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Adenosine and a good overall summary

From Integrative oncology: really the best of both worlds?, Nature Reviews Cancer (2014) doi:10.1038/nrc3822:

It has been proposed on the basis of mouse studies that acupuncture relieves pain through the local release of adenosine, which then activates nearby A1 receptors. Unfortunately, the key studies[121,122] that made this conclusion suffered from the awkward grafting of concepts of ‘qi’ and meridians onto what would other-wise have been straightforward interesting neuroscience studies of the role of the A1 receptor in pain modulation. Instead, needles were inserted into an ‘acupuncture point’ on the mouse that, relative to the mouse leg, was far larger and far closer to a major nerve than in the human. In essence, because this caused more tissue damage and inflammation relative to the size of the animal in mice than in humans, such studies unnecessarily muddled a finding that local inflammation can result in the local release of adenosine with analgesic effect, and they still fail to demonstrate a sufficiently biologically plausible mechanism to justify clinical?trials.

This phenomenon goes beyond basic science. When acupuncture is tested in the clinic, overall, with possibly one exception (for example, to treat nausea[123]), recent evidence strongly suggests that its effects are nonspecific and indistinguishable from placebo effects[124–128] that are highly dependent on practitioner–patient inter action[129,130]. Moreover, meta-analyses almost always conclude that there is insufficient clinical evidence to make a determination of efficacy[123,131–133] and include studies with a high risk of bias[134–136]. Also, contrary to the claimed mechanism of redirecting the flow of qi through meridians, researchers usually find that it generally does not matter where the needles are inserted, how often (that is, no dose-response effect is observed)[137], or even if needles are actually inserted[138]. In other words, ‘sham’ or ‘placebo’ acupuncture generally produces the same effects as ‘real’ acupuncture[138–142] and, in some cases, does better[143]. Even what is argu-ably the most persuasive meta-analysis[144] concluding that acupuncture has some efficacy against chronic pain included studies without sham acupuncture controls, and the reported difference due to acupuncture was still less than the minimal clinically important difference in pain for osteoarthritis[145,146], strongly suggesting that acupuncture effects are probably not clinically relevant. The most parsimonious explanation for this body of evidence is that acupuncture almost certainly has no specific effects greater than placebo for any condition[19], with the possible exception of nausea[123].

Refs for above:

19. Colquhoun, D. & Novella, S. P. Acupuncture is theatrical placebo. Anesth. Analg. 116, 1360–1363 (2013).
121. Goldman, N. et al. Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nature Neurosci. 13, 883–888 (2010).
122. Hurt, J. K. & Zylka, M. J. PAPupuncture has localized and long-lasting antinociceptive effects in mouse models of acute and chronic pain. Mol. Pain 8, 28 (2012).
123. Garcia, M. K. et al. Systematic review of acupuncture in cancer care: a synthesis of the evidence. J. Clin. Oncol. 31, 952–960 (2013).
124. Cho, S. H., Lee, H. & Ernst, E. Acupuncture for pain relief in labour: a systematic review and meta-analysis. BJOG 117, 907–920 (2010).
125. Ernst, E. Are the effects of acupuncture specific or nonspecific Pain 152, 952 (2011).
126. Ernst, E., Lee, M. S. & Choi, T. Y. Acupuncture: does it alleviate pain and are there serious risks A review of reviews. Pain 152, 755–764 (2011).
127. Gilby, A. Y., Ernst, E. & Tani, K. A systematic review of reviews of systematic reviews of acupuncture. FACT 18, 8–18 (2013).
128. Posadzki, P. et al. Acupuncture for cancer-related fatigue: a systematic review of randomized clinical trials. Support Care Cancer, 21, 2067–2073 (2013).
129. Street, R. L. Jr., Cox, V., Kallen, M. A. & Suarez-Almazor, M. E. Exploring communication pathways to better health: clinician communication of expectations for acupuncture effectiveness. Patient Educ. Couns. 89, 245–251 (2012).
130. White, P. et al. Practice, practitioner, or placebo A multifactorial, mixed-methods randomized controlled trial of acupuncture. Pain 153, 455–462 (2012).
131. Dodin, S. et al. Acupuncture for menopausal hot flushes. Cochrane Database Syst. Rev. 7, CD007410 (2013).
132. Franconi, G., Manni, L., Schroder, S., Marchetti, P. & Robinson, N. A systematic review of experimental and clinical acupuncture in chemotherapy-induced peripheral neuropathy. Evid. Based Complement Alternat. Med. 2013, 516916 (2013).
133. O’Sullivan, E. M. & Higginson, I. J. Clinical effectiveness and safety of acupuncture in the treatment of irradiation-induced xerostomia in patients with head and neck cancer: a systematic review. Acupunct Med. 28, 191–199 (2010).
134. Cheuk, D. K. & Wong, V. Acupuncture for epilepsy. Cochrane Database Syst. Rev. 5, CD005062 (2014).
135. Kim, T. H. et al. Acupuncture for treating acute ankle sprains in adults. Cochrane Database Syst. Rev. 6, CD009065 (2014).
136. White, A. R., Rampes, H., Liu, J. P., Stead, L. F. & Campbell, J. Acupuncture and related interventions for smoking cessation. Cochrane Database Syst. Rev. 1, CD000009 (2014).
137. Chiu, H. Y., Pan, C. H., Shyu, Y. K., Han, B. C. & Tsai, P. S. Effects of acupuncture on menopause-related symptoms and quality of life in women on natural menopause: a meta-analysis of randomized controlled trials. Menopause http://dx.doi.org/10.1097/GME.0000000000000260 (2014).
138. Cherkin, D. C. et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch. Intern. Med. 169, 858–866 (2009).
139. Linde, K. et al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA 293, 2118–2125 (2005).
140. Pastore, L. M., Williams, C. D., Jenkins, J. & Patrie, J. T. True and sham acupuncture produced similar frequency of ovulation and improved LH to FSH ratios in women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 96, 3143–3150 (2011).
141. Manheimer, E. et al. The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis. Hum. Reprod. Update 19, 696–713 (2013).
142. Bao, T. et al. Patient-reported outcomes in women with breast cancer enrolled in a dual-center, double-blind, randomized controlled trial assessing the effect of acupuncture in reducing aromatase inhibitor-induced musculoskeletal symptoms. Cancer 120, 381–389 (2014).
143. Goldman, R. H. et al. Acupuncture for treatment of persistent arm pain due to repetitive use: a randomized controlled clinical trial. Clin. J. Pain 24, 211–218 (2008).
144. Vickers, A. J. et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch. Intern. Med. 172, 1444–1453 (2012).
145. Stauffer, M. E., Taylor, S. D., Watson, D. J., Peloso, P. M. & Morrison, A. Definition of nonresponse to analgesic treatment of arthritic pain: an analytical literature review of the smallest detectable difference, the minimal detectable change, and the minimal clinically important difference on the pain visual analog scale. Int. J. Inflam. 2011 , 231926 (2011).
146. Tubach, F. et al. Minimum clinically important improvement and patient acceptable symptom state in pain and function in rheumatoid arthritis, ankylosing spondylitis, chronic back pain, hand osteoarthritis, and hip and knee osteoarthritis: Results from a prospective multinational study. Arthritis Care Res. 64, 1699–1707 (2012).


A decent summary, I think, and current (September 2014) and in an extremely reliable source. Guy (Help!) 12:26, 6 October 2014 (UTC)


Given the above, is it now time to take a slash and burn approach to the article as it currently stands? We have been pandering to quacks for far too long, so I suggest the wholesale removal of Section 2 Effectiveness, to be replaced with a quote - perhaps the following, "acupuncture almost certainly has no specific effects greater than placebo for any condition[19], with the possible exception of nausea."
just delete section 3.2 Cost effectiveness as it obviously isn't.
The Ethics section must now make clear what a bunch of self serving quacks acupuncturists are.
This is just an off the cuff response to Guy's post above, but something needs to be done to clear up article cruft.
best wishes. -Roxy the dog™ (resonate) 19:12, 6 October 2014 (UTC)

Careful of WP:UNDUE before going after the article with pliers and a blowtorch .... acu's use in mainstream settings shows the existence of sig views diverging from Gorski's, cf. Talk:Acupuncture#Serious_dispute. The disagreement is (as far as I can see) over whether to use/refer. Some believe that if it enhances a patient's sense of well-being and is low-risk, then it's justified, even if the effects are mostly/fully non-specific. This "logic" understandably drives people like Gorski nuts, but it is what it is. --Middle 8 (contribs • COI) 10:53, 9 October 2014 (UTC)

Academic centers

As mentioned above, acupuncture is used at a number of academic centers. This certainly belongs in the article; for starters, I've added its own subsection under Acupuncture#International_reception [1]. It's used at a great many such places, and at some point we might have so many that it may be a good idea to create a list.

I know acupuncture is a fringe topic, and I would like to apologize in advance for pushing mainstream POV into it. :-) --Middle 8 (POV-pushing • COI) 14:44, 28 August 2014 (UTC)

This is a good edit. I tweaked the text to indicate that the list presented is not exhaustive. We of course need to be careful not to imply that just because these centers use the practice that they know how it works (or even where it is effective), but we do need the information that it is used at hospitals as well as at stand alone clinics. A third or maybe even a fourth example citing non-US use would be good to help reflect a worldwide view. Maybe one from China and one from Germany or somewhere like that? - 2/0 (cont.) 15:25, 28 August 2014 (UTC)
Thanks; yes, good idea re worldwide view. We can also talk about acu's role in medical education worldwide; in China, IIRC, TCM is taught as anywhere from (very roughly) 5% to 50% of the curriculum. --Middle 8 (POV-pushing • COI) 12:00, 30 August 2014 (UTC)
I agree, that's valuable piece of information. The sources are perfectly reliable to illustrate the use of acupuncture at academic centers. I'll try to see if I can find anything about the situation in Finland (HYKS, KYKS, OYKS, TYKS and TAYS). Jayaguru-Shishya (talk) 11:57, 1 September 2014 (UTC)
Acupuncture is among popular CAM treatments in all five Nordic countries but it is used less in Finland.[232]
Since acupuncture is deregulated in Finland many people without education in healthcare are able to give acupuncture treatment.[246]
I have included specific information about Finland. QuackGuru (talk) 20:05, 5 September 2014 (UTC)

Discussion re sourcing -- i.e. are the sites of these medical centers RS for their use of acu -- continues below at Talk:Acupuncture#RSN:_Sourcing_medical_centers.27_use_of_acu. --Middle 8 (contribs • COI) 05:31, 13 October 2014 (UTC)

Primary sources/poor sources and original research

http://www.brighamandwomens.org/Departments_and_Services/medicine/Services/oshercenter/acupuncture.aspx

This source is a link to a hospital website. It is unreliable.

http://medicine.yale.edu/psychiatry/psychology/predoc/sites/cmhc/substanceabuse.aspx

This source is a link to a School of Medicine website. Where does this link mention acupuncture? Auricular acupuncture and acupuncture are different. The sentence is poorly sourced and partly fails verification. See WP:CIR. QuackGuru (talk) 02:02, 30 August 2014 (UTC)

IMO, the above criticisms from QuackGuru lack merit and the bit about competence (CIR) is gratuitous. Anyone else think QG is making any valid points here? --Middle 8 (POV-pushing • COI) 12:00, 30 August 2014 (UTC)
You are not addressing that you are adding primary sources and text that failed verification. I previously explained, Auricular acupuncture (ear acupuncture) is not acupuncture. You ignored it was original research. See WP:IDHT. Adding even more primary sources or poor sources is not appropriate. You have not shown how the sources are reliable in accordance with WP:SECONDARY. QuackGuru (talk) 17:41, 30 August 2014 (UTC)

QG is correct that even Wikipedia has a separate article on Auriculotherapy. jps (talk) 17:58, 30 August 2014 (UTC)

QG is incorrect. Ear acupuncture is a common form of acupuncture. See the meta-analysis below. -A1candidate (talk) 18:37, 30 August 2014 (UTC)
Did you read the entry for Auriculotherapy? Do you understand this is a primary source that says Auricular Acupuncture? User:John Carter warned you about nonproductive editing on the article talk page.
"This systematic review evaluated the effects of ear acupuncture, ear acupressure and auriculotherapy for cigarette smoking cessation (SC) at end-of-treatment (EoT), three, six and 12 months follow-up."[2]
According to the source ear acupuncture, ear acupressure and auriculotherapy are a bit different or is the source ambiguous? Middle 8's comment does not make sense given the evidence. QuackGuru (talk) 03:50, 31 August 2014 (UTC)

I did discuss the problems with this edit on Jayaguru-Shishya's talk page. Jayaguru-Shishya largely ignored my concerns or did not understand. "He wrote If you have a specific edit you'd like to discuss, please let me know. So far, you have said that "there is original research in the article using a primary source", and you are giving me a diff where QTxVi4bEMRbrNqOorWBV says at the Talk Page that "even Wikipedia has a separate article on Auriculotherapy". I am sorry, I don't really see the connection here?[3] I did let him know the issues. See WP:CIR. I left a message on his talk page. QuackGuru (talk) 19:16, 5 September 2014 (UTC)

The source does not verify the claim "several".[4] This confirms the source does not say "several". QuackGuru (talk) 19:33, 5 September 2014 (UTC)

So if Wikipedia has a separate article on Auriculotherapy, how is it connected to original research? :D I alrady provided you a source[5] (which seriously nobody needs). As Middle 8 well put it: "just as auricular acu is a kind of acu, and chocolate milk is a kind of milk". Just common sense.
QuackGuru, do you know what "paraphrasing" means? I think user NuclearWarfare has already noticed you about "getting caught over specific wording"[6], right? If you have problems with paraphrasing yourself, please leave it to other editors, that's what I'd like to suggest. Cheers and happy weekend! Jayaguru-Shishya (talk) 20:27, 5 September 2014 (UTC)
Indeed, indeed... "Being of a number more than two or three but not many" (http://www.thefreedictionary.com/several) Jayaguru-Shishya (talk) 20:44, 5 September 2014 (UTC)
I fixed the issues by using another source that verified the claim rather than use a source that was ambiguous. As a bonus, I expanded the sentence and included Duke. QuackGuru (talk) 20:41, 5 September 2014 (UTC)

I had a discussion on Jayaguru-Shishya's talk page: You added largely duplication using primary/poor sources. Rather than use poor sources I replaced it with independent sources. In my edit summary I explained one of the sources failed verification. This was discussed on the talk page. The section for the US under International reception already states "Acupuncture is used at many places in the US, including Harvard, Stanford, and Yale." Independent sources were being used but you restored the text using a bunch primary sources. There is no need for duplication or a separate section. The text for each country can go into each specific section for each country in the Acupuncture#International reception section. Please stop adding poor/primary sources when better sources were found. Please don't continue to WP:BATTLE. QuackGuru (talk) 21:22, 1 September 2014 (UTC)

After I explained it too Jayaguru-Shishya that there is still problems with the text and many is closer to the source he ignored my concerns and restored the original research and unneeded primary sources. He also restored the tag without consensus.[7] User:RexxS also explained Jayaguru-Shishya removed well sourced text. See Acupuncture#Reception for the current text. QuackGuru (talk) 15:57, 6 September 2014 (UTC)

Do you mean the discussion which resulted to an administrative warning to you?[8] The one where you were making accusations against me? Well, let's see dear.
    • The first diff where you claim that I "largely duplication using primary/poor sources", it has been already discussed at the Talk Page. Consensus? No problem for using primary sources to illustrate the use of acupuncture at mainstream medical centers.
    • The second diff, you said that: " I explained one of the sources failed verification". That's not true, I'm afraid. When one opens your diff, the edit summary merely says: "failed verification and duplication". So where is the "explanation you mentioned? Answer: there is none.
    • The third diff, you are saying that it was discussed that the source above failed verification. Let's see your diff more closely: it is pertaining to user QTxVi4bEMRbrNqOorWBV's comment "QG is correct that even Wikipedia has a separate article on Auriculotherapy." So, what does this have to do with "a source failing verification"? You just picked up a random comment from the Talk Page and use it to "support" something that has nothing to do with it...?
    • You said: "Please don't continue to WP:BATTLE.". Funny, you got warned by an administrator for your post.
    • "... he ignored my concerns and restored the original research and unneeded primary sources". Please see this section and participate the discussion if you have something meaningful to say. Jayaguru-Shishya (talk) 19:43, 6 September 2014 (UTC)

RSN: Sourcing medical centers' use of acu

There's been debate above over whether the websites of medical centers are RS's for the fact that they use acupuncture. Several editors have agreed this such use is fine; despite this one editor (QuackGuru) who disagrees has twice removed such sources, arguing that as "primary sources" they don't meet RS. I think they're fine per WP:SELFSOURCE, as well as WP:SENSE. I've posted about this at WP:RSN#Websites_of_medical_centers_as_sources_for_services_they_perform. --Middle 8 (contribs • COI) 05:28, 13 October 2014 (UTC)

You are making a series of controversial edits that were previously resolved. For example, the in-text attribution was removed by User:Jmh649 but you restored it to the article again. Better sources were found and editors have moved on. User:RexxS deleted the unnecessary primary sources too. He also commented on the talk page and the matter was resolved. QuackGuru (talk) 06:58, 13 October 2014 (UTC)
@QuackGuru - Unfortunately your comments and ES's address fail to address my arguments. I'll reply in order with specific requests:
  • Your first sentence relates to the section below, which please see.
  • As far as sourcing medical centers, we will see what RSN says. (1) But you're ignoring my argument that their sites are fine per WP:SELFSOURCE, as well as WP:SENSE; please address that.
  • (2) You're also ignoring the UNDUE argument for this pair of edits:[9][10]. Medical centers at Harvard, Stanford etc etc all vastly outweigh Gorski and Novella, and my 2nd edit [11] explains their position consisely -- which is more than enough. Please address.
  • Your revert [12] has a very misleading RS ("reorder"); please don't do that.
We've had difficulty communicating in the past, and I've accused you of IDHT, but now I'm going to AGF and assume we've just had difficulty communicating. Therefore I'm being as specific as possible. Please be equally specific in your responses to my questions (1) and (2) above. It will help me and probably others as well. Thanks! --Middle 8 (contribs • COI) 08:44, 13 October 2014 (UTC)

Outstanding issues

Acupuncture and placebo

The first review found some evidence that "biological differences" exist between a placebo response and sham acupuncture. The second review concluded that "acupuncture is more than a placebo". Are there any recent reviews that suggest otherwise? -A1candidate (talk) 02:31, 11 August 2014 (UTC)

Nocebo

Article fails to discuss the nocebo effect of acupuncture:

-A1candidate (talk) 02:31, 11 August 2014 (UTC)

Allergy

Article fails to mention acupuncture treatment for allergic diseases:

-A1candidate (talk) 02:31, 11 August 2014 (UTC)

Mechanism of acupuncture

Article fails to mention mechanism of acupuncture:

-A1candidate (talk) 02:32, 11 August 2014 (UTC)

Acupuncture and the brain

Article fails to mention acupuncture's effect on the brain:

-A1candidate (talk) 02:32, 11 August 2014 (UTC)

We might add a bit about contraindications for certain points, i.e. the "fordidden points" during pregnancy like LI4, SP6, and GB21. I don't remember the source that mentioned that but AFAIK it was a MEDRS. --Middle 8 (leave me alone • talk to me • COI?) 03:09, 14 August 2014 (UTC)
These studies are of the brain's reactions to the body being poked with sharp things. They don't lay the foundation for the effectiveness of acupuncture, just that the brain does, indeed, react to the body being poked with a sharp object. I'm not aware of anyone that denies that.—Kww(talk) 13:37, 13 August 2014 (UTC)
No, they do. Read the meta-analyses carefully. -A1candidate (talk) 13:56, 13 August 2014 (UTC)
Please provide exact quotes from the meta analysis which you find relevant, something that tells us more than is already obvious, which is that every spot in the body has areas in the brain which not only control it but also areas which react to anything which affects it. That's too basic and "duh". What do you have from that source which we can use? -- Brangifer (talk) 23:58, 13 August 2014 (UTC)
e.g. (bold text indicates subsection header): Acupuncture at non-acupuncture points in close proximity to acupuncture points" Two third (64%) [15], [23]–[37] of 25 studies showed that acupuncture treatments were associated with more activation, mainly in the somatosensory areas, motor areas, basal ganglia, cerebellum, limbic system and higher cognitive areas (e.g. prefrontal cortex). That's 16 of the studies. Different or contradictory results were found in the remaining 9 studies. Also see other quotes under section titled Descriptive findings of differences between verum and sham acupuncture. --Middle 8 (leave me alone • talk to me • COI?) 03:20, 14 August 2014 (UTC)

Brain studies are not about acupuncture effectiveness or theory. There is specific information in the article about the mechanism of action. QuackGuru (talk) 02:18, 7 October 2014 (UTC)

They are relevant in the scientific section. You removed them for different reasons than what you are protesting here. Why? LesVegas (talk) 03:01, 7 October 2014 (UTC)
I think User:Middle 8 put it pretty well above. QuackGuru, the Kww's comment you quoted here, are there any sources supporting that? I think a source for that would be the easiest way to solve this since unfortunately we can't use mere opinions to discard sourced material.
I can't see any "strong disagreement with using these sources" either, as it was stated in some deletion summaries[13][14][15]. Jayaguru-Shishya (talk) 14:55, 7 October 2014 (UTC)
I did explain the problems with the edits. Highly technical information about brain activity studies is confusing to the reader, is not directly about the acupuncture treatment itself, and it does not show whether acupuncture is effectiveness. This is undue weight. However, there is better information in the section that explains that the evidence suggests that acupuncture generates a sequence of events that include the release of endogenous opioid-like substances. QuackGuru (talk) 19:51, 7 October 2014 (UTC)
re QuackGuru's comments:
  • In the diff, QG wrote "Brain studies are not about acupuncture effectiveness or theory." So? The article isn't limited to those topics. Brain studies about acu are certainly on topic.
  • "Highly technical" information is all over Wikipedia, and this isn't that technical.
  • "is not directly about the acupuncture treatment itself, and it does not show whether acupuncture is effectiveness" -- again, the article isn't only about those things, no matter how much QG might like to make it that way. Indeed, it's undue weight to only cover the topics QG mentions without coving other aspects.
  • Endorphins -- sure, that's an aspect. But how is it "better"? The sources are fine and the arguments for excluding them are very thin. Aside: as Guy pointed out here, part of QG"s excessive OWN-ership of this article and chiropractic has included arguing that deleting any RS is bad. Now QG's wants to exclude RS material on thin grounds? This is self-serving. --Middle 8 (contribs • COI) 09:56, 10 October 2014 (UTC)
So far, only Kww has commented on the topic. QuackGuru, you have earlier quoted that comment by Kww, but it remains completely unsourced, right? Individual ponderings indeed might be interesting, but "unfortunately" need to be something reliably sourced to make it's way to Wikipedia. Jayaguru-Shishya (talk) 15:10, 13 October 2014 (UTC)
Self serving you say? My irony meter is off the scale. -Roxy the dog™ (resonate) 10:43, 10 October 2014 (UTC)
Delightfully clever as always, Roxy, but have you so soon forgotten this exchange? And I don't think you have an irony meter. Not when you get all righteous and dramatic about reverting wording when I use it, but not when, say, QuackGuru and Doc James do. And that in the purported defense of reason and objectivity.... --Middle 8 (contribs • COI) 16:10, 11 October 2014 (UTC)
Yet you still carry on with your same old "I don't have a COI" schtick. -Roxy the dog™ (resonate) 16:53, 11 October 2014 (UTC)
Not true. --Middle 8 (contribs • COI) 22:33, 12 October 2014 (UTC)
It should be noted any COI editors and any COI editor should follow the advise of WP:COI. QuackGuru (talk) 06:14, 13 October 2014 (UTC)

Article does not conform to scientific consensus

This article fails to conform to scientific consensus

Mayo Clinic
"The current scientific theories provide a basis for stating that acupuncture has an effect on the nervous system" [1]
Johns Hopkins School of Medicine
"The modern scientific explanation is that needling the acupuncture points stimulates the nervous system to release chemicals in the muscles, spinal cord, and brain." [2]
National Cancer Institute (USA)
"Acupuncture may work by causing physical responses in nerve cells, the pituitary gland, and parts of the brain" [4]
National Health Service (Britain)
"It is based on scientific evidence that shows the treatment can stimulate nerves under the skin and in muscle tissue." [5]
A Scientific Statement From the American Heart Association
"In the manual form of acupuncture, the mechanism of effect appears to be through sensory mechanoreceptor and nociceptor stimulation induced by connective tissues being wound around the needle and activated by mechanotransduction. In the case of electroacupuncture, the effects appear to additionally involve the stimulation of peripheral nerve fibers, including vagal afferents, that in turn activate central opioid (and other) receptors or anti-inflammatory reflex pathways. Reflex increases in sympathetic activity may also be reduced by electroacupuncture. The role of mechanoreceptor stimulation in the BP reductions in animal models is supported by the ability to attenuate this effect by gadolinium, which blocks stretch-activated channels. Both forms of acupuncture have similar central nervous system effects, although electroacupuncture tends to have a greater intensity of effect as determined by functional magnetic resonance imaging studies in humans." (PMID 23608661)

-A1candidate (talk) 02:32, 11 August 2014 (UTC)

These are really good MEDRS's that we've neglected but I don't see how they meet WP:RS/AC any more than some of the meta-analyses we quote. --Middle 8 (leave me alone • talk to me • COI?) 03:31, 14 August 2014 (UTC)
Excellent summary by A1! Given there is still doubt about exactly how acupuncture works, a true 'Mechanism of Acupuncture' section is probably still premature, but you have undoubtedly presented an outstanding case for rewriting the article to make it consistent with current scientific thinking and including a 'Possible Mechanism of action' section. Yet, we have been here before! I painstakingly set up a 'Possible Mechanism of Action' section for this article over a year ago - see: https://en.wikipedia.org/w/index.php?title=Acupuncture&oldid=561592493. It lasted about a week before its reversion. The subheadings for that section are still current and in-line with A1's summary, although some of the refs might need updating. I'd consider putting it back in again, but would this put me up for another bout of reversion and a caution? Tzores (talk) 21:47, 12 August 2014 (UTC)
It seems you have made your homework pretty well, A1candidate! I find it quite impressive all the sources you have listed above. With respect to the scientific consensus issue, what would you suggest? =P Jayaguru-Shishya (talk) 10:37, 13 August 2014 (UTC)
We already state, of scientists, that "They, along with acupuncture researchers, explain the analgesic effects of acupuncture as caused by the release of endorphins, and recognize the lack of evidence that it can affect the course of any disease." This (or some tweaked form of it) is enough - much more would be undue and a section on 'Possible Mechanism of Action' especially so, probably veering into OR territory. Alexbrn talk|contribs|COI 05:24, 13 August 2014 (UTC)
Huh? You'd omit MEDRS even if they don't fully accord with what you just wrote (re: no point specificity)? See PLOS One source supplied by A1Candidate above [16] and my diff giving e.g.'s of quotes from same [17]. --Middle 8 (leave me alone • talk to me • COI?) 03:28, 14 August 2014 (UTC)
First of all, Wikipedia is an encyclopedia, not a scientific research paper. Its articles are not supposed to "conform to scientific consensus", although they do report it. They are encyclopedic articles, and of a special nature, largely because of our NPOV policy, which requires coverage of all significant aspects of a topic, unlike normal encyclopedias.
Secondly, those nice snippets are basically saying "duh". Those are not surprising or unique results, and are about the same results as would be expected if you pinched someone or scratched them. Acupuncture does actually touch the body. It affects the body. It's not Therapeutic touch, where hands are waved over the body without actually touching it. These are real effects, but they are non-specific responses to external influences on bodily tissues. This proves nothing special about acupuncture, and says nothing about any specific and unique results from a specific poke in a specific acupoint. There is no consistent, specific, and reproducible reaction from acupuncture which applies to everyone.
There do seem to be some generalized reactions, sometimes of a somewhat positive nature (pain relief), but nothing one can count on, or that could not be obtained by any other method which triggered endorphin production, and certainly not better than, or as strongly or consistently or reproducibly as any of several standard analgesic drugs. That electroacupuncture seems to have a stronger effect is also unsurprising, and it's NOT acupuncture. It's electrotherapy.
So, what specific wordings are you proposing to make to the article? This is all speculation about possible mechanisms, but it really adds nothing we don't already know, so do you have something specific and unique to acupuncture which is a new addition to the article? -- Brangifer (talk) 06:28, 13 August 2014 (UTC)
You obviously failed to read the articles above. Scientific consensus isn't "speculation". It's something we summarize and conform to. -A1candidate (talk) 09:31, 13 August 2014 (UTC)
Brangifer, do you have anything aside from your own ponderings? Jayaguru-Shishya (talk) 10:37, 13 August 2014 (UTC)
A1, those aren't statements of "scientific consensus", they are simple statements of evidence, and that evidence is not special. Anyone, even the most ardent skeptic, will admit that they are true statements. So "...acupuncture has an effect on the nervous system". Duh! Of course it does. Has anyone denied that? No. So "... treatment can stimulate nerves under the skin and in muscle tissue." Duh! Of course it does. Has anyone denied that? No. I could go on with each one of the statements.
This amounts to a two year old finding a penny and presenting it to its mother and thinking that it has found something which no one else in the world knows about, and now it thinks it has taught its mother about the existence of money. The mother says "Oh, what a pretty penny!" If that same child does this every day, all the way up into its twenties, the mother replies "Duh. This is getting old."
So, we need to know what you're getting at, because you haven't brought anything new or enlightening to the table. How would you use these statements in the article? Don't we already acknowledge that the body does sense when it is poked? I don't think we deny that fact. The body is sensitive to anything which touches it. Duh! So what. We need more than what we already know and what we already acknowledge in the article. -- Brangifer (talk) 13:24, 13 August 2014 (UTC)

I love the smell of inappropriate use of sources in the morning. Here, we have promotions for acupuncturists at Mayo and Johns Hopkins being touted as representative of scientific consensus on acupuncture. The others are lay descriptions of acupuncture used to describe services that the scientific community still dismisses as being no more effective than a placebo. That certainly is a creative way to describe the sources, but hints at a strong desire to distort reality.—Kww(talk) 13:33, 13 August 2014 (UTC)

The article in Mayo Clinic Proceedings is classified in PubMed as a review article, not a promotion piece. -A1candidate (talk) 13:52, 13 August 2014 (UTC)
I can't find anywhere on that page where it's referred to as a "review article", but that's really beside the point. It is a RS, in the general sense of the word, but for what purpose in this connection? What you've quoted from it isn't really worth using, even if it was a "review article" which passed the criteria in MEDRS, so what are you proposing that we can do with it? -- Brangifer (talk) 00:36, 14 August 2014 (UTC)
The current scientific theories provide a basis for stating that acupuncture has an effect on the nervous system, but its effects cannot be explained with a single mechanism. -A1candidate (talk) 16:29, 14 August 2014 (UTC)

@A1candidate: you are seriously misrepresenting the NHS source. I only checked that one since I used it not so long ago and did not remember it conforming to your description. And so it does not. This gives me very little confidence that the rest of your edits may be taken at face value. Perhaps a specific proposal where we can all vet your use of sources would be better received? - 2/0 (cont.) 17:23, 14 August 2014 (UTC)

I quoted from NHS exactly as it is stated on their website. If it looks different from what you last saw, that's because the page was changed last month. They update their articles evey two years, so you need to check with the newest version.
If you want a specific proposal from me, see Talk:Acupuncture#Protected_edit_request_on_20_July_2014_2. There's still no consensus over there, so your input is very much welcome -A1candidate (talk) 18:00, 14 August 2014 (UTC)
Nobody said you messed up the copy/paste. Please read more carefully to avoid wasting the time of your fellow editors. You are misrepresenting the conclusions of that source; read it again to see how they treat the subject compared to your proposed use here. They do not conform. This is *never* appropriate. We must only and exactly provide a fair representation of the sources without cherry-picking or quoting out of context. - 2/0 (cont.) 18:38, 14 August 2014 (UTC)
And you are misrepresenting what I propose, which is that acupuncture stimulates the nervous system. That is exactly what the source says. -A1candidate (talk) 18:43, 14 August 2014 (UTC)
I think we all agree that inserting needles under the skin has an effect on the nervous system, at least based on discussion above. Please strike or modify your above aggressive comment in accordance with WP:CIVIL and WP:BATTLEGROUND. - 2/0 (cont.) 19:04, 14 August 2014 (UTC)
(e/c) 2/0, I may be missing something, but I don't see A1 giving any worse than he's getting from you on the aggression front; you both sound exasperated, and it may be just a misunderstanding. The NHS page [18], as of today, indeed includes verbatim the quote "It is based on scientific evidence....". Is there some other dispute about that source that I'm missing? What misrepresentation are you referring to specifically? Forgive some entirely possible denseness on my side (literally; my sinuses are all too dense at the moment, and it's radiating to what's left of my brain), but I'm not understanding what A1C is proposing to do with the NHS source beyond simply citing or paraphrasing that quote. --Middle 8 (leave me alone • talk to me • COI?) 19:25, 14 August 2014 (UTC)
oh -- you mean that A1Candidate is overstating the degree to which the NHS source represents scientific consensus? If so: yes, I think that several of these sources aren't as close to meeting WP:RS/AC as A1C is suggesting. But the NHS source is an excellent MEDRS, one of the best, and I think there's room for disagreement over how close it is to representing sci consensus. A1C, I hope you're reading this as well: The problem, which Brangifer has imo correctly identified [19], is that there is no unified sci consensus on most aspects of acu (other than its not being an established treatment). That's why there's such a broad range of views, and so much polarization; the extremes at each end (in real life and on WP) piss each other off. That there are good reasons to use it as a complementary therapy for pain and stress is a mainstream view; that that same view is unsupportable is also a mainstream view. (Note I said "good reasons", which is a superset of "good evidence". Patients really liking it is an example of what many consider a good reason.) So I think it would be better for A1C to portray his sources not as representative of sci consensus, but as MEDRS's (many of them excellent ones) that we need to weight adequately, and so far haven't been (perhaps because editorial consensus has thus far been overaggressive about depicting acu as wholly fringe). A1C, would you consider not reaching quite so far? You're losing some editors by doing so, editors who are reasonable enough to (gasp) accept that we can use good MEDRS's that don't wholly dismiss acu. The fact that many of the sources you're presenting haven't been given more (or any) weight shows how excessively editorial consensus had tended to swing past skepticism into outright, undue debunking. We need less hyperbole all around. It's not hyperbole to say that A1C has found no more and no less than a bunch of MEDRS's, not all but some about as good as they get, that deserve proper integration and weighting. --Middle 8 (leave me alone • talk to me • COI?) 20:14, 14 August 2014 (UTC)
Note. Stimulating nerves does not mean it is effective. QuackGuru (talk) 19:16, 14 August 2014 (UTC)
This is about the mechanism of action, not its effectiveness. -A1candidate (talk) 19:20, 14 August 2014 (UTC)
Exactly; it's a different aspect of point specificity (which I'm sure the text of the article will make clear). --Middle 8 (leave me alone • talk to me • COI?) 19:29, 14 August 2014 (UTC)
The text is under the heading "Theory" not mechanism of action. QuackGuru (talk) 19:34, 14 August 2014 (UTC)
It is referring to the theories about the mechanism of action -A1candidate (talk) 20:04, 14 August 2014 (UTC)
Is the fact that "acupuncture has an effect on the nervous system" some sort of great or new discovery? Has it EVER been denied? Is there any other possible "mechanism of action" when one touches or pokes the skin? (Hormones could also get involved, but that too is not specific.) I'm still not getting what this is about. It's still "duh", uninteresting, not unique, and not evidence for or against any claimed specific effects of acupuncture.
Please make a specific, precisely worded and sourced, proposal that isn't as foolish as the child with the penny, who is now twenty years old and is still presenting the same penny to its mother as if it has invented money. Please place your proposed edit here, in this thread. -- Brangifer (talk) 00:33, 15 August 2014 (UTC)
Just doing a search for "mechanism" in the current version turns up not even a "penny"-type comment. We have:
  1. "TCM is pseudoscience with no valid mechanism" (in lede and body);
  2. "The most common mechanism of stimulation of acupuncture points employs penetration of the skin by thin metal needles";
  3. "[blah blah pseudoscience]... making many scholarly efforts to integrate evidence for efficacy and discussions of the mechanism impossible"; and
  4. "[blah blah NIH]... even if research is still unable to explain its mechanism."
Similarly unhelpful stuff (with respect to mechanism) appears when one searches for the syllables "nerv" and "neur" (including examples of what is massive undue weight to serious adverse events). And the section Scientific view on TCM theory is almost absurdly weighted to sources from the skeptic movement, and at any rate only mentions endorphins. We can do better than that! Even if a penny is all there is to be found (and there does appear to be more, e.g. point-specific neurological responses), readers at least deserve to know that the damned thing is round, shiny (for awhile), coppery, and a little bigger than a dime. Let's.... de-escalate a little in terms of confrontational approach. What's obvious to editors is not always obvious to the reader. A1Candidate has found some terrific ones, and I'd rather encourage them to keep at it. A1C, how would you do this? There's probably some stuff in those sources on fascia, no? There's stuff from Napadow and Kaptchuk.... a whole lot of stuff has been neglected, which is what happens when too few editors are involved. A1C and Brangifer, you're both great assets here; don't alienate each other. --Middle 8 (leave me alone • talk to me • COI?) 05:41, 15 August 2014 (UTC)
Does the source say that "It is based on scientific evidence that shows the treatment can stimulate nerves under the skin and in muscle tissue."? If it does, what's the problem? In my opinion, we better stick to the sources instead of our own ponderings. Jayaguru-Shishya (talk) 18:09, 17 August 2014 (UTC)

Yes, fascia (connective tissue) is discussed in the consensus statement of the American Heart Association as follows:

In the manual form of acupuncture, the mechanism of effect appears to be through sensory mechanoreceptor and nociceptor stimulation induced by connective tissues being wound around the needle and activated by mechanotransduction.

PMID 23608661 -A1candidate (talk) 09:32, 15 August 2014 (UTC)

I added "The mechanism of action for acupuncture is still unclear.[170] Evidence suggests that acupuncture generates a sequence of events that modulate pain signals within the central nervous system.[170]" QuackGuru (talk) 17:55, 15 August 2014 (UTC)

You're doing it without consensus. The source is from 2008 and is way past WP:MEDDATE. We have many newer reviews to use -A1candidate (talk) 21:46, 15 August 2014 (UTC)
I added the source you proposed adding to the article. I added this source because it meets MEDRS and it was not ambiguous. QuackGuru (talk) 02:53, 16 August 2014 (UTC)
We should use the newest reviews, which are not ambiguous. -A1candidate (talk) 03:02, 16 August 2014 (UTC)
This was the specific source you wanted in the article and now you don't like what the source said? I added the source that was specifically about the mechanism of action for acupuncture, which was not vague or confusing. QuackGuru (talk) 03:20, 16 August 2014 (UTC)
I was proposing to use it to replace the editorials only. I am not entirely against your edit, but I think it needs to be formulated in a different way. "Modulate pain signals" is an ambigous phrase that requires explanation. -A1candidate (talk) 09:43, 16 August 2014 (UTC)
"They, along with acupuncture researchers, explain the analgesic effects of acupuncture as caused by the release of endorphins, and recognize the lack of evidence that it can affect the course of any disease." There is an explanation in the article. QuackGuru (talk) 16:49, 16 August 2014 (UTC)
Endorphins aren't pain signals. -A1candidate (talk) 17:34, 16 August 2014 (UTC)
The release of endorphins modulate pain signals. QuackGuru (talk) 02:22, 17 August 2014 (UTC)
That is what the article should say to reduce ambiguity -A1candidate (talk) 04:54, 17 August 2014 (UTC)
I added the context from the source according to the summary. QuackGuru (talk) 06:01, 17 August 2014 (UTC)

Arrhythmias

7 individual herbal therapies along with acupuncture and yoga have been studied and reported as having an antiarrhythmic effect:

Despite methodological shortcomings, these studies support acupuncture as an effective treatment for AF (atrial fibrillation), paroxysmal supraventricular tachycardia, inappropriate sinus tachycardia, and symptomatic premature ventricular contraction

-A1candidate (talk) 10:26, 15 August 2014 (UTC)

Good stuff -- hope you're being bold and adding at least some of these as you go, because good MEDRS's shouldn't be controversial -- as long as you're not removing others at the same time. If you also want to remove a MEDRS (for whatever reason), others might object to that part, so I'd do such an edit separately. (See situation below where an editor combined both good and bad edits into one big edit and it got reverted -- that was justified but could have been avoided.) --Middle 8 (leave me alone • talk to me • COI?) 07:50, 17 August 2014 (UTC)
Have these been added into the article? If not, I don't mind helping you guys out here. LesVegas (talk) 16:33, 30 August 2014 (UTC)

Removed material

Greetings. Why this material was removed?

Based on growing literature, regarding acupuncture's physiological effects, a 2014 review proposed a model combining both connective tissue plasticity and peripheral sensory modulation as a needle response.[20]

One review cited considerable development regarding neural mechanisms of both manual (hand stimulated) acupuncture and electrical acupuncture, stating manual acupuncture activates all types of afferent fibers, while electrical acupuncture can produce an analgesic effect by exciting Abeta and part of Adelta fibers. The same review found that acupuncture signals ascend mainly through the spinal ventrolateral funiculus to the brain.[21]

Several brain nuclei are involved in processing acupuncture analgesia. In addition to opioid peptides, glutamate, 5-hydroxytryptamine, and cholecystokinin octapeptide contribute to mediating acupuncture analgesia. In electroacupuncture, the release of opioid peptides is frequency dependent. Brain regions responsible for acupuncture analgesia in animal studies have been confirmed in humans via functional imaging.[22]?

Were the sources unreliable or what? I can't find any "strong disagreement with using these sources" either, as it was stated in some deletion summaries[23][24][25].

I can't see any reason why not to add these sources, but please do correct me if there's something I have missed. Cheers! Jayaguru-Shishya (talk) 15:32, 7 October 2014 (UTC)

This was explained in another section. See Talk:Acupuncture#Acupuncture_and_the_brain. QuackGuru (talk) 20:38, 7 October 2014 (UTC)
There is zero consensus QuackGuru. KWW wasn't even contending the sources I added. These were in a different section, and they had to do with much more than just the brain. These are reliable sources and belong in the article somewhere. If you still think they don't belong in 'Scientific Reception', then perhaps we should create a new section, 'Mechanism of Action'? LesVegas (talk) 20:12, 13 October 2014 (UTC)

Protected, again

I saw the recent flurry of reverts about an article improvement tag. A protection is nicer than blocks but make no mistake there may have to be blocks if some of this battleground behaviour continues. I don't care what this article ends up saying about acupuncture but we are not going to have edit warring or people attacking each other. I hope that's clear. Meantime you have one week to resolve what the POV problem may or may not be on the article. Please be nice as well. --John (talk) 12:11, 14 October 2014 (UTC)

I support this action, but I am very interested to know why you don't care what this article ends up saying about acupuncture ;) -Roxy the dog™ (resonate) 12:14, 14 October 2014 (UTC)
That's easy. It's a subject on which I am disinterested. --John (talk) 12:22, 14 October 2014 (UTC)
That explains a great deal. Thanks. -Roxy the dog™ (resonate) 12:43, 14 October 2014 (UTC)
Sounds like John is saying "I'm going to make sure you play nice (WP:DR), now you guys work it out within that framework". Makes sense to me. --Middle 8 (contribs • COI) 19:08, 14 October 2014 (UTC)
LOL, but I have seen no attempt here or anywhere else to solve this disagreement by discussion or meditation. The Banner talk 21:31, 24 October 2014 (UTC)

Protected edit request on 20 October 2014

www.naturalnews.com/025057_acupuncture_placebo_changes.html [unreliable fringe source?] 24.249.35.198 (talk) 17:14, 20 October 2014 (UTC)

It isn't very clear at all what you want to do with that source, but the answer is no, the source is one of the most unreliable in the whole multiverse. -Roxy the dog™ (resonate) 17:22, 20 October 2014 (UTC)
Do you have proof for that, Roxy? The Banner talk 20:59, 21 October 2014 (UTC)
It's making a medical claim, but doesn't meet WP:MEDRS (which see), and not by a long shot.... trust me, this is not something you want to push. --Middle 8 (contribs • COI) 10:44, 22 October 2014 (UTC)
So, the Harvard study is not reliable due to place where this is published? The Banner talk 11:12, 22 October 2014 (UTC)
@ Banner - I'm sorry, I admit I wasn't paying attention to the content, just the source. Sure, the study itself is entirely legit, but it's a primary source, and on WP we strongly prefer secondary sources (again, MEDRS and WP:SOURCES). And it's so small -- just 12 patients! Studies that small are not uncommonly outliers, cf. reversion to the mean. Since it's from 2008, reviews that we cite -- that take into account studies totaling to hundreds of patients -- will have taken this study into account. And those reviews say... well, what the article says they do, more or less. That said, I agree there is other stuff that should go in, e.g. at Talk:Acupuncture#Removed_material. --Middle 8 (contribs • COI) 15:11, 22 October 2014 (UTC)
I think it is very fair to say that if Middle8 agrees with me on anything then it is a slam dunk certainty. -Roxy the dog™ (resonate) 13:30, 22 October 2014 (UTC)
Yep. :-) Then again, the set of things on which I and most people agree, and that are slam-dunk true (like MEDRS being a good idea), is pretty big, cf. the thing about how we get to share opinions but not facts. And I'm a reality-based kinda guy... remember, I studied acu before we knew what we know now about its evidence base. The qi/meridian stuff never bothered me, since the map isn't the territory... ancient astrologer/astronomers, who thought that a serpent periodically ate the sun or moon and made them disappear, could correctly predict eclipses. --Middle 8 (contribs • COI) 15:11, 22 October 2014 (UTC)
My irony meter just asploded again. -Roxy the dog™ (resonate) 23:09, 22 October 2014 (UTC)
Tragic, that... assplosions can happen when one's diet includes too much hot air. ;-) --Middle 8 (contribs • COI) 07:39, 23 October 2014 (UTC)

I'm very concerned about the attempt to edit-war content into the article when there's clearly no consensus or, for that matter, WP:MEDRS. bobrayner (talk) 22:57, 25 October 2014 (UTC)

POV

I have just added a POV tag to this article. This article falls foul of the overly enthusiastic MEDRS-guys who refuse to allow any other sources into the article. Effect is that the article is rather negative. The Banner talk 10:01, 14 October 2014 (UTC)

I'm about to remove it because you haven't made a single suggestion for improvements to the article. -Roxy the dog™ (resonate) 10:44, 14 October 2014 (UTC)
Yup agree explanation / suggestions are required. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:15, 14 October 2014 (UTC)
@Jmh649/Doc James - note e.g. Talk:Acupuncture#Removed_material. I see no good reason to remove that. --Middle 8 (contribs • COI) 19:23, 14 October 2014 (UTC)
The suggestion is there refuse to allow any other sources into the article. So add more relevant sources. There is no need to dismiss every claim and/or source because it does not suit your opinion about medical sources. This is not a mainstream medical subject, so applying mainstream medical sources is not useful. The Banner talk 11:55, 14 October 2014 (UTC)
and now you are edit warring, and if I knew how to template you, I would. Nowhere in the article have reliable sources been refused, your objection is unsupportable, and I will again remove the tag, unless another editor beats me to it. You have to make real suggestions, not generalised observations. -Roxy the dog™ (resonate) 12:00, 14 October 2014 (UTC)
With your edit warring and template removal, you make loud and clear what the POV-problem is: refusal to see the unbalance. But take a look at the recent history and you will see several sources being removed with no or dubious motivation. The Banner talk 12:29, 14 October 2014 (UTC)
Yes, The Banner is right, reliably sourced material was not only removed, but one user even broke the 3RR with 6 reverts removing it. That was both a 3RR violation and disruptive, and I didn't know where I should file it, so I just filed a report here but it was pending for several days and is now archived. I'm curious why nobody ever ruled on this? Anywho, the user claimed "consensus" for removing the material, but never showed where consensus was reached when asked about it. I think this removal alone justified the tag, but as we can all see, there were several other instances where reliably sourced material was removed and makes the article unbalanced.
Anyway, let's focus on the material removed. In my opinion, it all needs to go back in and I don't see why not. Is anyone still opposed to the material being in the article? LesVegas (talk) 16:56, 14 October 2014 (UTC)
Of course. -Roxy the dog™ (resonate) 18:16, 14 October 2014 (UTC)
And here would be a great place to explain why. In the section above where this was also recently discussed, Talk:Acupuncture#Acupuncture_and_the_brain, you added nothing about content, just more stuff about contributors that had nothing to do with the content being discussed. [26][27]. --Middle 8 (contribs • COI) 18:58, 14 October 2014 (UTC)
Most of our articles on pseudoscientific subjects, and many on scientific subjects more generally (evolutionary biology, climate change and so on) are despised by those with strong beliefs opposed to the scientific consensus view. We understand this, but it does not amount to justification for a POV tag. Wikipedia has a systemic bias towards scientific rationalism, this is pretty much by design. If you don't like how we cover subjects you're free to fork, as Conservapedia did. Over the long term our model seems ot be more successful than theirs, but whatever. Guy (Help!) 19:20, 23 October 2014 (UTC)

Against consensus, the tag was restored again. MEDRS is not restrictive. There are over 250 references in this article. See Acupuncture#References. QuackGuru (talk) 21:27, 24 October 2014 (UTC)

It is used restrictive and the effect is that the article is not neutral. Simple as that. The Banner talk 23:04, 24 October 2014 (UTC)
Because of the exclusion the material at Talk:Acupuncture#Removed_material, I will support the tag -- not as a "badge of shame" but as a way to resolve the issue. Are there other examples? I'd also note that the issue may relate to one editor exercising WP:OWN to an unusual degree. --Middle 8 (contribs • COI) 00:54, 25 October 2014 (UTC)
There is consensus on Wikipedia to follow WP:MEDRS. On the contrary, a couple of sources that were not yet in the article does not justify the entire article is under dispute. Rather than have unencyclopedic technical information I rewrote the text. There was no legitimate reason to keep the tag. QuackGuru (talk) 04:59, 25 October 2014 (UTC)
Can you prove that, QuackGuru? And can you prove that the consensus still holds? Because I see repeatedly people disagree with that so called consensus. The Banner talk 18:17, 25 October 2014 (UTC)
The Banner: Are you suggesting that WP:MEDRS and WP:MEDMOS no longer or should no longer apply? Jim1138 (talk) 05:16, 26 October 2014 (UTC)
Good material you added[28]. Fixed wording a bit and made best guess that "encircles" should be "encircling".[29]. --Middle 8 (contribs • COI) 08:52, 25 October 2014 (UTC)

Suggestion going forward: Since edit-warring over tags is very, very lame, the best thing I can recommend is for The Banner to make a list of stuff that they feel is unfairly omitted -- perhaps some stuff from Talk:Acupuncture#Outstanding_issues. Then instead of tagging, for the time being, open discussion on that material. Then if there is entrenched and undue resistance, put the tag back, and then there will be something specific to discuss, and there will be much less justification to remove it. If there are multiple specific examples showing a pattern, and editors keep deleting the tag anyway, that would be tendentious editing justifying admin intervention. --Middle 8 (contribs • COI) 09:01, 25 October 2014 (UTC)

For now, I'm going to restore the removed material I added in, since nobody has given specific objections to it since {{reply-to|John}] got involved here. As far as specifics reasons to justify a POV tag, I added a long list of justifications justifications for the tag here which nobody has even attempted to resolve with specifics on a point by point basis. If this trend continues where editors insist on removing a tag without addressing specific concerns here on talk, I see no other option than to do an RfC. LesVegas (talk) 00:08, 26 October 2014 (UTC)
This material is duplication and misplaced text too. "However, in TCM theory, acupuncture is believed to restore the balance of yin and yang, and according to a 2011 review, this can be translated into Western terminology as "Acupuncture modulates the imbalance between the parasympathetic and sympathetic activity." We already have this in the article" Health is viewed by traditional acupuncturists as a balance of yin and yang, sometimes equated to the sympathetic and parasympathetic nervous systems.[3]"
I already restored the material without including the unreadable technical information. The concerns about the tag was addressed. See Talk:Acupuncture/Archive_15#The_tag_was_removed_multiple_times. QuackGuru (talk) 00:29, 26 October 2014 (UTC)
QuackGuru, first you object saying it's about opioid receptors and therefore redundant, then when I added in "In addition to opioid.." and new mechanism of action, you object that it's too technical. What exactly do you find to be unreadable about the technical information? Perhaps we can work on it or even add wikilinks to some of the terms, if you object so strongly. LesVegas (talk) 00:48, 26 October 2014 (UTC)
I explained the text was also redundant and the information that is too technical does not belong in the article. I did add the same sources to the same section. I did address the concerns and now the redundant and misplaced text was restored. This article is not about electroacupuncture. QuackGuru (talk) 00:54, 26 October 2014 (UTC)
OK, I will remove the now redundant information but I think that what's not redundant, and is sourced, should stay in because any well sourced information of the mechanism of action is relevant here. As I understand it, most acupuncturists do electroacupuncture. I know for a fact this is the case in China today. LesVegas (talk) 01:04, 26 October 2014 (UTC)
There is a separate article for electroacupuncture and the sources are already in the article. The information that is too technical is not appropriate for the general reader. The technical information goes against the clear wording of WP:MEDMOS of writing to a general audience. QuackGuru (talk) 01:10, 26 October 2014 (UTC)
QuackGuru, if you read the source, it is only half about electroacupuncture. The other half is on the effects of manual acupuncture. And on second glance, the information doesn't look redundant at all. We start out talking broad strokes like peripheral sensory stimuli and then get into the meaty details about how it works. This is how any good article should be written. LesVegas (talk) 01:16, 26 October 2014 (UTC)
"A 2014 review stated that despite ample controversy encircling the validity of acupuncture as a modality, developing literature on its physiological effects in animals and humans is giving new views into the basic mechanisms for acupuncture needling.[196] The same review proposed a model combining both connective tissue plasticity and peripheral sensory modulation as a needle response for acupuncture's physiological effects.[196] The evidence indicates that acupuncture-induced pain relief effect has physiological, anatomical and neurochemical origins.[197] The mechanism of action for acupuncture is still unclear.[198]" This is already in the article that is about acupuncture. QuackGuru (talk) 01:20, 26 October 2014 (UTC)
QuackGuru, I'm not going to edit war with you. When I asked if there was anyone still opposed to the material being in the article, nobody responded with any specifics, least of all not you. Now when I try adding them back in, you object on any grounds possible. So I again try discussing it with you, hoping we can work out our differences. It seems like anytime I hold out an olive branch, you take it and use it as a weapon to swipe at anybody who dares to challenge your ownership of this article. You violated the 3RR yet again. It looks like I'm going to have to try a different approach with you now. LesVegas (talk) 22:31, 26 October 2014 (UTC)

Better sources for efficacy in lede; MEDDATE

Reviews-of-reviews can be great sources, but not so much when the field has been changing rapidly, as it has for efficacy, where the trend has been toward the null (or at least clinically insignificant benefit compared to sham). Even though Ernst '11 is three years old, the reviews it summarizes go back to 2000, which introduces the caveats and complicated wording that's been such an irritant lately. We should be able to do with reviews less than 3-5 years old, per WP:MEDDATE. For starters, can we just remove the citation to Ernst '11 and cite to more recent stuff on efficacy? And to inform the reader about study design (especially what is unique to this field, i.e. use of sham acupuncture as placebo control), we could add something like this or this (and improving the sourcing where needed). --Middle 8 (contribs • COI) 09:19, 25 October 2014 (UTC) edited 09:25, 25 October 2014 (UTC)

I support this suggestion. I think your point is valid. TimidGuy (talk) 14:18, 25 October 2014 (UTC)
I also support this. What has happened in recent years (since, as I understand, the 2010 adoption of STRICTA reporting standards by Consort) is an overall improvement in the robustness of reporting, both in reviews and the primary studies that fill them. In every article, older reviews always need to go if we have new material to replace it; in the acupuncture article this is especially important. Scientists are improving ever more rapidly in their ability to understand the effects of this medicine, good, bad or null.LesVegas (talk) 23:53, 25 October 2014 (UTC)
Both edits were previously rejected and both proposals are W:OR and do not summarise the body. We don't need to repeat past mistakes. QuackGuru (talk) 00:22, 26 October 2014 (UTC)
Rejected by you, yes.
It is not OR to say what controls and placebos are, or that sham acu is the placebo used. We should absolutely say this, and if the body really doesn't, then -- in this case -- it should be made to. This is basic stuff.
QuackGuru and I appear to be completely opposed on this point. IMO, QuackGuru consistently makes the error noted at WP:CGTW, #5: saying that paraphrasing is OR. And this is an extreme example. So it will fall to others to sort it out. (Don't fall for ad hominem, though, cf. WP:CGTW #4).
Pruning the second diff, here's a proposal:
"Sham acupuncture", a form of placebo, is used as a control; when real acupuncture is found to be no better than sham acupuncture, that indicates a lack of effectiveness (relative to placebo).
--Middle 8 (contribs • COI) 10:39, 26 October 2014 (UTC)
A study design does not belong in the lede. For clarification there is a note for the general reader. The claim that when real acupuncture is found to be no better than sham acupuncture, that indicates a lack of effectiveness (relative to placebo) is original research and a SYN violation. You can't add you personal opinion to the WP:LEDE and then claim it was sourced to the 2011 review. QuackGuru (talk) 18:44, 26 October 2014 (UTC)

Ernst is from 2011 and thus within 5 years. MEDDATE does not exclude it. The two other proposals are poorly supported and thus I oppose them as well. The review states "In conclusion, numerous systematic reviews have generated little truly convincing evidence that acupuncture is effective in reducing pain." [30] I see no reason why we cannot summarize that. If people think this is wrong they could write a letter to the journal and ask them to retract it. When retracted I will no longer support us containing a summary of it. We do not need to do an indepth review of our sources to verify they did them right. That is the work of both the editor and the peer review. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:17, 26 October 2014 (UTC)

For uninvolved editors (or administrators) you can read the source to verify the current text in the WP:LEDE. The following sentence is a conclusion from the 2011 review: "Real and sham acupuncture were both more effective in reducing pain than no acupuncture at all, but real acupuncture was no better than sham." We should not replace sourced text with OR and with text that violates WP:LEDE. QuackGuru (talk) 18:44, 26 October 2014 (UTC)

I find your reply utterly distracting. This has already been discussed before, and you were explained that:[31]

Sham is placebo. We don't need a source for that, just like we don't need to cite Galileo Galilei when we say that the world is round. Jayaguru-Shishya (talk) 19:46, 8 September 2014 (UTC)

In the same diff, it was already noticed that you tend to call everything that you disagree with, as "OR":[32]

In my impression, it is typical for you to call every edit that doesn't please you as OR. I can tell that from my own experience when you have failed to explain even I have asked you. You must learn to explain why you consider some specific edit as OR. That kind of editing is not helpful even despite of the good intentions. Jayaguru-Shishya (talk) 19:46, 8 September 2014 (UTC)

Jayaguru-Shishya (talk) 19:47, 26 October 2014 (UTC)
Sham is not exactly a placebo. There is sourced text that explains this in the body. See Acupuncture#cite note-Madsen2009-14.
You could not verify the proposal because it is OR. There is broad consensus for the concise wording. See Talk:Acupuncture#There is broad consensus for the concise wording. QuackGuru (talk) 19:59, 26 October 2014 (UTC)

Two issues have become entangled that do not need to be: (A) summarizing Ernst '11, and (B) explaining study design to the reader. Ernst '11 is obviously MORE THAN FINE if we avoid trying to parse it too much. The extended dispute around Ernst is I think best resolved per Doc James' straightforward suggestion [33] to follow the abstract, i.e. "in conclusion, numerous systematic reviews have generated little truly convincing evidence that acupuncture is effective in reducing pain." [34]. Doc James and QuackGuru may also be right that study design may be best handled in the body. It is well worth getting study design right. Maybe we should pursue that in a new section, after a break to let the heat die down? --Middle 8 (contribs • COI) 03:08, 27 October 2014 (UTC)

Specific information about the study of sham is already in the body. See: "Due to acupuncture's invasive nature, one of the major challenges in efficacy research is in the design of an appropriate placebo control group.[14][15] For efficacy studies to determine whether acupuncture has specific effects, "sham" forms of acupuncture where the patient, practitioner, and analyst are blinded seem the most acceptable approach.[63]
Also see: "Placebo or sham acupuncture is a form of acupuncture that uses non-penetrating needles or needling at non-acupuncture points.[13]
If you want more specific information about the study design it would help if you provide a review to summarise.
The past discussion resulted in editors agreeing to include the information about sham versus real acupuncture in the lede and body. See bold edit. See Talk:Acupuncture/Archive 13#Bold edit to resolve the issue. Now that Middle 8 does not like the current wording he wants to propose to delete it.[35][36] In July Middle 8 tried to delete the text from the lede.
User:Dominus Vobisdu,[37] User:McSly,[38] User:Jim1138,[39] User:Roxy the dog,[40] User:Doc James,[41] User:Bobrayner,[42] prefer the current wording in the lede.
We are already including a conclusion and the conclusion in the lede. See: "A systematic review of systematic reviews found that for reducing pain, real acupuncture was no better than sham acupuncture and concluded that there is little evidence that acupuncture is an effective treatment for reducing pain.[n 1][8]" The wording is concise. The details are in the body. QuackGuru (talk) 04:38, 27 October 2014 (UTC)
QuackGuru, this is not a situation of Middle 8 arguing against consensus. There's plenty of others who take his position, including myself. This is exactly why it's more than justified to have a POV tag. Perhaps we need one specifically for the lede. LesVegas (talk) 17:51, 5 November 2014 (UTC)
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