. This is massive undue weight because (a) the WHO, et. al. far outweigh the individual critics, and (b) only the critics' side is explained.

I'm also concerned about the credulous mention of fatalities when risk of "serious adverse events" is 5 in one million, which means the fatality rate is much smaller (see this article, which used to be in the article, and was removed for some reason). Waving hands about raw number (Ernst's 86) without a rate is bad science; only a rate is meaningful. And the rate is so low that mentioning it in the lede is undue weight; saying that acu is safe from a qualified practitioner suffices. And there's other stuff -- the general tone is slanted, and specifics need adjustments, or at least broader consensus than what a half-dozen habitual editors generate. We need more editorial eyes and a tag is a good way to get that. regards, Middle 8 (talk) 10:21, 20 May 2012 (UTC)

We can fill the criticisms in if you'd like.

The mention of fatalities seems perfectly valid, couched as it is with their rareness.

Tags are terrible ways of gathering outside attention, noticeboards are much better. Tags are usually seen, used and treated as badges of shame, they never actually succeed in gathering outside attention. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:06, 21 May 2012 (UTC)

I also think that we should mention the fatalities, the question is just where. If the number is correct and SAE amount to about 5 in one million treatments, Middle 8 actually has a point - mentioning death in the lede would give undue weight to this matter. --Mallexikon (talk) 02:31, 21 May 2012 (UTC)

Agree with Middle8 that fatality rate is so low that it does not belong in the lead. Once this is fixed, however, the POV banner has to go. Famousdog (talk) 08:15, 21 May 2012 (UTC)

Yes, that'd be desirable. --Mallexikon (talk) 09:06, 21 May 2012 (UTC)

Thanks for the tweak, FD -- I tweaked further to accord with the source above, which I added. I'm not especially happy with removal of the tag since the SAE is obviously not the only actionable issue I mentioned. But I'm fine with using noticeboards if the rest of you dislike tags that much, and if I can count on you to help uphold WP:DR ("for the enemy" and otherwise). In particular, I suggest that we all undo drive-by reverts (and otherwise discourage them). By "drive-by reverts", I mean reverts done with little or no serious discussion on this page. This has happened a couple of times lately. I'm fine with my & others' edits not sticking if consensus so dictates, but not when it's just bullying behavior by an editor blowing off just about every aspect of WP:DR. Sound OK? -- Middle 8 (talk) 11:24, 21 May 2012 (UTC)

Here's yet another drive-by revert with a boilerplate, meaningless RS and not even cursory discussion on talk. All the edit did is remove a good source and prose that stuck close to it. It's a good example of this strategy, which we've seen before [9] [10]. Now's the time for others to step up and undo the drive-by if you want to help promote reciprocal good faith and decent WP:DR here. I can't be the only one doing this. --Middle 8 (talk) 22:40, 21 May 2012 (UTC)

This revert by SkepticalRaptor is definetely unacceptable. However, I don't see the problem in the what you call "drive-by' fashion it was done; what concerns me is that SR deleted sourced material without consent, discussion, or even a rationale. Anyways, thanks for keeping your cool. Cheers, --Mallexikon (talk) 02:35, 22 May 2012 (UTC)

@Mallexicon -- Yes, "drive-by" is a misleading term; it had to do with my suspicion as to how the revert was made: reflexively, with scant attention to the source or logic behind it, and probably just because it showed up on a watchlist or something, and didn't slant in the "acupuncture is a big fat murderous lie" direction. I appreciate your comments -- collegiality, calmness and rationality are like gold around here. regards, Middle 8 (talk) 08:26, 23 May 2012 (UTC)

@SkepticalRaptor (since you don't want posts on your talk page): "Reverted POV edits back to a strictly NPOV position that accupuncture has no efficacy and may have high risks" is not a valid rationale to delete sourced material. And the MEDRS evidence we have in the article contradicts your definition of a NPOV towards acupuncture. Middle 8 feels bullied by your behaviour, so please take it a little easier. Cheers, --Mallexikon (talk) 02:52, 22 May 2012 (UTC)

(1) I agree that the death thing need not be mentioned in the lead.

(2) Tags are a pain in the ass! They rarely do any good.

(3) As to "drive by" editing, if the edit summary is clear, discussion isn't always necessary, but if BRD is then violated by a restoration (edit warring), rather than a revision that deals with the concerns raised in the previous edit summary, problems ensue.

(4) If SR isn't participating, then (s)he should be encouraged to do so. If SR isn't accepting communication on their talk page, they don't deserve to edit here PERIOD! Talk pages are for communication, including with editors who hold opposing and uncomfortable views and comments. One has to tolerate a certain amount of it. We edit collaboratively here. If SR can't handle that fact, they shouldn't edit Wikipedia, or they should at least stay away from conflict and controversy. -- Brangifer (talk) 03:00, 22 May 2012 (UTC)

@Brangifer -- (applause) -- very well said. More below to Famousdog. cheers, Middle 8 (talk) 08:26, 23 May 2012 (UTC)

I agree that the issue of the minute risk of death does not need to be specifically addressed in the lead. To mention it specifically is giving it undue weight. The general statement about serious adverse events in the lede is consistent with other articles about medical treatments. I reverted the article back to the version that currently seems to hold consensus, without the specific mention of death. Puhlaa (talk) 00:20, 26 May 2012 (UTC)

Middle8, I agree SR is being a bit unhelpful, but including those edits by OrangeMarlin doesn't contribute anything to this particular discussion. It seems you're labeling as "drive-by" anything you don't agree with. They look fine to me. In terms of changes to the lead, i would recommend getting rid of "(five in one million)" because it impairs readability, is covered adequately by use of the word "small" (if you don't agree, feel free to make it "very small") and research has shown that most people don't understand or misunderstand probabilities stated like this. Just saying. Famousdog (talk) 10:19, 22 May 2012 (UTC)

@Famousdog -- Why, yes, I would very much appreciate it if you could undo any and all reverts of my edits -- and I have some general ideas for edits that you might do on my behalf. I am a busy person, after all. (j/k)

Seriously, Brangifer and Mallexicon explained it better than I did. Instead of "drive-by reverts" we might just point out reverts that are poor on the merits and poor substantively. Maybe (as in this case) they show hastiness, or occur in a pattern slanted toward a certain POV or targeted at a certain editor. I suspect SR has an eye on me because s/he reverted reverted me even after I added a good skeptical source. So you can see why I appreciate it when Brangifer restored the edit, sparing me a probable edit war.

As for the year-old examples I cited from OM, I remember that they were similar to SR's at the time, e.g., eschewing the talk page (cf. exchange at User_talk:Middle_8#Acupuncture). But your reply caused me to realize that those examples are not obvious without context, and it's a long time ago, and who cares, so.....

Finally, good idea re not cluttering up the lede with numbers; done (with quote and attribution, in hopes of keeping it stable -- but feel free to revert to plain text if it looks too busy). regards, --Middle 8 (talk) 08:26, 23 May 2012 (UTC)

@SkepticalRaptor: This is the second time you reverted a good-faith, reliably-sourced edit by Middle 8 (after this). Please stop doing that, it's disruptive. Much better to have a discussion instead. Cheers, --Mallexikon (talk) 03:37, 24 May 2012 (UTC)

Quick note I reverted Skeptical Raptor's most recent revert of a well-sourced edit by Mallexikon. SkeptcalRaptor, you said it was to be NPOV but actually it was clearly supported by the cited RS. Please read the sources.Herbxue (talk) 22:58, 31 May 2012 (UTC)

"Paradoxes in Acupuncture Research: Strategies for Moving Forward" reference

Regarding Middle 8's reference to the "Paradoxes" paper: I think if you're going to quote the paper where it says both sham and traditional acupuncture are equivalent and better than standard care, then you should also mention that the article concludes with "It is conceivable...that the therapeutic effects of acupuncture treatments are all or largely based on nonspecific, placebo-related responses." I feel like this should be expressed in your edit, and it would better represent the "Paradoxes" review. If sham works just as well as "real," it could just be because both equally evoke a placebo response.Dustinlull (talk) 12:57, 5 June 2012 (UTC)

True, although that's not the only explanation the authors cite, given the large number of unknown variables in the study design; see the section titled "3.1. Factors Potentially Contributing to “Therapeutic” Effects of Sham Acupuncture Treatments" (link to "Paradoxes"). There's a lot there to think about and possibly put in the article. (For a specific example of what could be happening besides placebo, see my comment to WLU just above.) That said, you may notice that we do get into the placebo thing heavily because we've referenced other review articles discussing the same sham studies that "Paradoxes" does. And it's in the lede, so readers can't miss it. --Middle 8 (talk) 05:49, 6 June 2012 (UTC)

Sources

• [11]
• [12]
• [13]
• [14] - Ernst mostly covered in terms of (S)AE's, but 86% relaxation is noteworthy

Hello~ is this recent review of the literature in the prestigious Journal of Gastroenterology and Hepatology which cites cites the effectiveness of acupuncture for the treatment of gastroesophageal reflux disease (GERD) a reasonable source? http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2012.07064.x/full

It shows that in patients who were already medicated with PPIs and still suffering symptoms, acupuncture was shown to be more effective in reducing regurgitation and heartburn than doubling medication. (http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2007.03520.x/full)

thanks Dickmojo (talk) 13:10, 6 June 2012 (UTC)

Nice catch. While not ideal (because it's not a meta-analysis of multiple RCT's), it is entirely acceptable because it's a sec source. WP:MEDRS says such sources are good even if they summarize a single primary source (which this one does with respect to acu). regards, Middle 8 (talk) 07:50, 13 June 2012 (UTC) (comment originally added 15:27, 6 June 2012‎)

"Adverse events" section: cleanup

I did a much-needed cleanup of the Adverse events section, keeping all the ideas and sources. Basically:

• Organized the section into four discrete paragraphs: one for intro, one for minor adverse events, and two on serious adverse events. (Two is probably far too much by weight -- most of these things are less than one in a million, literally -- since all SAE's are 5 in a million, and most of those are infections or pneumothorax -- but left it for now.)
• Incorporated material from the lede (already accepted by consensus) into this section, using essentially the same wording.
• Added summary sentences written for laypeople (e.g. first say "puncture of a major organ", then follow with "pneumothorax" and the like). Removed redundancies.

Here is the big diff including all the edits, though it's not especially informative, partly due to a couple of intervening edits by someone else. The best way to see what I did is just to compare the sections before and after. --Middle 8 (talk) 05:49, 6 June 2012 (UTC)

Good edits. :) Famous_dog 10:32, 11 June 2012 (UTC)

Sham acu

I agree that Mallixicon's edit [15] is reasonable, but I think the lede should explain the reasons suggested for the observation stated here. There's already too much weight in the lede toward the "not-efficaceous" view (e.g. my concern that certain scientists' views are weighted over those of the scientific bodies they criticized). We should explain why (or simply mention the fact that) "sham" acupuncture may actually be active; as I recall, the link I just mentioned goes into some detail. I'll have a look. -- Middle 8 (talk) 03:40, 29 May 2012 (UTC)

question: has anyone seen Ernst comment on which controls might be better than others in attempts to blind acu patients? I'm curious as to what he thinks. regards, Middle 8 (talk) 07:35, 31 May 2012 (UTC)

Trick or Treatment made the point that when retracting needles were used, which allowed double-blinding, the evidence base for acupuncture eroded considerably.

Part of the issue is what are you controlling for? Your options are needle placement, needle penetration, depth of penetration, manipulation, diagnosis technique, disease/disorder/symptom addressed and practitioner characteristics as a minimum starting point.

The use of "interestingly" is not a good choice, I've reworded. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:56, 1 June 2012 (UTC)

@WLU - Agree re "interestingly"; although that was in the source, it's the wrong tone for WP. I tweaked your wording some so that it almost exactly follows the source [16]; they qualified their statement with "apparently" for some reason (quite possibly because difficulties with controls). It's ironic that our resident disruptive editor keeps removing this argument & the source for it, because it actually affirms a finding to which skeptics rightly point in arguing against point-specific efficacy. [17] [18] [19]

Thanks for the head's up re Ernst. I do need to read ToT. I am skeptical of the value of retracting needles for a couple of reasons. First, TCM acupuncture emphasizes needle manipulation, without which the treatment will be less active. Second, acupoints are sensitive, so even the control group's nonpenetrating poke could have some effect. I think GERAC, at least sometimes, used such a design.

Good summary of the variables for which to control. It's complicated. Rater than go further astray of article specifics, I added some thoughts on my usertalk page. --Middle 8 (talk) 21:22, 4 June 2012 (UTC)

Lund I, Lundeberg T. Are minimal, superficial or sham acupuncture procedures acceptable as inert placebo controls? Acupunct Med 2006; 24: 13–5. CrossRef,PubMed Dickmojo (talk) 13:29, 6 June 2012 (UTC)

Basically, the answer is "There is increasing recognition in the acupuncture literature that superficial (needling of the skin), sham (needling of non-acupuncture points) and placebo (needling with blunt tip that does not penetrate the skin) acupuncture also provide an active therapeutic effect. This is particularly the case in pain conditions that are predominantly associated with an affective component. A recent study demonstrated that a system of slow-conducting unmyelinated (C) afferents responds to light touch. By using functional magnetic resonance imaging, the authors showed that stimulation of C tactile afferents after light touch results in activation of the insular region but not of the somatosensory cortex. Activation of the C tactile afferents results in a ‘limbic touch’ that may underlie emotional and hormonal responses commonly seen following caressing, for example.(Olausson H, Lamarre Y, Backlund H, et al. Unmyelinated tactile afferents signal touch and project to insular cortex. Nat Neurosci 2002; 5: 900–4.) Thus, it is likely that control procedures used in many acupuncture studies aimed at being inert may activate the C tactile afferents that alleviate unpleasantness and re-establish patients’ sense of well-being. Therefore, neither minimal, superficial, sham acupuncture nor placebo needles may be regarded as placebo, because they are not inert."Dickmojo (talk) 13:29, 6 June 2012 (UTC)

All of which, rather conveniently, renders acupuncture untestable. Hence its publication in an acupuncture journal and not Nature. Perhaps the acupuncture community can suggest a suitable placebo since they always manage to talk themselves out of any placebo suggested by the scientific community. Famous_dog 10:27, 11 June 2012 (UTC)

True, frequently, but some in the sci community have been too quick to talk themselves into the idea that one or another control is fine, despite obvious problems. Blinding any procedure (let alone double-blinding) is not a simple problem, and things aren't made any easier by the fact that a lot of acupuncturists don't know enough about how scientists think & work, and vice-versa. So I expect a lot more "can't be studied ever" vs. "no need to study it anymore" type arguing (that being a comment on the literature, not a complaint about this page). --Middle 8 (talk) 17:08, 13 June 2012 (UTC)

Well, I personally consider acupuncture to be a form of massage... Just a very precise form of massage that goes under the skin and into the tissue itself. So, whatever type of placebo they use when conducting clinical trials on massage might be more appropriate in my opinion.Dickmojo (talk) 04:59, 13 July 2012 (UTC)

I agree with Dickmojo. This article is backed up Reinventing Acupuncture: A New Concept of Ancient Medicine (Mann2000 page 24) that states "In my experience it does not matter what stimulus is used in acupuncture. I have little doubt that burning with a lighted cigarette, focusing the sun's rays with a magnifying glass, a drop of sulphuric acid or pinching the skin with a pair of pliers would all have the same effect as the more conventional stimuli used in acupuncture. All that is seemingly required is to exceed the threshold of excitability." ..."I once heard of a doctor who stimulated his patients so gently that instead of needling a specific place he would kiss it!" Mann advocates a style of needling that leaves the needles in place only a few seconds. He also says that he has had similar or equivalent medical effects with needles that were placed "in the general area" of the traditional point location. Where I think Mann is lacking, is the understand that acupuncture meridians aren't just lines on the skin, but specific 3D locations under the skin. In Anatomical Roots of Chinese Medicine and Acupuncture page 24, there's an anatomic cross-sectional diagram of the structures in the hand showing the point called Large Intestine 4. Obviously, quickly pricking the surface skin would not adequately stimulate this point. - Stillwaterising (talk) 06:37, 14 September 2012 (UTC)

Risk of SAE

Hi SkepticalRaptor! You reverted another good-faith, reliably-sourced edit (here), this time from me. May I asked what your objection to my edit was? --Mallexikon (talk) 07:02, 25 May 2012 (UTC)

(re another edit)... @Mallixicon, I think this is redundant: if the risk of SAE's is not zero but very low, then by definition they will occasionally be reported. In terms of summarizing Ernst (et. al., 2011, pmid21440191), I think his points are are already covered in the lede (partly because his comments are echoed in some of his other publications that we've already used). He raises concern about the risk of SAE's (despite giving no estimate of a rate), and goes on to say:

Many [SAE's] 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.-- Ernst et. al. 2011, pmid21440191

I think we mostly have that covered when we say:

"There is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles".

... but we might want to highlight it more, because the distinction between the risks of the modality and the training of the practitioner is important -- especially when talking about efficacy and risk. Ernst's other comments about efficacy -- that he doubts acu is, specifically, good for pain -- are also covered in the lede, in the second paragraph, second sentence. I would suggest that we use Ernst (2011, pmid21440191) as a citation for both of the above sentences in the lede. regards, Middle 8 (talk) 07:28, 31 May 2012 (UTC)

Ok. Any else comments? Otherwise I'd delete "These have, however, occasionally been reported[8]" again (per consensus). --Mallexikon (talk) 10:59, 31 May 2012 (UTC)

How about this? Maybe too much detail for the lede, but it's almost certainly appropriate in the body of the article, along with White's estimate of SAE's [20] (at present only in the lede). --Middle 8 (talk) 12:42, 31 May 2012 (UTC)

I'm in agreement with Middle8 on this and I think the addition of the sentence beginning "Many of these are not intrinsic to acupuncture..." is unnecessary. The text "There is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles(refs) and carries a very low risk of serious adverse effects.(refs)" is more than sufficient for the lead. Famousdog (talk) 12:39, 1 June 2012 (UTC)

We can/should be parsimonious in the lede, and the safety issue is not huge relative to the topic. If others like it, fine, but I'm neutral on it being there. --Middle 8 (talk) 20:39, 4 June 2012 (UTC)

I also agree with the "Many of these are not intrinsic..." sentence being unnecessary. Decided, then! I'll delete. --Mallexikon (talk) 06:03, 10 June 2012 (UTC)

It appears that SR is repeatedly eliminating well-sourced and good faith edits without discussion. Is this something that warrants a request for a topic ban? He/she keeps mentioning NPOV, but the text that is being removed is clearly supported by the research (such as Cochrane reviews). Herbxue (talk) 17:02, 4 June 2012 (UTC)

He might already have been: I have good "radar" for socks, and am pretty sure that he is a sock of a banned user. [21] If I'm wrong about that, he still should have been subjected to a series of escalating blocks a long time ago. Come over to my user-talk page if you want to discuss this more. --Middle 8 (talk) 20:39, 4 June 2012 (UTC)

SkepticalRaptor's disruptive edititing

SkepticalRaptor reverted another good-faith, reliably-sourced edit (here). I reverted the edit and have left SR a message on his talk page to please explain his/her actions. - Stillwaterising (talk) 20:11, 15 September 2012 (UTC)

That's a bit of rude statement. How about you apologize, or learn some AGF. Or not.SkepticalRaptor (talk) 02:45, 16 September 2012 (UTC)

I assumed good faith when I reverted your edit. Since I wasn't able to leave an edit summary due to a browser error, I left a polite message on your talk space asking you to please explain your reasons - which you blanked from your talk page diff with the edit summary "Removing RS'd edit from Acupuncture: Deleted angry commentary. Wow, some people need to really chill." In light of other editors' previous problems with your behavior and removal of content, along with your rudeness and inability to justify your actions, I would like second Herbxue's proposal for a topic ban, which should include all articles under Category:Alternative Medicine. - Stillwaterising (talk) 06:14, 20 September 2012 (UTC)

Needling: Template: undue-section

In subsection Acupuncture#Insertion, the extensive dwelling on the supposed painfulness of acupuncture treatments is unrealistic, cherry-picked and overdone. If treatments were really too painful to bear, I doubt that 86% of patients would report a feeling of relaxation from acupuncture [22] -- this from Ernst. Added {{undue-section}} (diff). Most or all of the references are not studies on the painfulness of needling, but rather studies on other areas that happened to mention pain in needling tangentially. These are poor MEDRS's; review articles should be used, and they should focus on the question of pain in needle insertion. Needs a rewrite & re-source. Tagging for now as a reminder -- tag is buried in article, not at top, and isn't that icky looking so it's not a big deal. --Middle 8 (talk) 10:54, 6 June 2012 (UTC)

I'd agree that a re-write and re-source is in order, but the issue of pain will be on a lot of readers minds! The issue probably doesn't require a whole section though. Famous_dog 10:18, 11 June 2012 (UTC)

Yes, it can just be a sentence in the sub-sub-section it's currrently in -- Acupuncture#Insertion -- with the poor sources removed and adding any good sources relevant to delivery of care. Our sources on adverse events discuss pain on insertion; it's considered minor and is on the order of 10%, IIRC 3%. A good dentist can make even a 20-something gauge hollow needle not hurt (i.e. the injection for delivering the initial dose of novocaine). So you can probably imagine that it's not that hard to keep 30-to-42 gauge, solid (non-coring) acu needles from hurting much. I've been busy but hope to get around to this.... --Middle 8 (talk) 07:45, 13 June 2012 (UTC)

When I was a patient of student intern clinic of the Texas College of TCM, I overheard students talking about the differences in the quality with different makes and manufactures. In the student intern clinic, students had to purchase their own supplies, including needles. Students and instructors shared information about which needle were easier to insert and produced less discomfort for the patient. In the intern clinic, I was often treated by a pair of interns under the supervision of an experience instructor. In my experiences with nearly 200 sessions and more than 35 practitioners (most of them were students) I've never found needle insertion to be "painless" as some advocates claim. In a typical session, a third of the needles are essentially painless, 1/3 hurt some for a while then fade quickly, 1/6 hurt a lot initially, then more slowly fade (especially the points on the outside edge of hands or feet right above where the little finger/toe begins), and a 1/6 have some sort of "De-qi sensation" (sometimes like strong electrical jolts). These sensations can be startling, but a skilled practitioner knows how to back the needle out slightly to stop the sensation.

I remember one session, Student A said she was almost out of needles, so Student B said, "Here try these, they are kinda of expensive, but from what I've heard, they go in smooth and are very comfortable." On that session, 2/3 of the insertions were painless, 1/6 hurt some, and 1/6 had "De-Qi" sensations of some sort. This morning I was remembering this session, and was wondering if anybody had used a Scanning electron microscope to examine the needle tips. I pleased to say that somebody has! There's hypothesis that some of the irregularities and impurities left on the needles can cause discomfort or even possible medical complications. The citation is here: Hayhoe, S.; McCrossan, M.; Smith, A.; Ellis, D.; Croft, S.; Mei, M. F. (2002). "Single-use acupuncture needles: scanning electron-microscopy of needle-tips". Acupuncture in Medicine. 20 (1): 11–18. doi:10.1136/aim.20.1.11. ISSN 0964-5284.

I'm asking for help in assessing how to use this source to improve the article. I've come the the conclusion that some editors who work on this article simply read the abstract and conclusion and don't read the body of the article. I would like to ask that any editor who has an opinion about a source please be honest and disclose whether you actually read the article from cover to cover or just glanced over it. Your transparency will be appreciated, and hopefully not criticized. (BTW: I agree with the OP about undue weight) Thank you (谢谢) - Stillwaterising (talk) 13:02, 15 September 2012 (UTC)

New source

Just saw this source for pain relief, I think it complies with guidelines and is reputable, someone else could confirm though and edit the main article if so inclined? http://archinte.jamanetwork.com/article.aspx?articleid=1357513 Dobyblue (talk) 16:28, 11 September 2012 (UTC)

Yes, a large systematic review of RCT's. It complies with MEDRS. Looks like Puhlaa and Mellexikon are already incorporating it. Herbxue (talk) 20:17, 11 September 2012 (UTC)

Here's the submission in citations format: Vickers, Andrew J. (2012). "Acupuncture for Chronic Pain:Individual Patient Data Meta-analysis". Archives of Internal Medicine: 1. doi:10.1001/archinternmed.2012.3654. ISSN 0003-9926.

This disuccion has been continued below at Talk:Acupuncture#September_2012_Archives_of_Internal_Medicine_paper - Stillwaterising (talk) 05:14, 30 September 2012 (UTC)

"Myofascial meridians"

That's an interesting paper introduced here by Stillwaterising, but unfortunately it's entirely based on the concept of "myofascial meridians". So what's that? The paper says:

"In 2001, Thomas Myers, a therapeutic massage and bodywork specialist certified in Structural Integration (Rolfing), introduced the concept of ‘‘myofascial meridians,’’ which are defined as anatomical lines that transmit strain and movement through the body’s myofascia. These myofascial meridians were discovered through his analyses of human cadaver dissections that examined the interconnections of the body’s fascia, tendons, and ligaments, which form anatomical grids postulated as integral to the support and function of the locomotor system."

What's an anatomical grid, then? Nevermind. The paper goes on:

"Myofascial meridians are postulated to occur along body paths where connective tissues (including myofascia, tendons, and ligaments) not only have anatomical continuity but also exhibit only a gradual change in tissue orientation (i.e., direction and=or depth of connecting fiber structures) along the entire pathways. This anatomical configuration conceptually allows strain to be transmitted across the structures in a given myofascial meridian..."

Now I understand that the correspondence between (the concept of) acupuncture meridians and (the concept of) myofascial meridians is pretty "strong", but unless someone finds a physical correlate for this "therapeutic massage specialist's" concept, we still don't have a physical correlate for acupuncture meridians. Thus, I reinstated the old text. Cheers, --Mallexikon (talk) 06:09, 13 September 2012 (UTC)

For starters, let me disclose any potential conflict of interest. I am a believer in the effectiveness of acupuncture. I have had more than 200 sessions with over 35 therapists, most of them student of the Texas College of Traditional Chinese Medicine, a highly respected acupuncture school in Austin Texas. I had a personal friend who was a student there and we had many interesting discussions regarding the theories and applications of acupuncture. I do not nor have I ever had any financial ties to anything regarding medicine nor alternative healing.

As to the question "what's an anatomical grid"? As best as I can figure, anatomical grid = myofascial meridian according to Dorscher.[23]

As far as I'm concerned, all the information I put forth meets Wikipedia's requirements regarding reliable sourcing and neutrality. Is the information "right, true, correct, or valid?" That's debatable, however there's no requirement that Wikipedia content be validated to "truth beyond a reasonable doubt or to any similar standard (including general acceptance by the scientific community). I contend that the information and sources I provided diff meet Wikipedia's standards, and should be reinstated. (Please ignore the first two lines of the diff, they were an unintentional editing error.) - Stillwaterising (talk) 19:27, 13 September 2012 (UTC)

You're absolutely right and I don't want to discourage you in any way from adding this information. However, this paper can be cited as a reliable source only in its claim that acupuncture meridians strongly correspond with Tom Myers' "myofascial meridians". And if you add this you would also have to explain what Myers' concept of myofascial meridians actually means (without giving undue weight to this section. Maybe writing an article about it and then wikilinking would be a solution). For the far-reaching conclusion that this whole correspondence translates into evidence of a physical correlate of acupuncture meridians ("The strong correspondence of the distributions of the acupuncture and myofascial meridians provides an independent, anatomic line of evidence that acupuncture Principal Meridians likely exist in the myofascial layer of the human body"), however, we'd need a source that strictly complies with WP:MEDRS. Since Dr. Dorsher's opinion alone won't do. Cheers, --Mallexikon (talk) 03:29, 14 September 2012 (UTC)

WP:DUE says "Neutrality requires that each article or other page in the mainspace fairly represents all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint."

I propose that Dorsher's article (Dorsher, Peter T. (2009). ["Myofascial Meridians as Anatomical Evidence of Acupuncture Channels" http://www.anatomytrains.com/uploads/rich_media/AAMA_myofascial_meridians_article.pdf]. Medical Acupuncture 21 (2): 91–97.) is a secondary source. It does not contain any research. It's an analysis of the Traditional Chinese Medicine's meridian theory as described in Acupuncture: A Comprehensive Text (1981) (a tertiary source) and Meyers textbook on "myofascial meridians" named Anatomy Trains (a primary source). An introduction/summary of the book can be found here in PDF form and is very interesting.

Now, as far as the Myofascial meridians being a separate article, that's a good idea. I found another source called Palpatory literacy, Chinese therapeutic bodywork (Tui Na) and the remediation of head, neck and shoulder pain (2003) (a tertiary source on Tui Na focusing on upper body pain) that says that myofascial meridians were first described by German anatomist Hermann Hoepke in 1930's.

I'm not sure what the next step is, but I do not think this article has due weight or adequate neutrality and possibly contains several dubious assertions. - Stillwaterising (talk) 05:45, 14 September 2012 (UTC)

Sorry, but I strongly disagree with your assessment of Dorsher's article. As you can clearly see from the structuring of this article (Objective / Design and Setting / Main Outcome Measure / Results / Conclusion), this is a primary source. Cheers, --Mallexikon (talk) 06:06, 14 September 2012 (UTC)

It's the content of article that defines its content, not the structure. Dorsher is using a standard format of headings that's used in many scientific papers. All outside sources that describe secondary sources regarding scientific papers all would seem to put Dorsher's paper as a secondary source. This source from BYU lib dept. says "In science, secondary sources are those which review, compare, contrast, repackage, reorganise, interpret, summarise, index or otherwise “add value” to the new information reported in the primary literature." Dorsher did not do the dissection of cadavers that were used to define his information on myofascial meridians, nor did he use the scientific method (or any other method (ie. Ouija board)) to define the 12 Principal Meridians. What he did do was overlay both sets of previously defined meridians and confirmed Meyer's hypothesis that the two systems are highly correlated. I have posted this issue here on the Wikipedia:Reliable sources/Noticeboard since there isn't a consensus opinion on this matter. - Stillwaterising (talk) 15:18, 14 September 2012 (UTC)

I'm glad you are bringing this up. The issue of what constitutes a reliable source has been a sore issue here for awhile. To me, the books and articles used by acupuncturists to study acupuncture should be the sources that define the structure of the article. Others view this as a scientific article in which only statements supported by secondary sources (systematic reviews) may be used. I agree with exclusively using secondary sources for efficacy claims, but not for basic descriptions of the theories and concepts that inform the subject.Herbxue (talk) 18:10, 14 September 2012 (UTC)

Sorry, but I'm not convinced that the journal is a reliable peer-reviewed journal. I can't find anything about peer-review on the website. Since this is a medical and pseudoscience related article, we need high-quality sources for fringe claims. Furthermore, if the paper has not been commented on by reliable peer-reviewed mainstream sources, it is impossible to tell whether the content of the paper is significant. Contrary to what Herbxue says, in-universe sources are just about worthless. Don't even go there. Dominus Vobisdu (talk) 00:21, 15 September 2012 (UTC)

The question is not wether the journal is peer-reviewed or not. The question is whether Dorsher's article constitutes a primary or a secondary source - and clearly, it's primary. It's not a comparison and synthesis of other sources, but a study ("The purpose of this study was to evaluate whether the distributions of the anatomically based myofascial meridians are similar to those of the acupuncture Principal Meridians.") His method consisted in comparing acupuncture meridians with Myers' "myofascial meridians" by using some special kind of software ("With Adobe Photoshop Elements software (Adobe Systems Inc, San Jose, CA), the distributions of corresponding acupuncture meridians were applied to the same human figure outlines used in Myers’ text to allow direct side-by-side comparisons of the acupuncture and myofascial meridians"). The result of his study is that "In 8 (89%) of 9 comparisons, there was substantial overlap in the distributions of the ... myofascial meridians with those of the acupuncture Principal Meridian distributions..." Please compare with Wikipedia:Identifying reliable sources (medicine)#Definitions --Mallexikon (talk) 01:47, 15 September 2012 (UTC)

Medical Acupuncture's editorial policy is posted here and states: "Medical Acupuncture is an essential, peer-reviewed journal written for physicians, by physicians [and] is under the editorial leadership of Editor-in-Chief Richard C. Niemtzow, MD, PhD, MPH, Director, United States Air Force Acupuncture Center, and other leading investigators. View the entire editorial board." As far as to DV's comment about "in-universe sources", are you referring to primary sources? Primary sources do have their place according to WP:MEDRS. Some primary sources contain even contain statements that "review, compare, contrast, repackage, reorganise, interpret, summarise, index or otherwise “add value” to the new information reported in the primary literature" and those statements can therefore be used as secondary sources. This is can be backed up by WP policy. "Don't even go there" is not, and could be construed as a WP:NOEDIT threat. - Stillwaterising (talk) 07:50, 15 September 2012 (UTC)

Starting work on article "myofascial meridians"

I've started a draft in my userspace, User:Stillwaterising/Myofascial_meridians. Anybody who is interested in developing this article or has something to add it welcome to edit. - Stillwaterising (talk) 05:59, 20 September 2012 (UTC)

I've finished the article and move it to main space. - (talk) 10:37, 24 September 2012 (UTC)

References

September 2012 Archives of Internal Medicine paper

I just added mention of this new paper to the lede. Please feel free to add more detail on it in the main part of the article. Cla68 (talk) 00:57, 16 September 2012 (UTC)

Since this is a very hotly debated article (especially its lede) I'd prefer if you mention this new material at the proper section first, since the lede should only be a summary of what is in the article already. Our problem is that the efficiency evidence seems to be contradictory in some areas, so summarizing it in the lede could be tricky. Cheers, --Mallexikon (talk) 05:59, 18 September 2012 (UTC)

Yes, the lede is currently more balanced than it has ever been, and does somewhat reflect the truly mixed picture in the available research. Unfortunately, it could be read as inferring that all effects from acupuncture are due to placebo, which is not conclusively proven in the mixed literature. Still, I'd rather it stay as it is rather than invite yet another shitstorm of controversy.Herbxue (talk) 00:38, 19 September 2012 (UTC)

I hope that this doesn't become a hotly debated item and I don't think it will. Our job as editors is to summarize the best sources we have available; if that means new sources find an effect that isn't placebo based then it shouldn't be controversial to add it to the article. I think most of what made this article controversial historically is people wanting to use cherry picked primary studies and non-peer reviewed work to ascribe a validity to acupuncture that didn't exist in mainstream review articles. If it is the case that newer metareviews are finding efficacy then that's what we should be reporting. At the end of the day, we can't argue with sources. Disclosure:I haven't read any of the newer metastudies and cannot comment on their validity, only that if that's what they say then that's what we report. Sædon^talk 01:01, 19 September 2012 (UTC)

I came here to see if that source had already been added, but after searching for keywords and reading the lead concluded that it had not. It seems probable that Wikipedia should give more weight to the most current state of the research. B^e——C_ritical 23:43, 3 October 2012 (UTC)

The new source has been added to the body of the text, in 2 locations [24]. It has been rejected from the Lede so far I believe. I also think that the newest and highest-quality sources should be given the most weight, as this is what is consistent with MEDRS. The same issue is under discussion at Vertebral Artery Dissection [25], where a new, high-quality source is available on the risk of stroke from neck manipulation, but there is resistance to include it's conclusions as well.Puhlaa (talk) 01:24, 4 October 2012 (UTC)

I think it also needs to be put into the lead of the Effectiveness section. B^e——C_ritical 19:17, 4 October 2012 (UTC)

I agree with you, it should be in the lead.Dobyblue (talk) 14:55, 15 October 2012 (UTC)

Yes, I also agree with you, and it actually already is included in the lede: "Scientific research supports acupuncture's efficacy in the relief of certain types of pain and post-operative nausea.[7][8][9][10]" It's source number [10]. Feel free to double check. Cheers, --Mallexikon (talk) 01:59, 16 October 2012 (UTC)

Acupuncture for plantar heel pain

This review is from a possibly biased journal and the wording is unusually opaque ("There is evidence supporting the effectiveness of acupuncture for PHP. This is comparable to the evidence available for conventionally used interventions, such as stretching, night splints or dexamethasone"). I can't get a hold of the original paper, but judging from the abstract there didn't seem to be any placebo controls - the two "high quality" trials mentioned obviously didn't have any ("In one, acupuncture was associated with significant improvement in pain and function when combined with standard treatment (including non-steroidal anti-inflammatory drugs). In another, acupuncture point PC7 improved pain and pressure pain threshold significantly more than LI4.") I recommend to not include this review until more data or an assessment from a less-likely biased journal is available. --Mallexikon (talk) 03:22, 6 November 2012 (UTC)

I think that the review paper should be included in the section for effectiveness research.

1. The Journal: The journal's aim is: "...to promote the scientific understanding of acupuncture...", the journal is indexed in Pubmed, it is peer reviewed (12% acceptance rate)[26], and it has a multidisciplinary editorial board. It is consistent with WP:MEDRS.
2. The Article: This source is a systematic review that identified 5 RCTs and 3 non-randomised comparative studies to examine. This is consistent with a high-quality source according to WP:MEDRS.
3. The conclusions: The authors conclude that there is evidence supporting the effectiveness of acupuncture for heel pain that is equal to the evidence available for conventionally used interventions; thus, acupuncture should be considered as an option. These findings are consistent with the mainstream view of acupuncture, as an effective tx for pain that is more than a placebo [27].

Thus, I see no basis for exclusion, but a good reason for inclusion, as it provides relevant, mainstream (evidence-based) information for a specific condition.Puhlaa (talk) 04:08, 6 November 2012 (UTC)

I agree with inclusion, based on the fact that editors of CAM WP articles are obsessed with litmus tests of acceptable MEDRS and this one passes the litmus test - a systematic review in a peer-reviewed medical journal. Mallexikon - you are a savvy critic with a good sense of research quality, but you must admit that it would be "original research" to decide that this source is of low quality when we do not have a systematic review in a peer-reviewed journal about research quality that states that this is a low quality or biased source. You can't just decide which sources to highlight or exclude based on personal judgement about quality. At least that is what you told me about that horrendous Matuk article I wanted to purge.Herbxue (talk) 06:23, 9 November 2012 (UTC)

True :) What has me concerned here is mainly that the wording is cloudy, and that I can only get a hold of the abstract, not the original paper. Just a gut feeling. The article of course is formally ok. Cheers, --Mallexikon (talk) 03:05, 13 November 2012 (UTC)

Arthur's opinion on the article

I don't know how and where could start a new talk, just put the question here: in the acupuncture history, currently used a bias view from a paper with negative viewpoint-- "Later it was found that the patients selected for the surgery had both a high pain tolerance and received heavy indoctrination before the operation; these demonstration cases were also frequently receiving morphine surreptitiously through an intravenous drip that observers were told contained only fluids and nutrients."

I was a graduate from Nanjing University of Traditional Chinese Medicine, my personal experience told me above statement is untrue.My teacher's wife was one of key personel in "acupuncture anesthesia group" in Jiangsu Provincial Hospital of TCM. The true condition was: (1)they did choose the patients whose mental condition is "stable"(calmer than average);(2) try acupuncture before the operation day and give patient explanation, have more pre-operation communication with patient than routine anesthesia; (3) use low dose tranquilizer,i.m. or i.v.for "the preparation". Only when patient couldn't endure the pain(due to nervous or strong pain caused by pulling organs), they did give the morphine or other pain killers, which only served as a remedial measure， in stead of some authors assumed "cheating".Such procedures were not kept secrets from the "foreigners". As you may don't know, at the Mao Zedong's stage, if a person did something wrong(such as cheating), or causing "foreigner" misunderstand New China, would be severely punished.So, the paper cited is not a true case. -- User:‎Arthur Fan

There's a button on the top right called "New section" for creating new topics.

You're asking me to weigh peer-reviewed scholarship against the personal experience/opinion of your teacher's wife. Check out WP:V and WP:OR to see what burden of proof wikipedia requires. TippyGoomba (talk) 04:49, 6 December 2012 (UTC)

Thats a strange thing to say given the source. Since when is The Committee for Skeptical Inquiry remotely NPOV? Cjwilky (talk) 06:08, 24 December 2012 (UTC)

I wasn't commenting on any particular source. TippyGoomba (talk) 18:38, 24 December 2012 (UTC)

What are you referring then when you say "You're asking me to weigh peer-reviewed scholarship ..." ? The source I mention is backing what you are discussing. Its a sceptic blog, not WP:NPOV. Maybe you are referring to something else? Cjwilky (talk) 00:19, 25 December 2012 (UTC)

The point is his teacher's wife isn't a reliable source. Are you suggesting an edit? TippyGoomba (talk) 04:27, 25 December 2012 (UTC)

I understand issues around Artur Fans evidence, no problem there. We are here to create a factually correct article supported by quality evidence as far as is possible, and to avoid basing information on dubious sources. However, as you avoided replying to my point, I assume your reference to peer reviewed scholarship is the Skeptic Inquirer which is clearly POV - references, but cherry picked to argue its assumed point. In this case, I don't see any reason to doubt the particular paragraph, although I can't find the original Keng and Tao source it bases this on. Cjwilky (talk) 07:30, 25 December 2012 (UTC)

I've already said, I wasn't referencing any particular source. TippyGoomba (talk) 22:06, 25 December 2012 (UTC)

Fair enough, but I have a pretty good idea that Arthur meant CSICOP, and I think the question of whether they're an RS on the practice of Chinese medicine in China is a good one. And what he's saying about anesthesia in clinical practice (which echos what my professors have said) should be verifiable in print, somehow. It's possible that they're both right, but CSICOP is only telling only the worst part of the story, e.g. acu's effectiveness in anesthesia has been misrepresented in some reports but not in most of the TCM literature -- just guessing at how this might play out. --Middle 8 (talk) 10:30, 27 December 2012 (UTC)

Word up. I know Arthur Fan IRL, and he is a highly-credentialed doctor (MD/PhD, neurology, IIRC) who happens to be relatively new to WP. Arthur, I am really glad you're here and will email you -- I go by "Middle 8" on Wikipedia and don't use my real name.

Per WP:BITE, let's all cut Arthur some slack while he gets up to speed on WP policy, and listen to his arguments. Consider accepting the realistic possibility that he's an expert editor who wants to help the Wiki, and try to work together and see to what degree we can source and integrate his ideas per NPOV.

I've seen good people be bullied before (why do you think I now use a pseudonym? Ask the science jihadist editors who finally got sitebanned after harassing me and a whole bunch of others...), and I would not like to see it happen again. Bullying can include snark/sarcasm when it comes to newbies, so please, be maybe almost as civil as you would be face to face in a professional environment --- I know that's a high threshold for around here in practice (let alone the internet generally) but that is what WP:CIVIL and WP:BITE mean together. --Middle 8 (talk) 08:16, 27 December 2012 (UTC)

Middle 8, don't forget to watch your tone as well. "science jihadist editors" and being civil "is a high threshold for around here" aren't exactly kind.Sgerbic (talk) 16:33, 27 December 2012 (UTC)

Sorry if I insulted anyone currently editing here, didn't mean to. The "jihadists" I refer to were a couple of editors to whom WP:FANATIC truly applied; I mentioned they were sitebanned. They poisoned the well pretty badly. I don't want to see that stuff happen again, but then it hasn't much, lately; I overreacted based on past bad experience. I should have just said let's welcome Arthur, he's the genuine article. As far as IRL collegiality being a "high threshold", I meant the whole wiki, not just here. Certain editors felt (with some justification) that WP:CIVIL was being used as a subtle way to POV-push, but instead of just pushing back hard on NPOV and substance they also pushed the pendulum too far away from civility, IMO. --Middle 8 (talk) 18:50, 27 December 2012 (UTC)

References

Category: Pseudoscience?

Not again. This has been discussed a whole lot, I've seen practically every damned one of them, and consensus is always not to have it once the reasoning is walked through. Seriously, just read the text in the diff where I removed it (after someone had added it without discussion), and it should be clear. NPOV policy on fringe science has been clarified in a series of ArbCom cases, and the threshold for explicitly calling something PS (for anything other than patent absurdity) is "generally considered pseudoscientific by the scientific community". That threshold invokes a high level of sourcing, i.e. something on the order of a scientific academy (like the kinds of sources that we rely on to say that sci consensus is that creationism and homeopathy are pseudoscience) -- and so far, no such source has appeared. It's not as if we can't quote RS's who say it is or isn't PS, it's just that we can't categorically call it PS. Hope this helps. --Middle 8 (talk) 07:53, 27 December 2012 (UTC)

Biased

This article is highly biased and is more appropriate for some 'skeptics' website. --Aleksd (talk) 10:14, 8 January 2013 (UTC)

Qi, meridians, etc. is only well scientifically researched in China where they have (logically) interest in the area from many years. --Aleksd (talk) 10:18, 8 January 2013 (UTC)

This article is about 'non-believers' opinion about acupuncture. --Aleksd (talk) 10:22, 8 January 2013 (UTC)

Yeah, well, I beg to differ. We have been having intense arguments at this talk page since there are quite a few skeptics and proponents involved in contributing to the article. Everything here is reliably sourced. The version right now is probably as NPOV as it gets. So unless you have something of substance to say (is a certain source we used not reliable? do you think some important source is not included? is there some unsourced material here you'd like to challenge? etc.) I'd prefer you taking that neutrality tag off again. --Mallexikon (talk) 04:48, 9 January 2013 (UTC)

A Bulgarian telling English wikipedia about secret chinese research that hasn't been translated and published in english scientific journals. Interesting.... obamacare?. TippyGoomba (talk) 07:39, 9 January 2013 (UTC)

Secret? Well if you don't speak Chinese and even more if you are not interested of its translations to various languages it could be secret to you. --Aleksd (talk) 10:28, 9 January 2013 (UTC)

Also, yes, I am interested in Obamacare. We live in a modern world where people are informed and interested in other's countries politics. I hope you don't mind that and not insist in returning into the cave age? --Aleksd (talk) 10:30, 9 January 2013 (UTC)

Do you see that section about the many other languages Obamacare articles. Seems like I am not the only one. --Aleksd (talk) 10:33, 9 January 2013 (UTC)

"A few Chinese scientists we met maintained that although Qi is merely a metaphor, it is still a useful physiological abstraction (e.g., that the related concepts of yin and yang parallel modern scientific notions of endocrinologic [sic] and metabolic feedback mechanisms). They see this as a useful way to unite Eastern and Western medicine. Their more hard-nosed colleagues quietly dismissed Qi as only a philosophy, bearing no tangible relationship to modern physiology and medicine." - this sounds like a gossip, who said what, this does not have any scientific value, and it is included in the article as a citation. --Aleksd (talk) 17:21, 9 January 2013 (UTC)

Ok, you got a point there. The citation is anecdotal. If you'd like to delete it, I won't object. --Mallexikon (talk) 05:45, 10 January 2013 (UTC)

Agreed. Aleksd, you may be interested to looking at WP:BRD. In short, make whatever edits you like and if people object, they can revert them, then you can justify your changes here and (hopefully) reintroduce the reverted changes. TippyGoomba (talk) 08:07, 10 January 2013 (UTC)

Possibly good material

[28] Some interesting stuff, here's an excerpt:

The side effects were simply amazing,” Kaptchuk explains; curiously, they were exactly what patients had been warned their treatment might produce. But even more astounding, most of the other patients reported real relief, and those who received acupuncture felt even better than those on the anti-pain pill. These were exceptional findings: no one had ever proven that acupuncture worked better than painkillers. But Kaptchuk’s study didn’t prove it, either. The pills his team had given patients were actually made of cornstarch; the “acupuncture” needles were retractable shams that never pierced the skin. The study wasn’t aimed at comparing two treatments. It was designed to compare two fakes.

Sædon^talk 03:34, 11 January 2013 (UTC)

Accreditation

Mallexikon, I liked most of your recent edit but disagree about removing the mention of ACAOM, the Accreditation Commission for Acupuncture and Oriental Medicine. It is important to show that all reputable schools need this level of accreditation. ACAOM is recognized by the U.S. Dept. of Education. Also, there are some acupuncture only (no herbal medicine) programs that are only 3 years in length. I didn't want to undo your edit but I will copy a verifiable portion of the previous editors text and reinsert.Herbxue (talk) 07:27, 16 January 2013 (UTC)

Ok, I understand. However, you know the standards... We don't want to look like we're advertising them. Cheers, --Mallexikon (talk) 01:28, 17 January 2013 (UTC)

Looks good now.Herbxue (talk) 03:27, 18 January 2013 (UTC)

Antiquity

Out of curiosity I tried reading all the sources cited in "Antiquity" that I could check online, and none seem to actually offer significant evidence for the sentences after which they're placed, especially with regard to acupuncture specifically being "ancient" or even having originated in China and spread to other east-Asian countries. Where does the theory that acupuncture is an ancient Chinese practice actually originate? Are there better sources out there which cite archeological evidence for sticking pins in specific locations to treat particular maladies? Curious about this stuff... --Sam (talk) 19:56, 16 January 2013 (UTC)

The Huang Di Nei Jing is a text, written over a period of time, by multiple authors, between 400 BCE and 200 CE, that represents a mostly complete practical and theoretical description of acupuncture. The practice is believed to be way, way older than the written record.Herbxue (talk) 03:38, 18 January 2013 (UTC)

We need to get Unschuld in there. --Middle 8 (talk) 11:00, 8 March 2013 (UTC)

Agreed, Unschuld is one of the most respected authors because he seeks to present Han dynasty Chinese medicine on its own terms, and he has no interest in being promotional.Herbxue (talk) 02:23, 10 March 2013 (UTC)

Synthesis in modern era

Acupuncture has been the subject of active scientific research both in regard to its basis and therapeutic effectiveness since the late 20th century, but it remains controversial among medical researchers and clinicians. In 2006, a BBC documentary Alternative Medicine filmed a patient undergoing open heart surgery allegedly under acupuncture-induced anesthesia. It was later revealed that the patient had been given a cocktail of weak anesthetics that in combination could have a much more powerful effect. The program was also criticized for its fanciful interpretation of the results of a brain scanning experiment.

This paragraph is grossly disjointed; acupuncture has arguably gone 'mainstream' as a complementary therapy which is recommended in Cochrane reviews for pain, muscular and neurological issues (as per the systematic reviews on effectiveness in the lead). Furthermore a random 2006 BBC Documentary is hardly notable in the grand scheme of acupuncture and could be interpreted as 'cherry picking' in worst case scenarios. Also Ernst (2007) states that acupuncture 'remains controversial among medical researchers and clinicians' which opposes the newer reviews which states the opposite, i.e. further integration into the mainstream, increased prevalence of use and increased research demonstrating effectiveness for specific medical conditions. DVMt (talk) 04:05, 14 March 2013 (UTC)

Well, I think it's safe to say that acupuncture "remains controversial among medical researchers and clinicians" - it's reliably sourced and a source date of 2006 or 2007 doesn't really outdate it... And BBC documentaries tend to be notable events (we have two different sources dealing with this particular one). So if your suggestion is to delete this whole paragraph, I wouldn't agree. How about just shortening the BBC stuff a little? --Mallexikon (talk) 07:09, 14 March 2013 (UTC)

Sounds good to me. DVMt (talk) 22:16, 14 March 2013 (UTC)

References

Srodigu: the official introduction!

I'm new to wiki and not in any way a writer, but have been using "acupuncture" or fine-filament-stainless steel and (hollow) stainless steel hypodermic needles in my office of 15 years. IMO what needs to be done is to a clarify what all these words mean. Acupuncture is not what I thought it was in 1997 and have to confess the ancient doctrines are confusing and irrelevant in todays society. But the truth of the raw data as to what a fine-filament-stainless steel needle does to the flesh can be simplified into 2 events. 1. Triggering the healing cascade. 2. Activating the twitch response in muscles. That is it! The tradition and mythology around those 2 events is just that a myth. See Gunn alternative thought about the needles as it relates to myofascial dysfunction. Gunn's IMS and Travell trigger point injections are all part of myofascial therapy on a spectrum from hands-on to needles. Word clarity would greatly help everyone understand this therapySrodrigu (talk) 02:21, 15 March 2013 (UTC)

Ok. In order to help improve the article, what suggestions are you making? Perhaps review one section at a time, starting with the lead. DVMt (talk) 03:33, 15 March 2013 (UTC)

Two things I'd like to contribute: 1. Please start with the body and not the lead. The lead should reflect the article as a whole so any changes should be made to the body, then bring up proposed lead changes on the talk page. This article is monitored by many many people as it is a controversial subject, so please do not be offended if your edits are reverted. Just make your case as best you can. 2. You have strong opinions that are shared by many, but also opposed by many. I would only agree with a more culturally neutral definition of acupuncture IF it had developed in parallel in different cultures with similar practices but different theories. It did not. Acupuncture would not exist as a practice if it had not been developed primarily in China. There would be no so-called trigger point dry needling. The would be no filiform needles. The needles used were defined in the Huang Di Nei Jing and nobody else knew or cared about Acupuncture until the 20th century. So, please go ahead and edit boldly, but anything that looks like revisionist history is likely to reverted until we can agree on statements by consensus.Herbxue (talk) 04:26, 15 March 2013 (UTC)

Good idea to start with the body rather than the lead and good advice overall DVMt (talk) 14:16, 15 March 2013 (UTC)

Revert of promotional material

Hello, I am trying to link acupuncture to myofascial therapy by noting the work of C. Chan Gunn-Intramusclular Stimulation, by using a stainless steel needle micro trauma triggering the healing cascade and unlocking tight muscle bands known as trigger points embedded in myofascial muscle tissue. Part of the Acupuncture article (A parallel theory is offered by C. Chan Gunn, MD. Gunn uses a technique in which he take advantage of acupuncture needle to insertion into tight bands. These bands have a overlapping pattern to the meridian of TCM. He called his technique Intramuscular Stimulation or IMS. He stated in his textbook the differences in IMS and traditional acupuncture as: 1. IMS requires a medical diagnosis. 2. A medical examination is imperative. 3. The placement of the needles is indicated by the examination. 4. Knowledge of modern anatomy is essential. 5. An immediate positive change in the subjective and objective finding is expected.[58]) Click. Srodrigu (talk) 05:18, 10 March 2013 (UTC)

Hi Srodrigu, the material you are attempting to add is promotional of one person's work and so is not appropriate for this article. Also, the description makes assumptions about traditional acupuncture therapy that many acupuncturists, especially in hospitals in China or those that focus on orthopedics, would take issue with.Herbxue (talk) 14:07, 10 March 2013 (UTC)

Any TCM-specific application or claim would better be dealt with in that article. I don't see why IMS as a subtype of acupuncture couldn't be mentioned somewhere, but the material written by Srodrigu needs secondary sources and not be written "in universe" which can come off as promo. Perhaps Sroridgu can create a new section for their proposal and we can work at it here at TALK. Regards, DVMt (talk) 20:28, 10 March 2013 (UTC)

Gunn is a notable physician, author and practitioner. So why can't I promote his work, discoveries, research and theories? Gunn was able to separate the traditional practice of Acupuncture from the raw truth of what the stainless steel needle does to the muscle fibers-myofascial tissues. Once this connection is made then "Acupuncture" can be connected to a vast arsenal of other myofascial therapies.Srodrigu (talk) 02:43, 11 March 2013 (UTC)

The best route to take is find secondary sources, (research, systematic reviews) that shares Gunn's view. I agree with you that the TCM elements of the article has too much weight and overshadows the non-meridian (anatomical) approach to acupuncture. To boot, the recent evidence shows an increasing role for acupuncture as a complementary therapy. I understand that the 'raw truth' is when you separate the TCM from acupuncture, the Westernized "medical acupuncture" is a reasonable adjunct for soft tissue therapy. Nevertheless, it boils down to the sources. A good PubMed search about acupuncture theory is my suggested starting point. DVMt (talk) 03:19, 11 March 2013 (UTC)

The problem I have with this issue is that acupuncture has already included a musculoskeletal or ortho-neuro approach for a very long time. It is not a unique "discovery" of western science (or one particular notable writer) that acupuncture leads to specific effects on muscles via motor points, ashi points, trigger points, etc. It is just marketing to say that this is attributable to Dr. Gunn (or Travell, or Callison, or Seem, or Chaitow, or whoever thinks they invented something). I would love to see this perspective fleshed out more in the article, but not the promotion of a single doctor's "style" and definitely not the distortion that Chinese acupuncturists have been somehow ignorant of anatomy and the effect of acupuncture on muscular function.Herbxue (talk) 05:39, 11 March 2013 (UTC)

I agree that acupuncture has long been used for NMS dysfunction and that Gunn isn't the only one who has taken a more anatomical based application as opposed to the TCM version. I don't know much about TCM personally, so I won't be able to add much depth to that debate. So, it looks like we're on the same page; I doubt we will be able to attribute it non any "guru" let alone Gunn, but non-TCM theory is a good start as any. DVMt (talk) 19:06, 11 March 2013 (UTC)

1. I wanted to expose the world to the work of Gunn, because I noticed that other authors having their work "promoted" in wiki. ie see john f. barnes on the myofascial release page. 2. Gunn was the author who found the origin muscle twitch-response phenomena that allows the a dense tight muscle to relax, immediately. 3. Another goal of my contribution is to link all myofascial therapy with myofascial release techniques from hands-on manual therapy to the release done with a stainless steel needles. The ultimate goal is to unlock the tight muscles as a treatment for complex MS issues.4. I was taught that the ancient Chinese did not study internal anatomy due to taboos.Srodrigu (talk) 03:17, 12 March 2013 (UTC)

I see. WP generally does not endorse individuals because they can be mis-used as a soapbox. See alternative medicine how the article reeks of soapboxing of various CAM skeptics. I have serious doubts that Gunn was the one who 'discovered' the twitch-response to acupuncture. If so, you need an MEDRS ref to prove the claim. We agree that acupuncture may be beneficial for soft tissue dysfunction. Regarding TCM applications, we don't know so we're just speculating, if they took anatomy. Perhaps your focus can be to show the anatomical application of acupuncture, aka medical acupuncture. DVMt (talk) 03:27, 12 March 2013 (UTC)

Sorry, here is the article that Gunn uncovered from the archives and referenced in his textbook; Cannon WB, Rosenblueth A. The supersensitivity of denervated structures: a law of denervation. New York, NY: MacMillan; 1949. ... as noted it is note his work but it was he who tied up the loose ends. I have to interject, the fine-filament-stainless-steel needle therapy you are calling "acupuncture" is the true therapy for many Muscle-skeletal-connective tissue ... so called "soft tissue" dysfunction. Apologies for the "s but words, definitions, mythologies, traditions, descriptions and semantic are getting in the way of this topic. You can questions "acupuncture" or TCM but the truth of what is actually happening within the muscle and flesh is the truth and has to be presented to the public. How do I begin to get this idea critiqued so it can be presented?Srodrigu (talk) 04:44, 12 March 2013 (UTC)

I wanted to expose the world to the work of Gunn, because I noticed that other authors having their work "promoted" in wiki. I removed the example you gave from the myofascial release article. If you have any other examples, please let me know.

I am confused, why did you remove the example? This is valid work, a real contribution and real science. ... who are you they is not sigSrodrigu (talk) 16:18, 12 March 2013 (UTC)

I don't know who removed what example. TCM acupuncture is very different than 'acupuncture' (minus the meridians and acu points woo). We agree on these key points. We disagreed on the promotion of individuals and the fact you didn't have any current citations. DVMt (talk) 16:21, 12 March 2013 (UTC) Edit: Checking on the diffs, it appears that User:TippyGoomba has removed your entry at MFR. I agree with him/her that these should be backed by secondary sources. Do you know what we mean when we state 'secondary source'? Read up on WP:MEDRS that should give you the gist of how to edit medically-related articles at WP. Regards, DVMt (talk) 22:06, 12 March 2013 (UTC)

It is actually not very different. "Acupuncture" comes from China and Chinese ("TCM") Acupuncturists use a number of approaches, including channel theory (what you term "woo"), microsystems (more woo but also utilized by western acupuncturists, most notably French neurologists), and an anatomical approach, including trigger points. "TCM" does not exclude an anatomical approach, having been systematized in the 1950's, on the contrary it embraces this approach. That is why, even in China, people mainly seek acupuncture for musculoskeletal or neurological disfunction, even though it can treat a wide variety of conditions.

Don't misunderstand me, I encourage inclusion of the material you are introducing, just not the promotion of anyone's work, or making the false statement that TCM does not include the study and use of anatomical information. Herbxue (talk) 21:58, 12 March 2013 (UTC)

Interesting, I didn't realize the Chinese (could) use an anatomical (non acu-point, meridian) approach towards acu. I also agree that some of Srodigu content may be applicable, I just think he/she should present the material on the talk page first. That way it will be less likely of being reverted and we can all chip in. DVMt (talk) 22:02, 12 March 2013 (UTC)

Here is what I would like to add below Gunn alternative idea related to acupuncture :::: Taking all this data into consideration one can conceptualize how a stainless steel wire or probe can effectively treat trigger points and thus myofascial and neuropathic syndromes; 1. Inserting the thin flexible solid stainless steel needle into the skin and muscle caused microscopic tissue injury. That injury ignites the healing cascade of repair which repaired the tissue injury and any local secondary injury. Muscle stem cells proliferate to restore muscle health and power. 2. The stainless steel needle, once it entered the muscle, triggered a muscular re-polarization creating a muscle twitch response. After the twitch, the muscle would relax. The relaxed muscle would be a little longer, less tense and tight. Better able to fit and correctly realign a joint.

Myofascial Trigger Point Therapy is grouped in to Myofascial Release Therapy and thus an additional class or type should be offered.Srodrigu (talk) 02:42, 13 March 2013 (UTC)

Hello all, my attempt here is to link TCM/Acupuncture to a form of myofasical therapy and to clarify what is happening within the flesh. This is a truth that the ancient chinese discipline called Acupuncture which includes inserting needles into to specific points in the skin is both a mythology surrounding two important scientific facts.Srodrigu (talk) 16:54, 31 March 2013 (UTC)

Myology: The way of thinking is related to a social, economic, ethical, religious, governmental and health/wellness. Facts: 1. Tissue injury that ignite the healing cascade. 2. Muscle release or reboot.Srodrigu (talk) 16:54, 31 March 2013 (UTC)

Another issues that is left out is the issues of myofascial tissues disease which are illness that are the results of improper therapy that will lead to a number of medical conundrums. Myofascial Trigger Point Therapy is grouped in to Myofascial Release Therapy.Srodrigu (talk) 16:54, 31 March 2013 (UTC)

What is the specific edit you are suggesting? TippyGoomba (talk) 17:27, 31 March 2013 (UTC)

Srodrigu, are you proposing a potential separate article on Trigger Points (therapy, treatment, diagnosis, etc...). It is a notable enough topic, per Travell and Simons. DVMt (talk) 23:56, 1 April 2013 (UTC)

Yes, Trigger Points are at the core of a lot of medical issues as per Travell. Some of the most complex pain, neurologic, vascular, movement, gait, balance and gut issues are related to the secondary effects of TPs. A complete list is in Travell text books. The beauty of all myofascial therapy is to release, unlock, breakup these TPs. Myofascial Release Therapy is on a spectrum from hands-on release to acupuncture, dry needles and Travell’s trigger point injections. Readers need understand the connections and the clue is in Gunn’s text which are his tenants explaining IMS vs Acupuncture whic was deleted a few months ago.Srodrigu (talk) 22:29, 17 April 2013 (UTC)

References

Synthesis violation in the lead

Other reviews have concluded that positive results reported for acupuncture are too small to be of clinical relevance and may be the result of inadequate experimental blinding, or can be explained by placebo effects and publication bias.

A 2009 usurped systematic review is being used (Madsen, 2009) to state the 2012 reviews effects are "too small to be of clinical relevance and may be the result of experimental blinding". The claim that acupuncture can be explained by the placebo effect (Singh, Ernst, 2008), (Ernst, 2006) is outdated research and the publication bias has nothing to do with the new reviews whatsoever. It is dated as well. For these reasons, this sentence should be removed from the lead. DVMt (talk) 03:03, 13 March 2013 (UTC)

Agree. --Mallexikon (talk) 06:37, 13 March 2013 (UTC)

Done. Good work! Ok, part 2:

Best to remove the Singh, Ernst reference from the page. This has been rejected by multiple authors at an imbalanced piece. Granted, truth is mixed in the work such as securing methodology are primary and tobacco cessation but the acupuncture section is not accurate. The reductionist view of CAM equates and conflates multiple procedures of CAM with acupuncture which are not related. Also, in violation of Wikipedia editorial guidelines, the work uses 25% of its own work as a primary source and not a secondary source.TriumvirateProtean (talk) 00:14, 23 May 2013 (UTC)

References

Choi et al

The above sections are a mess, per my own suggestion, here's a new section to discuss the one source that might be worth including: Choi et al, 2012. Discussing sham acupuncture controls, it states "The difference between sham and verum acupuncture remains unclear." It then goes into why. This is an interesting discussion that could be included in some form, but the equivocal nature must be reflected. The article does not indicate a consensus exists.

Next is a discussion of pain studies, which opens with "The majority of studies refuting the principle of point specificity evaluated the role of acupuncture in pain relief." Again, it discusses why, and again it's equivocal but useful in contextualizing future possible research.

Next is a discussion of "hemodynamic" studies - heart rate and blood pressure. This section would need to be treated with great caution, mixing electroacupuncture, exercise, rat and cat studies. Amazingly to me, they only cite four studies, but somehow draw conclusions from them. I really wonder if some cherry-picking is occurring. Why these four studies? Why the focus on exercising subjects (two studies), rats (one study) and cats (one study)? Is that the sum of the literature? Overally I would say this section is "suggestive" of point-specific responses, but no slam-dunk. It really reads like shit research.

Next is neurological studies - fMRI stuff. Similar to the hemodynamic section, it's really just summaries of single studies - why those studies? Why cats again? While they say "The point-specific actions resulting from stimulation of different acupoints in controlled laboratory trials confirm that needling different points on the body produces more than just placebo responses, given that placebo acupuncture is not associated with differential or acupoint-specific responses in anesthetized animals" the bold part seems quite relevant - people aren't cats.

Overall, given the totality of literature that exists for acupuncture, this seems like a shoddy, shallow, cherry-picked selection of evidence that is unduly extrapolated to humans. If this were my wikipedia, I wouldn't cite it at all. I'd probably mock it. However, since it's not my wikipedia, at best I would give it one sentence saying there is some evidence that certain points may have specific effects. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:23, 22 May 2013 (UTC)

Tough room. OK, let's try a more heavy weight study on the specific physiological responses evoked by acupuncture. The Annals of Internal Medicine is widely accepted as is the University of Maryland School of Medicine from which the lead author hails. As with an investigation, there are limitations but this finding is in agreement with your assertion that one sentence saying there is "some evidence" is appropriate. I don't think this research is worth mocking. TriumvirateProtean (talk) 17:33, 22 May 2013 (UTC)

That's Berman et al. 2004. It's 9 years old, it's a primary source, and it's only talking about one specific type of pain - osteoarthritis. Of the knee. The page already discusses acupuncture and the knee using several much more recent meta-analyses. It also has no bearing on the possible mechanism for acupuncture effectiveness. It doesn't add anything to Choi et al. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:07, 22 May 2013 (UTC)

Agreed, unrelated to Choi. I wasn't sure where to put it since it was an effort to reference physiological responses. Maybe move this comment to a better section?TriumvirateProtean (talk) 18:12, 22 May 2013 (UTC)

I wouldn't bother since there's no reason to expect it will be integrated into the page or used to verify any text. It's redundant to other sources. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:44, 22 May 2013 (UTC)

Physical correlates of acupoints

This interesting study contributed by Acuhealth unfortunately does not meet the requirements of a reliable source for medical articles. The sources you deleted, on the other hand, did; they're also not outdated. Good faith edit, but I still have to revert it. Cheers, --Mallexikon (talk) 06:11, 21 May 2013 (UTC)

The aforementioned research by members at Department of Biological Science, Sungkyunkwan University, Department of Chemistry and Nano Science, Ewha Womans University and the Graduate Program for Health Science and Technology, Sungkyunkwan University, was rejected as unreliable. However, the research is accepted, peer reviewed material and shows distinct characteristics of both acupuncture points and the meridians they are on.Acuhealth (talk) 14:35, 21 May 2013 (UTC)

You may find the research from the Massachusetts Institute of Technology more acceptable. Researchers from MIT and the University of Michigan utilized MRI research to demonstrate that autonomic nervous system (ANS) responses to acupuncture emanate from “distinct subregions” of “brain circuitry.” True acupuncture activated the secondary somatosensory cortex (S2), insula and the mid-cingulate cortex. The heart rate (HR) deceleration and skin conductance response (SCR) “magnitude of response was greater following real acupuncture” than with sham acupuncture. This research may allow for the acceptance of the edit. The source:Acuhealth (talk) 14:35, 21 May 2013 (UTC)

In reality, there are numerous studies from the most prestigious universities worldwide showing that true acupuncture points, when needled, activate and deactivate distinct areas of the brain and endocrine system whereas sham acupuncture does not. At this point, that is not considered a controversial topic in that it has been proven repeatedly in controlled, randomized trials of sufficient size and variable controls. Acuhealth (talk) 14:34, 21 May 2013 (UTC)

This next study is quite fascinating: Here, we find that researchers have found "electroencephalographic similarities of acupressure induced sedation and general anesthesia as assessed by bispectral index and spectral edge frequency." In this instance, needles were not required at the acupoints but rather pressure.Acuhealth (talk) 14:34, 21 May 2013 (UTC)

Dr. Cho's book, Neuro-Acupuncture written by Cho, Wong, Falton, shows not only does acupuncture SJ5 exist but that it functionally acts to stimulate the auditory cortex of the brain. As denoted by historical Chinese medicine texts, the function of this acupoint is to benefit hearing. Dr. Cho is a professor of Radiological Sciences and Director of functional Brain Imaging Laboratory for Acupuncture Research (BILAR). University of California, Irvine, California. From 979-1985, he was Professor of Radiology (Physics) and Co-director of Imaging Research Center, Columbia University, New York, New York. Dr. Cho is a member of the US National Academy of Sciences and has won numerous awards including the Distinguished Scientist Award: International Workshop on Physics and Engineering in Medical Imaging; Organizing Committee of International Workshop on Physics and Engineering in Medical Imaging,March 15-18, 1982, Asilomar, California U.S.A. To read his book on Neuro-Acupuncture: Acuhealth (talk) 14:34, 21 May 2013 (UTC)

You note that one reference is accepted, Trick or Treatment. This piece is largely a specific attack on homeopathy and chiropractic care. It is highly politically charged. One author of the book, for example, was dismissed from Exeter University over the Smallwood incident. It seems that the author took exception to Prince Charles' private secretary of the cost-effectiveness of CAM therapies. Politically charged books such as this are not exactly purely scientific investigations, the Smallwood incident is no exception. I suggest that this reference be struck. Granted the lawsuit from the British Chiropractic Association against the other author for material in this book, Singh, was dropped. Nonetheless, the controversy of this book surrounded other elements such as the dedication of the book to the Prince of Wales. Perhaps this was a tongue in cheek retort given the politically charged incident with his personal secretary. Acuhealth (talk) 14:51, 21 May 2013 (UTC)

The next reference that you note is acceptable is most clearly not and is entirely misleading. It is a support piece of acupuncture therapy with two negative quotes by Felix Mann in it. This is not peer reviewed literature and has no place as a reference. The article supports the efficacy of acupuncture and to cite it as an example of supporting the non-existience of acupuncture points is misleading. It is written by a singular author and is not part of a randomized, controlled trial or basic research. It is a nice historical piece, however, and nice reading but is not supportive of the claim for which it is used to cite. Rather, it supports the contrary. Moving to the Felix Mann quotes contained within the article cited, Mann wrote, "The meridians of acupuncture are no more real than the meridians of geography. If someone were to get a spade and tried to dig up the Greenwich meridian, he might end up in a lunatic asylum. Perhaps the same fate should await those doctors who believe in [acupuncture] meridians.... The traditional acupuncture points are no more real than the black spots a drunkard sees in front of his eyes...." This is hardly a scientific investigation or a conclusion based on research. I suggest this reference be struck immediately. This is a charged, opinion by Felix Mann and is taken out of context from Bauer's article. Highly inappropriate and goes to undermining the integrity of Wikipedia.Acuhealth (talk) 15:07, 21 May 2013 (UTC)

The final reference given to support the opinion that no scientific correlates exist regarding the existence of acupuncture meridians and acupuncture points actually goes so far as to suggest that studies showing the existence of acupuncture meridians are suggestive of the fact that they do exist. The sole purpose of the study was to investigate whether or not there are distinguishable electrical properties of acupuncture points and meridians. This does not preclude the research on oxygen levels showing the existence of both acupuncture points and meridians, nor does this negate Cho's MRI investigations showing the existence of acupuncture points. Further, the cited work used to support the notion that meridians do not exist goes so far as to say that future research may be able to detect the meridians with more sensitive equipment. The conclusion from the study reads, "While inadequate, the evidence is more supportive of the claim that acupuncture meridians are electrically distinct. The meridian studies were generally of higher quality and were more inclined to consider polarization effects than the point studies. While the results are suggestive, additional studies should be performed to determine whether the results are replicable. Preliminary interpretation of the data suggests that deeper, subcutaneous tissue layers may be an important component in the increased capacitance and decreased resistance reported at acupuncture meridians. If so, future studies may consider using larger surface electrodes (1 cm) separated by sufficient distance to minimize the contribution of superficial layers to the impedance or admittance values. Alternatively, they may use invasive electrodes. With the development of sophisticated impedance analyzers, frequency-related changes in impedance are relatively easy to perform and make this area of research ripe for further exploration."Acuhealth (talk) 15:31, 21 May 2013 (UTC)

This revision was undone by yet another user and referred to an explanation in talk. However, this user made no explanation in response to my response to the first undo. Citing non-MEDRS, the user did an undo. However, I demonstrated that the non-MEDRS was the material stating that there were no scientific correlates for acupuncture points and meridians. As shown above, there are a plethora of peer reviewed medical studies showing that the acupuncture points exist and function and the meridians. The user needs to respond to this research before performing and undo. Let the science speak for itself. The current version showing a scientific correlate cites studies from MIT, University of Michigan and more. The original statement removed was inaccurate and cited opinion papers and unsupportive documentation. Acuhealth (talk) 17:24, 21 May 2013 (UTC)

There is now a conflict between the lead - "Scientific investigation has found a measurable correlate for acupuncture points" and the section on Physical correlates of ... points .. meridians - "no research has established any consistent anatomical structure or function for either acupuncture points or meridians". The research cited in the lead would be acceptable in the Physical correlates section, but is probably too new (mostly primary sources) for the lead. There is also mounting primary research on correlates for meridians eg Zhang WB et al: Understanding propagated sensation along meridians by volume transmission in peripheral tissue, Chin J Integr Med. 2013; 19(5):330-9 and Silberstein M: Do acupuncture meridians exist? Correlation with referred itch (mitempfindung) stimulus and referral points, Acupunct Med. 2012; 30:17-20. These are primary sources too, but probably merit inclusion in the Physical correlates section. This article needs to reflect ongoing research in this area. What do other editors think? — Preceding unsigned comment added by Tzores (talk • contribs) 23:27, 21 May 2013 (UTC)

Acuhealth, you presented 13 (!) sources for your claim - and 12 of those do not support the claim about a physical correlate of acupoints at all! The one source that does still doesn't qualify as MEDRS. And this article of course has to reflect ongoing research, but only within the framework of what is verifiable - those primary sources are not reliable enough. That's why Wikipedia has guidelines about MEDRS. Cheers, --Mallexikon (talk) 04:45, 22 May 2013 (UTC)

How does the research from Sungkyunkwan University/Ewha University not meet modern scientific standards? These are perhaps the two most prestigious universities in Korea. It clearly shows partial oxygen pressure is higher at acupuncture points and through the meridians. Samsung Group owns Sungkyunkwan and the nanotechnology group is top notch and built with Samsung financial support. I need a reason why you feel that this is not some of the best research ever conducted. It is a scientifically validated, repeatable phenomenon. What aspect of the amperometric oxygen microsensor detections of partial oxygen pressure do you find unsubstantial or putative? How is this unverifiable, it hails from a top research institution worldwide. Ewha gave Korea its first female doctor, lawyer, court justice and prime minister. Sungkyunkwan has a dual degree program with Ohio State University and a joint program with MIT. Further, another study citing adenosine related to acupuncture point stimulation is widely accepted along with other research submitted showing endocrine and brain center correlates. I am now suspicious that this is an attack on scientific data in an effort to mollify the research on acupuncture. Acuhealth (talk) 04:53, 22 May 2013 (UTC)

I'm not saying this study doesn't meet modern scientific standards... I'm only saying it's not the kind of source that the MEDRS guidelines require (cause it's a primary source): we need secondary or tertiary sources here. Please read WP:MEDRS. --Mallexikon (talk) 07:03, 22 May 2013 (UTC)

If you want to add these sources, let's add them one at a time. To start, propose an edit which uses the Hong et al source and quote directly from the source to support your edit. TippyGoomba (talk) 05:15, 22 May 2013 (UTC)

Oh, reading above, it appears that the particular source I gave as an example is the poorest. Let's start with the other 12. Please pick one and let's get started. TippyGoomba (talk) 05:17, 22 May 2013 (UTC)

Why is the Hong et al considered the poorest? It is clear, hard, objective data. Acuhealth (talk) 05:20, 22 May 2013 (UTC)

(Please indent your posts using colons.) Apparently the journal sucks. Why don't we focus on your other sources first and we can talk about the journal when the rest is resolved. Would you like to propose an edit? TippyGoomba (talk) 05:23, 22 May 2013 (UTC)

Actually, I don't think the journal sucks. But the article in question is only a primary source. Cheers, --Mallexikon (talk) 07:03, 22 May 2013 (UTC)

Here are three important works:

Minagawa, Munenori, Yasuzo Kurono, Tatsuyo Ishigami, Atsushi Yamada, Toshinori Kakamu, Ryoichi Akai, and Junichiro Hayano. "Site-specific organ-selective effect of epifascial acupuncture on cardiac and gastric autonomic functions." Autonomic Neuroscience (2013).

A PET-CT study on specificity of acupoints through acupuncture treatment on migraine patients. Jie Yang1, Fang Zeng1, Yue Feng1,Li Fang1, Wei Qin2, Xuguang Liu1, Wenzhong Song3, Hongjun Xie3 , Ji Chen1, Fanrong Liang1.

Point specificity in acupuncture. Chinese Medicine 2012, 7:4 doi:10.1186/1749-8546-7-4. Emma M Choi, Fang Jiang, John C Longhurst. Susan Samueli Center for Integrative Medicine, Department of Medicine, School of Medicine, University of California, Irvine CA.

The first study shows specific points correlate to specific internal organ responses. The second demonstrates PET-CT verification that the point exists and exerts a specific brain response to eliminate migraines. The third demonstrates point specificity.Acuhealth (talk) 05:27, 22 May 2013 (UTC)

The assertion that the "journal sucks" does not seem like a scientific allegation that the research from a top university is not valid.Acuhealth (talk) 05:27, 22 May 2013 (UTC)

Hemodynamic changes associated with acupuncture are also scientific correlates as found in: Arai, Hiroyuki, Yoshifumi Saijo, Tomoyuki Yambe, and Nobuo Yaegashi. "RADIAL ARTERY HEMODYNAMIC CHANGES RELATED TO ACUPUNCTURE."Acuhealth (talk) 05:30, 22 May 2013 (UTC)

Let's start with just one to keep things simple. Suggest and edit and quote from the source in support of your edit. TippyGoomba (talk) 05:32, 22 May 2013 (UTC)

And please keep in mind that WP:MEDRS requires secondary or tertiary sources... --Mallexikon (talk) 07:03, 22 May 2013 (UTC)

Physical correlates of acupoints, Part Two

Naturally, after an exhaustive explanation of the garbage literature that has been allowed to stand and the redaction of qualified peer reviewed studies I am convinced that this is an attempt to wear credible resources down until the article reverts. Here is but one of many quotes ready to go:

Researchers at the University of California School of Medicine (Irvine, California) note, “Recent evidence shows that stimulation of different points on the body causes distinct responses in hemodynamic, fMRI and central neural electrophysiological responses.” The investigators reviewed MRI results and noted that “stimulation of different sets of acupoints leads to disease-specific neuronal responses, even when acupoints are located within the same spinal segment.”' Point specificity in acupuncture.

Acuhealth (talk) 05:39, 22 May 2013 (UTC)

That's the kind of suggestion I was looking for! I cleaned it up a bit for readability, i hope you don't mind. TippyGoomba (talk) 05:44, 22 May 2013 (UTC)

I see you undid the insertion, but how can you insert that trash literature and out of context work? We are talking about citing a resource for authors that were thrown out of Exeter University. I covered it in detail in talk. No place in science.Acuhealth (talk) 05:53, 22 May 2013 (UTC)

Don't forget to indent. No one has comment on your suggestion yet. See WP:CONSENSUS. TippyGoomba (talk) 06:05, 22 May 2013 (UTC)

Acuhealth, please answer some questions. What do you think of the purpose of this or any other article at Wikipedia? Do you think it is supposed to (according to our policies) only cover scientific research? Do you think it is supposed to only cover controversies? Do you think it is only supposed to cover history? Seriously, do you know anything about Wikipedia's content policies? -- Brangifer (talk) 06:23, 22 May 2013 (UTC)

The purpose of the acupuncture article is to cover acupuncture objectively. It most certainly includes opinion and, in this case, opinion trumps scientific data. Going to consensus building as a wikipedia policy, rewording to make an implied consensus taking into account variances is a standard wikipedia policy. I see the reversion meaning that the change was not acceptable to someone. The article should reflect objective findings and not present opinion as truth. It could be stated, "In my opinion, there is no correlate...." However, this is not stated and the new research is rejected. Please weigh in on the presented research demonstrating biomedical correlates for acupuncture points including MRI brain state changes, hemodynamics, oxygen pressure differentials and endocrine point specificity. Please read the above quotes and make your comment on whether or not the biomedical correlate issue is valid based on the objective evidence and presented data.Acuhealth (talk) 06:31, 22 May 2013 (UTC)

I obviously have a reason for asking. Keep in mind that objectivity is not a specific goal for ALL content. Some content documents the opinions of believers and skeptics, which is obviously subjective. NPOV requires that opposing POV be presented in articles, especially when there is controversy, and the removal of such content violates NPOV and is seen as whitewashing, which is not allowed. The controversy must be visible, not hidden, and you are well aware that acupuncture is controversial. In China it is even being used less and less as modern medicine is seen as more effective, but it has a long tradition there and still exists side by side with modern medicine. BTW, what is your exact position(s) at Five Branches University and Healthcare Medicine Institute? -- Brangifer (talk) 07:03, 22 May 2013 (UTC)

Please weigh in on the aforementioned quote, Researchers at the University of California School of Medicine (Irvine, California) note, “Recent evidence shows that stimulation of different points on the body causes distinct responses in hemodynamic, fMRI and central neural electrophysiological responses.” The investigators reviewed MRI results and noted that “stimulation of different sets of acupoints leads to disease-specific neuronal responses, even when acupoints are located within the same spinal segment.” Point specificity in acupuncture. Let's go with this and build consensus, I invite input on your view of the scientific validity, Acuhealth (talk) 06:43, 22 May 2013 (UTC)

"Stimulation of different sets of acupoints leads to disease-specific neuronal responses, even when acupoints are located within the same spinal segment”... I'm not even quite sure what this is supposed to mean... What statement do you want to use this as a source for, then? --Mallexikon (talk) 06:52, 22 May 2013 (UTC)

Thank you for asking. This quote is in response to a request for a quote on why there is a biomedical correlate for the existence of an acupuncture point. You had rejected the oxygen sensor study from two of the most prestigious universities in Korea. This study is from the USA. I thought that might avoid ethnocentric bias but including a different country of origin. In this quote, we see that specific acupuncture points are verifiable for specific biological effective actions. I find it more than wholly appropriate to delete the assertion that there is "no correlate" for acupuncture points.TriumvirateProtean (talk) 06:57, 22 May 2013 (UTC)

That is a typical finding of research that is extremely generic and tentative in nature. The quoted text has nothing to say about whether a particular person might benefit from paying money to someone who says they practise acupuncture, nor does it throw any light on whether acupuncture has ever been helpful for anyone. The proposed text might as well be "obviously the body will give various responses when needles are stuck in it, and we have measured some of those responses, but have no idea whether they mean anything". Johnuniq (talk) 07:05, 22 May 2013 (UTC)

The purpose of the quote was not to suggest medical benefits although there are numerous studies on that topic. Rather, this was to verify that acupuncture points exert specific biological responses as opposed to non-acupuncture points. The quote is specific to the edit in questions wherein I suggest removing the line "Scientific investigation has not found any histological or physiological correlates for traditional Chinese concepts such as qi, meridians and acupuncture points," because at least two of the supportive references are poor and the third is irrelevant (see earlier talk) and further, that biomedical correlates have been established. Simply, acupuncture points have specific effects on the human body hemodynamically and neurologically and that these effects are not caused by non-acupuncture points.TriumvirateProtean (talk) 07:10, 22 May 2013 (UTC)

Per MEDRS, we don't normally report on preliminary research that isn't confirmed by independent researchers and then as part of larger reviews. This type of thing takes years. These results you cite are highly speculative conclusions. It's sad to see this happen. Roughly speaking, every spot in the body has a corresponding "spot" in the brain. (Yes, that's very simplistically put!) There is nothing new about that, therefore affecting a spot on the skin is going to trigger some sort of response in a specific region of the brain. That proves nothing regarding acupuncture or potential effects on health. We need MUCH better research to conclude such things, but believers who perform this type of research immediately draw such unwarranted conclusions, which is one of the reasons that Chinese (and now Korean) research of this type is highly suspect and we'd like to see better research done, preferably by nonbelievers. If there really is something, it will show, regardless of the belief structure of the scientists involved. -- Brangifer (talk) 07:14, 22 May 2013 (UTC)

In response to "why anybody should pay for it", although I was not asserting specific medical benefits, I will list one very recent study showing acupuncture "was effective in lowering baseline BG (blood glucose) and modulating the change in BG."A relatively minor study, but it is very recent and somewhat interesting. Naturally, there are better studies than this with more substantive medical findings. Nonetheless, it shows a biomedical correlate to electroacupuncture and blood glucose changes so it is somewhat relevant to the discussion as to whether or not it is valid to assert there is no correlate.TriumvirateProtean (talk) 07:17, 22 May 2013 (UTC)

HRV is heart rate variability and acupuncture has been shown to improve HRV, an important measure of cardiovascular health. “HRV changes significantly during auricular acupuncture…” and “HRV total increases during auricular acupuncture….” come from one study. Another study from International Society for Autonomic Neuroscience notes that acupuncture “causes the modulation of cardiac autonomic function.” You mentioned non-believers, the International Society for Autonomic Neuroscience is rather staid if not stoic. They don’t need to believe, they need proof of medical effectiveness and found it. I suppose no one will like this either and you'll stick with the assertion that there is no correlate. There are many.TriumvirateProtean (talk) 07:24, 22 May 2013 (UTC)

I invite comment on the HRV quotes. Clearly, a correlate between biomedical findings and acupuncture point stimulation. Further, the sham acupuncture points in placebo controlled, randomized studies did not affect HRV whereas verum acupuncture does affect HRV. If you find this interesting and helpful in clarifying the correlate issue in question, please note. Medical fact is stranger than fiction.TriumvirateProtean (talk) 07:40, 22 May 2013 (UTC)

Specific acupuncture points increase antioxidant activity and decreases oxidative stress according to new research. TriumvirateProtean (talk) 12:57, 22 May 2013 (UTC)

A basic tenet of MEDRS for Wikipedia is to "respect secondary sources." At this point, I have given several sources from several of the most prestigious universities in the world. The current quote stating there is no correlate in biomedicine gives three non-MEDRS sources as explained in Talk. I suggest an immediate redaction of the "no correlate" statement as it is inaccurate and does not reflect MEDRS. TriumvirateProtean (talk) 13:03, 22 May 2013 (UTC)

To the effectiveness question by one reviewer, ““auricular acupuncture and intranasal midazolam were similarly effective for the treatment of dental anxiety,” as published in the prestigious Anesthesia & Analgesia from MDs from Hannover Medical School, Germany.TriumvirateProtean (talk) 13:09, 22 May 2013 (UTC)

Dr. Guidice, MD notes in the New England Journal of Medicine that acupuncture is effective for the treatment of endometriosis. TriumvirateProtean (talk) 13:12, 22 May 2013 (UTC)

Are you suggesting an edit? If so can you concisely restate it along with source(s) you wish to use? TippyGoomba (talk) 15:17, 22 May 2013 (UTC)

Yes, I am suggesting that the line in paragraph one stating, "Scientific investigation has not found any histological or physiological correlates for traditional Chinese concepts such as qi, meridians and acupuncture points" be redacted and supplanted with "Scientific investigation has found biomedical correlates for acupuncture points." The research was detailed in this talk section, parts 1 and 2. The Sungkyunkwan University (owned by Samsung Group) research cited oxygen pressure levels higher at acupuncture points and showed the meridians. The University of California report detailed hemodynamic and MRI findings on specific physical correlates for acupuncture points and specific biomedical actions for each point. The remarkable findings of HRV correlates for acupuncture point stimulation vs. placebo controls and sham acupuncture shows that acupuncture increases HRV and therefore benefits cardiovascular health. The International Society for Autonomic Neuroscience concurs stating, acupuncture “causes the modulation of cardiac autonomic function.” These are a few examples of supportive material for the edit. I also detailed the three citations for the existing, erroneous assertion that requires redaction. One citation is a discredited book and is an opinion piece, one is completely out of context and includes expletives in an unscientific manner and the third seems like valid research but only goes to the argument of the electroconductivity model of acupuncture points. This is completely detailed in Talk.TriumvirateProtean (talk) 15:56, 22 May 2013 (UTC)

So there appear to be four sources:

• Hong et al, 2012 - this is a primary source of a single acupuncture point measuring a single biomarker on a small number of subjects. It does not validate that all acupuncture points exist, that they are based on changes in skin surface oxygen level or that these changes are related to any of the health outcomes for acupuncture. I would not support citing this based on WP:MEDRS emphasis on secondary sources.
• Choi et al, 2012 - this is a recent secondary source, and could be integrated. I don't think it's definitive, and I'll definitely need to read it in detail to comment.
• Gao et al, 2012 - this is a primary source studying anaesthetized rats, not people. It shouldn't be cited.
• Kurono et al., 2011 - this is a primary study in 11 subjects.

Only Choi et al 2012 seems to be worth even discussing. Have I missed any sources? May I suggest starting a new section specifically for Choi so we can focus on whether, and how to include it? WLU (t) (c) Wikipedia's rules:^simple/_complex 17:04, 22 May 2013 (UTC)

Created below. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:24, 22 May 2013 (UTC)

Here are a few secondary sources that might help inform your consensus-building:

• Electrical Characterization of Acupuncture Points: Technical Issues and Challenges Ahn 2007
• Characterizing Acupuncture Stimuli Using Brain Imaging with fMRI - A Systematic Review and Meta-Analysis of the Literature Huang et al 2012
• How do acupuncture and moxibustion act? - Focusing on the progress in Japanese acupuncture research Kawakita et al. 2006
• Neuroanatomical basis of acupuncture treatment for some common illnesses Cheng 2009

Puhlaa (talk) 17:29, 22 May 2013 (UTC)

• Ahn, 2007 is pretty old, six years, and is probably redundant to Colbert et al. 2011 which is already on the page (and includes Ahn as a co-author).
• Cheng, 2009 perhaps, but again is speculative.
• Kawakita, 2006 is pretty old, focusses on Japanese acupuncture and moxibustion, but might be useable.
• Huang et al 2012 is recent and could probably be used, but again comes down to "there's no consensus and more research is needed".

Again these sources are long on speculation and short on consensus, often with competing models. Worth a mention, certainly not appropriate for saying "acupuncture is effective through X mechanism". I would see it basically as a list of possible explanation without much more text than that list. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:03, 22 May 2013 (UTC)

I have not seen anyone suggest that the text be changed to say "acupuncture is effective through X mechanism", I have only seen Acuhealth critique the current article lead, based on his/her assertion that it is POV and uses weak sources. The sources I provided are all peer-reviewed and secondary sources. The sources all seem to agree that some evidence suggests the possibility of some point specificity, but most interpretations beyond that are speculative. The current lead uses 3 sources to support the text "Scientific investigation has not found any histological or physiological correlates for traditional Chinese concepts such as qi, meridians and acupuncture points", however, 2 of those sources are not peer-reviewed (the critical narrative [29]'trick or treatment' and the 'Chinese medicine times'). The single peer-reviewed source included there says "Based on this review, the evidence does not conclusively support the claim that acupuncture points or meridians are electrically distinguishable. However, the preliminary findings are suggestive and offer future directions for research based on in-depth interpretation of the data"; this is not the same as "not found any histological or physiological correlates", as is currently stated in our lead. I would suggest qualifying the statement in the lead about 'physical correlates' with some acknowledgement that there is indeed a debate based on scientific investigation, because "preliminary findings are suggestive" - however "the evidence does not conclusively support the claim that acupuncture points or meridians are distinguishable".Puhlaa (talk) 19:52, 22 May 2013 (UTC)

That all said, if consensus is reached, it would be more appropriate to update the body of the article to reflect any "preliminary research" that is discussed in the available secondary sources, before the lead is updated (IE: lead should summarize the body).Puhlaa (talk) 19:56, 22 May 2013 (UTC)

Agreed, an update to the body seems appropriate. I argue that the lead is misleading and needs the half-sentence redaction based on the editorial editor mistake of citing references inappropriate to the content and refusal to remove them although addressed fully in TALK. TriumvirateProtean (talk) 23:57, 22 May 2013 (UTC)

I see that correlates has now been changed to "existence". This is a bold step given the ongoing controversy over the statement. At minimum, needs undo. There is no TALK prior to the edit and the sources quoted are in question and consensus is in development over secondary sources showing correlates and existence.TriumvirateProtean (talk) 03:53, 23 May 2013 (UTC)

As previously explained, NPOV requires the inclusion of opposing POV and controversies. Just because they do not agree with other content is no reason they should be removed. On the contrary. That would be whitewashing. Controversies should be stated plainly and not hidden.

The word "correlates" has been added at some point and has been creating problems. It's too vague and was not the original term used, where lack of proof of "existence" of qi, meridians, and acupuncture points was the more precise wording which expressed the precise POV of skeptics. I have restored that wording so the idea is clear. Obviously this conflicts with basic acupuncture theory and the views of proponents. That's the way it is in fact, and that's the way the article should state the conflict between the two world views. I have made two edits [30][31] to restore the previously clear content. If believers do not believe that content, then I have achieved the proper purpose by making the conflict plain. If improvements can make it even plainer and with better prose (and which also follows the references), then do so, but don't whitewash it or delete it. -- Brangifer (talk) 03:57, 23 May 2013 (UTC)

People are entitled to their beliefs and opinions, however, they are not entitled to skew facts. There is plenty of scientific research documenting the existence, structure and physiological properties of acupuncture. More than this, it could be stated that, "Many people believe that there is no scientific proof...., however, x and such studies have shown physiological properties, etc..." Note that the sources in that statement are not secondary, peer reviewed sources and are quire controversial. Yes, the controversy is hidden and covert in that the references do not support the claim. TriumvirateProtean (talk) 04:04, 23 May 2013 (UTC)

Which "references do not support the claim"? The skeptical references support the skeptical claims. That's all that's necessary for those claims. -- Brangifer (talk) 04:23, 23 May 2013 (UTC)

Perhaps illuminating the controversy, as you suggest, is intellectually honest. I suggest that I add some of the research presented in this section stating, "Numerous studies using MRI imaging demonstrate acupuncture point specific responses in brain EEG readings. Hemodynamic and oxygen pressure studies show anatomical physical correlates for acupuncture points." Then, of course, including the references.TriumvirateProtean (talk) 04:14, 23 May 2013 (UTC)

No, don't add that. It would just be deleted. They are primary research that prove nothing other than that brain cells are connected to body parts. Big deal. No evidence for or against acupuncture. As you say, "people are entitled to their beliefs, however they are not entitled to skew facts." That cuts both ways, and the beliefs of those who believe in acupuncture are just as much belief as anything else. Also read MEDRS. Your insistence on using poor and primary sources is not constructive.

Above I asked a question, but you have not responded, so I'll ask it again: What is your exact position(s) at Five Branches University and Healthcare Medicine Institute? -- Brangifer (talk) 04:21, 23 May 2013 (UTC)

Honestly, Brangifer, if I was Acuhealth I really wouldn't bother to respond. I can understand that you want to prevent WP:COI, however, trying to coax someone into WP:OUTING is not helpful. Cheers, --Mallexikon (talk) 07:24, 23 May 2013 (UTC)

Returning to the substantive topic at hand, Trick or Treatment is a valid, reliable source, and it and the other sources stating "no correlates of acupuncture points" are still correct. The best that has been provided alleging acupuncture points exist are really possible biological correlates of the actual points. They are not definitive, they are not universally accepted, they are not conclusively proven. If you go to a major centre like the NIH, or a current textbook, these sources do not say "acupuncture points are now identified as ____". Ahn, 2008, is accurately summarized - the "results" are suggestive of future research. Not conclusive. I see no reason to change the lead, bar perhaps adding something like "...though some possible structures have been suggested and research is ongoing." However, I consider such statements to be pointless wastes of words and would personally prefer such a change not be made. There is certainly not an adequate amount of scientific research documenting the existence, structure and properties of acupuncture. As said previously, the best evidence I've seen so far is suggestive, not conclusive. At best you could point out what avenues are being pursued - but certainly not based on primary sources, secondary only.

I have no problem with either "correlates" or "existence". I lean more towards the latter.

The problem with Acuhealth isn't his or her possible COI, it's the poor quality of the references being presented to verify a change. I don't care what Acuhealth does in meatspace, I do care that his/her references are inadequate. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:06, 23 May 2013 (UTC)

References

I've put in a reflist so I can see the actual studies, if anyone knows how, can they throw in one o' them fancy boxes that doesn't mess with the formating? WLU (t) (c) Wikipedia's rules:^simple/_complex 16:29, 22 May 2013 (UTC)

Extended content

Correlates vs existence

"Scientific investigation has not found any histological or physiological proof for the existence of qi, meridians, and acupuncture points..." is an awkward sentence. Qi, meridians etc. are (at the least) concepts that are existing in the theory of TCM (I think we can all agree on that). That's why the original wording (before it was changed by Brangifer) was "scientific investigation has not found any histological or physiological correlates for traditional Chinese concepts such as qi..." - which is both more elegant and more precise. So I changed it back. Cheers, --Mallexikon (talk) 06:42, 23 May 2013 (UTC)

Zhang, 2010

I'm surprised this systematic review isn't cited WLU (t) (c) Wikipedia's rules:^simple/_complex 18:33, 23 May 2013 (UTC)

• Zhang, H.; Bian, Z.; Lin, Z. (2010). "Are acupoints specific for diseases? A systematic review of the randomized controlled trials with sham acupuncture controls". Chinese Medicine. 5: 1. doi:10.1186/1749-8546-5-1. PMC 2818640. PMID 20145733.{{cite journal}}: CS1 maint: unflagged free DOI (link)

Needles

One line in the article: "Japanese acupuncturists use extremely thin needles that are used superficially, sometimes without penetrating the skin, and surrounded by a guide tube (a technique adopted in China and the West)" seems to need a citation for the part "without penetrating the skin." It is commonly known that 'Japanese' style needles come in very thin gauges and common practice in China uses thicker gauges so this part requires no citation. The "without penetrating the skin" assertion is not common knowledge and I have never heard of this. I am curious, however, to hear more about it. Also, the penetration aspect might be better put in the technique subsection and not in the needle section heading which deals with the makeup of the needle.TriumvirateProtean (talk) 18:50, 23 May 2013 (UTC)

I'd like to see someone add a section comparing wound needle handles with pipe handles. Also, comparison of metals used in needles is of interest. Moreover, a comparison of classical Chinese needle design with Korean and Japanese style needle design. In addition, there is no mention of the silicone coated needle vs. the uncoated needle- a major area of needle design and highly relevant to comfort levels.TriumvirateProtean (talk) 19:00, 23 May 2013 (UTC)

It is already sourced, citation 74, this book.

If you want to see a section added, find the necessary sources and add it. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:01, 24 May 2013 (UTC)

Needle Technique

"The skin is sterilized, e.g. with alcohol, and the needles are inserted, frequently with a plastic guide tube." I see that a citation has been requested. This is necessary in that plastic guide tubes are frequently used outside of China more than within China. Classical acupuncture insertion technique does not involve the use of a guide tube. Perhaps mention of the geographic region where they are more frequently used than other regions. This also goes to the gauge discussion between Japanese Style and Chinese style needles wherein there are geographic differences in equipment use.TriumvirateProtean (talk) 19:00, 23 May 2013 (UTC)

The citation was already there. If you wish to add more information, you will have to find reliable sources and expand the page with them. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:11, 24 May 2013 (UTC)

It is true that guide tube use is not common in China, but very common in Japan and the west. Perhaps the Clean Needle Tech manual addresses this.Herbxue (talk) 17:32, 26 May 2013 (UTC)

Suggestion: Current research and recommendations

Im wondering if its a good idea to add a new subsection called "Current research and recommendations" (by authoritative PUBLIC/GOVERNMENT INSTITUTIONS ONLY). Would that be a useful addition to the article? The following table and text is intended as a draft:

As scientific studies on accupuncture have so far produced mixed results, the effectiveness of accupuncture has become a controversial issue. Also, the exact mechnanism of acupuncture is still unknown, which further complicates the matter. The following table is intended to give an authoritative view of acupuncture based on recommendations by government institutions and supranational organizations:

Country	Authority	Guidelines	Last update
United States	National Institute of Arthritis and Musculoskeletal and Skin Diseases	Acupuncture may improve knee function among patients with osteoarthritis It serves as a complement to standard care	July 2010
	National Institute of Child Health and Human Development	Some research indicated benefits from acupuncture, especially when given immediately after severe traumatic brain injury	November 2012
	National Cancer Institute	Studies have shown that acupuncture changes the response of the body's immune system It may stimulate nerve cells, the pituitary gland, and parts of the brain There is strong evidence that acupuncture relieves nausea and vomiting caused by chemotherapy For many cancer patients, acupuncture treatment either relieves symptoms or keeps them from getting worse. Few complications reported	March 2013
	National Institute of Neurological Disorders and Stroke	Acupuncture is recommended as a treatment option for chronic pain Experiments have shown that acupuncture may lead to higher levels of endorphins in cerebrospinal fluid	May 2013
United Kingdom	National Health Service	Acupuncture is recommended as a treatment option only for lower back pain There is some evidence that acupuncture works for a small number of other conditions including migraine and post-operative nausea Serious side effects are extremly rare More research is needed	May 2012
Germany	Bundeswehr Joint Medical Service	Acupuncture points on the body contain free nerve endings and nociceptors Acupuncture has been successfully used to reduce pain during operations It is effective in treating bodily dysfunctions such as migraine and dyspepsia The main results of acupuncture are not caused by the placebo effect	April 2013
N.A.	World Health Organization	The diseases or disorders for which acupuncture therapy has been tested in controlled clinical trials can be classified into four categories: Effect of acupuncture has been proven Effect of acupuncture is shown but further proof is needed Accupuncture is recommended because treatment by conventional therapy is difficult Acupuncture may be tried out The full list of treatable diseases and disorders is available [here	2003

Any suggestions/feedback? -A1candidate (talk) 21:03, 28 May 2013 (UTC)

Yeah, I'm against this. The question of who is pro and who is contra acupuncture is overblown in our article already. And while it might be of interest what medical organizations think about it, I'd like to emphasize again that the opinion of the armed forces (or the police or whatever government institution) is irrelevant here. Cheers, --Mallexikon (talk) 04:54, 29 May 2013 (UTC)

Malexikon, I am not necessarily "for" this, but I am curious, why do you say it is irrelevant? Of undue weight perhaps, but what determines what is relevant or not for this article?Herbxue (talk) 06:10, 29 May 2013 (UTC)

Very good question. Common sense, I guess. --Mallexikon (talk) 06:32, 29 May 2013 (UTC)

Hmmm, that's flippant (and funny), but doesn't seem like a reliable rubric. If, for example, an American illustrator's take on TCM's attitude towards anatomy is considered relevant and reliable for reporting on TCM's purported ignorance of anatomy (because it is a "secondary source"), why can't the findings of an agency tasked with making heath care recommendations be considered a reliable and relevant secondary source?Herbxue (talk) 06:56, 29 May 2013 (UTC)

@Mallexikon: As a new editor of this artice, my main concern is the lack of authoritative sources that the general public can trust. When I first looked at the article it was confusing because it contradicts itself in many sections. IMHO, the benefits of citing from government institutions are:

• Official guidelines/recommendations are updated regularly, which reduces the need to add/include every single scientific study
• A clear line is drawn to separate what's proven from what's not proven
• The table summarizes all scientific findings in a way understandable to the general reader

-A1candidate (talk) 07:01, 29 May 2013 (UTC)

@Herbxue: I don't mind stating what agencies "tasked with making health care recommendations" have to say about acupuncture... The armed forces of the US and Germany hardly fall under that category, though. --Mallexikon (talk) 08:46, 29 May 2013 (UTC)

Ok thanks, I thought you meant all the proposed sources were irrelevant.Herbxue (talk) 14:13, 29 May 2013 (UTC)

I would agree with Mallexikon here, the recommendations of the WHO are clearly relevant as a body of medical experts while the opinions of the armed forces of some few (select) countries are hardly relevant for the article. Also relevant could be recommendations of medical bodies and scientists associations. However, I would now follow A1candidate completely and we should not blindly trust governmental bodies to summarize the research appropriately because governments have their own agenda while peer-reviewed, reputable scientific publications are generally less biased. Greetings --hroest 11:49, 29 May 2013 (UTC)

That is mostly true, what we could perhaps do is gather everything regarding the effectiveness of acupuncture into one section and split it into four parts:

• Recommendation by WHO
• Guidelines and research by government institutions
• Results by reputable scientific publications and academic organizations:
  • If the results support the above guidelines then there's no point including them again unless they're highly notable
  • If the results do not support the above guidelines then they should be included
• Criticism

Is there consensus that this would make the article better than its current state? Im pretty sure we could condense the entire resarch and findings if and when acupuncture ever becomes an established science, but as long as it remains a controversial topic, I think organizing the article this way would give it a better structure.-A1candidate (talk) 12:15, 29 May 2013 (UTC)

I still think listing the opinions of all those institutes is a waste of article size. Those institutes base their recommendations and views on exactly the same sources we already have in the article - yes, acupuncture might be a good idea for back pain, and yes, for nausea, too, even if the mechanism of action is still not understood, etc., etc... Duh! I guess I can't argue against stating what these institutions recommend (although I regard that as information of very limited value), but I would definitely leave their summaries regarding the current state about what is scientifically known about acupuncture out - it's just redundant. We've already listed all of that in earlier sections. Cheers, --Mallexikon (talk) 01:57, 30 May 2013 (UTC)

That is indeed true to a certain extent, but I would argue that the includsion of the guidelines will draw a clear line separating what works, probably works, and doesn't work. So far, the reader has to read every single study in order to draw definite conclusions that require a considerable amount of medical knowledge. If you can organize the entire research into a way that draws a DEFINITE conclusion about acupuncture then I would certainly support it -A1candidate (talk) 06:43, 30 May 2013 (UTC)

Yeah, I would support that, too :)... however, to use the NHS's words, current "evidence does not allow us to draw definite conclusions..." It's as messy at that. No convenient way out for the reader, I'm afraid. Cheers, --Mallexikon (talk) 09:09, 30 May 2013 (UTC)

Yes, but if you look at my table I've included the part where NHS says that more research is needed. The peoblem is that this article contains numerous assertations by people/organizations with questionable notability. There is even a lengthy quote by an organization that doesn't have its own Wikipedia article. I hope you understand why its difficult for the general reader to draw a definite conclusion here. Lets see what other editors think, shall we? -A1candidate (talk) 10:17, 30 May 2013 (UTC)

References

New debate in Anesthesia & Analgesia

Note that these two articles appear in the same edition and reference each other, so the authors were allowed to critique and respond to each other:

• Colquhoun, D; Novella, S (2013). "Acupuncture is theatrical placebo". Anesthesia & Analgesia. 116 (6): 1360–1363. doi:10.1213/​ANE.0b013e31828f2d5e. Retrieved June 2, 2013. {{cite journal}}: zero width space character in |doi= at position 9 (help)

• Wang, S-M; Harris, RE; Lin, Y-C; Gan, TJ (2013). "Acupuncture in 21st century anesthesia: is there a needle in the haystack?". Anesthesia & Analgesia. 116 (6): 1356. doi:10.1213/​ANE.0b013e31828f5efa. Retrieved June 2, 2013. {{cite journal}}: zero width space character in |doi= at position 9 (help)

PS: There is something wrong in the DOI parts of my citation templates above. Please fix.

The conclusions are of most interest, and are definitely quotable. I think skeptics Colquhoun and Novella scored a very strong point by quoting promoters Wang, et al's conclusion. The skeptics said this:

• "Although the article by Wang et al.23 is written to defend the continued use of acupuncture, the only condition for which they claim that there is any reasonably strong evidence is for postoperative nausea and vomiting (PONV). It would certainly be odd if a treatment that had been advocated for such a wide variety of conditions turned out to work only for PONV. Nevertheless, let us look at the evidence."

The actual quote from promoters Wang, et al:

• "In conclusion, clinical trials support the efficacy of acupuncture in reducing PONV and postoperative pain; however, evidence supporting acupuncture as a treatment for chronic pain conditions is mixed."

That the skeptics do not agree, largely because promoters, including Wang et al, make claims far beyond what the evidence supports, and what they themselves (Wang...) have concluded, goes without saying -- Brangifer (talk) 20:53, 2 June 2013 (UTC)

I really find it hard to take sides here... "make claims far beyond what the evidence supports" ... really? He only says that there's rock solid evidence for successfully treating PONV, and that for chronic pain conditions, evidence is mixed. Actually, you could easily turn the skeptics' rationale ("it would certainly be odd if a treatment that had been advocated for such a wide variety of conditions turned out to work only for PONV") around - it actually would be odd, so if the have strong evidence for efficacy in PONV already, the mixed evidence for pain is probably going to turn into solid evidence soon... the reviews we've included in the efficacy section actually seem to pinpoint to that. Cheers, Mallexikon (talk) 02:24, 3 June 2013 (UTC)

He paraphrases them: "reasonably strong evidence is for postoperative nausea and vomiting (PONV)." One need not turn their rationale around, but take if for what they say. That may end up happening for some conditions, and when RS unequivocally prove it, we'll include that here. I don't know what weight Wang, et al have, but if they - promoters of acupuncture - only can state what they said ("clinical trials support the efficacy of acupuncture in reducing PONV and postoperative pain; however, evidence supporting acupuncture as a treatment for chronic pain conditions is mixed."), then there apparently isn't much more than that out there, or they would say it.

What's always nice about quoting one's opponents, is that it makes your case MUCH stronger. A good example is with homeopathy. In spite of all the claims made by homeopaths, when it came right down to it, none of the world's leading pro-homeopathy experts and homeopathy organizations could present good enough evidence to sway the British House of Commons Science and Technology Committee, which stated:

"In the Committee's view, homeopathy is a placebo treatment and the Government should have a policy on prescribing placebos. The Government is reluctant to address the appropriateness and ethics of prescribing placebos to patients, which usually relies on some degree of patient deception. Prescribing of placebos is not consistent with informed patient choice - which the Government claims is very important - as it means patients do not have all the information needed to make choice meaningful.
Beyond ethical issues and the integrity of the doctor-patient relationship, prescribing pure placebos is bad medicine. Their effect is unreliable and unpredictable and cannot form the sole basis of any treatment on the NHS."

If there was more evidence out there for acupuncture, Wang et al would know it and would have said it. I suspect their opinion trumps any cherry picked OR sources in our article. -- Brangifer (talk) 03:21, 3 June 2013 (UTC)

Sounds like you are doing some OR here - one systematic reviewer's failure to properly summarize all of the positive results seen in acupuncture studies is ample evidence for you to say that there is an absence of evidence? Seems like cherry picking of antimatter to me:) Also, the comparison to homeopathy seems inappropriate to me.Herbxue (talk) 05:26, 3 June 2013 (UTC)

I would agree. This is not a CAM forum. Mallexikon (talk) 05:48, 3 June 2013 (UTC)

Suggestion: Mechanism of action

Acupuncture#Possible_mechanisms currently consists of a single sentence, that's IMHO inadequate for such a large topic. Here's an explanation of the mechanism by the Johns Hopkins School of Medicine (Source):

• Conduction of electromagnetic signals (which releases substances like endorphins)
• Activation of the body's natural opioid system
• Stimulation of the hypothalamus and the pituitary gland
• Change in the secretion of neurotransmitters and neurohormones

This can be backed up by the following quotes published on various scientific journals:

• Nature (journal): "...We found that adenosine, a neuromodulator with anti-nociceptive properties, was released during acupuncture..." (Source)
• Journal of Endocrinology: "...Acupuncture blocks cold stress-induced increases in the hypothalamic–pituitary–adrenal axis..." (Source)
• Oxford Journal:"..The acupoints are located at sites that have a high density of neurovascular structures and are generally between or at the edges of muscle groups..."(Source)
• Peptides (journal):"..These data suggested that AVP (Arginine vasopressin) in the brain played a role in the process of acupuncture analgesia in combination with the endogenous opiate peptide system.." (Source)
• Radiology (journal):"...Results from human and animal studies (2,9–13) suggest that acupuncture acts as a neuromodulating input into the central nervous system (CNS) that can activate multiple analgesia systems and stimulate pain modulation systems to release neurotransmitters such as endogenous opioids..." (Source)
• The American Journal of Gastroenterology:"...The more remarkable modulation on the homeostatic afferent network, including the insula, ACC, and hypothalamus, might be the specific mechanism of acupuncture." (Source)
• The Lancet:"...After electroacupuncture in the patients with pain CSF β-endorphin levels rose significantly in all subjects, but met-enkephalin levels were unchanged. These results suggest that the analgesia observed after electroacupuncture in patients with recurrent pain may be mediated by the release into the CSF of the endogenous opiate, β-endorphin..."(Source)

The biggest challenge would probably be presenting the information in a way that's understandable to the general reader who does't have much much medical knowledge. -A1candidate (talk) 08:55, 30 May 2013 (UTC)

True... how about: "besides a lot of theories and suggestive findings, no hard evidence for any specific mechanism of action exists so far"? --Mallexikon (talk) 09:09, 30 May 2013 (UTC)

There is actually one specific mechanism that has been proven numerous times - Acupuncture does lead to the release of natural opioids. I dont know if you're medically trained so I wont go into details, but this should be mentioned in the article. Lets just see what other editors say, shall we? -A1candidate (talk) 10:13, 30 May 2013 (UTC)

I have always supported mentioning all of these mechanisms. The question of "which one" is "THE" mechanism explaining acupuncture is not an important question to me. All of these journals note specific physiological effects of acupuncture needle stimulation. There is no 1:1 correspondence between the traditional theories of how acupuncture works and the various physiological responses that have been experimentally observed. Each phenomenon is notable on its own terms.Herbxue (talk) 21:05, 30 May 2013 (UTC)

Why not approach this topic in a way similar to how other medical articles would deal with interventions with unknown mechanisms. For example, at the article for antidepressants the section on mechanism of action starts with an admission that no one knows how they work, then the most probable theories are detailed.Puhlaa (talk) 00:59, 31 May 2013 (UTC)

Agreed.Herbxue (talk) 21:19, 2 June 2013 (UTC)

ATP addition

Besides undue weight, the recent addition of a section on ATP violates MEDRS. It's primary research. It is not specific to acupuncture and doesn't "prove" acupuncture. It was done on mice, not humans, so what about acupuncture points? It just tells what happens when the bodily tissues of mice are damaged, including damage caused by acupuncture needles. The human body apparently reacts in a similar manner when damaged. Interesting. The addition of reactions in the press doesn't improve the matter and doesn't lend more weight to the findings, although I can't think of any other possible reason for adding them. Otherwise the research is interesting. -- Brangifer (talk) 14:14, 31 May 2013 (UTC)

It's not about whether its interesting or not, this study is central to the understanding of acupuncture, which is not exclusively used on humans. The study itself is notable enought to deserve a standalone article, I think its just fair to summarize it briefly here -A1candidate (talk) 14:23, 31 May 2013 (UTC)

Read MEDRS. You have added huge amounts of primary research, commentary, OR and synth violations. Start discussing each single edit before you make it. You're not going to use this article as your personal blog. -- Brangifer (talk) 15:34, 31 May 2013 (UTC)

Brangifer beat me to it, as I was intending on reverting the lot of your changes to the article myself because they violate WP:NOR and WP:MEDRS. Also agree that it was begining to look like a blog or persoanl essay. Any medical claims have to be backed up by rock-solid peer-reviewed secondary sources per WP:MEDRS. Primary papers are out of the question except to illustrate and supplement what is said about them in the secondary sources. Propose changes one at a time here and get clear consensus first. Dominus Vobisdu (talk) 15:50, 31 May 2013 (UTC)

These studies can all be backed up by secondary sources, lets start with Adenosine Triphosphate since this seems to be the major point of contention. I cited the primary sources for historical reasons, but here are some secondary sources:

• Medical textbook by Springer Publishing: "...Additional observations have implicated tissue release of nucleotides and adenosine in acupuncture analgesia, and shown analgesia results from peripheral actions at adenosine A1Rs... " (Source)
• Review article by Evidence-based Complementary and Alternative Medicine: "... These data strongly suggest that acupuncture-released ATP and its metabolite adenosine in local acupoint tissues block pain impulses from sites distal to needling point...." (Source)
• Review article by the Pflügers Archiv: European Journal of Physiology: ...In a separate study, the mechanistic action of acupuncture was observed by focusing on adenosine. It was found that insertion and manual rotation of acupuncture needles triggered a general increase in the extracellular concentration of purines, including the transmitter adenosine and ATP metabolites..." (Source)
• Review article by Neuropsychopharmacology (journal): "...In another recent study, Goldman et al. (2010) found that localized A1R activation underlies the antinociceptive effects of acupuncture. Manual stimulation of acupuncture needles resulted in localized extracellular increases in nucleotides (ATP, ADP, and AMP) and adenosine...'" (Source)

If there are any other issues or any suggestions/feedback, I'll be happy to address them. -A1candidate (talk) 18:37, 1 June 2013 (UTC)

Yeah, well... that's a very unspecific effect for an invasive procedure. If you punch someone hard enough you'll find lots of nucleotides and adenosine in the tissue as well... probably a few extravasal red blood cells and some histamine, too... On top of that, you keep on citing single studies (or in this case, the articles you cite are citing single studies)... That's not really what we need here - it inevitably leads to cherry picking. The aim is to report scientific consensus. --Mallexikon (talk) 06:07, 2 June 2013 (UTC)

The bigger problem here is relevance. Like Mallexikin said, the effect observed is hardly surprising, and does little to explain the phenomenon. Dominus Vobisdu (talk) 08:10, 2 June 2013 (UTC)

I see these mechanism studies as relevant, because this is information people want to know about Acupuncture. If you are unwilling to buy into traditional theory, what possible explanation can there be for the specific or non-specific effects of Acupuncture? I think that is a relevant question the article already seeks to answer.Herbxue (talk) 21:23, 2 June 2013 (UTC)

Yes, mechanism is relevant, but we need MEDRS sources, not primary studies. Using such sources creates an OR problem, because anyone can cherry pick any primary studies to paint the picture they wish. That's not acceptable here. When there are large reviews of many quality studies, then we can talk about inclusion of such information. Until then we continue to follow MEDRS for inclusion AND exclusion of sources making biomedical claims. These are excluded. -- Brangifer (talk) 22:35, 2 June 2013 (UTC)

I would argue that unless a medical claim of efficacy is being made, the following statement from MEDRS applies: "Sources for all other types of content—including all non-medical information in medicine-related articles—are covered by the general guideline on identifying reliable sources rather than this specific guideline." - the question of what happens physiologically when a needle is inserted in flesh is a general scientific question, rather than a medical question such as "does acupuncture effectively treat migraine" - thus primary sources are appropriate for the kind of content this article is missing.Herbxue (talk) 05:36, 3 June 2013 (UTC)

You misunderstand our general criteria with using primary sources on wikipedia. We almost never use primary sources so as to avoid original research. Primary sources should only be used to augment secondary sources. Primary sources can only be used for basic descriptive statements. IRWolfie- (talk) 11:21, 3 June 2013 (UTC)

The sources being discussed here are all secondary sources, mostly review articles -A1candidate (talk) 12:48, 3 June 2013 (UTC)

The fourth source you cited ([32]) is not secondary (they talk about their own research). The first 3 sources ([33], [34], [35]) actually are secondary. In none of them, however, can I find mention of adenosine being a major element in the mechanism of action of acupuncture - what statement would you like to use these sources for, then? --Mallexikon (talk) 03:57, 4 June 2013 (UTC)

The fourth citation is a review article based on the findings of other scientists. Perhaps you may wish to read the parts I've highlighted in bold.-A1candidate (talk) 06:46, 4 June 2013 (UTC)

Yes, they do review the works of other scientists, but just as a framework for their own studies ("In the first set of studies, our lab found that...") - this is probably something between a primary and a secondary source. The important point here is, however, that they can't be perceived as an independent source (as in: "Whenever writing about medical claims not supported by mainstream research, it is vital that third-party, independent sources be used..."). Cheers, --Mallexikon (talk) 01:17, 5 June 2013 (UTC)

I beg to differ; if you look at the first source its actually a medical textbook which summarizes consensus on this topic. Much of the controversy/disagreement has been centered on the clinical effectiveness of acupuncture alone, and not on its mechanism. So far, I haven't seen a single source say that acupuncture doesn't lead to higher adenosine/ATP levels. If you find one that says so, then Im highly interested to take a look at it -A1candidate (talk) 06:15, 5 June 2013 (UTC)

I sincerely hope you're not deliberately misunderstanding me... So let me repeat: a) My comment directly above refers to the 4th source you mentioned, not the 1st one. b) The 1st, 2nd, and 3rd of your sources do constitute secondary sources, however, in none of them can I find mention of adenosine being a major element in the mechanism of action of acupuncture - so what statement would you actually like to use these sources for? --Mallexikon (talk) 06:45, 5 June 2013 (UTC)

These sources don't explicitly say that because its assumed the reader already has some medical knowledge and knows what adenosine is. If that isn't the case the case for you, I apologize. If you want a source that explicitly states the obvious, here you go: "...AMP and adenosine concentrations remained increased after acupuncture and enhanced the duration of the pain-relieving effects of acupuncture. This work provides a mechanism for the basis of acupuncture..." (Science Signaling) -A1candidate (talk) 07:05, 5 June 2013 (UTC)

I still don't see evidence of a specific effect attributable solely to acupuncture or to stimulation of specific acupuncture points. What I see is some evidence that when one sticks a needle in the body, in this case an acupuncture needle, and especially when one twists it, one sees a reaction. A good experiment would check for similar reactions, measuring the same changes, using other types of stimuli, and also when other bodily points are stimulated/affected. Now THAT would be interesting! If there were differences that were beneficial and solely attributable to acupuncture needles on specific acupuncture points, THAT would be significant. We haven't seen anything close to that yet. If we had secondary reviews of multiple studies of good quality that are independently reproduced (that's what we mean by MEDRS compliant) that showed such evidence, we'd have them put into this article so fast your head would spin, but they don't seem to exist. Please provide us with such sources when you find them. We need controlled studies using control groups and methods, with as much blinding as possible. -- Brangifer (talk) 07:14, 5 June 2013 (UTC)

@A1candidate: This Science Signaling source you provided is - again - dealing with a single study (the one from Goldman et al.) - this just doesn't cut it for a MEDRS. And the 3 secondary sources we talked about are not being explicit about adenosine being a major element for the mechanism of acupuncture action simply because they recognize that it's just one of the factors in acupuncture analgesia (actually, in analgesia in general) - not, as you suggest, because "its assumed the reader already has some medical knowledge and knows what adenosine is" (on the contrary: everybody who knows what adenosine is would also know that its release into the tissue is quite common in all kinds of tissue trauma). --Mallexikon (talk) 08:26, 5 June 2013 (UTC)

A separate study by Zylka et al would probably be of interest; it also confirms the earlier discovery by Goldman et al by exploiting their findings -A1candidate (talk) 15:44, 8 June 2013 (UTC)

(Sigh)... great, another single study!... I can't access this article (at Nature; actually I could, but I don't want to spend the 15€ they want for it), but I read that he also experimented with mice. So, no, this doesn't cut for a MEDRS (again), but I think it might be interesting to discuss this mice acupuncture phenomenon. Please see the new thread I started below. Cheers, --Mallexikon (talk) 04:58, 9 June 2013 (UTC)

I am not sure that I understand the strong resistance to include information for the reader with regard to theoretical mechanisms of action of acupuncture. I note that the [mechanism of action] section of the antidepressant article includes primary studies, including some animal model studies using mice. I see no problem including this kind of information here, EG: The ATP hypothesis, the endorphin hypothesis, the Qi hypothesis, etc. Provided the section is not making medical claims, only informing the reader with regard to current theory, I think we can loosen MEDRS, as was done at the antidepressant article.Puhlaa (talk) 05:13, 9 June 2013 (UTC)

Acupuncture on mice

Yeah, just off the top my head: two thoughts.

1. Measuring pain reduction is not that easy in studies (since it's a feeling), so it's usually tested by having your test subject use a pain scale... So how can you measure pain reduction in mice (measuring their stress hormone levels? Functional MRI?...) and how reliable can that possibly be?
2. I've never seen any historic acupuncture charts for mice and I assume none of the old Chinese put much empiric research into that... So how can we know where the acupuncture points are on a mouse (e.g., an important point like Zusanli/St36)? And even if we could find a (reliable) way of finding out: how on earth can you make sure you really hit those points with your needles? I understand it's not always easy to accurately hit the points even in human patients (whose anatomy is not quite as minuscule and who at least can tell you if they get a de-qi sensation)... --Mallexikon (talk) 04:58, 9 June 2013 (UTC)

By measuring the amount of purines and adenosine, and how quickly each mouse pulled its paw away from stimuli. The more pain the mice were in, the faster they pulled away. The Weizhong acupuncture point is located at the popliteal fossa. -A1candidate (talk) 07:20, 9 June 2013 (UTC)

So what they measured basically was that if you put a needle into a mouse's popliteal fossa, it will pull its paw away from stimuli much slower...? --Mallexikon (talk) 09:16, 9 June 2013 (UTC)

Indeed! This is truly mind blowing! What can I say but "duh"...? Yes, it's interesting pathophysiology, but still no proof for acupuncture, and still totally ineligible here per MEDRS. When a "scientist" like Zylka takes assumptions (that the dots on ancient drawings of acupuncture points have real histological and unique correlates) and then does research without first overwhelmingly proving those assumptions are true to the satisfaction of 95%+ of other scientists, Zylka is over in deep pseudoscience. That's why I put "scientist" in quote marks. Zylka's credibilty is approaching zero. At Wikipedia we'd call use of this source a violation of MEDRS, among other things. We still need to see properly controlled studies, then reviews of multiple duplications of those studies, then wide acceptance. None of that has happened yet. -- Brangifer (talk) 17:19, 9 June 2013 (UTC)

The question is really whether or not this is an acceptable source based on guidelines I guess. The question of whether or not needling an animal and measuring the reaction is applicable to understanding Acupuncture is a yes as far as I can tell. Does it prove that that point has a relationship to the "stomach" or that it is the "earth point of the earth channel"? Of course not. It may only tell us about non-specific effects of acupuncture, or specific effects other than the intended effects, but it is still valuable to know.Herbxue (talk) 14:51, 10 June 2013 (UTC)

I agree. It's very interesting from a pathophysiological standpoint. What happens when one needles the body, or provokes it with other measures? That's always interesting, because sometimes we find out something that is predictable and also useful. As far as traditional Chinese acupuncture theory, etc., I'm not sure we're any closer to proving anything that backs it up, but needling does have some effects, just as other ways of stimulating the body do, and they may work just like the elephant effect: If your finger hurts and an elephant steps on your foot, you no longer feel the pain in your finger. Even nonspecific actions can have general effects that relieve pain. So far it seems that it makes no difference where one sticks an acupuncture needle to get a pain relieving effect, which basically means that acupuncture, as a system, is humbug. General pain relief seems to be one thing that's generally agreed upon, even if it's inconsistent, unpredictable, and nonspecific. The question of worth then comes into play. When one can get more specific and predictable results using other methods, why use acupuncture? -- Brangifer (talk) 06:57, 11 June 2013 (UTC)

Good points, and I agree that is an important question. But remember acupuncture is a heterogenous practice with many practitioners treating mainly pain and neurological conditions by needling locally (typical in Chinese hospitals) and many practitioners focusing on the more esoteric aspects. If scientific inquiry shows that the more esoteric aspects are just a mental construct that serves to focus or train the patient and practitioner to have certain reactions to stimuli, then so be it. But simply sticking needles into people to stop pain is certainly part of the picture too.Herbxue (talk) 14:05, 12 June 2013 (UTC)

Changes to article's lede

I've added the following statement to reflect current research and scientific consensus on the topic "Currently, the official MEDLINE database compiled by the U.S. National Library of Medicine acknowledges that researchers do not fully understand how acupuncture works." and made some other minor edits. I dont think these edits should be controversial, but if there is disagreement lets discuss it here -A1candidate (talk) 13:31, 15 June 2013 (UTC)

"Acupuncture". NLM. Retrieved 31 May 2013.

References

Acupuncture usage in the US military and other military forces

Very sorry, but I just can't see the merit of those sections. Maybe it's because I'm European. Anyways, this is supposed to be an encyclopaedic article informing people on the topic of acupuncture; whether the US army or the Iranian mullahs or the German postal service like acupuncture is really irrelevant. A1candidate, if you think this army stuff is encyclopedic material, please create a proper article about it. Otherwise, I'd just delete it. Cheers, --Mallexikon (talk) 02:58, 27 May 2013 (UTC)

Im not sure why you claim that your European heritage should influence your judgement on my work, I thought the usage of acupuncture in armed military forces would probably be interesting for 99% of readers out there. What do other editors here think? -A1candidate (talk) 06:21, 27 May 2013 (UTC)

I'm ambivalent. "Battlefield Acupuncture" is certainly notable in the U.S., though it does not add to understanding Acupuncture on its own terms. However, the question of whether acupuncture is "mainstream" or not is often raised. For this reason, I would say it should be included.Herbxue (talk) 14:40, 28 May 2013 (UTC)

Reverted edits by Mallexikon

I've reverted edits by Mallexikon because there was no consensus for its removal. See discussion above. -A1candidate (talk) 06:33, 17 June 2013 (UTC)

I have to agree with Mallexikon. It's not relevant to the topic of this particular article. Dominus Vobisdu (talk) 08:12, 17 June 2013 (UTC)

Recent edit

I've restored related, non-medical content since there was no consensus for its removal as per Talk:Acupuncture#Acupuncture_usage_in_the_US_military_and_other_military_forces -A1candidate (talk) 13:26, 15 June 2013 (UTC)

Well as I wrote in my edit summary, there was consensus about this - in the Talk:Acupuncture#Suggestion: Current research and recommendations section. Cheers, --Mallexikon (talk) 07:40, 17 June 2013 (UTC)

I believe you are clearly misinterpreting the entire discussion. It was about medical claims/recommendations. As for its usage, I think Herbxue seems to agree that it should be included, see Talk:Acupuncture#Acupuncture_usage_in_the_US_military_and_other_military_forces. Lets hope this doesn't drag into an edit war -A1candidate (talk) 07:44, 17 June 2013 (UTC)

"Clearly misinterpreting"... hmmm. The part of the discussion I'm referring to says this:

"@Herbxue: I don't mind stating what agencies "tasked with making health care recommendations" have to say about acupuncture... The armed forces of the US and Germany hardly fall under that category, though. --Mallexikon (talk) 08:46, 29 May 2013 (UTC)

Ok thanks, I thought you meant all the proposed sources were irrelevant.Herbxue (talk) 14:13, 29 May 2013 (UTC)

I would agree with Mallexikon here, the recommendations of the WHO are clearly relevant as a body of medical experts while the opinions of the armed forces of some few (select) countries are hardly relevant for the article...()... Greetings --hroest 11:49, 29 May 2013 (UTC)"

As would I. I can't see any relevance to this article. Dominus Vobisdu (talk) 08:38, 17 June 2013 (UTC)

I'm sorry if I misinterpreted this as consensus to my position on Herbxue's side if there actually is none... I think hroest was pretty non-ambiguous, though. --Mallexikon (talk) 08:21, 17 June 2013 (UTC)

Proposed New Mechanism of Action Section

I am not a very experienced editor, but have a background in biology and neuroscience. A number of editors have suggested modeling the Mechanism section on the antidepressants page. Here is my understanding of current literature:

The mechanism of acupuncture's effect is unknown. A number of theories have been suggested to explain it:

Placebo

There is some evidence that acupuncture's effect includes a placebo component but this effect incompletely explains acupuncture's effects on pain and eg nausea/vomiting.

Stimulation of Neurotransmitter Release

Acupuncture has been shown to stimulate release of a number of endogenous compounds, including opioids ie endorphins and enkephalins, monoamines, adenosine, ATP and the neurotransmitters involved in Diffuse Noxious Inhibitory Control. None has been definitely shown to be responsible for all of acupuncture's effects in humans.

Gate Control Theory of Pain

This is based on Ronald Melzack and Patrick David Wall's work, that acupuncture stimulates competing nerves which reduce or "gate" pain sensation in the spinal cord. It is not uniformly accepted and does not explain non-pain effects.

Interstitial Transmission Theories

These theories propose that the acupuncture signal is transmitted along non-neural, non-vascular meridian-like networks. These include Becker's bioelectric theory, the Primo Vessel theory and Langevin's Fascial theory. Although Langevin's work is supported by the most evidence, it has yet to be confirmed as the mechanism of acupuncture's effect on pain.

Autonomic Modulation

Originally described by Looney, this theory proposes that acupuncture results in release of various brain chemicals that modulate the autonomic nervous system, to influence a wide variety of organs and systems.

Viscero-Somatic and Somato-Visceral Reflexes Theory

This theory is based upon Felix Mann's work which proposes that acupuncture activates spinal reflexes, thus explaining its visceral effects. Mann has recently distanced himself from supporting acupuncture points and meridians.

Neural Deactivation

There has been recent work suggesting that acupuncture is not directly stimulatory, but, instead, blocks either peripheral nerves directly or blocks the release of brain stress chemicals.

I would appreciate the input of other editors, and, if they deem it appropriate, edit this and then paste into the page!--Tzores (talk) 01:33, 12 June 2013 (UTC)

Wow. Very bold, and very productive. I hesitated incorporating very much of it into the article, though, because when glancing over it it seemed to me there's a lot of primary sources here...? --Mallexikon (talk) 05:59, 13 June 2013 (UTC)

Thanks Mallexicon for great effort on the new Mechanisms of action section. Why have you omitted 4 of the sub-sections above? The Placebo effect has very wide support and incorporates tertiary evidence ie meta-analyses. Dr Langevin's work on fascia, although citing a primary source, is very widely supported, has been cited many hundreds of times and is included in a number of secondary sources elsewhere in the article. Dr Pomeranz's work on monoamimes also has much support as does Diffuse Noxious Inhibitory controls. Some of the neural deactivation work is also supported by secondary sources. Either way, given that this whole section talks about research and hypotheses, there is a good case for including primary sources here. If you go to Wikipedia's Antidepressants page you will see that every reference in the Mechanism of action section is supported only by primary reference sources. Does the acupuncture postulated mechanisms of action section require a higher level of evidence than that of antidepressants for inclusion? There is a good case for the whole section - as above - with all 7 sub-headings to be part of the article. I'd be interested to hear from Herbxue and Puhlaa on this.--Tzores (talk) 04:06, 14 June 2013 (UTC)

Well, you have a point about the primary sources... Why don't you insert the remaining sections into the article and see what the other editors think? Would be interesting to see what the sceptics have to say... --Mallexikon (talk) 13:08, 15 June 2013 (UTC)

Have made this a separate section to the Questionable validity of the acupuncture model section. I will work on finding more secondary sources and will then insert remaining into the Possible Mechanism of Action section.--Tzores (talk) 01:19, 21 June 2013 (UTC)

As suggested by Mallexicon, I have now incorporated this into the article to reflect current scientific thinking. Most of the sources are secondary/tertiary, but have included some primary sources too as the section is about theory. This is in line with the Antidepressants article's Mechanism section (I think originally suggested as a model for this by Herbxue??) which only has primary sources. For the sceptics (including me, although I have maintained NPOV), top of the list is Placebo which wasn't much in the article before, but has the most scientific community support! I'd appreciate some assistance please - the ref by Vickers has been cited elsewhere in the article and needs to be merged; also, there is a Diffuse Noxious Inhibitory Control Wikipedia article, but I can't seem to link to it - thanks--Tzores (talk) 23:42, 25 June 2013 (UTC)

References