Talk:Acupuncture/Archive 20

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Allergic Rhinitis

A new systematic review has concluded that "acupuncture could be a safe and valid treatment option for AR patients"[1] There is a section on allergies in the article, but I was unsure how to introduce this new review into the current section, in light of older reviews that are already included there that came to different conclusions. — Preceding unsigned comment added by 108.181.201.237 (talk) 18:33, 16 January 2015 (UTC)

Hello and welcome to the talk page! I'm glad you found this excellent review and I will add it into the article. To answer your question, newer reviews are placed ahead of older reviews in chronological order. If it contradicts older and dated research, say from 2-3 years but definitely 5, then we remove the older research in place of the fresh reviews so that the science stays up to date. Oh, and one thing, if you add four of these ~ at the end of your posts on talk, it automatically signs your name. Anyway, welcome to the article! LesVegas (talk) 18:47, 16 January 2015 (UTC)

I just added it and noticed it was a meta analysis and not a systematic review. For your information, these generally carry more weight than systematic reviews themselves, since they are a statistical approach derived from underlying systematic reviews. LesVegas (talk) 19:14, 16 January 2015 (UTC)

This is an example of precisely why I think having this rack of individual studies distorts the POV of the article. If this new study had documented the prevailing view on acupuncture, would there have been such a rush to add it? I think not. Instead, because it takes the unusual point of view that jamming needles into one's body will impact the immune system, it gets presented here, well in advance of the remainder of the scientific community having an opportunity to examine and reject it.—Kww(talk) 20:27, 17 January 2015 (UTC)

And when the rest of the scientific community examines it, we'll quote that too. LesVegas (talk) 00:46, 18 January 2015 (UTC)

Kww, there is no deadline. The editors are encouraged to add the latest findings of MEDRS compliant sources. Indeed, I find you statement: "If this new study had documented the prevailing view on acupuncture, would there have been such a rush to add it?" very curious. Also, as we keep getting new research results, "the prevailing view" will also get more precise, right? I find your thought, according to which we should only present research result that conform the historical data, extremely absurd. In statistical terms, it'd mean that you'd accept only either positive or negative values, and omit the others. :-D

I don't think you are doing yourself a favour here. Instead of serving your personal opinions, please stick to sources. And if discussing the statistics, please discuss the statistics instead of serving opinions as mentioned above. Cheers! Jayaguru-Shishya (talk) 23:35, 18 January 2015 (UTC)

And while we wait, we get another advertisement for acupuncture. Funny how that works. I would suggest that we remove it unless and until it is confirmed by supporting studies.—Kww(talk) 05:52, 18 January 2015 (UTC)

It's just another reliable source that says what it says, and we should use it, without over-generalizing its findings. No reason to not include it, and no reason to not be accurate by just saying "A 2015 meta-analysis shows…" Kww are you saying that this source is considered a primary source? It is not according to MEDRS. Are you saying that Les Vegas' wording over-generalizes its findings? Herbxue (talk) 15:15, 18 January 2015 (UTC)

No, I'm saying that the overall scientific consensus is that acupuncture works primarily through the placebo effect, and little to none of any effect it has on the patient are genuine physiological effects induced by the treatment. Any study reporting positive results is more likely to be a false positive than a genuine result. We shouldn't report it until multiple studies report the same conclusion.—Kww(talk) 16:38, 18 January 2015 (UTC)

To not include this source based on your thoughts about "consensus" that may or may not exist would be original research. I have only read the abstract, but it does not appear to even address the question of whether it worked by specific effects of treatment or non-specific effects. If another reliable source says this study shows positive results but thats probably due to placebo effect, then we could include that too. In the present state of the literature the right thing to do is include the conclusions, but not give any suggestion that this is generalizable or that there is a known mechanism of action.Herbxue (talk) 17:00, 18 January 2015 (UTC)

"Any study reporting positive results is more likely to be a false positive than a genuine result.", again serving your own opinions, Kww. Seems like a one-man-struggle against scientific publications. Jayaguru-Shishya (talk) 23:37, 18 January 2015 (UTC)

No, editorial judgement is not original research. Two separate concepts. If I were to write "in a probable false positive, a 2015 meta-analysis showed a significant reduction in nasal allergies ...", that would be original research. To simply omit the study until there are confirming studies is editorial judgement. I think that we should omit 95% of this entire section, and include only that the two most widely-accepted reviews (Ernst and Vickers) agree that most of the effects of acupuncture are placebo effects. The only controversies that remain are whether the remaining effects that can't be explained as placebo are study errors or legitimate indications of a trivial effect, and whether health agencies and insurance companies should pay for it based on the effects because it helps people feel better, even when they know most of that "feeling better" is based on the placebo effect.—Kww(talk) 17:14, 18 January 2015 (UTC)

Why don't we burn all the books (except what we like, we'll keep that) and base our editorial decisions on the available literature at that time? Sounds like a plan to me. While we're at it let's make Socrates drink poison, imprison Galileo, and sit on our hands while we allow editors to grossly break all the rules in the name of editing from our POV? LesVegas (talk) 19:43, 18 January 2015 (UTC)

Aaaah ... the scientific equivalent of Godwin's law: comparing criticism of pseudoscience to the persecution of Galileo.—Kww(talk) 20:15, 18 January 2015 (UTC)

"To simply omit the study until there are confirming studies is editorial judgement." Seriously, maybe we will keep in the phase of the scientific study, not in the phase of one editor's moods. Jayaguru-Shishya (talk) 23:41, 18 January 2015 (UTC)

"I think that we should omit 95% of this entire section, and include only that the two most widely-accepted reviews (Ernst and Vickers) agree that most of the effects of acupuncture are placebo effects." You think? I am afraid that we are interested what the sources say on the topic, not what individual editors think on the topic. Cheers! Jayaguru-Shishya (talk) 23:44, 18 January 2015 (UTC)

Which part are you claiming isn't what reliable sources say, Jayaguru-Shishya? Ernst, Vickers, and Novella, certainly do agree that the bulk of acupuncture's effect is due to the placebo effect. Vicker's "Although the data indicate that acupuncture is more than a placebo, the differences between true and sham acupuncture are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to therapeutic effects" and Novella's "the benefits of acupuncture are likely nonexistent, or at best are too small and too transient to be of any clinical significance" are in substantial alignment, differing primarily in the value judgement of whether a trivial impact is worth paying for, not in whether the impact is trivial. Ernst's conclusions aren't much different. What widely noted review has claimed an effect for acupuncture that was large compared to the effect for placebo? —Kww(talk) 00:51, 19 January 2015 (UTC)

It seems odd to try and compare Ernst/Vickers review and this review. Sources from Ernst and Vickers used in the article are examining chronic pain and pain treatment/outcomes, whereas this systematic review that is under question examined the literature about allergies and allergy treatment/outcomes, such as nasal symptom scores (stuffiness and drippiness), medication usage and serum IgE. I have read through MEDRS guidelines and this systematic review seems to clearly fit as the highest form of evidence available - a secondary source published in a medline-indexed peer-reviewed medical journal within the past 5 years. 108.181.201.237 (talk) 01:33, 19 January 2015 (UTC)

That's right. The source is as good as they come. Kww I generally support editorial judgement over strict guideline enforcement but in this case we have a contentious article, so MEDRS does the work for us. The caution you recommend is the caution MEDRS requires us to take when evaluating primary studies. In this case, the errors that we are at risk of committing are minimized by choosing secondary sources over primary, and this one in particular has a solid sample size and great p values. It is not ambiguous.

Now, there is a separate concern that you bring up - is the clearly demonstrated benefit due to specific effects or placebo effect? For the source in question, that issue is not even brought up - the source just says it works for this condition. Does it work better than slapping people in the face? We don't know, the study did not seek to answer that question. We can only report on what they found in relation to the question they sought an answer for. Since this is a reliable secondary source, we include it, but we do NOT over-generalize and pretend that this means acupuncture works for everything, and we do not use it to make a point about acupuncture being more than placebo.Herbxue (talk) 04:27, 19 January 2015 (UTC)

It's certainly a false positive of the highest quality, I'll give it that. To study acupuncture and not rate its performance compared to a placebo would appear to be a purposeful sin of omission, however, which is one of the reasons I fully expect this study to not be supported by others. Any general reader reading this excerpt is likely, however, to leap to the erroneous conclusion that there is some form of evidence that indicates that acupuncture is now believed to be an effective treatment for allergies.—Kww(talk) 05:56, 19 January 2015 (UTC)

It looks like there may be some confusion about the source. I see that it's been referred to as a "study" and therefore, it's easier to assume it's an outlier. But it's not, it's a meta-analysis, and all the studies which composed it did test it versus placebo. The n's and p's in the analysis were astounding. And there's really nothing better than a meta-analysis. The only thing better are meta-analyses using individual patient data. Even better than that would be only using studies with very robust reporting standards, like CONSORT, so that researchers can know things like needle size used, stimulation methods used, and whether or not trained acupuncturists administered the acupuncture in the studies. They even know what type of placebo control was used, and where and how it was placed. Details like these matter, and as the research improves we will see richer outcomes and, perhaps, even new findings. Anywho, I hope this clarifies a few aspects about both the source and research as well. LesVegas (talk) 18:03, 19 January 2015 (UTC)

Misrepresenting the source

The conclusion was "Our meta-analysis suggests that that acupuncture could be a safe and valid treatment option for AR patients."[2] The source is about safety.

How did an editor conclude "A 2015 meta-analysis showed a significant reduction in nasal allergies, medication scores, and serum IgE levels in patients receiving acupuncture versus the control group. [100]"? QuackGuru (talk) 19:52, 16 January 2015 (UTC)

? The source says "we collected and analyzed the randomized controlled trials (RCTs) of acupuncture for the treatment of AR patients to assess its efficacy and safety"Herbxue (talk) 20:02, 16 January 2015 (UTC)

Hi QuackGuru, under results, the source says "Compared with control group, acupuncture treatment group exerted a significant reduction in nasal symptom scores (weighted mean difference [WMD]: -4.42, 95% confidence interval [CI]: -8.42 to -0.43, p = 0.03), medication scores (WMD: 1.39, 95% CI: -2.18 to -0.61, p = .0005), and serum IgE (WMD: -75.00, 95% CI: -91.17 to -58.83, p < 0.00001)." In the future, please assume good faith before claiming the source is being misrepresented. LesVegas (talk) 20:06, 16 January 2015 (UTC)

You misrepresented the source. Read the comment by Herbxue. We should summarize the conclusion. QuackGuru (talk) 20:15, 16 January 2015 (UTC)

I'm still confused, what was misrepresented? My comment above is that the source states it assessed both safety and efficacy. The wording in question comes right from the results section. Herbxue (talk) 20:38, 16 January 2015 (UTC)

Ehm... Herbxue quoted that "...we collected and analyzed the randomized controlled trials (RCTs) of acupuncture for the treatment of AR patients to assess its efficacy and safety...". And LesVegas reported the very findings of the source concerning what Herbxue quoted, isn't it? Quite impressive p's, don't you think? Cheers! Jayaguru-Shishya (talk)

Herbxue, the conclusion was not summarised. QuackGuru (talk) 20:43, 16 January 2015 (UTC)

Oh I get it now, the text added to the article came from the results section rather than the conclusions. Are we trying to only use the conclusions of studies and not cite anything from the body? I would be generally ok with that if we're doing that across the board. And yes JS, those p values are lovely :) Herbxue (talk) 20:49, 16 January 2015 (UTC)

The results were not the conclusion. The text is summarised as other text in the same section. The source sad "Compared with control group, acupuncture treatment group..." The acupuncture treatment group does not represent acupuncture as a whole. Obviously the text was original research. QuackGuru (talk) 21:13, 16 January 2015 (UTC)

QuackGuru, as you said, the source said, "Compared with control group, acupuncture treatment group.." and the edit said "in patients receiving acupuncture versus the control" which is a valid representation of the source. And obviously, by stating acupuncture vs. control the edit wasn't trying to represent acupuncture as a whole. It was attributed to a 2015 meta-analysis, afterall. You're essentially claiming that the edit said, "Acupuncture causes XYZ in all cases, in all cases, everytime, everywhere" Why are you misunderstanding what is rather obvious? LesVegas (talk) 21:27, 16 January 2015 (UTC)

A control group from the results section does not represent the conclusion of acupuncture in general. This is also undueweight to include a control group. What you want to include appears to contradict the conclusion. QuackGuru (talk) 21:57, 16 January 2015 (UTC)

QuackGuru, seriously? With due all respect, but I think your comment shows that you are not really familiar with statistical science. Indeed QuackGuru, that's the "sample". How representative the sample is, is another issue. Jayaguru-Shishya (talk) 22:17, 16 January 2015 (UTC)

"Thirteen full papers that met our inclusion criteria were included, and a total of 2365 participants, including 1126 as treatment group and 1239 as control group, were enrolled", pretty good n as well. Can't see any reason why we can't use this systematic review. Jayaguru-Shishya (talk) 22:22, 16 January 2015 (UTC)

The citation does not say acupuncture in general. Nor does it imply acupuncture in general. It says acupuncture vs. control group. It said "A meta-analysis showed.." Meta-analyses are, by their nature, never representative of a treatment modality. You've added meta-analyses to the article and should know that they aren't entire representations of a modality. Nor does anyone think this. In fact, nearly every meta-analysis cited in our article goes something like, "A 2013 meta-analysis showed acupuncture, compared to sham, showed X." No reasonable person would think acupuncture in general is being stated here. QG, listen, you really need to work towards being more collaborative rather than undoing work. Constantly misunderstanding editors on talk pages and quibbling over obviously implied wording really doesn't help us build a good encyclopedia either. I'm afraid this is such an ongoing problem with you, I have no other option than to report this. LesVegas (talk) 22:08, 16 January 2015 (UTC)

You wrote "A 2015 meta-analysis showed a significant reduction in nasal allergies, medication scores, and serum IgE levels in patients receiving acupuncture versus the control group." This is a broad and misleading claim.

The read conclusion: "Our meta-analysis suggests..."[3]

The raw data was not what the meta-analysis showed. After the researchers reviewed the raw data they came to a limited conclusion. I fix the wording. The individual studies distorted the POV of what the actual meta-analysis concluded. QuackGuru (talk) 20:54, 17 January 2015 (UTC)

QuackGuru, about a month ago you decided to twist an edit I made by framing the premise from the abstract as though it was a conclusion. So, just for the record, it is ok to quote an abstract out of context as a conclusion, but it's not okay to quote results from a meta-analysis? (even though we all do that pretty frequently, and you know that) If we should only quote from the conclusions, as you say, then how do you explain this edit? You added (or ineffective) to it, which was not in the conclusion, but rather from the "background" portion of the source I'm not here to play games with you, I'm here to build an encyclopedia. LesVegas (talk) 00:34, 18 January 2015 (UTC)

I never said it is not appropriate to quote from the results for certain situations. But for this meta-analysis I do think it is inappropriate (read my previous comments). Your providing an old diff. I continued to try to improve the wording for the source that most editors think is not MEDRS compliant.

The source is about "Acupuncture for the treatment of allergic rhinitis" in general. The individual symptoms from the results are what the researchers evaluated to come up with the conclusion for allergic rhinitis. QuackGuru (talk) 04:13, 19 January 2015 (UTC)

Confusing misplaced text is stepping on WP:SYN

The text is misplaced and was not a response to both Edzard Ernst and David Colquhoun. QuackGuru (talk) 18:21, 29 January 2015 (UTC)

Actually, Vickers makes this exact point (paraphrased) both in the original paper and in his response to Ed & Dave; apparently he anticipated their criticism. I'm happy to cite either or both if you like. --Middle 8 (contribs • COI) 20:56, 29 January 2015 (UTC)

It was not a direct response to Edzard Ernst and David Colquhoun. The text is misplaced and undue. The source written in the article is "A 2012 meta-analysis conducted by". The reader does not know what is "Vicker's". The sentence does not make any sense as written. QuackGuru (talk) 21:08, 29 January 2015 (UTC)

Fine, so tell me how you'd like to see it improved. Point taken re the reader not knowing who Vickers is; we can mention that. Should we mention Vickers' point before Ernst and cite to Vickers original review, or mention it after Ernst and cite to his response to Ernst? Or both? Like I said, he makes the same point in both.--Middle 8 (contribs • COI) 21:30, 29 January 2015 (UTC)

Since it was not a direct response to Edzard Ernst or David Colquhoun it should not be used to counter the point made by Edzard Ernst or David Colquhoun. You can't improve a SYN response. QuackGuru (talk) 17:53, 30 January 2015 (UTC)

Like I said, Vickers addresses their point twice: in his review (where he apparently anticipated it), and in his published response. Per NPOV we need to cite at least one of these. --Middle 8 (contribs • COI) 20:03, 30 January 2015 (UTC)

Vickers' review [4]:

• Our finding that acupuncture has effects over and above those of sham acupuncture is therefore of major importance for clinical practice. Even though on average these effects are small, the clinical decision made by physicians and patients is not between true and sham acupuncture but between a referral to an acupuncturist or avoiding such a referral.

Vickers' reply to Colquhoun and Ernst [5]:

• The one critique in the scientific press, published on the website of the BMJ, came from David Colquhoun, a well-known critic of complementary therapies. He stated that ‘acupuncture does not work to any useful extent … Vickers et al showed that the difference is far too small to be of the slightest clinical interest’.2 Colquhoun’s point appears to be that ‘clinical interest’ depends on the difference between acupuncture and sham, whereas we argue that that the decision taken in clinical practice is between referring to acupuncture or not doing so.

Vickers also says that the difference between sham and verum -- the same difference Colquhoun speaks of -- is comparable to NSAIDs. Additionally, re Ernst's criticism and that of one blogger, he says:

• Edzard Ernst was cited in several media outlets as stating: ‘I fear that, once we manage to eliminate this bias [that operators are not blind] … we might find that the effects of acupuncture exclusively are a placebo response’.6 One blogger asserted that acupuncture ‘has an effect size that is very small and, in my opinion, overlaps with no effect at all’.3 It is simply bizarre to dismiss years of careful statistical analysis on the grounds that results ‘might’ change; similarly, it should go without saying that whether an effect size overlaps with no effect is not a matter of opinion but of CIs.

He also refuted Ernst's criticism about unblinding (which Novella also voiced). In general we weight Vickers insufficiently: it's not explictly mentioned in the lede despite being the most rigorous type of meta-analysis (IPD), and in the body we say relatively little as well. We don't even specify which kinds of pain they reviewed. --Middle 8 (contribs • COI) 09:48, 31 January 2015 (UTC)

I'm happy with stating Vicker's primary conclusion in the lead, that any actual effect of acupuncture is small relative to the placebo effect. What I would oppose is placing any strong emphasis on his comfort level with recommending placebo therapies: that's a social issue, not an issue of facts related to what acupuncture is. That's really the major argument between Vickers and others: Vickers vehemently argue that we should compare acupuncture to non-treatment, where others compare it to placebo treatments only. All major reviews agree that the delta between placebo treatments and acupuncture is small, and that statement of consensus belongs in the lead.—Kww(talk) 01:04, 1 February 2015 (UTC)

Vickers, A. J.; Maschino, A. C.; Lewith, G.; MacPherson, H.; Sherman, K. J.; Witt, C. M. (2013). "Responses to the Acupuncture Trialists' Collaboration individual patient data meta-analysis". Acupuncture in Medicine. 31 (1): 98–100. doi:10.1136/acupmed-2013-010312. ISSN 0964-5284. PMID 23449559.

Including both lengthy quotes is too much. Please make a specific propose using a reliable source. I thought there was a previous discussion that found "Acupunct Med" was unreliable. Maybe someone can check the archives. I'm not sure if we can use this specific source. QuackGuru (talk) 01:11, 1 February 2015 (UTC)

Okay, I just checked the archives and found it, and yes, there was actually consensus. But actually the consensus was that it's reliable and you were IDHT'ing. Scroll down to your comment, "The proposal to use the fringe Acupuncture in Med journal makes no sense" LesVegas (talk) 02:05, 1 February 2015 (UTC)

See Wikipedia_talk:Identifying_reliable_sources_(medicine)/Archive_8#Question_about_a_journal. QuackGuru (talk) 03:03, 1 February 2015 (UTC)

That's not a review

This change inserts a source that is nowhere close to MEDRS. Yes, the title contains the word "review", but it doesn't correspond to what MEDRS means by "review". This is not far from adding a source that is a book review -- because it's a review, isn't it?

Independent of my assessment, I noticed others on this talk page have been saying the same thing, but to little avail. There may be no polite way to bring up WP:CIR, but there comes a point where it has to be done. Editors' time shouldn't be wasted like this. Manul ~ talk 18:18, 15 January 2015 (UTC)

Sorry to disagree, but just because other editors say it doesn't make it true. I have responded to these objections and have yet to hear back from them, which is why I added the source back. If editors say "it's not a review" but then fail to respond to me when I explain that it is, actually, a secondary source and then come back repeating each other without engaging in substantive discussion, isn't that actually a waste of my time? LesVegas (talk) 18:54, 15 January 2015 (UTC)

On my cursory analysis it seems like it's classed as a review article by EBCAM. But I think there's a more important question, which is whether EBCAM is reliable for this in the first place. It's not indexed in MEDLINE, and it's published by Hindawi, which has been on Beall's list of predatory publishers. In 2013 it was removed from the list, but Beall at the time said it was a "borderline case" (source). I don't think this meets the standard of MEDRS. Sunrise (talk) 00:42, 16 January 2015 (UTC)

Thanks for that link Sunrise and for noticing that it is a review, as I have always stated. As you said, it's not on Beall's list, but the source never said EBCAM was on the list, only a set of Hindwai's journals. Regarding those, here is the quote from the link you provided: A set of Hindawi's journals appeared on a version of Beall's list because he had concerns about their editorial process, but has since been removed. “I reanalysed it and determined that it did not belong on the list,” he says. It is indexed on Pubmed and has a solid impact factor for the source. Given all of that, what specific guidelines in MEDRS would exclude the source? LesVegas (talk) 01:29, 16 January 2015 (UTC)

By the way, here is the PMID for the citation. LesVegas (talk) 01:40, 16 January 2015 (UTC)

As I said above, the rest of the quote is "It was always a borderline case." But can we please not do the bolding thing? It comes across, to me at least, as similar to caps lock. :-)

Pubmed indexing is not a good benchmark for reliability - MEDLINE indexing is much better, and indeed lack of MEDLINE indexing is mentioned in MEDRS as a red flag. MEDRS also endorses Beall's evaluations as red flags, since he is cited as a source of examples of predatory publishers. I actually hadn't realized that the Nature source only said "set of," as you rightly point out. But in any case: Beall divides his list into separate categories for publishers and individual journals. Hindawi appeared on the publisher list as well. (More specifically, it appeared in the watchlist section, not the confirmed section, but as Beall says, it is borderline.)

That's not to say that any particular article from EBCAM cannot be useful. The suggestion (again, quoting MEDRS) is that for any individual article, the red flags can be overcome by showing that "the article has garnered significant positive citations in sources of undisputed reliability suggesting wider acceptance in the medical literature." Sunrise (talk) 02:12, 16 January 2015 (UTC)

Hey Sunrise! I really do appreciate you responding to each of my points. It is always helpful to find editors who are willing to have a thorough, fair and serious discussion and I am most grateful. And you're right, EBCAM (or eCAM) is not Medline indexed. WP:MEDRS says that this "might" raise red flags, but of course not red alerts. A red flag isn't a scarlet letter of shame, of course, just an indication that we want to look further into it. Looking into the Beall's list, we see that not only is the current publisher not on it any longer, we also see that, at the very time Hindwai was added to Beall's list, EBCAM was actually being published by the rather prestigious Oxford University Press where it had a high impact factor relative to its field While published under Hindwai, it has retained a similarly high Thompson-Reuters impact factor relative to its field. Given all of this, I think a rather strong case can be made that this journal is not only MEDRS compliant, but is actually a great source, and I see nothing specific in MEDRS to allow us to exclude it. But am I missing anything? LesVegas (talk) 18:08, 16 January 2015 (UTC)

I agree with Sunrise that "...the red flags can be overcome by showing that "the article has garnered significant positive citations in sources of undisputed reliability suggesting wider acceptance in the medical literature."". In my humble opinion, LesVegas has tackled this problem really well in his response. Cheers! Jayaguru-Shishya (talk) 19:18, 16 January 2015 (UTC)

Thanks! - I'm just trying to be the best editor I can. :-) As are we all, I suppose.

Impact factor can be a useful indication of reliability, but only when you get to high numbers (I would say >8-10 is probably a good benchmark in the biosciences). The lack of MEDLINE indexing, as described by MEDRS, is still a red flag, so I'm not sure what you're trying to say there. It doesn't make something automatically unreliable but it is an indication that we should be cautious. Indeed OUP is a good publisher, so perhaps you could make a case for articles published prior to the change in 2010 (from a good publisher to a poor one), but this one is from 2011.

@J-S since the quote actually refers to the individual article, not the journal, addressing that issue would involve specific citations of the article in question. Also, impact factor measures only number of citations, not quality - for example, it's possible for a journal to reach IF 4-5 using primarily self-citations to its own articles. In the case of this paper, there's actually only one citing article in Pubmed, and a couple of the authors are the same. In the biosciences, a paper being largely ignored for close to 4 years is also a bad sign, unfortunately. Sunrise (talk) 21:51, 17 January 2015 (UTC)

I looked a little more into Beall's list. First of all, I have to ask, is Beall's list the gold standard in open access journal quality? We have to keep in mind that Jeffrey Beall is a librarian and open access journals threaten his livelihood, so there certainly may be many "false positives" on his list. But when he recognizes a false-positive journal as being legit, he removes them from his list. Beall reconsidered Hindwai after representatives from the company met with him in Denver, and now they aren't even listed as "questionable". Since reconsideration is tantamount to admitting you made a mistake in the first place, I don't see how we could possibly exclude this journal on any basis. I see no reason to exclude anything published from Hindawi on the grounds that it was once on Beall's list mistakenly.

On another note, you noted that journals with an impact factor of >8-10 are a good benchmark for biosciences. But the American Journal of Sports Medicine (the highest ranked orthopedic journal) isn't even close to that high! (4.699). And eCAM isn't really biosciences, though, per se, at least not like JAMA or Nature are. If we compare it to its relative field (CAM journals) it consistently ranks amongst the very highest CAM journals. We also need to remember that MEDRS states reliability does not include a journal's "content being outside the journal's normal scope (for instance, an article on the efficacy of a new cancer treatment in a psychiatric journal or the surgical techniques for hip replacement in a urology journal)." Yet we have many journals without knowledge and expertise on acupuncture making statements on acupuncture. Now, I'd prefer not to argue that we get rid of anything published in biomedical journals on acupuncture even though it may be outside its normal scope. Personally, I think we should allow a pretty broad range of sources in. But, that said, the argument that one of the highest impact factor journals in the CAM field cannot be used to cite something in its field violates the intention of MEDRS's "journal's normal scope" rather grossly if one believes a journal that doesn't normally cover acupuncture is more reliable than eCAM regarding the acupuncture field. I can't see any reason to keep eCAM out on reliability grounds. The only hard evidence regarding reliability that I can see is actually in this journal's favor regarding its high impact factor amongst CAM journals. LesVegas (talk) 22:44, 26 January 2015 (UTC)

Yes, Beall's list is the gold standard in this area (though of course it isn't perfect), and this is also enshrined in MEDRS as I said above. If it had simply been removed from the list without comment I think that would be a reasonable argument, but again, we also have a high-quality source where Beall calls Hindawi a borderline case for inclusion on the list. In other words, on the spectrum of dubiousness/reliability it falls close to the line.

On scope, I think you meant to say that being outside a journal's normal scope is a red flag, not that it isn't. :-) If you have examples of citations from the article I'd be happy to give my opinion on them, but note that a journal's scope doesn't have to be "acupuncture" to be considered a good source for this article, e.g. a journal on pain medicine publishing articles on the use of acupuncture for pain, or Nature publishing pretty much anything. That said, I'm not sure why you brought up scope as an issue, because it's only used to argue in favor of unreliability and I didn't bring it up myself.

For impact factor, >8-10 is the benchmark for using it as an indication of reliability. That doesn't mean that lower IF journals are unreliable, but rather that we cannot use IF to support their reliability. Sunrise (talk) 23:45, 28 January 2015 (UTC)

Hey Sunrise! Thanks again for continuing on in this with me. Can I bother you to point me to where was it decided that 8-10 on IF is the standard for reliability support? Was it an RfC somewhere, on MEDRS or Project Medicine maybe? I'd like to read the analysis because it seems like it doesn't make much sense, to me, to apply an IF of 8-10 in all cases where reliability is in question. The highest rated Orthopedics journal is a 4.699! That would mean that all orthopedics journals in question would be excluded if anyone questioned them. Even the very highest one in the category! And that's a bias that favors sexier topics. Orthopedics literature happens to not get cited much because it's old and just not titillating enough. What it needs to be is not a standard 8-10 threshold but a relative impact factor to avoid "sexy bias" or whatever you want to call it. Excitement bias? I don't know. There's probably a term for what I'm talking about. LesVegas (talk) 00:45, 1 February 2015 (UTC)

I'll discuss as long as any particular topic holds my interest. :-) The specific number is my (probably generous) summary based on past experience - the larger point is in the problems with using impact factor at all. Some RSN discussions on impact factor are here and here, which are about as conclusive as RSN discussions usually get. Note that these are discussions on whether IF can be used even just for meeting RS, let alone MEDRS!

Again, the point is not that lower IF journals are unreliable, but rather that we cannot use IF to support their reliability - so e.g. observing that the highest IF orthopedic journal is 4.7 isn't relevant. It's possible there wouldn't be a consensus for any specific benchmarks, but if not, I can all but guarantee that the consensus would be to use it not at all or only with strong caveats. I'm happy to discuss more general points about impact factors my user talk page, since it's not all that relevant to the discussion here. :-) Sunrise (talk) 02:41, 2 February 2015 (UTC)

Jumping in for a moment: neither RSN seems conclusive. Both caveat relying on IF's too heavily. From the second we might glean that IF's are useful metrics within fields, which goes to the point LesVegas is making for EBCAM's being high for its field. The Beall's objection seems moot on account of Beall having recanted his concerns. Is there any evidence that EBCAM changed when it went from Oxford to Hindawi? Different editors, or whatever? If not, I'm inclined to say the source is OK. (There are several sources talking about evidence for point specificity, and even one editorial by skeptics -- the one by Colquhoun and Novella mentioned above -- cited some. We can't keep excluding it beyond a certain point.) --09:20, 2 February 2015 (UTC)

Hmm. I haven't been on this talk page for a while and I've just come across this discussion. I'm a bit disturbed by the spurious connection being made (or not) between IF and reliability. I think that we should all be clear that there is none. Although there is likely a correlation between the two, IF says nothing about reliability or quality of a source, it says more about the profile of the journal, it's accessibility and how aggressive the editors are at acquiring self-citations! The variance in IF is huge between different fields and it is a very unreliable index of reliability. There has historically been some absolutely brilliant science published in journals with a very low impact factor for a variety of reasons: because the field is so specialized that the readership is small, or because the research has few (if any) commercial applications, or because certain scientists are sentimentally attached to certain journals... any number of reasons. Sorry if all of this has been said before. As I said, I've just caught the tail-end of this discussion. Famous_dog (c) 15:46, 3 February 2015 (UTC)

Sunrise, you said "For impact factor, >8-10 is the benchmark for using it as an indication of reliability" which seemed to me like you were saying it was a standard or agreement of consensus amongst editors somewhere. So I am understanding you correctly that it is just your opinion of where it ought to be? Middle 8 was right that neither RSN seemed conclusive on this, and that the Beall's objection is moot because it's not on even the "questionable" list, and was never even once considered predatory. And I agree with Famousdog that IF says nothing about the reliability of the source. While I understand that we don't exclude sources based on IF, we could make an argument not to include them, if it appears the source is unreliable and if IF is too low. There's really no evidence that the journal is problematic, no current evidence Hindawi is, and plenty of evidence that eCAM makes a large impact in its field; a huge impact if we consider it's ranking in CAM publications. LesVegas (talk) 21:49, 3 February 2015 (UTC)

As somebody who is regularly spammed by Hindawi with requests to publish with them or requests to act as an editor, I am of the opinion that they disreputable and they parasitize the open-source movement (but that is just my opinion, albeit one forged in the fires of a thousand spam emails). The reputability of either the publisher or the journal aside, the problem with Bai et al is that it is not a review, it is a synthesis. They are taking lots of what appear to me to be unrelated papers, including three published in a very dubious source and squishing them together in a fashion that supports their theory or lends credibility. For example, the citations of research papers published in reliable MEDRS journals (such as references 40-42 on back pain) do not in any way support their central argument - they are just padding. We don't accept that sort of behavior on WP, so we shouldn't accept it in published articles. Famous_dog (c) 12:31, 5 February 2015 (UTC)

In WP:MEDRS, "reviews" refer to literature reviews, which do not present new findings, much less groundbreaking ones. The answers given by Dominus and Brangifer were already more than sufficient to explain why this source cannot be used. There are still more reasons, such as the flimsiness of the journal, as Sunrise points out. It's incredible that apparently a month has passed since the paper was first proposed. Let's not spend more pixels about this. The source is out. Manul ~ talk 03:07, 16 January 2015 (UTC)

Manul, if you read my previous argument you will see that I state MEDRS allows multiple types of reviews, such as systematic and narrative reviews. The source comments on primary studies, clearly making it a secondary source by the very definition of what a secondary source means. And yes, you're right, I have spent the last month or so on this, but only to give fellow Wikipedians ample chance to respond before I added the source back in. There's no hurry really, Wikipedia doesn't have deadlines, as you know. LesVegas (talk) 18:18, 16 January 2015 (UTC)

True, there is no deadline (WP:NORUSH). We can afford to take the time. Jayaguru-Shishya (talk) 19:32, 16 January 2015 (UTC)

Original research should not be restored

This change made by User:LesVegas was original research and did not summarise the source. Neutral wording:

"Despite scientific debate in the validity of meridians and acupoints has been increasing, the premise for the idea of acupuncture points and meridians in TCM has not been determined. A 2011 article, representing a theoretical basis, suggested that the human fascial network is consistent with the ancient view of the meridian network pattern, and might be considered to be the anatomical basis for acupoints and meridians within the human body. Further, the article suggested that the efficacy of acupuncture has been observed to depend on interactions with the fascia."

If there is consensus to restore the source that is not a review the wording must be sourced and neutrally written. So far I did not think there is consensus to restore the source. QuackGuru (talk) 20:18, 2 February 2015 (UTC)

The wording was sourced and was not OR. I explained this before when I posted the wording directly from the source here on talk and you accused me of a copyvio. Then you pulled directly from the source something completely out-of-context which sounded the opposite of what the source actually said. We've been through this nearly two months ago. You were IDHT'ing then and now you still are. The degree to which you don't hear the point, ever, really baffles me. LesVegas (talk) 19:46, 3 February 2015 (UTC)

In the text you add you claimed it was a 2011 "review".[6] It was not a review and you did not accurately summarise the source. The wording I wrote is more accurate.

You wrote :However, a 2011 review noted that the human fascial network is consistent with the ancient view of the meridian network pattern, and could be the anatomical basis for acupoints and meridians within the human body."[7] But the source said "Specifically, this hypothesis is supported by anatomical observations of body scan data demonstrating that the fascia network resembles the theoretical meridian system in salient ways, as well as physiological, histological, and clinical observations." The source also said "In this paper, a convergence of evidence from various fields related to fascial anatomy and physiology were reviewed and considered with respect to the possibility that the fascia might be the physical substrate referred to as the meridian system in TCM."[8] The entire paper is clearly speculated and the fascial network. QuackGuru (talk) 00:22, 4 February 2015 (UTC)

Oh, too bad that's not the only thing the source said. The source also said this: "The anatomy of the fascial network in the human body, as demonstrated through VCH and living body imaging studies, is consistent with the traditional view of the meridian network pattern, and the efficacy of acupuncture has been shown to rely on interactions with the fascia." Please don't accuse me of OR again while you try justifying your disruptively taken, out-of-context edit which you pulled from the first line of the abstract, something you claimed you didn't do IDHT'ing all the way until I posted the abstract here on talk to show it. LesVegas (talk) 01:03, 4 February 2015 (UTC)

Rewording Nature citation

Re the Nature editorial about TCM [9]:

At Talk:Traditional Chinese medicine, there has been an RfC: Is the Nature article an appropriate source for the claim it is attached to?. After input from ca. 20 editors, an uninvolved admin, Shii, closed the RfC; see section here (and diff here).

Based on their determination of consensus, I'm making the same change at this article: According to Nature, TCM is "fraught with pseudoscience". (Diff of change: [10]). Already made change at Traditional Chinese medicine article. --Middle 8 (contribs • COI) 08:46, 26 January 2015 (UTC) edited 09:03, 26 January 2015 (UTC)

Thank you Middle 8. For whatever it is worth, I emailed Nature asking them to clarify as to whether or not their position on TCM is that it is pseudoscience, since this was the contention. Here was their response:

Dear Les, Thank you for getting in touch regarding the editorial ‘Hard to Swallow’.

The best advice I can give you is just to quote the piece exactly as it is written and attribute it to Nature as a whole. The editor who was in charge of editorials in 2007 is no longer in that position and the current editor in not able to comment.

I am sorry not to be able to be of more help on this occasion.

LesVegas (talk) 19:33, 26 January 2015 (UTC)

Midle8, you violated consensus. The closing was only a suggestion and the wording was already changed. See diff. QuackGuru (talk) 22:30, 26 January 2015 (UTC)

QuackGuru I see no such violation of any consensus. This wording is what you alone support. I don't see any editors on the TCM talk page supporting this version. Most say they want it attributed. Please don't tell others they're violating consensus as justification to make edits only you support. LesVegas (talk) 22:57, 26 January 2015 (UTC)

It is attributed in the body and the part "with no logical mechanism of action for the majority of its treatments." was deleted for no good reason. QuackGuru (talk) 22:58, 26 January 2015 (UTC)

Explained in closing admin's comment section here (and diff here): "Accordingly, the following wording should not be employed...". Which I referenced multiple times: just above [11], mainspace diff [12], and in two diffs at TCM article [13] [14]. --Middle 8 (contribs • COI) 00:35, 27 January 2015 (UTC)

The text is attributed to Nature and you have failed to explain why you deleted "with no logical mechanism of action for the majority of its treatments."

11:55, 12 May 2014

5:40, 25 June 2014

01:09, 4 July 2014

23:57, 4 July 2014

You were warned to not make changes like that. QuackGuru (talk) 00:46, 27 January 2015 (UTC)

Kww asked me to make sure there was consensus before making any similar edits, and very obviously, I edited precisely according to the consensus that the closing admin determined. Your diffs are cherry-picked and your complaint is WP:GAME-ing: the exact same kinds of edits were being made by you [15] and others [16]. Seems to me you're IDHT-ing, ignoring consensus and dredging up old WP:GAME-ing. Don't do that. You should be officially warned for this kind of conduct. --Middle 8 (contribs • COI) 03:29, 27 January 2015 (UTC)

You are continuing to avoid explaining why you deleted "with no logical mechanism of action for the majority of its treatments." on 08:53, 26 January 2015.

You did roughly the same thing against consensus before on 11:55, 12 May 2014. QuackGuru (talk) 03:34, 27 January 2015 (UTC)

The wording was recently changed to closely reflect the source.[17] I don't see any editor wanting to revert back to Middle 8's bold change now that the wording was adjusted. QuackGuru (talk) 20:54, 27 January 2015 (UTC)

QG - the now-closed discussion indicates that the intent of the nature source's wording is unclear, that it is a weak source for the claims it is being used to make, and that the wording within the source is describing prevalent opinions rather than expressing that opinion. The consensus is that we use that source to say something like "a Nature editorial notes that TCM is characterized as fraught with pseudoscience". It is not productive to keep arguing about this source. The source is not strong enough to support the text "no valid mechanism for the majority of its treatments". I was gone for six months and we're still talking about this same article. Maybe we should remove it altogether so some progress can be made?Herbxue (talk) 22:40, 27 January 2015 (UTC)

You wrote "Maybe we should remove it altogether so some progress can be made?" That is unproductive. Other editors have also edited the text to improve it. I disagree with your proposals. QuackGuru (talk) 23:07, 27 January 2015 (UTC)

I too disagree with removing it, but I understand Herbxue's frustration with beating this horse, especially given the RfC. --Middle 8 (contribs • COI) 16:58, 28 January 2015 (UTC)

Am making a bold revert to original RfC wording ("fraught with pseodoscience") and removing the rest about mechanism and drug discovery for the simple reason that Nature is talking about herbs, not acupuncture. That's unambiguous. The cite is fine re pseudoscience, but it's undue weight to discuss herbs except in passing -- especially in the lede. For the criticisms of the mechanisms of acupuncture -- which I agree obviously weigh -- we should rely on sources that actually discuss that point, not sources that discuss herbs. We actually mention this already under Effectiveness, with another Nature source: A 2014 Nature Reviews Cancer article found that "contrary to the claimed mechanism of redirecting the flow of qi through meridians.... --Middle 8 (contribs • COI) 01:41, 28 January 2015 (UTC)

Comment on attack list of diffs above: QuackGuru, I find your postings above of my four similar edits [18] of a Nature citation to be WP:GAME-y. You're implying that my multiple edits were improper, when you too were making multiple edits to the exact same citation:

20:00, 24 May 2014

19:59, 5 June 2014

3:01, 29 June 2014

and most recently this 22:25, 26 January 2015, which -- unlike any of my edits you listed -- was flagrantly in violation of consensus. Specifically, you reverted against Shii's finding of consensus in an RfC: section here (and diff here).

More on your talk page: [https://en.wikipedia.org/w/index.php?title=User_talk:QuackGuru&oldid=644640686#Reply_to_your_complaint_at_Talk:Acupuncture. --Middle 8 (contribs • COI) 18:14, 28 January 2015 (UTC)edit: fmt & link updated 02:13, 29 January 2015 (UTC)

I see a different problem. We haven't explained why the statement "TCM is fraught with pseudoscience" is relevant to this article. In addition to attempting to imply synthesis by adjacency, the argument:

• Acupuncture is based on TCM
• TCM is (fraught with) pseudoscience

Therefore

• Acupuncture is (fraught with) pseudoscience.

is quite faulty. If Nature commented on acupuncture, that would be a different matter, entirely. I'm not sure which RfC or noticeboard results I am disputing, if any, but there is something rotten in the State of Denmark. — Arthur Rubin (talk) 01:01, 29 January 2015 (UTC)

It may be relevant in the body, which discusses TCM in more detail, but not in the lead, even if acupuncture is a "core belief" in TCM. — Arthur Rubin (talk) 01:04, 29 January 2015 (UTC)

Arthur Rubin, I'm not as concerned about it simply for WP:SNOWBALL reasons; we have editors here (one in particular) who want to see pseudoscience mentioned as often and as prominently as possible, even when the sources don't match the assertion.

On a related note, see the lede's 2nd para, 3rd sentence: "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." [19] Again, the source doesn't support the claim; the relevant sentence is taken out of context. My analysis here. We actually had a discussion on this at WT:MED, and agreed on a bold edit by User:Manul (previously Vzaak) [20] to fix the wording. I've tried to restore it [21], but one editor (QuackGuru) insisted otherwise, despite initially supporting the consensus. Such is the editing environment here. --Middle 8 (contribs • COI) 02:43, 29 January 2015 (UTC)

QG, I feel your pain. It's clear to me that the RFC reached the wrong conclusion, as it was started by someone that played a logical game with the opening sentence. He failed to take into account the interplay between that opening line of "one answer is that it is largely pseudoscience, with no rational action for the majority of its treatment" with the subsequent "fraught with pseudoscience" quote. The Nature editorial clearly says just what you think it does, and your edits, in a perfect world, would be fine. However, the misphrased RFC was then closed by an editor that didn't pay heed to any of the comments that indicated how the RFC had been swayed by the misleading opening statement, and now we're stuck. In a few weeks, I'll try to reopen the RFC, but for now, lay off. It's a flawed consensus, no doubt about that, but it is against the text you are trying to preserve.—Kww(talk) 03:02, 29 January 2015 (UTC)

I understands me some grammars purty well, as do some of the others who expressed doubt. I agree it's not slam-dunk clear, although I don't strongly object to your an QG's reading. The statement about mechanism is stronger than, and doesn't necessarily follow from, the "fraught" statement. Given reasonable doubt among editors, I see no harm at all in simply quoting the unambiguous section of the text. It's a reasonable compromise. That accords with what Nature's staff suggested to Les Vegas, per above.[22] Besides, we have plenty of other sources that are unambiguous in their criticism. --Middle 8 (contribs • COI) 05:37, 29 January 2015 (UTC)

Imo, I find it unacceptable that some editors dig their heels in and refuse to compromise continuously, breaking policies constantly, ignore consensus constantly while constantly engaging in battleground behavior by accusing others of exactly that, while good and decent behavior (like making concessions only because a snowball would ensue, or nobly declaring a possible COI) is rejected. Wikipedia shouldn't work this way. LesVegas (talk) 17:00, 29 January 2015 (UTC)

Middle 8 worte "That accords with what Nature's staff suggested to Les Vegas, per above.[23]" That's what was deleted from the body. The quote. QuackGuru (talk) 18:21, 29 January 2015 (UTC)

@ QuackGuru -- Two different issues.

• (1) Should the Nature editorial about drug discovery and herbs be quoted at length (including pro and con arguments about herbal preparations) in this article? No, and especially not in the lede; talk about undue weight! And THAT is why I removed the text from this article on 28 January. I explained this three times before: above at 1:41, 28 Jan); in my ES; and at FTN.
• (2a) Should either article depict Nature as saying TCM is "largely PS with no valid mechanism..."? According to the RfC closure, no. Hence my edits here [24] and at the TCM article [25][26]. I explained those edits no less than five times, as I pointed out on your user talk (version here).
• (2b) However, can we rephrase the text neutrally and use at in the TCM article? Yes. Per the RfC closure, the version on the left hand side of this diff is not OK, but the version on the right is. I'm sure that you, QG, will understand this since you wrote (or helped write) both versions.

Again, QG, I hope these answers help. But if you still wonder, just keep asking! I'll be happy to answer as often as you'd like. --Middle 8 (contribs • COI) 07:48, 30 January 2015 (UTC) removed redundant commment 19:58, 30 January 2015 (UTC)

Yes, when a respected and neutral editor wants to remove the source altogether from the Acupuncture lede and Middle 8 shows restraint in order to keep the peace around here, don't you see how over the top it is to make attacks at him? Saying there is a violation of consensus when there is none is bad enough. It's even worse when there is consensus on TCM not to use certain wording, and you're editing against it. LesVegas (talk) 21:27, 30 January 2015 (UTC)

Consensus per RfC

Past edits
The following discussion has been closed. Please do not modify it.
11:55, 12 May 2014 5:40, 25 June 2014 01:09, 4 July 2014 23:57, 4 July 2014 Kww warned Middle 8 to not make changes like that without consensus.

Current edits

User:HJ Mitchell also warned Middle 8 "to respect Wikipedia policies on neutrality, consensus, and verifiability as well as all other applicable policies. Should you fail to adhere to this warning, there is a high probability that you will face substantive sanctions in the future."

Middle 8 was also notified of the sanctions specifically for acupuncture by User:Callanecc from the Arbitration Committee.[27]

Middle 8 wanted the wording to be "According to Nature, TCM is "fraught with pseudoscience".[28] So what did Middle 8 do? He replaced the wording with what he wanted without gaining consensus first.[29][30]

Note: In the context of TCM, the traditional therapies in China are TCM. The Nature editorial is about TCM, and the mention of traditional therapies is clearly a referral to TCM's traditional therapies. There is nothing in the editorial that suggests otherwise.

Violation of consensus by Middle 8.[31]

Violation of consensus again by Middle 8.[32]

There were "many requests for proper context and phrasing to be supplied." See Talk:Traditional Chinese medicine#Result.

Shii (tock) wrote "My point in setting out that example sentence was to show what views could be attributed directly to Nature and not to say that only three words could be used and the rest could not be mentioned."[33] See Talk:Traditional Chinese medicine#Result.

I requested confirmation that the result from the RfC was what I knew all along. Middle 8, if you follow WP:COIADVICE this may not happen again. QuackGuru (talk) 20:56, 5 February 2015 (UTC)

QG, drop this line of argument. Consider this an administrative warning. There was a recent RFC. As flawed as the problem statement in that RFC was and as ridiculous as the close was, Middle 8's edits are largely in compliance with it. If you want to find a wording that conforms to the RFC and is a little more forceful than the current statement, feel free to propose it, but bringing up nine-month-old edits in an effort to paint him making those particular edits in bad faith is unreasonable.—Kww(talk) 21:26, 5 February 2015 (UTC)

See the diffs to confirm what the closing admin meant. The current wording at TCM is "satisfactory".[34] The RfC closing was never meant to use "only three words".[35] This change is in accordance to the RfC. QuackGuru (talk) 21:38, 5 February 2015 (UTC)

Interesting. Haven't you got more than one administrative warning for posts like this already? Now you just took a more public venue by moving from User Talk Pages to Article Talk Pages. Cheers! Jayaguru-Shishya (talk) 21:45, 5 February 2015 (UTC)