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Badge of shame

The recent re-add of the NPOV tag[1] directs us to Template:POV, where it says, "The editor who adds the tag should discuss concerns on the talk page, pointing to specific issues that are actionable within the content policies."

Looking at this talk page, the tag is apparently present because "what we need to work out here is a checklist of sorts", and other vagueness. There are complaints about the removal of fringe journals, which would seem to be an attempt to form a local consensus that is contrary to the established consensus and common practices with respect to WP:FRINGE and WP:MEDRS.

The article history shows over three months of either the POV or CONTENT tag being present. There is no clear end here; no specific, practical issues that have been identified. Template:POV warns that the tag should not be used as a badge of shame, much less a permanent one with conditions of removal that nobody can figure out. Manul ~ talk 19:21, 11 August 2015 (UTC)

Agreed. The editor who keeps tagging seems to have an issue with the policy, which they should bring to WT:MEDRS not here. VQuakr (talk) 19:30, 11 August 2015 (UTC)

Yup, no need for the tag. Dbrodbeck (talk) 19:45, 11 August 2015 (UTC)

Neither WP:FRINGE nor WP:MEDRS use the term "fringe journal" and yet some editors frequently invoke that term to reject content from sources that are acceptable according to MEDRS. I have repeatedly asked those editors to identify a guideline or policy that excludes a source due to Chinese authorship, or the fact that the journal has the word "complementary" in its title. It is not the person placing the tag that has a problem with MEDRS, it is a culture of authors rejecting evidence they BELIEVE is erroneous, and that's why we have a POV issue.Herbxue (talk) 21:58, 11 August 2015 (UTC)

It's more basic than that, see WP:QUESTIONABLE. Tgeorgescu (talk) 22:05, 11 August 2015 (UTC)

That's because they are fringe. MEDRS is primarily concerned with medicine, whereas fringe journals are primarily concerned with pseudomedicine. There are fringe journals for physics, too, where they discuss free energy devices and the like. The problem with Chinese studies is not something dreamed up by Wikipedia, it is a real world problem discussed by a real-world expert here. Guy (Help!) 22:06, 11 August 2015 (UTC)

Agree, the tag is being replaced POINTedly, and hasn't been justified here. -Roxy the dog™ (Resonate) 23:21, 11 August 2015 (UTC)

Guy, just repeatedly saying "fringe journals" does not make that a real thing. Science is either carried out appropriately or it isn't, and if its vetted by a peer review process by reputable editors then who are you to question it? It is not appropriate to say all Chinese authors practice faulty science because Ernst wrote an editorial about it. And you don't get to decide on the fly what journals are real and which are fringe. How about BMJ? Is that a fringe journal to you? They publish plenty of favorable acupuncture studies. And btw, look at some more conventional medical articles and you are bound to see papers authored by Chinese researchers. Do you have enough knowledge about them or their institutions to decide which ones are doing legit science? I highly doubt it. Herbxue (talk) 00:14, 12 August 2015 (UTC)

You don't believe that fringe journals exist? Anyways, WP:MEDRS explicitly instructs us to look at the source's content to evaluate the methodology used; merely stating that a journal is "peer reviewed" is not enough to comply with the policy. WP:MEDSCI also requires us to look at the wider picture to determine the level of acceptance of a viewpoint. VQuakr (talk) 00:39, 12 August 2015 (UTC)

You are right, but we rarely get to discuss methodology of individual reviews because they get rejected for reasons not outlined in MEDRS. MEDRS does caution us against journals that are not indexed in Medline, or journals that publish on topics outside of their scope. MEDRS does not say Chinese authors are unreliable, or that lesser known journals are necessarily unreliable. We do not have clear enough criteria to decide when a lesser known journal is reliable or not.Herbxue (talk) 01:09, 12 August 2015 (UTC)

If you dont have evidence that it is reliable, then when the journal is making claims counter to what actual reliable sources state and present, then obviously we treat it as not reliable. WP:REDFLAG. -- TRPoD aka The Red Pen of Doom 02:15, 12 August 2015 (UTC)

Ok, fine, but you're still not addressing the issue I'm talking about. Obviously, if a lesser known journal publishes a review or editorial that says "acupuncture is effective and cost effective care for TMJD" but the Lancet or JAMA has a recent systematic review of RCT's that concludes "acupuncture is no better than sham or standard of care for TMJD" - I'm not gonna argue over which is the more reliable source. If World Journal of Gastroenterology or Pain Medicine or Journal of Complementary and Alternative Medicine publishes a review of trials of acupuncture for abdominal pain, written by faculty at the Beijing University of TCM, and there's no conflicting evidence from a more well-known journal in the last 5 years, then that source should be fair game. MEDRS identifies a few journals as generally reliable, but it does not require that lesser known journals must prove their reliability like you suggest - I mean, how would you even do that? How do you prove beyond a shadow of a doubt that articles in the Lancet are reliable? Herbxue (talk) 06:57, 12 August 2015 (UTC)

"Reliable source" does not mean "true". But Edzard Ernst's article is a fairly definitive, referenced comment from a notable researcher. In this field, as in others, "researchers" who are prepared only to confirm prior beliefs may be ignored. Unless we want a section on the quality of "science" in acupuncture, which actually might be a better option than the present tag. Richard Keatinge (talk) 12:54, 12 August 2015 (UTC)

The review Ernst cites is certainly damning and there is definitely a real problem there (I've seen it firsthand), but Ernst's conclusion is somewhat lazy (can't be bothered to even read the methodology of papers to evaluate quality, just discard all) and self-contradictory: the systematic review he cites is from Beijing University of Chinese Medicine! So… Chinese research is ok when it is critical but not ok when its positive? That's a form of bias too. China is an ENORMOUS country with a wide range of quality in terms of educational institutions. To say ALL Chinese research is unreliable because Ernst says so it not adequate. Herbxue (talk) 16:31, 12 August 2015 (UTC)

There is a problem with "researchers" who are prepared only to confirm prior beliefs. That's not a problem limited by nationality. But it is widespread in fringe science and in this case Ernst's point is one that we should use. Richard Keatinge (talk) 16:41, 12 August 2015 (UTC)

I agree about the nature of the problem, but not Ernst's conclusion. We should evaluate journals and articles on a case by case basis, not reject them because the authors are Chinese. Herbxue (talk) 17:20, 12 August 2015 (UTC)

In general, that's certainly arguable. In the particular case of acupuncture we can save ourselves a very great deal of time and trouble by using Ernst's conclusion. Richard Keatinge (talk) 08:28, 13 August 2015 (UTC)

That would be a convenient way to push a POV by omission, ignoring a large body of potentially valuable research because of one expert's opinion (which is based on the findings of a Chinese review). I'd be willing to go along with something more specific - like using reviews published in a reputable Chinese journal only with caution and attribution when they appear to use appropriate methodology. But if a systematic review is authored by Chinese researchers and published in a Western journal like BMJ, NEJM, Medical Acupuncture, or Integrative Cancer Therapies, I do not see justification for excluding it as it has passed through an appropriate peer review and editorial process. Herbxue (talk) 14:51, 13 August 2015 (UTC)

The point is that while appropriate methods may "appear" to have been used, we have a notable commentator telling us that in this large body of work appropriate methods have generally not been used; the work is invalid and if we use it at all it should be described as claims based on pseudoscience. (That word again, but fully justifiable here, this is work that has the appearance of science but is not actually testing hypotheses.) Richard Keatinge (talk) 15:13, 13 August 2015 (UTC)

Richard, there is no way I can take such a sweeping generalization seriously. Please get a little more into the weeds on this. People here Iincluding you) are seriously proposing that all research into acupuncture, written by people with Chinese names, is unreliable, EVEN if it s published in a mainstream journal. Just pause for a moment and consider how absolutely absurd and racist that is.Herbxue (talk) 16:23, 13 August 2015 (UTC)

I am confused? A blog post from Edward Ernst is being used to suggest that articles with Chinese authors cannot be used here?75.152.109.249 (talk) 16:41, 13 August 2015 (UTC) I guess that the review mentioned in Ernst's blog post (from 199 and done by Chinese authors), and not his blog post itself, is the source actually being used to suggest that Chinese sources are unreliable?75.152.109.249 (talk) 17:14, 13 August 2015 (UTC)

Both. I paste a large chunk of Ernst's post:

"In this case, you might perhaps believe Chinese researchers. In [this systematic review http://online.liebertpub.com/doi/pdfplus/10.1089/acm.2014.5346.abstract], all randomized controlled trials (RCTs) of acupuncture published in Chinese journals were identified by a team of Chinese scientists. A total of 840 RCTs were found, including 727 RCTs comparing acupuncture with conventional treatment, 51 RCTs with no treatment controls, and 62 RCTs with sham-acupuncture controls. Among theses 840 RCTs, 838 studies (99.8%) reported positive results from primary outcomes and two trials (0.2%) reported negative results. The percentages of RCTs concealment of the information on withdraws or sample size calculations were 43.7%, 5.9%, 4.9%, 9.9%, and 1.7% respectively.

The authors concluded that publication bias might be major issue in RCTs on acupuncture published in Chinese journals reported, which is related to high risk of bias. We suggest that all trials should be prospectively registered in international trial registry in future.

I applaud the authors’ courageous efforts to conduct this analysis, but I do not agree with their conclusion. The question why all Chinese acupuncture trials are positive has puzzled me since many years, and I have quizzed numerous Chinese colleagues why this might be so. The answer I received was uniformly that it would be very offensive for Chinese researchers to conceive a study that does not confirm the views held by their peers. In other words, acupuncture research in China is conducted to confirm the prior assumption that this treatment is effective. It seems obvious that this is an abuse of science which must cause confusion.

Whatever the reasons for the phenomenon, and we can only speculate about them, the fact has been independently confirmed several times and is now quite undeniable: acupuncture trials from China – and these constitute the majority of the evidence-base in this area – cannot be trusted."

I'll drop the matter here, but, just to repeat the point, this is a reference and comment from a very notable commentator, and we should use it. Richard Keatinge (talk) 17:27, 13 August 2015 (UTC)

It might be fine to use the comment. However, using a single cmt to disallow multiple sources is a violation of Weight. RS are determined per the content they support and underpin and should be scrutinized as such. As an example of how an overarching, general statement can abuse; I noticed at one point an editor here mistook Japanese names for Chinese ones and on that rational decided the source was no good. It is necessary I think to keep Ernst's comment in mind as it provides insights but the comment is not a carte blanche permission to exclude studies. In every instance individual sources must be scrutinized for their reliability per the content they are purported to support.(Littleolive oil (talk) 17:10, 19 August 2015 (UTC))

We should definitely exclude pseudoscience (in the strict sense) and Ernst's comment is an evaluation that helps us to do so. I suppose you could repeat all the work he's done; without that, we should exclude the sources that he condemns. I agree it's important not to confuse Japanese names with Chinese, or, say, English ones with Basque. Richard Keatinge (talk) 17:22, 19 August 2015 (UTC)

I disagree. We can't exclude sources on Ernst's comments. He's not editing here; we are. We can use his insights to help us determine what is useful to us, but again his word is not a carte blanche to exclude. And thanks this is the first time I see someone use pseudoscience, in my opinion, its accurate sense.(Littleolive oil (talk) 17:49, 19 August 2015 (UTC))

It looks like the Ernst post is being misinterpreted and/or overblown here. Ernst is saying that acupuncture trials from China cannot be trusted, not random papers that have Chinese names attached. The post doesn't seem particularly relevant to us anyway since we shouldn't be citing specific RCTs in the first place. Following WP:MEDRS and WP:BESTSOURCES should naturally, on its own, have the effect of incorporating Ernst's advice.

Also, Ernst's conclusion is being profoundly misunderstood as "can't be bothered to even read the methodology of papers to evaluate quality, just discard all". Scrutinizing methodologies has no power to thwart the file drawer effect, for example, even if the methodologies are found to be impeccable. If we receive reports that someone is consistently rolling 6s on a six-sided die, and if upon examination we find that the die is fair and method of rolling is fair, that doesn't imply that the reports are to be trusted. If the reason for that isn't immediately clear then see the wikilink in this paragraph. Manul ~ talk 03:02, 20 August 2015 (UTC)

Thanks Manul and Littleolive oil. Indeed, Ernst's comments aren't carte blanche to exclude the studies he mentions from the article. They exist and are notable in themselves. Ernst's comments do, however, exclude this body of work from consideration as serious testing of the efficacy of acupuncture. Any mention of them should be brief and should be framed by some version of Ernst's comments. Richard Keatinge (talk) 10:02, 20 August 2015 (UTC)

I hate to sound like an extremist here, but can somebody show in our policies or guidelines where that position would be appropriate? I would love to say that studies or reviews that don't use CONSORT reporting standards should be weighed less heavily than sources that do. And it makes great sense to do that since we should give preference to the sources with the most robust evidence as possible. But I don't see where in our policies this would be allowed. Similarly here. Anywho, if somebody can show the policy where we should weigh sources form one country less heavily than other countries' based on commentary by a retired professor, I would love to see it. LesVegas (talk) 19:38, 20 August 2015 (UTC)

WP:PSCI is probably your best guide. Richard Keatinge (talk) 20:34, 20 August 2015 (UTC)

Can you show me the specific statement there that applies to this case? LesVegas (talk) 21:09, 20 August 2015 (UTC)

are you looking for WP:BESTSOURCES? -- TRPoD aka The Red Pen of Doom 03:00, 6 September 2015 (UTC)

AD

Medications work poorly in AD per this high quality secondary source.[2] Stating that acupuncture may work in AD as well as medications, stating how well meds work is important. Doc James (talk · contribs · email) 23:26, 5 September 2015 (UTC)

Hum. Discussion is here. Doc James (talk · contribs · email) 01:11, 6 September 2015 (UTC)

Yes, it sometimes takes a minute to respond. This isn't an article about medications. If it were to become one, where would we stop? Given the many applications of acupuncture, it would be one enormous article. Furthermore, there are many claims of how well meds work for varying conditions. Choosing only one of those becomes problematic and is best left to the article on the med or the condition itself. LesVegas (talk) 01:13, 6 September 2015 (UTC)

This is similar to the issue of codeine as a cough medicine. Codeine is the "gold standard" cough medicine. Evidence states it works similar to placebo. This is important when a review states that dextromethorphan is as good as codeine. One needs to define how well codeine than works. Doc James (talk · contribs · email) 01:16, 6 September 2015 (UTC)

Doc James, do we compare every medication to every other medication when claims are made about comparative efficacy on their respective Wikipedia pages? Furthermore, some sources disagree on how effective meds are in certain instances. For instance, some sources show overwhelmingly positive results for SSRI's for depression. Others show them to be no more effective than placebo for most cases of depression. Comparisons on efficacy can thus be cherry-picked, which is a violation of our policies. LesVegas (talk) 01:23, 6 September 2015 (UTC)

That is not the case here however. Doc James (talk · contribs · email) 01:28, 6 September 2015 (UTC)

Sure, the benefits are low in this case. But that's according to one source. Are you sure there aren't other sources that state different results? LesVegas (talk) 02:17, 6 September 2015 (UTC)

All good sources may or less say the benefit is small. Doc James (talk · contribs · email) 04:31, 6 September 2015 (UTC)

Context matters for statement like this. You really don't want to write things like "Lying down in the middle of the road is just as safe as eating arsenic", because it's misleading. However, depending on the source, it might not be necessary to write a direct comparison. You could instead write "Acupuncture works poorly for Alzheimers" and leave out the "just like everything else" part. WhatamIdoing (talk) 02:33, 6 September 2015 (UTC)

Much as I admire Doc James's editing in general, and however correct his comment is, we really don't need, here, a comment on the uselessness of a not-acupuncture intervention. Richard Keatinge (talk) 09:12, 6 September 2015 (UTC)

• In my view, per Talk:Acupuncture#Proposal:_truce_conditions, we shouldn't even discuss AD in this article, just like we shouldn't discuss infertility. as there is no reasonable basis to assume that it even could work. I do wish the editors here would agree to limiting the scope of this article to mainstream uses of acupuncture as an adjuvant in some pain conditions and some side effects of cancer treatment. Jytdog (talk) 16:01, 6 September 2015 (UTC)

There was not any acceptance of your proposal because it was too sweeping and made presumptions that amount to original research. That said, I support the basic idea of limiting the scope, especially if it is limited to descriptive content the way most medical articles are. Unfortunately ,the proposal that acupuncture cannot possibly be effective for any specific condition is, despite what passes as common sense, an assumption rather than something proved by reliable sources. Studies that show acupuncture as effective or more effective than standard of care are indeed notable.Herbxue (talk) 23:38, 6 September 2015 (UTC)

Today in 2015, there is no plausible mechanism by which sticking needles in your skin could do something as extremely specific within the body as affecting any step where fertility goes awry (sperm count or the viability of sperm, or the ability of a fertilized egg to implant in the uterus or stay there or any other step). Likewise the notion that acupuncture could actually be disease-modifying in AD. Maybe acu could be useful for dealing with anxiety or something else messy (like pain and cancer side effects) in AD where placebo effect is huge, but not for actually treating AD. Efforts to add content about these kinds of things are lead balloons and just lead to endless turmoil. Until the basic science establishes actually plausible mechanisms for that kind of stuff (if ever - doing that would be a miraculous Nobel-prize winning kind of thing), they are going to be rejected. You really should be willing to walk away from them. More importantly, there is no way the crap state of this article can improve until both sides agree to limit the scope. Everybody wins some that way, and everybody loses some that way (the skeptics will not like acknowledging that pain/alleviating cancer treatment effects, is mainstream. That would be a huge win for you Herbxue. But you have to give up this other stuff and agree to actually enforce keeping it out, and actually do that.) Jytdog (talk) 00:01, 7 September 2015 (UTC)

I will reject untrue claims like "acupuncture cures cancer" any day, but if a reliable review says "acupuncture reduces chemotherapy-induced leukopenia" I don't see why a lack of knowledge about the mechanism of that phenomenon is relevant. We can't reject whole categories of conditions because we don't see how its possible that it might work (if it has been shown to work). I'd be interested to see a skeleton draft of what you are proposing, I do see the value of simplifying the article. Until we can agree on what neutral really means though, I support inclusiveness and attribution of claims in order to responsibly represent the mixed messages that actually exist in the literature. Herbxue (talk) 14:35, 7 September 2015 (UTC)

Herbxue, you want to continue playing evidence-war and what you cannot see is that this is the exact attitude that keeps the quackfighters at the ready, with knives drawn. So be it. You create your own hell. Jytdog (talk) 09:58, 16 September 2015 (UTC)

Wait, so do you think classical and historical books were lying when they documented the many instances of acupuncture being used successfully to treat issues beyond back pain? I can attest that I witnessed acupuncture aid in stroke recovery many times while I lived in China. There are entire clinics and sections of hospitals devoted to it. It's also used as a first-line treatment in China for cholecystitis with surgery as the back-up option and rarely needing to be used from what I understand, and I have personally witnessed it working for many other issues beyond pain during a hospital stay of my own while I was in China. That said, I don't care one bit what acupuncture can and can't do, all I care about is what the sources say. That's what seems to separate most of us here. LesVegas (talk) 23:30, 16 September 2015 (UTC)

Hi Les. Do you know the difference between anecdote and evidence? That's what separates us here. -Roxy the dog™ (Resonate) 07:08, 17 September 2015 (UTC)

• • Yes if we remove the content completely my concerns are addressed. Doc James (talk · contribs · email) 22:37, 6 September 2015 (UTC)

What part of our policies alllow editors to remove reliable sources because they don't like or disagree with the source's conclusions? LesVegas (talk) 02:47, 11 September 2015 (UTC)

We need to be careful about incorporating content that is sourced to journals which have lax editorial standards. It looks like we may be looking at that here. jps (talk) 13:30, 11 September 2015 (UTC)

Chinese authors again

"A 2015 systematic review and meta-analysis found that acupuncture may be more effective than medications for Alzheimer's disease, and that it may also enhance the effect of donepezil for this condition." See Acupuncture#Alzheimer.27s disease.

Zhou, J; Peng, W; Xu, M; Li, W; Liu, Z (June 2015). "The effectiveness and safety of acupuncture for patients with Alzheimer disease: a systematic review and meta-analysis of randomized controlled trials". Medicine. 94 (22): e933. doi:10.1097/MD.0000000000000933. PMID 26039131.

The benefit of medication for Alzheimer's disease is low,[3] yet the pseudo-review does not mention this. I recommend deleting the misleading review. QuackGuru (talk) 03:49, 6 September 2015 (UTC)

We at least need to put it into context. Doc James (talk · contribs · email) 04:08, 6 September 2015 (UTC)

The Zhou meta analysis appears to have purposefully included Chinese Acupuncture Journals. A meta analysis that is based on bad source materials would seem to be inherently not the best research and source.-- TRPoD aka The Red Pen of Doom 04:18, 6 September 2015 (UTC)

Likely why they say "may be" which equally means "may not be" Doc James (talk · contribs · email) 04:30, 6 September 2015 (UTC)

agree --Ozzie10aaaa (talk) 11:00, 6 September 2015 (UTC)

• According to the review, most of the included studies did not require the outcome assessors to be blinded. That's a very serious weakness. Looie496 (talk) 16:34, 6 September 2015 (UTC)

The methods of the review itself seem decent, so I think its findings should be included, but with the caveats mentioned above, particularly inclusion of trials that were not double blinded (not sure that some trials were "Chinese" is a caveat per se, but we could mention it without insisting that reader interpret that info one way or the other). Herbxue (talk) 23:27, 6 September 2015 (UTC)

With respect to mechanisms, there is a recent review addressing how acupuncture could be effective for Alzheimer's based on animal models. According to the review, "It is suggested that acupuncture improves cognitive function of Alzheimer's disease by regulating glucose metabolism, enhancing neurotransmission as well as reducing oxidative stress, A protein deposition, and neuronal apoptosis." [4] Everymorning (talk) 16:33, 7 September 2015 (UTC)

Do many animals get Alzheimers? (dogs, for instance?) -Roxy the dog™ (Resonate) 16:35, 7 September 2015 (UTC)

Many dogs do experience, in old age, Alzheimer-like issues. (Littleolive oil (talk) 18:17, 7 September 2015 (UTC))

Thank you Olive, that explains a few things for me. ;) -Roxy the dog™ (Resonate) 18:58, 7 September 2015 (UTC)

Alzheimer's section

This page is under discretionary sanctions, and is controversial. Therefore, please be bold but not reckless. If you want to add something you know is going to be controversial, please work it out on talk first. I have cut the new AD section from the article and am pasting it here for discussion. I see that discussion is ongoing above. Please work out acceptable language so that the article isn't destabilized. Jytdog (talk) 15:55, 6 September 2015 (UTC)

A 2009 systematic review found only a small number of studies looking at acupuncture for Alzheimer's disease (AD), and concluded that "the existing evidence does not demonstrate the effectiveness of acupuncture for AD." A 2015 systematic review and meta-analysis found that acupuncture may be more effective than medications for Alzheimer's disease, and that it may also enhance the effect of donepezil for this condition.

References

Why was this section removed? What is so controversial about it?LesVegas (talk) 04:31, 8 September 2015 (UTC)

The second paper should go due to the well documented bias in favour of acupuncture among Chinese authors. The first states the obvious: there is no remotely plausible reason to suppose acupuncture would work for Alzheimer's. We really don't need a separate section for every single condition where Chinese authors claim a marginally significant effect and the reality-based community either ignores them or finds the opposite. Guy (Help!) 13:41, 8 September 2015 (UTC)

So it's okay to reject a high quality source, Medicine, because the authors happen to be Chinese? The first review published their findings, stating the "existing evidence" didn't demonstrate effectiveness way back in 2009, 6 years ago. If a good source finds new evidence and publishes it, we cannot reject it because the authors are Chinese. LesVegas (talk) 19:39, 8 September 2015 (UTC)

I don't think it's okay if the open access journal cited farms out its editorial work to an acupuncture apologist: Dr. Sarah Fogarty. I will be writing to the editorial board to see what happened. Looks like another case of the acupuncturists taking over editorial boards when the systems are swamped with papers. Mid-range journals are especially susceptible to this sort of gaming. Shameful, really. jps (talk) 19:47, 10 September 2015 (UTC)

What exactly is your problem with this Dr. Fogerty?Herbxue (talk) 20:39, 10 September 2015 (UTC)

Take a look at her publication record. Not exactly what I would look for in a good editor. jps (talk) 22:29, 10 September 2015 (UTC)

What are the specifics? LesVegas (talk) 02:56, 11 September 2015 (UTC)

Fogerty's brief publication history consists entirely of improperly conducted trials and reviews of acupuncture that invariably find it to be effective. Her trials are using acupuncture to treat eating disorders, and none of them contain proper controls or blinding. Someguy1221 (talk) 03:03, 11 September 2015 (UTC)

Not only that, but the publications are all in journals we would not accept as reliable sources. jps (talk) 11:33, 11 September 2015 (UTC)

Update I received e-mails back explaining that the editorial board listed at the website is inaccurate. [5] Apparently, since Wolters Kluwer decided to move to a fully open access model for the journal, they no longer use the editorial board listed there. I have now e-mailed the editorial coordinator to ask out how they chose the current editorial staff and will let you know when they respond. The documented issues with open access formats are elucidated here and I have also e-mailed Jeff Beall to find out whether he can shed some light on this situation. jps (talk) 12:45, 11 September 2015 (UTC)

I didn't see anything on the editorial board page [6] that says that the journal "farms out its editorial work" to Fogarty, she's just one of at least dozens--probably hundreds--of members of the editorial board listed there. Also, my understanding is that although Medicine (Lippincott Williams & Wilkins journal) may be open access, it is published by a reputable publisher (LWW) and has an impact factor assigned by the Journal Citation Reports, so it is not predatory. Everymorning (talk) 14:57, 11 September 2015 (UTC)

I just got an e-mail indicating that because of my query they just changed the editorial board listing. However, I'm not sure who the academic editors are which would be the ones who assign referees, for example. I will keep you informed. I agree that this journal is not listed at Beall's list (Wolters Kluwer is a respectable publisher, after all), but it is important that they indicate how they choose their academic editors so that we can determine what happens with specific articles. I notice, for example, that PlosOne has only one academic editor whose expertise is listed as "acupuncture", for example: [7]. I wonder if the acupuncturists have tried their hand at that journal yet? jps (talk) 17:04, 11 September 2015 (UTC)

It was pointed out to me that this article has been severely criticized by Edzard Ernst here. I'm still waiting on the editorial staff to get back to me as to how Fogarty, someone who has no medical or statistics training whatsoever, became the section editor for Medicine in the area of acupuncture. Since it is now the weekend, I imagine we will have to wait until Monday for their response. jps (talk) 23:47, 11 September 2015 (UTC)

Eh… Ernst's critique has some debatable points, and some that are not directly critiques of this particular review. I do think we would need to see replication of the results using improved methods (compare acu+drug with drug+placebo) to claim the effect in WP's voice, but I see no reason to not include the source with attribution. Jps, how did you conclude that Fogarty has no medical or statistical training? All I can see in your previous link is that she has a PhD from Australia and that she has published some research on CAM subjects. Is there a website with more info?Herbxue (talk) 07:04, 12 September 2015 (UTC)

Sarah Fogarty's PhD is on traditional Chinese medicine. There is no evidence she has ever learned actual medicine. And if she feels that her trials actually demonstrated what she concluded from them, any publisher that thinks she is qualified to review papers on medical topics is suspect. Someguy1221 (talk) 07:16, 12 September 2015 (UTC)

Her dissertation is on eating disorders and TCM, I can't find what her PhD is in but it is not from a Chinese medicine school. Her publications are not ground-breaking stuff, but they don't claim to be. All her conclusions are reasonable as they are all pilot or feasibility studies. She's also pretty candid in the descriptions of limitations. She has at least studied research methodology and has done several of the same kind of feasibility study. Was there a conclusion in particular you thought was a reach?Herbxue (talk) 07:49, 12 September 2015 (UTC)

"Acupuncture and acupressure and massage may improve the patient's subjective sense of well being, and further research is needed." This sort of statement is technically true, and very typical of the acupuncture field. Run a study with the wrong control, don't use any blinding, and then be sufficiently vague in your conclusion that you can't be wrong. It's not so much that her conclusions are factually wrong as she thought this was worth publishing. It's not simply "not ground breaking", it's completely meaningless. Fogarty knows what a sham control is, she discusses it in her thesis. I think from an NPOV/UNDUE/FRINGE perspective, we need to recognize that essentially all of the positive viewpoints of acupuncture are coming from a walled garden that should simply be ignored. Someguy1221 (talk) 09:55, 12 September 2015 (UTC)

Sounds like you got a beef with most medical/ scientific research, because most of it is of questionable value. Thats how science works. Little steps like this. Anyway, nobody is trying to use her primary pilot studies in the article. The question is can she responsibly fulfill the role of an editor? I don't see how having a meek publishing record herself shows that she cannot.Herbxue (talk) 18:31, 12 September 2015 (UTC)

Academic editors are generally expected to be excellent senior researchers who have the connections and experience necessary to be able to identify good reviewers, reject problematic papers, and curate a body of literature that is of the highest caliber and accords with the goals of the journal. Getting someone with a meek publishing record who is four years out of a PhD that was apparently invented just for her is unorthodox at best. If that doesn't send up WP:REDFLAGs, I'm not quite sure what would. It's way out of the ordinary. jps (talk) 19:52, 12 September 2015 (UTC)

Ok, I definitely see the concerns here, especially if the process at this journal is to only have one editor read the paper and clear it for publication, but I assume it goes through a more formal peer review process. I'll take a look at their guidelines again.Herbxue (talk) 12:45, 14 September 2015 (UTC)

An acutely accurate observation from Someguy1221 that applies across the board in this article. I totally agree that essentially all the positive viewpoints should simply be ignored as wishful thinking. The woolly worded conclusions that have been shoehorned into this article do not represent what NPOV/UNDUE/FRINGE suggest, but the last gasp response by true believers who wish it were true (obviously). Shameful. -Roxy the dog™ (Resonate) 10:07, 12 September 2015 (UTC)

According to her former place of employment, Fogarty received her PhD in "Acupuncture and Eating Disorders" [8]. As for what's wrong with her dissertation, I'll start with the fact that she doesn't deal with the substantive critiques of traditional Chinese medicine at all. This is a tremendous oversight that is also reflected in the paper published in Medicine. The lack of simple control and blinding procedures is particularly egregious. A certain number of patients who experience any sort of intervention will receive positive outcomes and her sample shows no evidence that this obvious effect was even considered. The thesis shouldn't have been accepted and I imagine it was because it was not submitted under a school of medicine or statistics. jps (talk) 11:44, 12 September 2015 (UTC)

The staff at Medicine stubbornly refuses to answer my queries, and I think we've arrived at an impasse. In light of my inability to verify that there was anything like editorial oversight of the section editor (I think there wasn't since there is no corresponding editor one can contact), I think it is irresponsible for us to use this particular paper as a source until this question about how they conduct peer review is resolved. In fact, I would argue that any paper that has ben published in Medicine in the last year should probably be looked at with caution if not suspicion. For this particular paper, the critique from Edzard Ernst makes it all the more difficult to take at face-value the results, and I strongly recommend that we simply remove reference to this paper until we can get some perspective on the work. My best guess is that it will simply fade away like so many other attempts at "verifying acupuncture". Low quality papers have a way of disappearing into oblivion when they aren't retracted. jps (talk) 21:07, 16 September 2015 (UTC)

Note. It was recently moved to the other conditions section since there is little or no evidence of benefit. See "alzheimer's disease,[156]". QuackGuru (talk) 01:27, 17 September 2015 (UTC)

A discussion on country of origin

I have been reading some of the discussions here with interest, and I want to remark on one issue I think has gotten in the way of meaningful discussion: a question about the country of origin of authors of studies. I strongly, strongly recommend not making any judgments on the basis of country of origin.

What I think people are reacting to are some rather poorly vetted articles that have been published in moderately respectable mid-range journals about the efficacy of acupuncture. The thing that needs to be investigated when these papers are being relied upon is not the country of origin of the authors but rather the identities of the editors and reviewers of the article in question. Every time we have identified problematic papers published in these places I have been able to trace exactly who the editors were who handled the paper and why this is problematic. If you have an acupuncturist running your editorial decisions for papers written about acupuncture, you are essentially curating a new version of the Journal of Acupuncture and Meridian Studies, which we would not accept as a reliable WP:MEDRS. That's the kind of evaluation that needs to be done. When acupuncturists who believe in the efficacy of acupuncture a priori are put in charge of evaluating the evidence-basis for their own ideas, it is a failure of the editorial and review process and can only be traced to the editors and the reviewers who are the ones responsible for making sure that the articles published in journals are reliable. The buck stops there. It is not the author's fault for seeking out corrupt editorial boards -- good on them -- and certainly it is not the country of origin that matters.

I have written to the editorial board above to ask them how the reviewers for the article were chosen. In the meantime, I think it's pretty clear that we cannot simply allow for closed-shop, poorly-cited articles to be uncritically accepted as unproblematic in article text. I would encourage careful review of the editorial boards for all the articles that seem to exhibit the WP:REDFLAGs that are obvious to longtime Wikipedians working with this subject.

jps (talk) 23:15, 10 September 2015 (UTC)

I agree with your main points, and appreciate you diving into details about individual publications and editors (as opposed to wholesale rejection of impossibly large categories of sources). The most important concern is the quality of the research itself. Herbxue (talk) 19:41, 11 September 2015 (UTC)

Really? So you haven't understood the importance of the published evidence of bias in Chinese-authored articles on acupuncture then. It speaks volumes that the first supporting voice is a long time proponent of quackupuncture here. Guy (Help!) 22:09, 11 September 2015 (UTC)

And you don't seem to understand the two sentences I wrote above.Herbxue (talk) 03:44, 12 September 2015 (UTC)

You misunderstand me if you think that I don't think there is evidence of bias coming from Chinese-authored articles on acupuncture or that this evidence of bias has importance. It is true that, for example, Ernst has found that the many of the journals and papers that originate in China do not rise to level of reliability that we would want here at Wikipedia [9], but the criticism is not on the basis of "these studies come from China", but rather on the basis of poor scholarship. Country of origin simply is not a solid basis on which to make a judgement about whether a source is reliable. The way to impeach unreliable sources is to look and see whether the journal, editorial boards, and reviewers are operating at the highest standards. jps (talk) 01:07, 12 September 2015 (UTC)

What I appreciate is that you actually made an effort to get into the weeds, even if it was to discredit a source that supports acupuncture. When you say "Country of origin simply is not a solid basis on which to make a judgement about whether a source is reliable. The way to impeach unreliable sources is to look and see whether the journal, editorial boards, and reviewers are operating at the highest standards." - I've been saying the exact same thing here for weeks, but people like Guy just want to say "Chinese authors, so it must be in favor of acupuncture". And btw, Ernst did not "find" anything of the sort, he quoted one Chinese (!) review that found significant bias and poor methodology in acupuncture trials in China. Hardly an exhaustive study by Ernst, and he does not put that sweeping generalization in his papers, just his opinion website. If you've been following this debate you have read me say I have seen problems with researchers proving their professors right in China firsthand - but to say that problem was universal or systematic would be to generalize anecdotes and commit confirmation bias by ignoring appropriate studies and focusing on inappropriate ones. Herbxue (talk) 03:44, 12 September 2015 (UTC)

What Ernst found unique from the study he quoted was that it was very difficult for him to take seriously (as a sample) studies that came from China. This was not due to the origin of the studies from China but rather to the evidence he has been gathering that points to the set of studies considered to be unreliable. The distinguishing feature that they came from China is not explained except by way of speculation, but that's the conclusion. What I'm saying is that you shouldn't put the conclusion as an antecedent. Tomorrow a study may come out of China that deals substantively with the two things that acupuncture studies lack: a mechanism and an honest appraisal of the placebo effect. This isn't a problem unique to Chinese studies, obviously. jps (talk) 03:52, 12 September 2015 (UTC)

I just wanted to point out that Ernst did not undertake an actual study of publication bias and make conclusions about it in a journal publication - he opined about it on his personal blog. WHat I like about Ernst is he very responsibly does not reach too far in the conclusions of his systematic reviews (for example, he never claims acu=placebo in his conclusions, because he know the data do not support such a bold statement). What I dislike about Ernst is he inserts his opinion and conjecture whenever possible, and readers often fail to differentiate the opinions and conjecture from the study conclusions, thus giving more weight to his opinions and authority than his "findings" and data.Herbxue (talk) 07:17, 12 September 2015 (UTC)

That's your view as a True Believer, but Ernst's work is published in peer-reviewed journals so luckily we don't have to rely on our own beliefs as to the validity of his analysis. There are similar problems with studies on certain subjects emanating from Russia. The bias is a fact, and we have no need to speculate on the reasons for it, we can simply attribute those views (which are generally clearly identified as opinion, as distinct from the factual conclusion of systemic bias) to the source. Guy (Help!) 11:49, 17 September 2015 (UTC)

Take the good and leave the bad. As far as I can tell, he's the best we got as a source. He shouldn't have been drummed out of his professorship, in my opinion. jps (talk) 11:32, 12 September 2015 (UTC)

Question

The answer is clean needle technique. QuackGuru (talk) 20:41, 20 September 2015 (UTC)

OK, thanks. I see that addresses a query in my edit summary, and the issue has been fixed. Johnuniq (talk) 05:14, 24 September 2015 (UTC)

Medical organization guidelines

Note that a section of the article called "medical organization guidelines" was tagged since May and has now been removed. [10] We should discuss it here.

I am concerned that much of the content in that section seems to rely on recommendations that are given for "when all else fails" types of situations. Surely having a person try safely executed acupuncture, aromatherapy, highly diluted homeopathic remedies, rolfing, meditating, whatever, is not likely to do any harm as long as there is no working treatment that you are avoiding by doing this. This seems to be the sense of these recommendations. I can imagine many doctors advising their patients, "do what makes you feel better" as a corollary to the famous joke that you should stop doing that if you say it hurts when you do that.

That type of advice, however, doesn't strike me as being particularly encyclopedic or well-posed for an article on the actual practice.

jps (talk) 21:22, 16 September 2015 (UTC)

It is notable and sourced, and reflects the position of medical associations, they would not bother mentioning it if they did not (tepidly) recommend it. Herbxue (talk) 22:24, 16 September 2015 (UTC)

Practice guidelines are something that practitioners consider as a guideline However, these are more like recommended guidelines and thus are not notable. There is little systematic investigation compared recent reviews. Higher quality evidence is under each specific condition section. See Acupuncture#Specific conditions. QuackGuru (talk) 01:27, 17 September 2015 (UTC)

Saying that it is "notable" doesn't make it so. It's a little weird to insist on content due to mention rather than substantive commentary. Actually, it's more than weird. It's downright suspect. jps (talk) 02:34, 17 September 2015 (UTC)

Don't know why you think these are notable. They all strike me as relatively obscure organizations. What do the more prominent ones say? As I recall, the AMA makes no recommendations about acupuncture except to state there is no evidence for its effectiveness. It makes me wonder if someone simply cherry picked the half dozen medical organizations that give the least insulting recommendations on acupuncture, to make it look like there is some level of support from the medical community. Though perhaps someone will prove me wrong. Someguy1221 (talk) 03:09, 17 September 2015 (UTC)

I think the positions of mainstream medical organizations are notable. That should be obvious. If AMA has a statement on acupuncture, its likely to be notable, positive or negative. We do not state their recommendations in WP's voice, we show what they recommend.Herbxue (talk) 03:23, 17 September 2015 (UTC)

Did you know that Wikipedia has articles on more than 500 mainstream medical organizations? Should we include them all? Someguy1221 (talk) 03:30, 17 September 2015 (UTC)

Do they all have official positions on acupuncture? Or, are we not so concerned about "mainstream" medical opinion?Herbxue (talk) 04:03, 17 September 2015 (UTC)

You need to make a better case than just that the organization is mainstream. Just because an organization is notable (has a Wikipedia article) doesn't mean that its position on acupuncture deserves WP:PROMINENCE in our article. See Wikipedia:Notability vs. prominence. jps (talk) 05:43, 17 September 2015 (UTC)

What about a brief comment to the effect of "Many mainstream medical organizations, without endorsing acupuncture as effective, suggest that it may be offered as an adjunct to conventional therapy." Richard Keatinge (talk) 10:46, 17 September 2015 (UTC)

I think offering some sort of WP:SUMMARY might be justifiable. The trouble will be getting wording that everyone can agree to. And if the decision is to include such, how much space should be devoted to this? One sentence? Two? A paragraph? jps (talk) 11:30, 17 September 2015 (UTC)

• I support removal, actually. Much of it was around medical organisations either trying to limit the harm of fraudulent practice, attempting to bend their minds around the "integrative" use of bullshit alongside reality-based treatments, and in a few cases, falling prey to True Believer Syndrome. In summary: the medical orgs are rather bad at working out what to do about the substantial majority acupuncture claims that are bogus. Guy (Help!) 11:43, 17 September 2015 (UTC)
  • I'm inclined to agree. I wonder if anyone has written anything about this sort of effect. jps (talk) 11:50, 17 September 2015 (UTC)

Edzard Ernst has, of course. But in general, no. This sort of weak statement of lukewarm acceptance tends to be based on, one, the presence of a few True Believers in any large medical organization, and, two, a vague feeling that even a placebo effect might as well have some sort of blessing. We do like people to feel better, whatever the reason. Personally I'd think the existence of such statements worth a very brief summary in this article, but deleting the whole lot would also be reasonable. Richard Keatinge (talk) 13:50, 17 September 2015 (UTC)

If deleting or reducing this content were done with the purpose of being concise, I would be happy to settle for a summary statement. I think we should keep all the content, though.Herbxue (talk) 17:04, 17 September 2015 (UTC)

Let's try to be concise to see what kind of wording you would come up with. Can you write a sentence or two that summarizes this content that you think deserves prominence? jps (talk) 17:06, 17 September 2015 (UTC)

The text is redundant to what is at Acupuncture#Specific conditions using higher quality sources. QuackGuru (talk) 20:06, 17 September 2015 (UTC)

The purpose of that section is different from the acu for specific conditions. Editors often say the article needs to reflect the mainstream medical view of acupuncture, so the positions of mainstream medical associations were included. Herbxue (talk) 21:07, 17 September 2015 (UTC)

These are "relatively obscure organizations"[11] not mainstream medical associations. QuackGuru (talk) 21:10, 17 September 2015 (UTC)

Let's see if anyone has any concrete proposals. It's pretty clear to me that simply reinstating the problematic sections is not an option. jps (talk) 13:14, 18 September 2015 (UTC)

Check out these orgs in more detail. I think the only one you could say is "obscure" is the British Geriatric society due to low membership numbers, and maybe the American College of Chest Physicians. The rest are large physician organizations with long histories. Herbxue (talk) 15:45, 18 September 2015 (UTC)

None of these sources were specifically about acupuncture. We have highly detailed information on all the Acupuncture#Specific conditions. QuackGuru (talk) 18:30, 18 September 2015 (UTC)

What policies can someone give for removal of medical organization guidelines such as these? If it's a matter of trimming, we had better remove low quality self published sources as well, which aren't anywhere near the quality of these contested sources. LesVegas (talk) 22:15, 18 September 2015 (UTC)

Tagged content may be removed. Since we're discussing what to do with it and the consensus seems to be in favor of at least shortening, it is highly irresponsible to keep replacing the content. Please stop that provocation. jps (talk) 23:12, 18 September 2015 (UTC)

No, just because it might be shortened doesn't mean it should be removed. If editors all agree to shorten it, we can do that here. I'm not necessarily in favor of shortening it, but I am in favor of a rewrite to more accurately reflect what the medical orgs say. There is some original research in the statements which needs to be taken out and we can focus on that. LesVegas (talk) 03:55, 19 September 2015 (UTC)

I you think the section should be rewritten, why don't propose new wording instead of edit warring? That's the current state of the discussion, we are waiting for concrete proposal from people who want the section to stay.--McSly (talk) 04:25, 19 September 2015 (UTC)

The section in question can be seen in this 14 September 2015 permalink. In addition to what has been noted above, the text is a subsection of "Effectiveness" where a reader expects to see what is known about how effective acupuncture is for treating various conditions. The removed text is a cherry-picked list of what some organizations have recommended as treatments that clinicians should consider. A reader could interpret the removed text in a wide variety of ways: suppose an organization recommends that under some circumstances acupuncture should be considered—does that mean it is effective? Johnuniq (talk) 23:44, 18 September 2015 (UTC)

MEDRS suggests that medical association guidelines are high-quality sources, so I support inclusion of the materials under discussion. However, I see there is sometimes a disconnect between what guidelines suggest and what the actual science supports. I suggest that the text could be frames similar to the way it is done at Paracetamol, where the guideline is noted, but qualified by science. EG: "Osteoarthritis: The American College of Rheumatology recommends paracetamol as one of several treatment options for people with arthritis pain of the hip, hand, or knee that does not improve with exercise and weight loss.[23] A 2015 review; however, found it provided only a small benefit in osteoarthritis.[24]" AND "Low back pain: Based on a systematic review, paracetamol is recommended by the American College of Physicians and the American Pain Society as a first line treatment for low back pain.[26][27] However other systematic reviews concluded that evidence for its efficacy is lacking.[24][28]" 108.181.201.237 (talk) 01:14, 19 September 2015 (UTC)

While that's a possibility, such an approach invites WP:OR by cherry-picked sources. It's better to just report what the review says about effectiveness. Johnuniq (talk) 01:33, 19 September 2015 (UTC)

I disagree Johnuniq! OR may be an issue and the wording will have to be sure not to violate OR policy. However, what would be cherry-picking would be to include some of the highest-quality sources that claim one thing and excluding other high-quality sources that claim something different, this is contrary to NPOV. Since guidelines from mainstream medical organizations are considered some of the highest-quality evidence by MEDRS, I cannot see how any editor will successfully argue for their exclusion. Instead, all relevant and high-quality sources should be included (guidelines and systematic reviews) and if they do not agree then IMO it should be presented like it is at paracetamol.108.181.201.237 (talk) 01:48, 19 September 2015 (UTC)

At this diff I have tried a bold edit. I have put in a one-sentence summary of mainstream medical guidelines, not in the Effectiveness section where indeed it does not belong, but under Clinical Practice, where it clearly does. I have used three references from the controversial section. I hope that this is helpful. The edit also includes a minor typo fix elsewhere in the section. Richard Keatinge (talk) 10:45, 19 September 2015 (UTC)

I think this is fine. I wish there was better wording than the verb "may", but I could not think of what it would be. jps (talk) 11:04, 19 September 2015 (UTC)

• MEDRS gives authority to reviews (evidence) as well as consensus-in-practice (treatment guidelines; statements by major bodies). Usually, those are aligned ad in my view, they are are aligned pretty well for acu as well. My "truce" proposal) called for the health content of this article to be based on guidelines and limited in scope to what guidelines describe, and evidence-based sources be used to supplement the guidelines. I think we could have a fairly stable article that way and avoid a lot of strife. However it seems that parties on all sides working here prefer to keep evidence-based sources in the foreground. So be it. I feel like I am starting to a beat dead horse, so this is the last time i will mention the truce thing. Jytdog (talk) 11:50, 19 September 2015 (UTC)

Sorry Jytdog - your proposals may well be worth revisiting. For the immediate issue it's worth remembering that clinical practice isn't entirely based on evidence from randomized controlled trials. Or, to put it another way, nobody doubts the genuine effectiveness of the placebo effect. Richard Keatinge (talk) 13:55, 19 September 2015 (UTC)

Very we'll put, Richard. It might be instructive to consider the positions of major organizations on the application of placebos when there is no more effective available alternative.LeadSongDog come howl! 13:27, 23 September 2015 (UTC)

Original research?

I just got done checking the page for OR and SYN violations. There appears to OR/SYN added to the page. For now I tagged the violation. QuackGuru (talk) 19:49, 19 September 2015 (UTC)

Do you think the summary can be improved so that it is not in violation? What would you propose? jps (talk) 11:03, 20 September 2015 (UTC)

The part "Many mainstream medical organizations," could not be sourced. The part "without necessarily endorsing acupuncture as effective" also could not be sourced. Using a review and another source I summarised the current evidence.[12] QuackGuru (talk) 20:28, 20 September 2015 (UTC)

"... without necessarily endorsing acupuncture as effective" cannot be sourced, but no implication that the organizations do endorse acupuncture as "effective" should be here, unless present in the sources. — Arthur Rubin (talk) 19:33, 23 September 2015 (UTC)

@Arthur Rubin: True, but please consider QG's diff—is that change desirable? I have put off responding here until finishing some other stuff, but now that I examine the diff, it appears like a good solution. It may be easier to look at the proposed text in the sandbox. The proposal is that the recently added text:

Many mainstream medical organizations, without necessarily endorsing acupuncture as effective, suggest that it may be offered in addition to conventional therapy if the patient desires it.

be replaced with:

Published guidelines recommend the use of acupuncture for the management of non-specific low back pain, among other treatments. For example, the American Society of Anesthesiologists states it may be considered in the treatment for nonspecific, noninflammatory low back pain only in conjunction with conventional therapy.

The problem with the recently added text is that it attempts to generalize from the statements released by various organizations and expresses a view that is not present in the sources. The proposed replacement avoids that by sticking to the facts—for simplicity I omitted the refs here but the proposed text is exactly supported by the refs which can be seen in the diff. Johnuniq (talk) 05:13, 24 September 2015 (UTC)

OK, good suggestion. However, we have several guidelines by mainstream organizations, and more can be adduced if necessary, saying that it's OK to use acupuncture in addition to conventional therapies. I'd suggest that it's a fair summary, not SYN or OR, to say that "many mainstream medical organization suggest that acupuncture may be offered in addition to conventional therapy" and follow with as long a list of refs as may be desired. Just a thought... Richard Keatinge (talk) 09:28, 24 September 2015 (UTC)

Sounds good to me. Herbxue (talk) 18:24, 24 September 2015 (UTC)

The proposal to add or keep "many mainstream medical organization suggest that acupuncture may be offered in addition to conventional therapy" is unsourced and following it with a list of sources is a WP:SYN violation. I thought I was clear about this. QuackGuru (talk) 18:40, 24 September 2015 (UTC)

You were. I don't agree and I'm wondering what others think. Richard Keatinge (talk) 20:59, 24 September 2015 (UTC)

First, let's establish that the current wording is not suitable. The main problem is "if the patient desires it" which is not present in any of the refs—it's quite likely that advising what non-conventional treatments are reasonable if requested by a patient was on the minds of those writing the guidelines, but we can't draw that inference. The text "without necessarily endorsing acupuncture as effective" is plausible, but for a contentious topic like this it is best to stick to facts—none of the refs use endorse terminology, and the qualifier "without necessarily" produces an empty statement which says nothing about what is in the refs (the refs also do not necessarily say that apple pie is good). Finally, there is the "many" in "Many mainstream medical organizations"—while fine in general, that qualifier is asserting that of all the mainstream medical organizations (worldwide?), more than 50% have made the stated suggestion—"many" probably means 60% or more. By contrast, the above proposal starting "Published guidelines recommend the use..." avoids OR issues by sticking to the facts stated in the refs.

The most-recent suggestion is: "Many mainstream medical organizations suggest that acupuncture may be offered in addition to conventional therapy."

While a minor issue, "many" is still a problem. There are other issues: the first ref is much more restrained—it says "For patients who do not improve with self-care options, clinicians should consider...[long list relating to low back pain]." The second ref says "Acupuncture may be considered as an adjuvant to conventional therapy ... in the treatment of nonspecific, noninflammatory low back pain"; again, that's more nuanced than the proposed text, and only refers to a specific condition. The above comments by QG is not helpful, but his proposal is good because it avoids the problems that arise from a summary of a complex situation. Johnuniq (talk) 07:54, 26 September 2015 (UTC)

OK, thanks to all. To repeat, QuackGuru's proposal is that the recently added text: "Many mainstream medical organizations, without necessarily endorsing acupuncture as effective, suggest that it may be offered in addition to conventional therapy if the patient desires it." be replaced with: "Published guidelines recommend the use of acupuncture for the management of non-specific low back pain, among other treatments. For example, the American Society of Anesthesiologists states it may be considered in the treatment for nonspecific, noninflammatory low back pain only in conjunction with conventional therapy." Per Johnuniq this seems good to me and nobody has objected. Does QuackGuru feel like making the change? Richard Keatinge (talk) 09:20, 29 September 2015 (UTC)

Thanks, but there is a backstory and apparently QG cannot make such an edit—pretty weird, and I don't fully understand, but there is some info here for anyone interested. That's why I want to make sure there is agreement here, then one of us can make the change if no objection is raised. Johnuniq (talk) 10:06, 29 September 2015 (UTC)

I'd do it if you want. This is my usual technique for taking all the glory - sit back and watch while others do the hard work and nip in at the end and take the credit - but I wont unless there is consensus. -Roxy the dog™ (Resonate) 13:51, 29 September 2015 (UTC)

Thanks to Johnuniq for the backstory; I'd generally agree with Adjwilley's ideas. Anyway Roxy, so far as I'm concerned the glory is all yours. Richard Keatinge (talk) 20:08, 29 September 2015 (UTC)

@Roxy the dog: Yes, please go for it. Johnuniq (talk) 21:33, 29 September 2015 (UTC)

@QuackGuru? -Roxy the dog™ (Resonate) 22:14, 29 September 2015 (UTC)

Aren't you gonna ask me :) Herbxue (talk) 16:25, 30 September 2015 (UTC)

I always look for your opinion, Herb. -Roxy the dog™ (Resonate) 17:14, 30 September 2015 (UTC)

Thanks Roxy. btw the text looks fine, I still prefer the original list of orgs and recommendations but I appreciate the compromised summary.Herbxue (talk) 20:52, 30 September 2015 (UTC)

Done. If it is wrong, revert! -Roxy the dog™ (Resonate) 17:35, 30 September 2015 (UTC)

You did not delete the other references that do not verify the claim. QuackGuru (talk) 17:40, 30 September 2015 (UTC)

Thx for that QG, and for the uncontroversial main page edit. -Roxy the dog™ (Resonate) 17:50, 30 September 2015 (UTC)

Only this ref verifies the claim. The others FV. I propose removing [36][37] refs. QuackGuru (talk) 18:42, 30 September 2015 (UTC)

• Out of curiosity, is there actually an answer to the question: "What do mainstream organizations generally recommend regarding acupuncture?" Is there no answer to the question, or is the answer just unverifiable with secondary sources? ~Adjwilley (talk) 23:56, 2 October 2015 (UTC)

• For earlier comments, I extracted the parts relating to acupuncture from each of the statements by an organization that were listed as refs, then tried to make sense of them. The problem is that there is no way an editor can summarize the views expressed because they are all over the place—a secondary source would be needed to make a general statement. However, the current text captures their essence well because they each state, with various qualifications, that acupuncture may be considered for the treatment of low back pain in conjunction with other procedures—one ref has a very long string of qualifications making it clear they think acupuncture is at the bottom of the list, while another ref has a much simpler recommendation ("Acupuncture may be considered as an adjuvant to conventional therapy") for certain low back pain, although it also has some weasel language that is a bit hard to interpret. In other words, I don't think this article can have a better statement without a secondary source. Johnuniq (talk) 01:00, 3 October 2015 (UTC)

Adjwilley, for statements from the most mainstream medical orgs available see here for the NIH, and see here for the NHS and here for the WHO. Keep in mind that the WHO's last analysis was done in 2002, so it may be a little dated in comparison to other orgs. Beyond those, small medical organizations have all made various statements which are limited by their actual scope. Pain societies only look at and comment on pain, for instance, and allergy societies the same. LesVegas (talk) 01:14, 4 October 2015 (UTC)

NCCIH is unreliable per previous discussion. See Talk:Acupuncture/Archive 19#Weight violation. Please read the comments by User:Sunrise and others.

There is a specific proposal for NHS. See Talk:Acupuncture#New proposal.

WHO is unreliable according to many sources. See previous wording in the acupuncture page. "The 2003 World Health Organization's (WHO) report was controversial; critics assailed it as being problematic since, in spite of the disclaimer, supporters used it to claim that the WHO endorsed acupuncture that were lacking sufficient evidence-basis.[89] Acupuncturists have cited the report as evidence of their approach of being therapeutic, and people have been convinced that acupuncture must work for a wide range of conditions because it was endorsed by WHO.[90] The 2008 book Trick or Treatment said the report included too many results from low-quality clinical trials, and included a large number of trials originating in China where, probably due to publication bias, no negative trials have been produced.[90] A 2006 review described the report as "[p]erhaps the most obviously over-optimistic overview [of acupuncture]", noting that of the 35 conditions that the WHO stated acupuncture was effective for, 27 of the systematic reviews that the WHO report was based on found that acupuncture was not effective for treating the specified condition.[7]"[13] QuackGuru (talk) 03:02, 4 October 2015 (UTC)

Yes I understand some editors here dispute major medical orgs (which MEDRS says are highly reliable) all because they don't trash certain modalities some editors want trashed, or some skeptical gurus trash. After the WHO, NIH, and NHS who is left? No major orgs. While I think due weight should be given to the WHO on the basis of their recommendations being 13 years old, a couple of skeptics criticizing it are but tiny flies by comparison and by no means diminish what the biggest medical org in the world says. I highly doubt neutral editors would want major medical orgs in disfavor while every statement made by critical bloggers and discredited skeptic researchers forced into retirement but still worshiped by a tiny cult following of a few Wikipedia editors peppered every few sentences, but I could be wrong. LesVegas (talk) 06:51, 4 October 2015 (UTC)

WHO is certainly among the gold standard when it comes to available sources. Indeed, they have all the best expertise and the best sources in their disposal which they go through when giving their guidelines. There might be some dissidents critical to WTO though, just like there are entities that would like to label all the public institutions "unreliable" because they believe in some conspiracy theories.

Besides, wasn't that "Trick or treat" book discussed already in another thread about Sources for history? If I remember correctly, it didn't get a lot of support even for that purpose. Jayaguru-Shishya (talk) 14:27, 4 October 2015 (UTC)

Possible restructure in sandbox

Bearing in mind Jytdog's comment at 15:55, 6 September 2015 above (that editing has to be cautious per the discretionary sanctions), I put a copy of the article at 15:53, 6 September 2015 in Talk:Acupuncture/sandbox. I have been inactive on this topic but have watched proceedings, and the recent country of origin RfC highlights the divergent views on the article. I'm wondering if people would like to try reworking the current page. Any such work could then be considered for use in the article. Johnuniq (talk) 03:14, 7 September 2015 (UTC)

You mean reworking it in the sandbox, right?Herbxue (talk) 14:40, 7 September 2015 (UTC)

Yes, reworking in the sandbox would allow trying more massive rearrangements whereas bold editing on a contentious article would be unsuccessful. Johnuniq (talk) 21:06, 7 September 2015 (UTC)

It would also make it virtually impossible to compare line-for-line and identify the subtle (and often not-so-subtle) bias that has characterised pro-needling edits for the last however many years, and thus delight the pro-needling editors as they stand more chance of flying quackery under the radar. Guy (Help!) 13:42, 8 September 2015 (UTC)

Way to AGF, Guy. Herbxue (talk) 15:45, 8 September 2015 (UTC)

We are not obligated to ignore years of history not obligated to ignore years of history. -- TRPoD aka The Red Pen of Doom 20:52, 8 September 2015 (UTC)

Solution for comparison: install Cygwin, cut and paste the fragments to be compared in two different text files and use the utility diff to compare them. What's the suicide link about? Someone threatened with that? Tgeorgescu (talk) 21:16, 8 September 2015 (UTC)

oops, wrong link. -- TRPoD aka The Red Pen of Doom 01:27, 9 September 2015 (UTC)

I'm all for re-working the article in the Sandbox. But we need to resolve long standing disputes first or else we'll just be arguing about what to publish there. I don't think the involved editors can ever come to agreement, so we'll probably need some outside help on that. LesVegas (talk) 23:02, 8 September 2015 (UTC)

How do you foresee "outside help" as being able to bring editors together on policies such as WP:UNDUE and WP:MEDRES? -- TRPoD aka The Red Pen of Doom 14:59, 9 September 2015 (UTC)

I would love to see COMPLETELY uninvolved editors (good editors with no editing history in controversial science or medical articles) have their way with that sandbox, requiring us all to completely stay out of it. Would love to see what they come up with. (I know its not practical, but wouldn't that be interesting?)Herbxue (talk) 16:32, 9 September 2015 (UTC)

I wouldn't. It is rather important that long-term Wikipedians with a sound understanding of policies such as WP:FRINGE stay on top of articles on topics prone to fraudulent pseudomedical claims. Guy (Help!) 22:33, 10 September 2015 (UTC)

QuackGuru has done a bunch of edits to the sandbox. I thought he might have finished because he adjusted the categories as if it were final, but he has just made another edit that I haven't examined. I've thought about helping but it's bigger than I can manage at the moment. I compared the article and sandbox and found some changes that I thought should be made, and my recent edits to the article incorporate them. The change from the current Acupuncture to the current Talk:Acupuncture/sandbox is this diff. Any thoughts on incorporating more changes from the sandbox? Johnuniq (talk) 05:51, 14 September 2015 (UTC)

I like the changes, which means the needleists won't. Guy (Help!) 08:26, 14 September 2015 (UTC)

I checked the rest of the sandbox changes and they looked good, so I updated the article by copying the text from the sandbox. Are all the points in the last paragraph of the lead (starting "Scientific investigation has not found...") covered in the article? I would have expected histology to be mentioned somewhere but can't see it. Johnuniq (talk) 05:15, 15 September 2015 (UTC)

This does not seem in keeping with your proposed intent, to do bold edits that would be contentious in the actual article. I assumed we would look at those bold edits and discuss first, but if this is actually a way for Quackguru, who has been prohibited from making contentious edits, to have edits made by proxy, then I suggest scrapping the sandbox. What is the purpose of the sandbox if you are just putting QG's edits into the actual article right away? Just edit the main article. Herbxue (talk) 16:16, 15 September 2015 (UTC)

The way the sandbox is currently being used isn't going to work. Massive changes like adding/removing sections, moving paragraphs, and contentious additions/removals need to happen here at the article with appropriate edit summaries. There's too much potential for abuse, slipping in contentious edits under the radar, and I don't think a bunch of large overly bold edits is the way to go here. The regular editorial process should work fine, people just need to be careful and try to edit according to consensus. ~Adjwilley (talk) 23:50, 15 September 2015 (UTC)

@Herbxue: Sorry if my above comments were not clear, but my intention was to propose a reworking in the sandbox with edits that may not be achievable in the article because, for example, it is only possible to judge whether a proposed rearrangement of material is desirable after a few edits have been done in order to make the change, then polish any rough edges. In an article on a contentious topic, that may never happen because the first edit might have been reverted before the idea was realized. Further, the revert may well have been justified since the first edit might have left the article in a rough state because several steps may need to be performed in order to get a result. I studied the changes in the sandbox and believe that they improve the article. It's not clear whether anyone wants to do any more work in the sandbox, but I judged that what had been done was valuable and should be included in the article. I have found from working in other topics that people often don't want to discuss a hypothetical edit, but would prefer to have something in the article to discuss. That's why I edited the article.

@Adjwilley: It may be that no one wants to use the sandbox any more, so it doesn't have to work. I participated during the development of a much more contentious article: Shakespeare authorship question (Arbitration case). It was impossible to have any serious discussion about a significant change because anything beyond fixing a typo was immediately reverted, so no one could develop new text, let alone polish it and add references. Therefore, two editors decided to develop a proposal in a sandbox. When ready, it was copy/pasted into the article, and discussions concluded that the change was beneficial, and the article went to FA and was featured on the main page. A history merge was later performed so the edits in the sandbox can no longer be seen as they are now incorporated in the article's history. The history merge was requested here. Getting consensus for making changes sentence by sentence is never going to work because what some editors want is opposed by others. The current situation is that the rearranged text in this article can be slowly examined and discussed. If necessary, uninvolved editors can be invited to comment via an RfC. It would not be feasible to conduct an RfC for each paragraph. Johnuniq (talk) 10:57, 16 September 2015 (UTC)

I think I understand your reasons for doing this, but the result is problematic. The fact that you did a "move" rather than copying and pasting what you considered to be good edits into the article made it more difficult to track what changed and where. And the fact that your move implemented QG's edits without watchers of the actual article being able to see them and raise questions is problematic because of the history of QG's contentious editing here. Please do not do any more wholesale moves of the sandbox to the main article. I recommend scrapping the idea, unless it can be worked on in a slower, more methodical manner with more discussion before incorporating large changes.Herbxue (talk) 16:03, 16 September 2015 (UTC)

Quibbling over process seems a bit peculiar here. Either the move improved the article or it didn't. I'd argue it did. If you can point to something that did not improve the article, let it be known, but complaining about how it was done is not productive. jps (talk) 20:58, 16 September 2015 (UTC)

request a history merge. then make a null edit with an edit summary that there has been a significant change. -- TRPoD aka The Red Pen of Doom 21:02, 16 September 2015 (UTC)

Jps, process IS important here. For example, this move allowed QG to slip this in "A systematic review of systematic reviews found that for reducing pain, real acupuncture was no better than sham acupuncture" - Sound familiar? We had MONTHS of debate over that misrepresentation of the source, here and at project med, with neutral readers rejecting QG's misrepresentation of the source. And here it is again, amongst - I don't even know how many edits, that we do not have clear diffs and edit summaries on and were not seen by article followers as they were being made. This is a major problem. Johnuniq, I respectfully request that you revert back to the version before you installed QG's problematic edits. Herbxue (talk) 22:37, 16 September 2015 (UTC)

It was deleted but User:Dominus Vobisdu,[14] User:McSly,[15] User:Jim1138,[16] User:Roxy the dog,[17] and User:Bobrayner[18] preferred the sourced, more concise wording. User:Yobol stated that it does seem to be a conclusion Ernst is making and therefore citable as a source for that conclusion.[19] The wording in the lede is clearly sourced according to a number of editors.

The original research was problematic.[20][21] No editor was removing the unsourced text. Unsourced text was replaced with sourced text. The text was also organised such as moving the history paragraph to the 4th paragraph in the lede to follow the same order as the body. QuackGuru (talk) 02:21, 17 September 2015 (UTC)

The process really is not important, so let's deal with your single concern. "A systematic review of systematic reviews found that for reducing pain, real acupuncture was no better than sham acupuncture." is claimed to not be a properly sourced statement. Would you care to offer an alternative statement with the same sources? Because I see that statement as being a reasonable summary and so does Edzard Ernst. jps (talk) 17:00, 17 September 2015 (UTC)

Yes, the process is important because transparency and establishing consensus are important in WP, and this page move was admittedly an effort to bypass discussion and debate on individual edits (see his explanation above). Regarding the review - QG's text is taken from Ernst reporting on the result of one primary study. And that statement is not part of the conclusions of the review article. Like I said, Ernst is too careful to incorrectly state that the whole body of reviews he reviewed support that statement, but he does refer to that one primary study to justify his SPECULATION that FUTURE reviews are likely to share the conclusions of that primary study. Please go back to the discussion at project medicine to see the lengthy debate. Herbxue (talk) 17:23, 17 September 2015 (UTC)

See "Real and sham acupuncture were both more effective in reducing pain than no acupuncture at all, but real acupuncture was no better than sham."[22] While not a primary conclusion it is "a conclusion".[23] Whether Ersnt cited a primary study or a review is not relevant. We are citing the review of reviews not another source. QuackGuru (talk) 20:01, 17 September 2015 (UTC)

Other changes to lede:

Previous wording in 2nd paragraph. Acupuncture is believed to have originated around 100BC in China, around the time The Yellow Emperor's Classic of Internal Medicine (Huangdi Neijing) was published, though there is some evidence it could have been practiced earlier. Scientific investigation has not found any histological or physiological evidence for traditional Chinese concepts such as qi, meridians, and acupuncture points, and many modern practitioners no longer support the existence of life force energy (qi) flowing through meridians, which was a major part of early belief systems.

Current text moved to 4th paragraph. Scientific investigation has not found any histological or physiological evidence for traditional Chinese concepts such as qi, meridians, and acupuncture points,[n 2][26] and many modern practitioners no longer support the existence of life force energy (qi) flowing through meridians, which was a major part of early belief systems.[27][8][28] Acupuncture is believed to have originated around 100 BC in China, around the time The Yellow Emperor's Classic of Internal Medicine (Huangdi Neijing) was published,[29] though some experts suggest it could have been practiced earlier.[7]

The wording is essentially the same with minor tweaks to ensure the text is sourced. The difference is that the text was organized and moved to follow the same order as the body. QuackGuru (talk) 19:15, 17 September 2015 (UTC)

I did more checking about my above comment where I wondered if the "Scientific investigation has not found..." text in the lead is covered in the article. I see it is in Acupuncture#Purported scientific basis but there is no mention of histological or physiological evidence. The issue of those words is minor and could be addressed later if felt necessary. However, I see that the substantive points in the lead are covered. Johnuniq (talk) 03:46, 19 September 2015 (UTC)

There was broad consensus for the previous changes. See Talk:Acupuncture#Possible restructure in sandbox. However, changes against consensus were made to partially revert back to an old version without explanation on the talk page. Useful information was deleted and the text was misplaced. Misleading text and original research were restored. Let me remind editors that OR is forbidden. QuackGuru (talk) 22:05, 4 October 2015 (UTC)

Mediocre

As someone who came here to learn about acupuncture, knowing little about it, I found this article pretty unhelpful. It's poorly organized, and it feels overwrought and strained. It could be retitled "Wikipedians problems with acupuncture (and also a little about acupuncture too)." How about an article about the practice, and a separate article, or one section, about efficacy? This article really tells me more about the interests and priorities of the various authors than the topic itself. — Preceding unsigned comment added by 2601:646:4101:9057:9545:AA4F:6B48:F034 (talk) 06:43, 28 September 2015 (UTC)

See Acupuncture#Clinical practice for practice. I'm not sure what is missing. QuackGuru (talk) 18:38, 28 September 2015 (UTC)

The same could be said about most topics at Wikipedia since an encyclopedia does not provide "how to" advice. There are plenty of websites with information about acupuncture, so if you learn something that is not present in this article, please give details. The normal policies of WP:RS and WP:DUE would need to be observed. Johnuniq (talk) 01:13, 29 September 2015 (UTC)

Every couple months or so an uninvolved reader drops by to tell us this same message. Its true. An encyclopedia article should be mostly descriptive, but many editors here feel it is their mission to persuade readers to dismiss acupuncture as being without merit. The observation that the current article is "Wikipedians problems with acupuncture (and also a little about acupuncture too)" is spot-on.Herbxue (talk) 16:12, 29 September 2015 (UTC)

Do you have sources or a specific proposal for Acupuncture#Clinical practice? QuackGuru (talk) 16:29, 29 September 2015 (UTC)

I could be wrong, but I don't think they are complaining that something is missing, they are complaining that there is too much noise. Herbxue (talk) 16:33, 29 September 2015 (UTC)

The IP is spot on when s/he said It could be retitled "Wikipedians problems with acupuncture (and also a little about acupuncture too)." (which actually gave me a good chuckle). 2601, some of us have tried - I have tried - but we quickly give up because we know the signs of article ownership, as is the case with this one. A few continue to struggle...and I give them my best. Gandydancer (talk) 16:50, 29 September 2015 (UTC)

A specific proposal along the lines of my above comment would be helpful. Johnuniq (talk) 21:36, 29 September 2015 (UTC)

if you came here looking for "Acupuncture does X" you will be disappointed because there are no reliable sources providing evidence that "Acupuncture does X", and Wikipedia presents what the reliable sources state. That leaves Wikipedia to cover the history of acupuncture and the sources that state "Claims of acupuncture doing X are bunk." -- TRPoD aka The Red Pen of Doom 21:02, 30 September 2015 (UTC)

Herbxue, could you imagine how much "noise" would be added to the article by our trying to be "mostly descriptive" of the many and varied different acupuncture practices? Where would we stop? Should we include the totally bonkers ones like Colorpuncture? Readers who want to learn how to do (any particular form of) acupuncture should go elsewhere - in fact, they shouldn't be trying to learn how to stick needles in people from ANY internet article! Famous_dog (c) 12:21, 1 October 2015 (UTC)

I definitely don't think it should be a "how to" article, but descriptive in the sense of what is acupuncture? Who does it? Where, why? Now of course the big question every reader will have is "does it work?" and that's where it gets complicated. Since we can't agree on how to summarize available literature, I think the noise of presenting as many secondary sources as possible and letting the reader sift through them is actually preferable to potentially misleading summaries or over simplifications of the situation. Herbxue (talk) 18:11, 2 October 2015 (UTC)

Indeed, this is an encyclopedia not a guide to doing things. But if I had the time and the space to rewrite this article, I'd aim to use most of the space describing what acupuncture is, and I'd do so mostly by describing what acupuncturists have said about it - all within a frame of scientific scepticism. Our article on Hindu astrology is quite a good example of how to do that sort of thing. Richard Keatinge (talk) 14:20, 1 October 2015 (UTC)

I basically agree, Richard, but it's a lot more difficult because whereas astrology is clearly bullshit and has no science whatsoever, acupuncture is awash with pseudoscience and the occasional bit of good science. Also the concluding para of the astrology article, which would essentially also cover acupuncture, would never be permitted by the aciculaphiles. Guy (Help!) 23:04, 1 October 2015 (UTC)

As you say it wouldn't be easy, and the ongoing argy bargy - a very real weakness of crowdsourcing - means that it's not likely to happen. I propose to lurk and make the occasional comment when I think it may be possible to nudge matters in a useful direction. Richard Keatinge (talk) 09:19, 2 October 2015 (UTC)

Is there a policy or guideline about inventing new words, and using them, on Talk pages? Roxy the dog™ (Resonate) 09:51, 2 October 2015 (UTC)

It is a perfectly cromulent activity that embiggens the discussion. -- TRPoD aka The Red Pen of Doom 23:30, 2 October 2015 (UTC)

What new words? The term argy-bargy was first used more than a hundred years ago, and is still in use (wikt:argy-bargy). Johnuniq (talk) 01:02, 3 October 2015 (UTC)

aciculaphiles. I searched at The University of Google - there were no results. I think the wordsmith who invented it should be added to a handy arbcourt case. -Roxy the dog™ (Resonate) 09:30, 3 October 2015 (UTC)

Oh Herb, the biggest q people have is not "how does it work?", it is "how do these people get away with it?" They know it doesn't work. -Roxy the dog™ (Resonate) 09:36, 3 October 2015 (UTC)

I agree entirely with the OP. When I got interested in this article it was because I came across it and saw that it read more like a Quackwatch web-article than a real encyclopedia article. Since then we've seen many editors stop by making similar observations, but a rather small but dedicated group IDHT's any criticism of their article and reverts any changes. Why shouldn't we have one section of efficacy, and have the rest on acupuncture's history, methods, and theory? An expanded article on results and efficacy could be attached. In short, we should try to move it towards looking somewhat like an actual encyclopedia article. LesVegas (talk) 20:45, 3 October 2015 (UTC)

@Roxy the dog: re: "they know it doesn't work"...Never underestimate the power of people's ridiculous superstitions.

@LesVegas: I think you (and OP) make a good case for having good coverage of all aspects of the topic, but I'm not sure I understand where this article is lacking in doing that. I see a decent amount of history and coverage of the practice itself. What specifically could be improved? I'm not sure I'd agree that it'd be an improvement to have a separate article entirely about efficacy, not least of all because in that case we'd really have a Quackwatch article on acupuncture. There is an "Effectiveness" section here, but I don't know if there's a good reason to leave out any mention of efficacy while discussing specific treatments, if that's what you mean. AdventurousSquirrel (talk) 23:32, 3 October 2015 (UTC)

Thanks for your response AdventurousSquirrel, I'm not sure I'd want that either, it was just a suggestion. But throughout the article endless undue weight is given to skeptics unknown outside the skeptic community whose opinions and comments the average reader could care less about. The problem is this: we treat the acupuncture article differently than we do anything else. If you look at the article on SSRI medications, for instance, you see a short lede and a sentence at the end saying,"The efficacy of SSRIs in mild or moderate cases of depression has been disputed." (this, because of a meta-analysis showing SSRI's to be equal to placebos in most cases, but that meta-analysis is also disputed). That's the way disputes should be handled in a NPOV manner. Describe but don't engage and don't give undue weight. Don't drone on about it endlessly, and especially not in the lede. All throughout this article, every time a positive claim is made editors feel the need to neutralize it with a negative claim. And everytime a negative claim is made, it's also neutralized with a positive one. The OP seemed to indicate trying to limit most of these disputes to one section and I think that would be a great idea. And we should just neutrally describe, but not engage in, disputes in the lede as we do in SSRI and other articles. From there, I think it would be a good idea to describe the many other additional types of acupuncture. As it stands the article lends undue weight to TCM-style acupuncture, which was actually invented in the 1950's. with very little information on other types such as Japanese, classical, 5Element, Tung and other family lineage styles. All that could and should be expanded. The history section could also be expanded a great deal and might even need its own article as well. But those are just a few suggestions. But as a starting point, perhaps we should pattern the article after other articles on Wikipedia, using those as an outline? LesVegas (talk) 00:52, 4 October 2015 (UTC)

We have no way of assessing what an average reader cares about, but speaking for myself, I would not want to read a long article that led me to believe the topic was a standard medical procedure then later learn that in fact not much is known about its efficacy. At any rate, while editors cannot determine what readers want, we can discuss claims of specific problems: what text in the current article is a problem and why? Johnuniq (talk) 04:05, 4 October 2015 (UTC)

Yea, for starters the article mentions Felix Mann more than it does Sun Simiao or the Yellow Emperor. And every three sentences is a statement by some obscure author nobody has heard of outside a few skeptics who edit here. LesVegas (talk) 07:04, 4 October 2015 (UTC)

Sun Simiao is mentioned once in the article, and the Yellow Emperor is mentioned three times. By contrast, Felix Mann is not mentioned, and only appears as the author of a reference used once. I think the problems alluded to in this section are due to the fact that testing the efficacy of acupuncture is very difficult, and there are few definite conclusions about the topic. The history and adoption sections are important, but since we are mentioning average readers, I think most people would want to know if acupuncture is recommended as a treatment for a particular condition they have in mind. The sources are very equivocal about that, and that's why the article is full of qualifying clauses. I have just posted at #New proposal above; please comment there if you have an opinion. Johnuniq (talk) 09:35, 4 October 2015 (UTC)

No, the Yellow Emperor's Classic is mentioned multiple times (actually 4) but not the Yellow Emperor himself. And very little of the excellent information from that book is used here. I tried adding it before but was reverted by editors who would rather edit war anything I do than have a good article. As for Felix Mann, I see he's been taken off recently, which is a step in the right direction. Yes we mention Sun Simiao, once, but we quote Stephen Barrett more times than that from a self-published source, mind you. My point really is that there's more than that just him: there is Li Dong Yuan, Li Shi Zhen, and many others as well as modern practitioners nowhere to be found. We used to have Felix Mann (and we still quote from his books) not because he's really that notable, but because he's a skeptic. Nowhere do we mention family lineage styles of practice, very little is written about Japanese acupuncture, nothing on 5 Element acupuncture, nothing on classical styles. To your point about readers wanting to know efficacy more than anything else, that may or may not be true, but regardless, I doubt readers care much about the history of SSRI's and would care more about their efficacy than anything, but we treat disputes and unknowns there quite differently than we do here. And we don't add in statements and comments from obscure critical scientists or authors every three sentences on that article. And yet there are plenty, much, much more than with acupuncture. Point is, a reader interested in efficacy and disputes can still get their info if it's in its own section and not systemic throughout the article. LesVegas (talk) 14:42, 4 October 2015 (UTC)

I think it would certainly be appropriate to include new sections on the other styles you mention (Japanese, classical, 5Element, Tung and other family lineage styles, if well-sourced) and clarify the differences and similarities between those and TCM-style, which might even eventually even become WP:SPLIT if they became unwieldy here. But I'd agree that regarding the content we have on efficacy of various treatments, presenting it in neutrally would require us to present each claim with a disclaimer, the preponderance of the available evidence pointing to the conclusion that such positive results should be viewed with some scientific skepticism. AdventurousSquirrel (talk) 23:47, 4 October 2015 (UTC)

New proposal

I was not sure if the source was reliable since we have so many high-quality sources. I made this change in the sandbox. Thoughts? QuackGuru (talk) 02:00, 21 September 2015 (UTC)

Did Ernst comment on this set of recommendations perchance? jps (talk) 18:13, 23 September 2015 (UTC)

Ersnt did write about it in the overview of Cochrane reviews for acupuncture (PMID 18789644). It is summarised in the lede and body. For the lede we are using the higher quality source which is the overview of Cochrane reviews. See Acupuncture#cite_ref-Ernst2009_13-1. For the body see Acupuncture#cite_ref-Ernst2009_13-3. This proposal adds another view. QuackGuru (talk) 19:06, 23 September 2015 (UTC)

Following is some text based on QG's above diff, but with edits. I propose adding the following to the end of the first paragraph at Acupuncture#Pain:

The UK National Institute for Health and Care Excellence found some evidence that acupuncture may have a useful effect for chronic lower back pain, tension-type headaches, migraines, nausea and vomiting after chemotherapy or surgery, osteoarthritis, neck pain, and irritable bowel syndrome. However, they stated that some positive evidence does not indicate acupuncture is definitely effective for these ailments; instead, they recommend acupuncture as a possible treatment choice only for chronic lower back pain, chronic tension-type headaches, and migraine.

References

The findings of NICE may not satisfy WP:MEDRS, but it seems reasonable to use the statement. Any thoughts? Adjwilley? Johnuniq (talk) 09:24, 4 October 2015 (UTC)

I don't have any problems with the statement itself, but as an editor I think it's too much detail for being in a section on effectiveness for treating "Pain". Why talk about chemotherapy, nausea/vomiting and irritable bowel syndrome? For that matter, it seems to contradict what the first sentence of the section is saying. If this were my article the first sentence of "Pain" would say something along the lines of "It is unclear whether acupuncture is an effective treatment for pain" instead of "A 2009 overview of Cochrane reviews found acupuncture is not effective for a wide range of conditions, and they suggest it may be effective for only chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache." That way readers know pretty much what how the rest of the section is going to go and can skip the nitty gritty details if they want, without having to try to piece together all the conflicting statements from organizations they've never heard of. ~Adjwilley (talk) 22:29, 4 October 2015 (UTC)

I placed the text at the introduction of the section that tells the reader that the research is largely inconsistent. QuackGuru (talk) 00:23, 5 October 2015 (UTC)

I know what you mean about excessive detail, but I suspect that's an inherent problem for this topic because acupuncture is used as a therapy for dozens of conditions, and many people would probably like to see what a reasonable source says regarding the conditions for which there is some positive evidence, even if the source says it's not conclusive. I might leave that for now and think more later. Johnuniq (talk) 03:41, 5 October 2015 (UTC)

This more concise proposal than my original proposal is better than the WP:SYN violation "but[improper synthesis?] there is some evidence that it may have a beneficial effect for eight conditions.[23]"[24] using the same source. It is important to note that this source should not be used in the lede again because it is a weaker source that was used to argue against an overview of Cochrane reviews. QuackGuru (talk) 05:00, 5 October 2015 (UTC)

Mangled tense?

According to User:Famousdog the part "has been" is a mangled tense. Thoughts? QuackGuru (talk) 16:48, 4 October 2015 (UTC)

I tend to agree that "is has been" is a mangled tense. --Amble (talk) 17:11, 4 October 2015 (UTC)

Yes, I'm irritated that I didn't notice "is has been" despite reading that text several times. Thanks to Famousdog for fixing it. Johnuniq (talk) 03:23, 5 October 2015 (UTC)

The wording was changed again. Both versions are better than the OR "described by some[not in citation given]". QuackGuru (talk) 04:48, 5 October 2015 (UTC)

I am happy with either "is" (present tense) or "has been" (present perfect tense). The present perfect tense implies that it was labeled pseudoscience in the past and still is considered pseudoscience. The past tense "was" implies that it used to be considered pseudoscience but isn't any more. I suspect that most will agree with me that the latter suggestion is unacceptable! Famous_dog (c) 11:12, 5 October 2015 (UTC)

Interesting new editorial in the journal of family practice

A new editorial in The Journal of Family Practice: "The mainstreaming of alternative therapies" http://www.jfponline.com/specialty-focus/neurologic/article/the-mainstreaming-of-alternative-therapies/6dc51562474ba0332e6045351dbb876d.html 75.152.109.249 (talk) 20:17, 22 October 2015 (UTC)

An opinion piece, the author of which seems to be conflating 'popular' with 'valid'. he also seems to be under the impression that rebranding 'alternative medicine' as 'integrative medicine' somehow makes it 'real'. Famous_dog (c) 11:44, 23 October 2015 (UTC)

For what its worth, the more developed professions labeled CAM or "integrative" (acupuncture, chiropractic) are trying to mainstream themselves by weaving more inclusive evidence -informed practice concepts throughout their schools' curricula. Understanding research design and statistics have been included for a long time, but ACAOM (accreditor for acu schools) has increased the expectations in recent years. These free EIP modules offered by the U of Minnesota can give you a sense of one model of clinical decision making in these professions, if you are interested. The thing I think the non-clinician skeptic crowd is missing is that good MD's know that many medical conditions are humbling - with all our scientific advances there are patients suffering right now for whom there are no "proven" therapies. Those are situations where they (good MD's) are willing to try experimental therapies or refer to alternative therapies in the hope that they can relieve some suffering. The editorial you posted is by a doc that treats a particular stubborn condition, so that explains why he is relatively more open to unproven therapies. Herbxue (talk) 16:52, 23 October 2015 (UTC)

Mild and controlled Wallerian degeneration

add that text after the paragraph Purported scientific basis

Acupuncture causes balanced symmetrically throughout the body, mild and controlled Wallerian degeneration. It (acupuncture) causes nerves to thicken a little bit, to become more myelinated, and to seek variant pathways and thus to initiate some maintaining. Also during the Wallerian degeneration process more neurotransmitters are forced to be secreted.

Patients that have axonal inabilities or degenerate axon growth may be harmed by acupuncture. We have to be precise though. Not all neuronal or axonal degenerate conditions render acupuncture a prohibited method. Only the degenerate conditions of which their corrupt Wallerian degeneration causes permanent and uncorrectable damage (regeneration not initiated) and also if the disoriented Wallerian stage had become either the final stage, or never stops until the patient paralyses or dies (very rare but substantial).

Wallerian degeneration is the only statistically significant acupuncture consequence, long enough in duration enough to cause an affect. — Preceding unsigned comment added by 2.84.218.210 (talk) 19:50, 18 October 2015 (UTC)

This looks like original research. Famous_dog (c) 11:38, 23 October 2015 (UTC)

Is there a review you'd recommend, 2.84.218.210? --Middle 8 (t • c | privacy • COI) 21:20, 27 October 2015 (UTC)

Aside: compare Britannica

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

On a related, general note, compare how Britannica handles acupuncture and TCM. WP's goal is the same as Britannica's, and they are doing it better. Some degree of quackery-debunking naturally figures into WP:ENC, especially to counter quackery-promotion, but it shouldn't be the dominant focus. --Middle 8 (t • c | privacy • COI) 14:50, 26 October 2015 (UTC)

No, a six paragraph article, light on details, is not "doing it better". --NeilN ^{talk to me} 15:24, 26 October 2015 (UTC)

What they're doing better, I should have said, is not getting bogged down in a tug of war over quackery. Other stuff they're not doing better, including their section on efficacy itself, which is outdated and repeats absurdly wrong PRC propaganda re anesthesia. Still, though... re our article's excesses, see e.g. 4th through 10th sentences (about Germany) in 2nd para at Acupuncture#Adoption. There's a place for some of that information, but it's at German acupuncture trials, not here, where it just makes eyes glaze over. That said, the trend is positive, something I want to encourage. --Middle 8 (t • c | privacy • COI) 16:48, 26 October 2015 (UTC)

No, that article is horrible and a disgrace to an otherwise reputable encyclopaedia. We reference our content and don't report what "Western visitors have witnessed". Glazing over some of the most authoritative evidence that acupuncture lacks any efficacy whatsoever speaks of an already made up mind and of being immune to evidence. CFCF 💌 📧 12:28, 27 October 2015 (UTC)

"Western visitors have witnessed" = the PRC propaganda I criticized. But you know what, Britannica is a poor example for the point I wanted to make. --Middle 8 (t • c | privacy • COI) 19:18, 27 October 2015 (UTC)

What does PRC mean? -Roxy the dog™ (Resonate) 13:04, 27 October 2015 (UTC)

People's Republic of China? --McSly (talk) 13:10, 27 October 2015 (UTC)

Thx, and Oh, not that again. -Roxy the dog™ (Resonate) 13:15, 27 October 2015 (UTC)

Uninvolved editors passing by this article report that it reads less like an article about acupuncture and more like "wikipedians' problems with acupuncture". Of course reviews of RCT's need to be included, but the rhetoric in this article is like the nuclear arms buildup between the US and USSR in the 80's - its gotten out of hand. A real encyclopedia has restraint and a sense of priorities (description rather than persuasion). Herbxue (talk) 14:29, 27 October 2015 (UTC)

May I ask which uninvolved editors you refer to? Those that have a vested interest in promoting acupuncture? Wikipedia presents evidence, not anecdote. CFCF 💌 📧 18:47, 27 October 2015 (UTC)

...Sorry I started this tangent, CFCF. I'd like to talk about your thoughts on this source, though. --Middle 8 (t • c | privacy • COI) 19:37, 27 October 2015 (UTC)

A quote from a 'real' encyclopaedia ... assertions that acupuncture can actually cure disease defy rational clinical practice and have yet to be substantiated by Western medical researchers. -Roxy the dog™ (Resonate) 14:44, 27 October 2015 (UTC)

Yes, that's a reasonable sentence, though not the whole picture. I shouldn't have brought up the comparison -- see how editors are commenting on it but not the substantial issues re Ernst's review, the IPD meta-analysis and mainstream academic use. My bad for the Britannica red herring -- yes, they get the lack o' minutiae right, but not much else, so it's a crappy comparison that I made. --Middle 8 (t • c | privacy • COI) 19:18, 27 October 2015 (UTC)

So, Britannica = poor comparison, sorry I mentioned. There is some stuff above re content we could talk about, though. [25] [26] [27] --Middle 8 (t • c | privacy • COI) 19:29, 27 October 2015 (UTC)

Middle 8, I wouldn't worry too much about editors not taking to your Britannica suggestion. The Britannica article may have its own problems, but it's actually readable. WP's isn't. I think it's in need of a major overhaul myself. I recently suggested to Awilley (Adjwilley for you veterans), that the article be more Cochrane, NIH, and NHS based with regards to claims of efficacy or non-efficacy and the remainder of the article should be history and interesting facts, and that uninvolved and very reasonable editor thought it was an interesting idea. So I don't think you're off base at all here. Regarding Ernst '11, I think we may have to go the RfC route. Almost everybody agrees the current statement is highly inaccurate. I'm going to restore Everymorning's version because it stuck for a very long time before QG canvassed an editor here to make it for him. Unfortunately, the same editor seems to be making an edit only QG supported for the longest time. I'll restore it and if it doesn't stick, I suggest going another route. LesVegas (talk) 20:34, 27 October 2015 (UTC)

LesVegas, I would be careful about throwing around such allegations - you made quite a deal of noise trying to elbow in questionable content into WP:MEDRS to push your POV here. Wikipedia expresses what reputable sources say, and the above suggestions are detrimental to the article. CFCF 💌 📧 21:01, 27 October 2015 (UTC)

I won't make these allegations again. Next time edits QG notoriously supported are made by you or others, I will just notify the appropriate board and they will look into it. LesVegas (talk) 21:51, 27 October 2015 (UTC)

I started this unproductive thread, asked to end it and you guys ignored me, and am going to close it now. --Middle 8 (t • c | privacy • COI) 21:57, 27 October 2015 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Mainstream use (academia), undue weight again

Acupuncture is widely used academic medical centers; e.g. it's used and taught at Harvard Medical School [28][29], as well as Johns Hopkins, Stanford, UCLA and others [30]. Some scientists are critical of such usage, calling it "quackademic medicine". These facts are relevant, but we need to write about them without giving undue weight to either side. Right now we're giving considerably undue weight to one critic, David Gorski, by framing the issue just as he does:

Acupuncture is used at academic medical centers despite little scientific evidence for explicit effects for any condition that is discernible from placebo.[31]

That's all we say about it. I'm pretty sure that the views of docs and scientists at these medical centers qualify as significant views, and I doubt that they are outweighed by science bloggers. --Middle 8 (t • c | privacy • COI) 14:50, 26 October 2015 (UTC)

Meta-comment: The widespread use of acupuncture in academia isn't due to stupidity or credulity, no matter how convinced skeptics are that the forces of ignorance are encroaching. Rather, clinicians view things through a different lens: not whether real acu is better than sham, but whether their patients feel better when they get acu versus when they don't. This is a mainstream view, and it's being neglected, again due to tigers who are too attached to promoting or debunking acupuncture: and the debunking tigers are on a much longer leash around here. rest of "meta comment" placed in subsection below --Middle 8 (t • c | privacy • COI) 14:50, 26 October 2015 (UTC) copyedit 21:42, 26 October 2015 (UTC)

Always reliable for the acupuncturist point of view M8, it would appear though that you are unclear what 'widespread use' actually means, and a mainstream view without sources is just waffling. I am curious as to where in academia acupuncture is used? What the evidence for its efficacy is etc. you know, the sort of thing Wikipedia expects us to know about and understand so that our articles can be accurate. -Roxy the dog™ (Resonate) 13:13, 27 October 2015 (UTC)

The sampling mentioned at the beginning above is synonymous with top-tier med schools/clinics. --Middle 8 (t • c | privacy • COI) 18:59, 27 October 2015 (UTC)

These would not be considered WP:RS sources, go ahead and find a review article that states this and we can discuss. CFCF 💌 📧 23:33, 27 October 2015 (UTC)

When an academic medical center says on their own page that they use a modality, a review article isn't needed to verify that fact. Sphere of use isn't a MEDRS claim. We should first just state the fact that it's used, then the pro/con. --Middle 8 (t • c | privacy • COI) 02:51, 28 October 2015 (UTC)

No, but mentioning single institutions is undue. A review article would be needed to show that it is widely used. I also said WP:RS not MEDRS, specifically for this reason. CFCF 💌 📧 15:45, 28 October 2015 (UTC)

Got it. No, I'm not suggesting we have to say it's widely used per se. But why a review article, as opposed to other kinds of (MED)RS? --Middle 8 (t • c | privacy • COI) 00:31, 29 October 2015 (UTC)

This from John Hopkins is RS for places that use it. (Gorski also notes it's used at particular places affiliated with cancer care.) --Middle 8 (t • c | privacy • COI) 18:41, 4 November 2015 (UTC)

There is no weight violation in giving a peer-reviewed review article greater prominence than lower-quality sources. The new sources are fine for reporting the (appropriately qualified) fact that acupuncture is used at these locations, but not for disputing the conclusions of the higher-quality source. I would also avoid the framing in which these sources are implied to be in opposition, since if the new sources are used only to cite sphere of usage, then they don't contradict the statement about evidence - and if they are intended to directly address the evidence, then they would be excluded by MEDRS. This one might possibly be peer-reviewed, but even then it would only be acceptable for citing uncontroversial information, since it's outside the medical literature. Sunrise (talk) 04:35, 28 October 2015 (UTC)

Which higher-quality source are you referring to? If you mean Gorski, it's not a review article (I too assumed so initially), it's an opinion piece in Nature Reviews Cancer (screenshot). Still, it turns out to be a really good, wide-ranging source for CAM sphere of use. --Middle 8 (t • c | privacy • COI) 11:47, 28 October 2015 (UTC)

Well, to be strict, it's a "review-type article," at least in my understanding of their structure. It's specifically in Perspectives>Opinion, not Opinion directly - Nat Rev Cancer doesn't have a "standard" Opinion section. (In case I'm mistaken about how that works, I'll cite the section description: "an opportunity to present a new or revised model or hypothesis on the basis of research data," [32] though this article itself doesn't really fit neatly into that.) I do think it's reasonable to e.g. consider using attribution, especially if sources of similar quality are available, but the comparison was to university/hospital websites in this case. :-) Sunrise (talk) 08:36, 29 October 2015 (UTC)

Good way to describe the Gorski source. Sounds like we're pretty close re: not juxtaposing his framing of clinical use with the initial mention of said use itself. More later re wording idea... ok, how about this. --Middle 8 (t • c | privacy • COI) 06:26, 4 November 2015 (UTC) added diff 15:29, 4 November 2015 (UTC)

Wow, the version by Middle 8 reads a bit like a promotional text.

The usage of acupuncture in John Hopkins is overstated? It's listed as an example of "increasingly used", but it's done only because a foundation is throwing money at it, and it's only 15 patients a week![33]

Surely there's a better wording..... --Enric Naval (talk) 21:59, 4 November 2015 (UTC)

To promote acupuncture by saying that these institutions are running small trials is WP:UNDUE. The current text makes it sound like it has wide acceptance, and even if it did at those institutions it isn't WP:DUE to mention single institutions. CFCF 💌 📧 22:25, 4 November 2015 (UTC)

Enric Naval, CFCF -- my goal is, per NPOV, to disentangle facts about scope of use from opinion about scope of use. Which means, at a minimum, splitting the current wording (the sentence in red above) in two.

Acupuncture is used at academic medical centers at nearly all of the Top 10 Med schools in the US [34] (the only one I can't verify is #6), and at least half of the Top 10 in the world [35]). That seems relevant to reception and scope.

CFCF, it's reasonable to debate sourcing to individual institutions; opinion on that has been divided in the past. But it is also UNDUE to suggest in WP's voice that these places are acting unscientifically or unethicallly. They have their reasons.

Enric, "increasingly used" is from (and cited to) Gorski's review/opinion piece, and is not promotional. I used the Hopkins source to cite clinical use at Hopkins and elsewhere, not the "increasingly" part.[[36] --Middle 8 (t • c | privacy • COI) 04:43, 5 November 2015 (UTC)

If you have one source that says they are the top 10 schools in the US and another that says that these schools use acupunture it is WP:synthesis or WP:original research to suggest that the top 10 schools in the US use acupuncture. Either we need a reliable source that ties these two together on their own, or we omit it from our articles. The alternative, which is singling out specific institutions is undue. CFCF 💌 📧 12:34, 5 November 2015 (UTC)

Not saying we must mention Top 10 -- but sphere of usage, given how important these places are, weighs, and we shouldn't overdo the "it's quackery" view. And this mentions some of those places and is RS. --Middle 8 (t • c | privacy • COI) 23:17, 5 November 2015 (UTC)

I have restored an earlier version[37] per Talk Page discussion. The other editors are invited to participate the discussion as well. Meanwhile, better to WP:TALKDONTREVERT. Cheers! Jayaguru-Shishya (talk) 00:01, 8 November 2015 (UTC)

You partly beat me to the punch, J-G; I was about to do a partial revert and improve that edit (less chance of revert wars that way), so here goes. CFCF and Enric made some points I've tried to address: see this, for sec RS citing an institution, and this to clarify what supports what. I'm still not clear on whether CFCF is really saying that we must use review articles for sphere of use, as opposed to other good sec RS.

Anyway, it's now the second para under Acupuncture#Adoption. After some tweaking, it looks like this (refs shown for clarity). I have a hard time reading this as "promotional" toward acupuncture:

In the US, acupuncture is increasingly (as of 2014)^Gorski used at academic medical centers.^Gorski Examples include those at Harvard University,^Highfield Stanford University,^{Bennet Swingle} Johns Hopkins University,^{Bennet Swingle} UCLA^{Bennet Swingle} and at least a dozen others.^{Bennet Swingle} Usually treatment is given through CAM centers or anesthesia and pain management services.^{Bennet Swingle} This usage has been criticized owing to there being little scientific evidence for explicit effects for any condition that is discernible from placebo.^Gorski Acupuncture has been called 'theatrical placebo',^Colquhoun and David Gorski argues that when acupuncture proponents advocate 'harnessing of placebo effects' or work on developing 'meaningful placebos', they essentially concede it is little more than that.^Gorski

(Note that I normally wouldn't put the same ref after each academic center; just trying to be as clear as possible while we discuss.) --Middle 8 (t • c | privacy • COI) 14:27, 8 November 2015 (UTC)

Also, could editors on the Talk Page please enlighten me about the difference between these edits[38]? Thanks! Jayaguru-Shishya (talk) 00:03, 8 November 2015 (UTC)

Some water has passed under the bridge since then.... see section above. --Middle 8 (t • c | privacy • COI) 14:27, 8 November 2015 (UTC)

Thanks for your response, Middle 8. Yeah, I just saw your latest edits[39], and it looks a lot better now. Cheers! Jayaguru-Shishya (talk) 16:13, 8 November 2015 (UTC)

Ernst '11, real and sham ... redux redux

See archived talk: my opening comment, & scroll to "Everymorning" for their suggestion which was implemented with consensus at the time. As noted, Kww and LesVegas and Alexbrn and J-S and 2/0 and Herbxue and most other editors who have carefully read the paper have all agreed that the old wording is a misreading. restoring Everymorning's suggestion: [40] --Middle 8 (t • c | privacy • COI) 07:18, 26 October 2015 (UTC)

The old wording was:

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.

The edit changed that to:

A systematic review of systematic reviews found numerous contradictions in the evidence regarding acupuncture's effectiveness for treating pain.

That's a big change, and the new wording is so waffly that it has almost no meaning. I have only browsed the earlier discussion and would have to study it all to form a firm opinion, but while it may be true that the systematic review (that is, the Ernst reference) did not "find" that conclusion about sham acupuncture, a significant portion of the ref's discussion section was dedicated to outlining the "recent results" in a way that suggests Ernst believed that his outline of those results was consistent with the review. It looks as if the Ernst ref supports a stronger statement than the above edit. Johnuniq (talk) 10:11, 26 October 2015 (UTC)

Yes -- if you read the archived discussion (particularly my opening comments) and the relevant portions of article itself, I think you'll see that the new wording is a good summary. That is, it's a good summary of the source, which covers dated and often poorly-designed studies, which is a big point Ernst makes. --Middle 8 (t • c | privacy • COI) 11:20, 26 October 2015 (UTC)

OK just made another couple edits to summary so it now says

A systematic review of systematic reviews found little evidence of acupuncture's effectiveness in treating pain.

That's sufficient, I think, since inconsistency of evidence is mentioned above, and I added Ernst '11 as a source for that statement as well. (Contradictions in the evidence being one of the ways it's inconsistent.) --Middle 8 (t • c | privacy • COI) 12:38, 26 October 2015 (UTC)

I see that CFCF reverted with no explanation besides "No, the previous version was far superior" [41]; I've invited them to comment here. [42]. --Middle 8 (t • c | privacy • COI) 18:48, 27 October 2015 (UTC)

We should not hide that "fake" poking is as effective as "real" poking. -- TRPoD aka The Red Pen of Doom 21:47, 27 October 2015 (UTC)

When sources say that, yes. Did you read this one? --Middle 8 (t • c | privacy • COI) 21:56, 27 October 2015 (UTC)

N.B. TRPoD et. al. - Ernst didn't say that the "real = sham" result was consistent with his review. He predicted that, as methods improved, pain trials would trend in that direction, instead of being all over the place. --Middle 8 (t • c | privacy • COI) 12:44, 28 October 2015 (UTC) ping'd 01:27, 29 October 2015 (UTC)

Since there's apparently no objection, I'll restore the wording: A systematic review of systematic reviews found little evidence of acupuncture's effectiveness in treating pain. This isn't meant to be the final word (or lack thereof) on sham vs. verum -- just a proper summary of this source. --Middle 8 (t • c | privacy • COI) 06:37, 4 November 2015 (UTC)

To explain my objection, here is a quote from Ernst 2011's discussion section: "These findings should be seen in the light of recent results from high-quality randomized controlled trials. Cherkin et al. have shown that, for chronic low back pain, individualized acupuncture is not better in reducing symptoms than formula acupuncture or sham acupuncture with a toothpick that does not penetrate the skin". There is more like that. Johnuniq (talk) 10:10, 5 November 2015 (UTC)

That's exactly what I'm referring to when I talk about reading in context... "these findings" being the all-over-the-place findings of the reviews that he is reviewing, and the real/sham result being the finding of two recent high-quality trials (Cherkin [14] and Suarez-Almazor [128]). In the Discussion section (5th para, top of p.762) he compares those more recent trials with his findings from the reviews, and predicts the direction of future research. But we wouldn't excerpt that material out of context and take it as a finding about the whole body of literature reviewed. Rather, conclusions are exactly as he states: "contradictions abound", and there is "little truly convincing" evidence for efficacy.

A number of good trials have found real=sham, but not all, and reviews including Ernst '11 and Vickers '12 (the two best we have) reflect this. --Middle 8 (t • c | privacy • COI) 23:38, 5 November 2015 (UTC) copyedit 03:46, 6 November 2015 (UTC)

Yes, and my comment at 10:11, 26 October 2015 above indicates my understanding of what is in the discussion. Nevertheless, it's a bit of a stretch to reduce a paper with that discussion to something which suggests no opinion. I'm not particularly disturbed, and merely wanted to record that "no objection" wasn't completely right. Johnuniq (talk) 08:06, 6 November 2015 (UTC)

Agree, it should be stronger than suggesting no opinion, and I think you make a valid point in your comment above. Hence my edit series of edits changing Everymorning's wording to stronger wording. Thanks; sounds like we're not too far apart. --Middle 8 (t • c | privacy • COI) 08:41, 6 November 2015 (UTC) corrected last diff 06:20, 9 November 2015 (UTC)

Mechanism and control groups (somewhat meta, but helpful)

(refactored from above):   We don't need proven mechanisms to reasonably consider efficacy, just plausible ones. [43][44][45][46] --Middle 8 (t • c | privacy • COI) 22:44, 2 December 2015 (UTC)

I don't see a proposed mechanism which distinguishes "true" acupuncture from "false" (needles inserted at arbitrary points) acupuncture, although some proposed mechanisms distinguish either from non-penatural ingredients "acupuncture". Still, effectiveness doesn't require a plausible mechanism. — Arthur Rubin (talk) 15:27, 20 December 2015 (UTC)

@Arthur Rubin-- (Your comments are insightful, and appreciated.) I'm not sure what your "although..." clause means. On your preceding clause, IIRC, there are studies suggesting differences (between verum and sham acupuncture) in FMRI or endorphin release, both of which obviously have implications for mechanisms, not to mention efficacy.

BTW, comparing verum to sham is complicated by the fact that "sham" can mean multiple things -- hence STRICTA -- and does not always equate to a meaningful definition of placebo. The famous GERAC's version of sham was shallow insertion at acupoints, and they even went so far as to elicit de qi (a distinctive subjective response that TCM generally considers necessary, and which is more specific than just knowing you got stuck with a needle). TCM considers both acupuncture arms of GERAC to be verum, and the observed difference between the two does not equate to "efficacy with respect to placebo treatment". Someone needs to do a meta-analysis of verum vs. the different kinds of "sham".

Anyway, Merry Christmas to all! --Middle 8 (t • c | privacy • COI) 13:15, 25 December 2015 (UTC)

My smartphone's autocorrect significantly damaged what I wrote. What I intended to write was: although some proposed mechanisms would distinguish [acupuncture, and "randomized" acupuncture] from non-penatrating "acupuncture". I have no idea what was autocorrected to "ingredients" — Preceding unsigned comment added by Arthur Rubin (talk • contribs) 17:56, 25 December 2015 (UTC)

Well, they have to be reasonably plausible, not barely plausible, and that's a bit more of a problem since for many of the conditions acupuncturists purport to treat the purported mechanisms are either fatuous (qi) or very far-fetched. Guy (Help!) 22:03, 2 January 2016 (UTC)

No surprises here.

If Your Veterinarian Offers Acupuncture, Find a Different Vet. Guy (Help!) 01:26, 19 December 2015 (UTC)

Silly article. The actual review they cite concludes: "For cutaneous pain and diarrhea, encouraging evidence exists that warrants further investigation in rigorous trials. Single studies reported some positive intergroup differences for spinal cord injury, Cushing's syndrome, lung function, hepatitis, and rumen acidosis. These trials require independent replication. On the basis of the findings of this systematic review, there is no compelling evidence to recommend or reject acupuncture for any condition in domestic animals. Some encouraging data do exist that warrant further investigation in independent rigorous trials." This article is cherry picking and POV-pushing. No surprises here.Herbxue (talk) 21:17, 19 December 2015 (UTC)

Ah yes, the SCAM "get out of jail free" card: more trials are needed. And I support more trials, just as soon as they come up with a credible mechanism and good quality basic science research proving the existence of what they want to test. Anything else would, of course, violate the Declaration of Helsinki. I am still waiting for the proof that qi exists, but it seems oddly elusive :-) Guy (Help!) 22:43, 19 December 2015 (UTC)

The "more studies needed" conclusion is commonplace in medical research of all kinds. This systematic review found encouraging evidence of efficacy - in a population that supposedly does not experience the placebo effect. Herbxue (talk) 01:18, 21 December 2015 (UTC)

I'd be pretty surprised to hear anyone familiar with the scientific texts to criticize the "further investigation is needed" clause in the conclusions of each scientific paper. That's the case we face with the human sciences, be it medicine, economics, or sociology; nothing isn't really carved in stone, and the scientists do hedge their position. Moreover, we do not need - nor do we allow - a second peer-review by anonymous Wikipedia editors. Cheers! Jayaguru-Shishya (talk) 21:04, 2 January 2016 (UTC)

That's irrelevant, because the context is SCAM studies. Any SCAM study with a weak result, especially a negative result that's been spun into a positive one by P-hacking, has this text. SCAM proponents always keep asking until they get the answer they want, and since no competently conducted study ever delivers the answer they want, the conclusion is always that they should keep asking. And, per the Declaration of Helsinki, the vast majority of their trials are unethical, because there is no remotely plausible mechanism by which the study population can benefit form the results of the research (the only way they could would be if fraudulent treatments were dropped, and as we know, no negative result is ever considered valid by SCAM proponents, and many are never even published). Guy (Help!) 09:45, 21 December 2015 (UTC)

Are you suggesting an edit, or just using this as a forum to vent and make stuff up?Herbxue (talk) 20:50, 21 December 2015 (UTC)

I don't see the "summary" you posted above as at all positive. However, Guy, the Declaration doesn't apply to veterinary research. (We could discuss some of the more unethical phrases in the Declaration at a later date, in a different forum.) — Arthur Rubin (talk) 17:59, 22 December 2015 (UTC)

If 'SCAM' isn't some kind of acronym that I am unaware of, then what makes a study's context an a priori 'scam'?

In real science (not sure if medicine counts as such) there are many examples of 'scientific facts' that once had consensus as well as a lack of 'plausible mechanisms' to support alternatives (e.g. the earth standing still and NOT rotating or going around the sun), but that were later determined to be wrong. Having said that, I personally consider acupuncture to be a (originally well-intended) pseudo-science. But I base that view primarily on the outcome of studies (i.e. checking the claims) rather than the largely irrelevant lack of a 'plausible mechanism'.

Try to convince astronomers that Dark Matter is an a priori 'SCAM' because there is no 'plausible mechanism' (yet)... 110.23.118.21 (talk) 09:05, 8 January 2016 (UTC)

SCAM: Supplements, complementary and alternative medicine. Guy (Help!) 00:09, 14 January 2016 (UTC)

I think a translation is required. "further investigation is needed" = "Please continue funding my work" -Roxy the dog™ woof 09:09, 15 January 2016 (UTC)

JzG's removal of overview of SRs

JzG claimed in his revert of my edit in which I added this article that the journal in which it was published is "low level". [47] However, this is not true: the journal in question, Scientific Reports, is published by the prestigious Nature Publishing Group and has an IF of 5.578. [48] It is, however, true that, as JzG also said, the authors of the article (an overview of systematic reviews) are Chinese. But I don't think this is necessarily, in and of itself, a good reason for excluding this article, which meets the MEDRS criterion about being a secondary source exceptionally well, being an overview of systematic reviews. I would like to hear from other editors as to whether they think this overview belongs in this article. Everymorning (talk) 02:22, 14 January 2016 (UTC)

Agree with Everymorning. The ethnicity of the authors is irrelevant, what matters is their scientific background and the quality of the journal. The article is written by researchers of the prestigious Chinese University of Hong Kong, and published by a reputable scientific journal, and should be considered reliable. -Zanhe (talk) 04:42, 14 January 2016 (UTC)

Unsuitable. Did anybody look at the provenance of the authors. I'm surprised it was added. Interested to see other comment. -Roxy the dog™ woof 08:48, 15 January 2016 (UTC)

The source is reliable. JzG is pulling a Donald Trump. Roxy, how much do you know about those specific institutions? Herbxue (talk) 21:52, 15 January 2016 (UTC)

That statement is deeply (and I think deliberately) offensive. The problem of Chinese studies of quackery is documented in reliable independent sources. It is a systemic bias based on well understood cultural norms. It is no more racist to describe this than it was racist for Peter Piot to describe the spread of AIDS among sex workers in African countries. Here's a paper addressing precisely this area: bias in Chinese studies of acupuncture. [49] Guy (Help!) 00:07, 16 January 2016 (UTC)

The only pic I have ever seen of Guy, he was wearing a bicycle helmet. I doubt an experienced editor like him would dare to sport a Trump haircut. -Roxy the dog™ woof 08:35, 16 January 2016 (UTC)

The accusation of racism is not trivial, and is deeply offensive. The issue of systemic bias in Chinese studies has been discussed before. The rhaphiophiles have already been shown this evidence, they just don't like it. Guy (Help!) 09:39, 16 January 2016 (UTC)

The "bias in Chinese studies of acupuncture" you cited above is itself written by mainland Chinese researchers, which shows how ridiculous it is to dismiss papers purely based on the ethnic background of its authors, especially those published in peer-reviewed Western journals. If the Nobel Prize committee finds it suitable to award a Chinese scientist with a strong focus on traditional Chinese medicine (Tu Youyou) the Nobel Prize for Medicine, there's no reason for us to dismiss all Chinese research as unreliable. -Zanhe (talk) 20:53, 16 January 2016 (UTC)

That is rather an odd view. The fact that the authors are Chinese shows that the report is not motivated by anti-Chinese sentiment. I can't think of anyone more appropriate to analyse the systemic bias in Chinese studies. And this is not the only paper to find this - for example, Ernst has also noted that almost all Chinese-authored studies of acupuncture are positive. And the context here is a study by Chinese authors purportedly finding benefit in some random conditions for which no consistent plausible mechanism of action exists. That speaks of P-hacking, if nothing else. Guy (Help!) 22:26, 16 January 2016 (UTC)

The Trump comment was heavy-handed in retrospect, I apologize, it was intended to be a light-hearted jab . If you refer to the discussions about including ethnicity as a way of excluding sources, the consensus was formed that we did not need to protect against using ethnicity to exclude a source because it was so absurd to do so that nobody would ever do it. But here we are again. It is not acceptable to dismiss a source on the basis of ethnicity, period. You have to look at the quality of the journal, and the body of work of the individuals. I highly doubt you have had enough exposure to Chinese medicine researchers in Asia to appropriately assess the quality of their work. Ernst's article citing one (Chinese) review of SOME poorly conducted studies is just not enough to rule out all Chinese journals, much less articles in respected Western journals written by Chinese authors. There may be real concerns with this paper, but I haven't seen a REAL concern raised yet.Herbxue (talk) 17:37, 16 January 2016 (UTC)

A study that contradicts the consensus view, by aggregating studies with known risk of bias. This is exactly the sort of source we should not include. Remember the great sub-prime mortgage crisis? It happened because people aggregated crappy mortgages and pretended that the aggregate was somehow not crappy. Guy (Help!) 22:28, 16 January 2016 (UTC)

Just so I am clear, here we have a systematic review (secondary source) that is published in a high impact, western medical science journal that is indexed in Medline and published by the Nature Publishing Group, but it is being rejected by an administrator (Guy) because the authors are Chinese (added:) and authorship Nationality is a potential source of bias? Is this a correct interpretation of the issue here? Can we really reject a source based purely on the Nationality of the authors? 2001:56A:75B7:9B00:81A8:1EE6:5502:9C83 (talk) 23:49, 16 January 2016 (UTC)

That is a complete misreading of the situation. If you want to make a comment, try responding to the post at 00:07, 16 January 2016 above. Johnuniq (talk) 01:14, 17 January 2016 (UTC)

Johnuniq, the only concern raised by Guy is with regard to author Nationality as a potential source of bias. I believe that the source under question must be considered on more than one potential source of bias, in this case, the Nationality of the authors. Where is the consideration of this being a secondary source? or that it is published in a very high impact journal? or that the journal is a Western medical journal (not a Chinese publication)? or that the journal is published by a highly credible scientific publisher? As such, it seems that the basis for Guy's rejection is based purely on the fact that the Nationality of the authors as a potential source of bias. However, the balance of variables to consider seem to weigh heavily in favor of including the source. PS. Johnuniq: I have added a qualifier to my comment above to ensure that it is understood that my concern is with the emphasis of a single variable on inclusion decision, rather than mistakenly give the suggestion that it is a racial issue.108.181.201.237 (talk) 02:48, 17 January 2016 (UTC)

Did you examine the paper linked in the post I mentioned? That's the part which needs a response. There is no need to speculate about what Guy thinks because he wrote very clearly and provided a link to demonstrate his point. Johnuniq (talk) 04:04, 17 January 2016 (UTC)

Yes, I read the paper, but it is not at all a convincing argument for exclusion of this secondary source. Have you read the results of the 2011 study posted by Guy? It found that most systematic reviews of acupuncture that are published in Chinese journals did not use the most up-to-date Cochrane risk of bias tool available, but it found that ~75% did do some kind of 'inferior' risk of bias assessment (ie: using older Cochrane tools, or the Jadad scale were most common); reporting was also often incomplete. I could actually see this as a reason to consider excluding a source that was published in a Chinese journal, especially if it was itself assessed in the review posted by Guy and found to be flawed. However, in this case, it is a very far-fetched reach to use the 2011 article posted by Guy that critically assessed reviews published in Chinese journals to suggest that a 2015, peer-reviewed secondary source, published in a medline-indexed, high-impact, Western medical journal from a very reputable publisher should not be included in the wikipedia article.2001:56A:75B7:9B00:5923:32E2:CCE:307D (talk) 03:13, 19 January 2016 (UTC)

Until WP:MEDRS is changed, we shouldn't exclude sources on the basis of the country of origin of the authors. As you know, this has been discussed at length and there's no consensus for making this change to the guideline. This source appears to meet the criteria set by Wikipedia's guidelines. TimidGuy (talk) 12:08, 19 January 2016 (UTC)

• Another systematic review/meta-analysis has just been published in the same high-quality journal and might also be worth adding to the article here. Inclusion might as well be discussed along with the other source as they are both relevant secondary sources from the same MEDRS-compliant publication. See: [50] — Preceding unsigned comment added by 75.152.109.249 (talk • contribs)

It might be useful if reliable sources could actually be produced to state on a good empirical basis that Ernst, also Yuyi Wang, Liqiong Wang, Qianyun Chai, and Jianping Liu are wrong about the unreliability of trials of acupuncture from within the Chinese academic system? Other sources that support great caution with results from certain academic jurisdictions: Controlled Clinical Trials. 1998 Apr;19(2):159-66. Do certain countries produce only positive results? A systematic review of controlled trials. Vickers A, Goyal N, Harland R, Rees R. (China, Japan, Taiwan, Russia are mentioned.) BMJ. 1999 Jul 17; 319(7203): 160–161. Review of randomised controlled trials of traditional Chinese medicine. Jin-Ling Tang, Si-Yan Zhan, and Edzard Ernst Chinese sources only. Can anyone give us a reliable source to contradict these? Richard Keatinge (talk) 16:16, 28 January 2016 (UTC)

First, not sure about Ernst's blog (not MEDRS, so not relevant here), but Yuyi Wang, Liqiong Wang, Qianyun Chai, and Jianping Liu did not say trials of acupuncture published in Chinese journals are unreliable, they said that they commonly did not use the most up to date cochrane risk of bias tool (they used other risk of bias tools) thus there is the potential for bias in such articles in chinese journals. This does not invalidate them, it just adds a potential source of bias. Second, perhaps someone can explain why we care what Yuyi Wang, Liqiong Wang, Qianyun Chai, and Jianping Liu have to say about articles published in Chinese journals when we are discussing reviews published in a mainstream, western medical journal with high impact factor and solid publisher.2001:56A:75B7:9B00:F4B4:1A16:8F56:249C (talk) 16:26, 28 January 2016 (UTC)

Ernst is a highly notable commentator who conveniently sums up an issue. And we are discussing work originating from (and often, but not always, published in) specific academic jurisdictions. I hope this helps. Richard Keatinge (talk) 16:36, 28 January 2016 (UTC)

Does not help with the discussion at all Richard Keating. Ernst's blog is a self-published source and carries no weight in a discussion of MEDRS sources, plus it is irrelevant because he is summing up an issue with Chinese journals and we are not discussing Chinese journals. The source produced by Guy, and discussed in Ernst's blog, states in the discussion: "We only selected SRs and MAs published in Chinese journals and therefore our results are only applicable to those journals." Here we are discussing inclusion of 2 systematic reviews published in a Western medical journal. No editor has provided any convincing rational for why we would exclude 2 secondary sources from a Western medical journal on the basis that an older review suggests there is the potential for bias in articles published Chinese journals.75.152.109.249 (talk) 17:15, 28 January 2016 (UTC)

To repeat, we have RS saying clearly that certain types of work from certain jurisdictions is not really science because those jurisdictions only publish positive results. Rehashing the positive results really isn't helpful. It would be helpful to find RS that give good reason to believe that the papers presented are in fact reliable. Until then we should use the relevant types of work, from the relevant jurisdictions, very carefully indeed and only within a clear frame of their limitations. Using them, without warnings, to support a statement in Wikipedia's voice is not good. Richard Keatinge (talk) 18:08, 28 January 2016 (UTC)

Here, we are not discussing any work from those jurisdictions you speak of (Chinese journals), so there is no logic to your statement. We are discussing work from a western journal, not a Chinese journal. Where is the source that says articles about acupuncture published in Western medical journals are not really science? That is what would be required to suggest that the reviews being discussed here are not worthy of inclusion.75.152.109.249 (talk) 18:21, 28 January 2016 (UTC)

The problem is with the entire corpus of papers on which your source relies. Publishing meta-analyses etcetera of work known to be unreliable is only as good as the primary work. Garbage in, garbage out. Richard Keatinge (talk) 18:38, 28 January 2016 (UTC)

The problem is with systematic reviews published in Chinese journals and the problem is a risk of bias, not 'lack of real science'. The systematic review under question here is not in a Chinese journal and only had 13% of the studies it examined come from Chinese publications (a small minority). Moreover, the review under discussion did a risk of bias assessment for all of the articles that it included (as per appropriate systematic review procedure) and was deemed appropriate for publication in a well-respected western medical journal. There is no rational grounds for excluding this review.75.152.109.249 (talk) 18:48, 28 January 2016 (UTC)

The review under question is a review of systematic reviews, which depend largely on primary work whose unreliability we have established. No analysis can be better than its primary material. The problem is not with the journal of publication or with the affiliation of the authors of this specific review. It is with the nature of their primary material. To repeat, we should use the relevant types of work, from the relevant jurisdictions, very carefully indeed and only within a clear frame of their limitations. Richard Keatinge (talk) 18:57, 28 January 2016 (UTC)

The purpose of a systematic review is to find and assess the quality of all the available relevant literature. Here, you are suggesting that wikipedia editors should be assessing the quality of primary sources to determine if a systematic review can be included. MEDRS asks us to use secondary sources so that the information is filtered, I see no policy provision for editors to assess secondary sources based on the quality of primary sources they review, that is the exact job of the systematic review itself. Here, we have a solid secondary source published in a respected and high-impact journal and peer reviewers have decided that the source, and it's interpretation of the primary source that it assessed, were worthy of publication. Now we have wikipedia editors doing their own review and suggesting that the primary sources may not be good enough so we cannot allow the inclusion of a secondary source? Please show some policy that supports this approach.75.152.109.249 (talk) 21:19, 28 January 2016 (UTC)

We should follow RS on the quality of sources. We have clear and reliable evidence that rather a lot of the primary literature is poor. I would be interested to see any guidance that allows us to interpret this to mean that their aggregated results are good. To repeat, we should use the relevant types of work, from the relevant jurisdictions, but we should do so very carefully indeed and only within a clear frame of their limitations. And, while these strange wrangles carry on, the article remains in a very poor state. Richard Keatinge (talk) 21:46, 28 January 2016 (UTC)

It seems rather difficult to improve the article when there are arguments over just including high-quality secondary sources that policy seems to support. I do not see how any source can be included in this wikipedia article under the general terms you are suggesting. If questions about the quality of a subset of the primary literature on a topic can be generalized to exclude all secondary sources on a topic (even those in the best journals), how can the wikipedia article be expected to evolve? This likely warrants a post on the RS noticeboard I think....do you agree?75.152.109.249 (talk) 22:07, 28 January 2016 (UTC)

Feel free. I'll be impressed if you can come up with guidance that says we should use, uninterpreted, the aggregated results of a corpus of work that is known to be unreliable. I think there's been far too much wrangling on the drama boards already and I can't see that more will help. Personally I'd suggest putting the effort into rewriting the article, which is in a parlous state. We do need to give an overview of the literature, including the point that much of it is entirely biased - this graphic is probably a good summary. That doesn't mean leaving out the biased literature. But we should not present it, or analyses which rely on it, in Wikipedia's voice. Richard Keatinge (talk) 22:24, 28 January 2016 (UTC)

Having read through the discussion above, I take extreme exception to the idea that this journal article (http://www.ncbi.nlm.nih.gov/pubmed/26608664) should be discounted because of the race of the authors. This is probably the most insane thing I've read on a Wikipedia talk page. It is a reliable source. The fact that its interpretation of primary sources clashes with the interpretation of the same primary sources by other secondary sources is not a reason to exclude it. It just means that we can include those other sources as well. I usually don't make remarks against other editors, but the discussion took such a strange turn that I could not but comment. Seriously. And the idea of us editors coming along and picking all the holes in the articles and then refuting them on our own grounds also does not wash. If you disagree so much go get a paper published with explicitly rebuts those allegations, and then use that to argue. Or else show that this paper was explicitly discounted. Cleopatran Apocalypse (talk) 04:46, 29 January 2016 (UTC)

The idea of discounting work because of the race of the authors is indeed a bizarre suggestion and one to be rejected on sight. You seem to be the only editor making it. Just to clarify, we have excellent evidence that, in this field, work from certain academic jurisdictions (RS denominate these by nations of origin) is biased, so biased as to be invalid. This is a major point which should frame any outline of that work. I hope this helps. Richard Keatinge (talk) 07:36, 29 January 2016 (UTC)

Read the edit comment accompanying the original revert that removed the content [51], I'd say a majority of readers would consider it racist. If a research is published by a peer reviewed, reputable Western journal, it satisfies WP:MEDRS unless it's later overturned or retracted. If the academic reviewers and editors do not find bias in the research, who says we are more qualified to overturn their judgment? -Zanhe (talk) 00:59, 2 February 2016 (UTC)

We need to use all the RS to write a good article. In this case, we have RS that say clearly that other groups of RS are so biased as to be invalid. I feel that a bold edit is needed, aiming to outline briefly at the top of the relevant section the RS that describe the evidence for bias, and then to describe the results of the probably-biased RS (even if they are biased they are still reliable sources for the existence of their claims, and they are clearly notable) within that section. Richard Keatinge (talk) 10:02, 2 February 2016 (UTC)

You just have to be careful to not imply that the RS describing bias is specifically referring to specific papers not covered by the review showing bias. It would be original research (and a stretch) to suggest that the paper showing certain Chinese trials did not follow best practices is generalizable to all research done by people with Chinese names. The findings of that review should be included in the article, but not used as a lens through which we view other sources beyond the papers it reviewed. Herbxue (talk) 23:12, 2 February 2016 (UTC)

Unfortunately the RS describe bias within specific national academic communities, and we should precisely and carefully use them to frame the relevant "research" done within those communities. This might change if we have RS to say that these communities have changed their habits, and I suppose the lapse of sufficient time for all researchers active at the time of our RS to have left work, say fifty or sixty years, might also justify not using our RS. If you want to disallow this use of RS, you would therefore need to wait to, say, 2050 and gain consensus, or find other RS that give good reason to believe that the relevant academic habits have changed. Richard Keatinge (talk) 10:43, 3 February 2016 (UTC)

Two questions

Question the first: I finished reading the article and wondered that if acupuncture is such a load of quackery, why is it so popular? Perhaps the article could include some of the literature on that. Perhaps like racism, fascism, and Donald Trump, this can be explained by the general susceptibility of the population to believe things that they think superficially think sound good, or that play to their emotions. Or, something else. I don't care, particularly, but I read the article and I'm confused about why there is no explanation of this.

A good point, though we would need RS relating it to acupuncture if we are to include them here. Didn't Aristotle define humanity as the animal with a desire to take medicine? Maybe a better question would be: why do a tiny minority of people sometimes insist on good evidence to believe things, rather than just following the herd and their own wishful thinking? This discussion probably isn't appropriate here. Richard Keatinge (talk) 07:50, 29 January 2016 (UTC)

Question the second: why is there no section setting forth the epistemological basis on which acupuncture supposedly rests? There is a lot of debunking of it within the epistemology of the empirical sciences, and there is some arm-waving section about qi and whatnot, but there is no discussion of the first principles upon which acupuncture is presumably based for it to be believable by anyone in the first place. All the scientific-epistemological refutation seems to boil down to is: we don't understand how this works so it must be a placebo. Of course, it's not put that way, but that's me reading between the lines. I would have thought that these meta issues would be addressed in frank language somehow. Cleopatran Apocalypse (talk) 04:58, 29 January 2016 (UTC)

As for the principles on which acupuncture is traditionally based, they exist and we have some discussion of them. They don't relate to anything revealed by science about the human body, but then, neither does humoral theory, and that's still used too. No doubt the article could be improved - it really is in a bad state - so do feel free to find RS that address the matter explicitly. Richard Keatinge (talk) 07:50, 29 January 2016 (UTC)

In conclusion, it seems that there are no particular reasons for not including RS discussing the reasons for the popularity of acupuncture, and that there is no particular reason for not engaging in an RS-based discussion of the epistemological ground on which acupuncture is presumed to rest. I will look into the availability of sources on those topics. I will review my Unschuld a bit later and see if there is anything useful on at least the epistemic front. Cleopatran Apocalypse (talk) 04:30, 1 February 2016 (UTC)

See argumentum ad populum. Guy (Help!) 12:54, 1 February 2016 (UTC)

You may have misunderstood my question or not read it closely. I am not suggesting that we engage in arguing for the practice of acupuncture based on its popularity. I suggest that readers will probably be curious about the reasons for its popularity, in particular in the context of an article that roundly debunks its efficacy. It may make sense to cite RS which discuss why acupuncture is popular. That is all I mean.Cleopatran Apocalypse (talk) 04:23, 5 February 2016 (UTC)

Sounds good. I have no idea what if anything may be available and look forward to profiting from your research. Richard Keatinge (talk) 09:23, 5 February 2016 (UTC)

Semi-protected edit request on 20 February 2016

Hi I work at the Dallas Museum of Art under the Asian curator and have chronically been studying East Asia both before I started working there and currently as my job. To be frank, this article is problematic and seems like disinformation. The article takes an incredibly negative, western-centric tone towards acupuncture especially in the initial description where a balanced view is the most important. In outright dismissing the medicine technique wikipedia is doing a disservice to people seeking knowledge. From the article someone with no experience or understanding of acupuncture would likely gather at the very best it only has minor effects on things such as pain relief and that in all likelihood it is a placebo effect.

If anything the flagrant second paragraph in the intro (flagrant due to its purely negative, unbalanced tone) needs to be qualified. I am referring to:

"The conclusions of many trials and numerous systematic reviews of acupuncture are largely inconsistent.[5][13] An overview of Cochrane reviews found that acupuncture is not effective for a wide range of conditions, and they suggest it may be effective for only chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache.[13] An overview of high-quality Cochrane reviews suggests that acupuncture may alleviate certain kinds of pain.[14] A systematic review of systematic reviews found little evidence of acupuncture's effectiveness in treating pain.[5] The evidence suggests that short-term treatment with acupuncture does not produce long-term benefits.[15] Some research results suggest acupuncture can alleviate pain, though the majority of research suggests that acupuncture's effects are mainly due to placebo.[7] A systematic review concluded that the analgesic effect of acupuncture seemed to lack clinical relevance and could not be clearly distinguished from bias.[16]"

Either in the same paragraph following the last existing sentence or in a new one immediately following it I recommend putting in this text or something similar to it:

"It should be qualified that there is the possibility that so called "scientifically" conducted studies can be manipulated depending on who conducted them and for what reason. The colossal, endless profit the western medical industry maintains by perpetuating the belief acupuncture is not effective leads to the possibility bias could affect such studies. For instance, if acupuncture was proven to be effective it could cause sales in prescription pharmaceuticals treating bodily problems to decrease since it is a more natural process absent of the often harmful side effects associated with manufactured drug medications. Indeed, as acupuncture seeks to eliminate the cause of an affliction instead of just relieving its symptoms it would appear much more desirable than opiod and NSAID pain medications that only do the latter. Moreover, if mainstream legitimacy was given to acupuncture by the western medical industry, expensive and invasive surgeries would be needed less frequently and become a last resort measure as they are in East Asia.

For reasons like these, it is potentially not in the best interest of people conducting studies in western countries to believe acupuncture works. Moreover, the methodology of western medicine in which the people leading these studies are trained is inherently dismissive of eastern medicine which could result in subconscious bias. Such bias stems in part from the legacy of Europe's belief in its superiority to other cultures which historical events such as colonialism and the relative geo-political dominance of the West over the past four hundred years have strengthened. Moreover, western doctors conducting studies may lack a proper understanding of Chinese medicine which could potentially make them unsuitable to conduct the study as they may have employed improper techniques and parameters. To understand and become an effective practitioner of Chinese medicine takes years of study and practice as one must master an incredibly complex and unintuitive methodology that sees the maladies of the human body as inter-connected. A person's arm might hurt due to a problem somewhere else entirely on their body. A typical western doctor would just treat the arm and perhaps the immediate muscles surrounding it whereas an acupuncturist may treat somewhere that appears completely unrelated according to western medicine. This likely stems from how western civilization likes to view things as distinct and separate whereas Chinese civilization traditionally viewed existence as being in a state of confluence which meant nothing was singular and everything was related."

If whoever reviews my request thinks the above paragraphs are too positive in respect to acupuncture I ask them to note the negative paragraph right before them and the second one that would follow them if they were inserted that concludes the intro:

"Scientific investigation has not found any histological or physiological evidence for traditional Chinese concepts such as qi, meridians, and acupuncture points,[n 1][25] and many modern practitioners no longer support the existence of life force energy (qi) flowing through meridians, which was a major part of early belief systems.[8][26][27] Acupuncture is believed to have originated around 100 BC in China, around the time The Yellow Emperor's Classic of Internal Medicine (Huangdi Neijing) was published,[28] though some experts suggest it could have been practiced earlier.[7] Over time, conflicting claims and belief systems emerged about the effect of lunar, celestial and earthly cycles, yin and yang energies, and a body's "rhythm" on the effectiveness of treatment.[29] Acupuncture grew and diminished in popularity in China repeatedly, depending on the country's political leadership and the favor of rationalism or Western medicine.[28] Acupuncture spread first to Korea in the 6th century AD, then to Japan through medical missionaries,[30] and then to Europe, starting with France.[28] In the 20th century, as it spread to the United States and Western countries, the spiritual elements of acupuncture that conflict with Western beliefs were abandoned in favor of tapping needles into nerves.[28][31][32]"

This article needs more balance and my proposed edits work towards that. I hope I didn't write all this in vain since I've read new accounts always get dismissed. The current state of it honestly tarnishes wikipedia's usually well-rounded articles.

ZhuGeLiang77 (talk) 23:32, 20 February 2016 (UTC)

Not done: please provide reliable sources that support the change you want to be made. see WP:NPOV and more specifically WP:WEIGHT. Balance and neutrality does not mean giving all sides equal validity. What you perceive as a "biased, western-centric" tone is simply the scientific consensus. If you have a source that contradicts this, feel free to provide it, though be forewarned that it is doubtful you will find something as reliable as a Cochrane review. Cannolis (talk) 00:04, 21 February 2016 (UTC)

Actual Origins of Acupuncture.

Its an Indian Art Form. Its 12,000 years old. Years ago few Chinese people called the experts from India to China and learnt the art from them. After acquiring the knowledge they killed them. They established many schools and popularized this method. Since then this art is thought of having Chinese origins, but its not. In wiki also the actual story is not posted about this method. I will highly suggest to go through the current literature and research on this area to make people aware of the truth.

Nothing serious but after-all truth must be said. — Preceding unsigned comment added by 129.2.54.156 (talk) 20:49, 4 February 2016 (UTC)

Do you have a reliable source verifying this claim? TylerDurden8823 (talk) 03:21, 21 February 2016 (UTC)

Revised Edits and Observations based on Editorial Response to my Prior Edit Request

Sorry if the proper procedure was simply to edit my other edit request, I just wanted the previous request and response to be easily visible so this one will make sense to anyone who hasn't already read the other. In addressing the editor of my previous edit requests' statements I found a number of inconsistencies in current sources under the framework provided by the editor of my previous edit request so if nothing else my observations may be useful for overall consistency with wikipedia's standards for this article. Two separate editing suggestions have evolved out of my forging a response to the "Not Done" comments. They were quite helpful, I've worked the past few hours researching and creating a productive response so please hear me out since I tried my best to address the concerns brought up.

Edit 1: In the introduction the phrase "Some research results suggest acupuncture can alleviate pain, though the majority of research suggests that acupuncture's effects are mainly due to placebo.[7]" should be changed to "Some research results suggest acupuncture can alleviate pain, while other research suggests that acupuncture's effects are mainly due to placebo." If you take the time to look at the source for the existing statement (a link is not provided in the citation I had to find one http://www.ncbi.nlm.nih.gov/pubmed/16420542) the study does not suggest acupuncture's effects are placebo but rather needles resulted in patients believing a positive effect had taken place even when the needles did not correlate to pressure point locations and meridians according to Chinese medicine (known as placebo needles). All this means is the effects of acupuncture are not understood and that the traditional Chinese medicinal parameters do not fully grasp the complexity of the human body. It would be incorrect to state what is currently posted based on the source provided and the intensely varied responses studies suggested throughout the article make it even more improper to suggest with such decisiveness ("majority of research") Some studies suggest placebo as indicated in other parts of the article but not most of them.

Indeed, there have been attempts at western/eastern fusion techniques utilizing western understandings of neurophysiology in the use of acupuncture needles as also stated elsewhere in the current entry. It's likely the pressure points that Chinese medicine designates are simply potentially effective areas to place needles discovered over time. Since the needles effect and interact with nerves (which the article states has been looked into), the places you could put needles extends beyond the traditionally designated points and really matters more on what is effected. This makes the statement I wish to edit misleading as it currently exists since it's not that the cited study showed placebo effect for acupuncture outright but that placebo needles also had positive effects on patients just as regular insertions did.

Edit 2: In response to "Not Done" comments as Edit 2 is a modification of the single edit suggestion I initially created that they were written in regards to. I see what the editor is saying in their referencing of WP:WEIGHT. My remarks from my previous submission are too much for the intro section. I read NPOV like was suggested which I think is why this edit should be moved from the intro but still be included in the article. I think the edit would juxtapose nicely in terms of NPOV with what is written in the Publication Bias section being inserted after the single paragraph currently there. The current paragraph in the publication bias section only regards countries in Asia in terms of bias but does not address western studies. Moreover, the implication of what is currently written is that eastern studies are faulty and western ones are not since most of the article's cited western studies suggest acupuncture is not effective in a variety of ways yet are not called into question in any way besides in regards to their inconsistency (yet this admission of inconsistency is too counterweighted by the overwhelmingly negative evidence cited and focused on). Just because a study did everything by the numbers (control group, blind experiment, etc.) does not mean it cannot be called into question.

This especially is the case since as the article suggests opinion is rather bipolar in distribution (all the negative ones come from the west and the positive ones come from Asia). Yet only western studies are described in any detail in the article while the Asian studies in the publication bias section as simply blanketed with the term "uniformly favorable" without a description of the effects or findings. This is highly problematic given that the only asian studies of acupuncture that have details elaborated upon beyond a general positive/negative response are cited in the safety section only to comment on negative findings. Most damning of all is if you read the source for these negative findings (227), it says in its methods summary "Case reports, case series, surveys and other observational studies were included if they reported factual data, but review articles, translations and clinical trials were excluded." If we are going by the logic of the comments provided by whoever looked over my post this sighted evidence should not be allowed to be used to discount asian studies of acupuncture since it was not gathered from authentic clinical trials. Responding to me with "What you perceive as a "biased, western-centric" tone is simply the scientific consensus. If you have a source that contradicts this, feel free to provide it, though be forewarned that it is doubtful you will find something as reliable as a Cochrane review" becomes problematic in light of the observations I have made so far in this edit suggestion in regards to the current existing evidence on the page. I believe my analysis of the existing evidence/sources on the page accomplishes resolving the concern brought up here and gives reason to include it since otherwise this section would not be NPOV as it currently exists.

The Suggested edit: [insert after existing text in Publication Bias section in two new paragraphs]

Existing text- Publication bias is cited as a concern in the reviews of randomized controlled trials (RCTs) of acupuncture.[58][82][83] A 1998 review of studies on acupuncture found that trials originating in China, Japan, Hong Kong, and Taiwan were uniformly favourable to acupuncture, as were ten out of eleven studies conducted in Russia.[84] A 2011 assessment of the quality of RCTs on TCM, including acupuncture, concluded that the methodological quality of most such trials (including randomization, experimental control, and blinding) was generally poor, particularly for trials published in Chinese journals (though the quality of acupuncture trials was better than the trials testing TCM remedies).[85] The study also found that trials published in non-Chinese journals tended to be of higher quality.[85] Chinese authors use more Chinese studies, which have been demonstrated to be uniformly positive.[86] A 2012 review of 88 systematic reviews of acupuncture published in Chinese journals found that less than half of these reviews reported testing for publication bias, and that the majority of these reviews were published in journals with impact factors of zero.[87]

Suggested addition- "It should be considered that there is the possibility that studies on acupuncture deemed scientifically sound and of legitimate quality can be unintentionally manipulated despite having followed the standards of the scientific method that clinical trials must adhere to depending on who conducted them and for what reason. The immense profit the western medical industry currently gains from not implementing acupuncture into its procedures leads to the possibility bias could affect studies derived from its methodology. For instance, if acupuncture gained promotion and wide support through mainstream channels in Western countries more people would be willing to try what so often is perceived as an odd, foreign practice filled with risk associated with things like dirty needles from a lack of regulation. Such an event could cause sales in prescription pharmaceuticals treating bodily problems to decrease since it is a more natural process absent of the often harmful side effects associated with manufactured drug medications if done with proper technique [make sure to read the new source fully and not just the summary paragraph and you will see how it applies]. Indeed, as acupuncture seeks to eliminate the cause of a symptom instead of merely treating its symptoms the practice would likely appear much more desirable than pharmaceuticals for issues such as pain relief and regulating blood pressure that only do the latter [if this blog reference seems illegitimate the reason I include it is because I think it is a useful source since it explains why acupuncture treats pain and interacts with muscles while every source I have checked so far that currently exists merely states results without explaining how the processes responsible for the concluded results come about so it would be useful. It also is the product of a people who utilized a fusion form of acupuncture that incorporates western understanding of the nervous system. Regardless of opinion on this source the other new source I listed evidences this claim sufficiently alone based on what the reply to my initial edit informed me of in regards to proper sourcing]. Moreover, if mainstream legitimacy was given to acupuncture by the western medical industry, expensive and invasive surgeries would be needed less frequently and become a last resort measure as they are in East Asia.

For reasons like these, it is potentially not in the best interest of people conducting studies in western countries to neutrally entertain the idea that acupuncture works to a significant degree. Moreover, western doctors conducting studies may lack a proper understanding of Chinese medicine which could potentially make them unsuitable to conduct the study as they may have employed improper techniques and parameters. To understand and become an effective practitioner of Chinese medicine takes years of study and practice as one must master an incredibly complex and unintuitive methodology that sees the maladies of the human body as inter-connected. A person's arm might hurt due to a problem somewhere else entirely on their body. A typical western doctor would just treat the arm and perhaps the immediate muscles surrounding it whereas an acupuncturist may treat somewhere that appears completely unrelated according to western medicine.

Additionally, the methodology of western medicine in which the people leading these studies are trained is historically dismissive of eastern medicine which could result in subconscious bias. Such bias stems in part from the legacy of Europe's belief in its superiority to other cultures which historical events such as colonialism and the relative geo-political dominance of the West over the past four hundred years have strengthened. Since European Rationalism resulted in the curing of disease and the creation of modern, life-saving surgical practices the superiority of western medicine became engrained culturally. However, while such feats are not to be disregarded in their importance it must be noted these triumphs of western medicine are purely responsive. In contrast, studies show the commonly held lay viewpoint that acupuncture may stimulate the body's immune system to actively prevent problems from developing.."

Thank you for reading over my edits. I'm open to suggestions and revisions but I think it is evident if you check all my observations on existing sources that the current state of the article could use some work. I'm new at this so please work with me as I assume certain things I say will make sense while others will still seem problematic. It took a lot of hard work and research, but I really have enjoyed doing this and would like to continue to assist in making wikipedia better. ZhuGeLiang77 (talk) 07:29, 21 February 2016 (UTC)

No. -Roxy the dog™ woof 09:42, 21 February 2016 (UTC)

Thanks to ZhuGeLiang77 for your hard work. I'm sorry to say that, in Wikipedia terms, it is original research, and in scientific terms, it is misunderstood nonsense. In plain English, it is useless rubbish. I had thought of going through your conceptual problems in detail, but I find myself otherwise engaged. I will limit myself to pointing out that the references you adduce are examples of positive Western attitudes to acupuncture. (Unless you think that California and Madrid don't count as "Western" academic communities. I hope we all agree that they do.) And that non-scientific "Western" systems, notably humoral medicine, have been buried by the scientific community far deeper than acupuncture. Richard Keatinge (talk) 10:53, 21 February 2016 (UTC)

References

I get 20k upvotes and all you can do is snub me?!!! My criticisms of the misuse of existing sources warrants a legitimate address even if you don't agree with my new additions.

Misunderstood the number next to my articles on contributions thought they were votes not file size but that doesn't change the problem with the last response to my edits. — Preceding unsigned comment added by ZhuGeLiang77 (talk • contribs) 12:27, 21 February 2016 (UTC)

The editorial response to my edit requests is not acceptable. The latest one sweeps my entire second post into blanket remarks. Original research? Maybe some of my ideas but isn't that how Wikipedia articles get made in the first place? So it's original research to read the sources the article currently uses and then point out how they don't add up to many of the claims and statements in the article that use them? I know my post is elaborate with many points to go over but just because editors are lazy is not a good reason to tersely dismiss it.

The editor simultaneously attempts to ridicule my work to make it sound ridiculous and not worth addressing yet feels the need to put in some remark that supposedly shows he knows something better "And that non-scientific "Western" systems, notably humoral medicine, have been buried by the scientific community far deeper than acupuncture. Richard Keatinge (talk) 10:53, 21 February 2016 (UTC)" How is that relevant when I am talking about acupuncture specifically? How does that negate anything that I said?

If Wikipedia is legitimate it should at least review my criticisms of the existing use of sources as there are many instances of selective use of evidence, a lack of reading the full text over its abstract, and making statements not supported with the evidence used as a source. How can wikipedia claim to be legitimate when editors run away from claims that its use of evidence is inaccurate and framed to be something it is not?

Found another one just now, intro second paragraph.

"A systematic review of systematic reviews found little evidence of acupuncture's effectiveness in treating pain.[5] The evidence suggests that short-term treatment with acupuncture does not produce long-term benefits.[15]" A systematic review of systematic reviews is poor writing both in its crudeness repeating systematic and the fact that the statement is vague. However, factually the first sentence is fine. Nevertheless, the following sentences wording "The evidence" is worded so that its meaning is hard to pin down. The reader is either lead to believe "The evidence" refers to the review from the previous sentence (which is does not) or that by that the author mean comprehensively. Yet we see other studies of studies throughout the article that come up with different results, including some of the sources I suggested adding in my previous post.

If you read source 15 you will discover the person who wrote "The evidence suggests that short-term treatment with acupuncture does not produce long-term benefits.[15]" probably did not read the full article. In the section on neck pain their is this statement "Preliminary data suggest that acustimulation may establish the efficacy of acupuncture as a long-term treatment for chronic neck pain." In other words, for neck pain this source is uncertain of long term benefit results from acupuncture not that that it does not produce long term benefits. As for knees source 15 says "However, a follow-up at 1 yr revealed no differences among the various study groups." This article does not take into consideration continuing treatment over time but at less frequent intervals than initial treatment may result in sustained benefits. It's a black and white scenario of analysis but the authors admit more research needs to be done so that is unavoidable it would seem.

Source 15 also states the following: "Alternative medical therapies, such as acupuncture and related forms of acustimulation, will likely assume an increasing role in western medicine as scientific evidence supporting these therapies becomes available to practitioners." This is intensely similar to my statement about acupuncture likely becoming popular if the public has proper access to it that I support with new clinical studies not yet cited in terms of its beneficial effects in comparison to existing methods in western medicinal practices alone. It presents a narrative that acupuncture is something misunderstood and potentially very useful so it is rather dicey to use it in such a grandiose statement that collectively all evidence ever on acupuncture suggests no long term benefits without qualifying it also says this.

I guess I'm at the mercy of editors hopefully someone bothers to properly address my second post's challenges to the misuse of evidence. It's cool if you want to be snooty and just continue to prove the criticism of wikipedia that established editors wield their privilege corruptly. Honestly the responses to my criticisms are juvenile and petty. ZhuGeLiang77 (talk) 12:15, 21 February 2016 (UTC)

Unfortunately the only one who is misusing sources is yourself. This really isn't the place to instruct you in the details of a scientific approach to medicine. I do note that it requires skills different to those of the art historian and additional to those you've displayed so far. Furthermore, if you hope to contribute constructively to anything on Wikipedia, you really do need to internalize the main messages of WP:OR, WP:AGF, and WP:NPA. Richard Keatinge (talk) 18:05, 21 February 2016 (UTC)

Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format. EvergreenFir (talk) Please {{re}} 01:24, 22 February 2016 (UTC)

NICE guidance

The National Institute for Health and Care Excellence (NICE) has just produced draft guidelines on lower back pain[52] says acupuncture must not be used as a treatment. As clinical practice guidelines these are the strongest possible WP:MEDRS and so should be used - though maybe it is worth waiting until they progress from draft status (though possibly the draft itself is of such weight it needs to be mentioned?) A lay summary is here Alexbrn (talk) 17:48, 24 March 2016 (UTC)

Yes, once the draft is published we should definitely note this. Guy (Help!) 23:37, 24 March 2016 (UTC)

Can you direct me to where it discusses acupuncture?Herbxue (talk) 16:01, 5 April 2016 (UTC)

You need the draft guidance entitled Low back pain and sciatica: management of non-specific low back pain and sciatica. It's packed full of in-depth and interesting stuff on acupuncture but perhaps the two money quotes are:

The GDG discussed that despite a large number of trials reporting pain as an outcome and the inclusion of trials with large numbers of patients for these and other outcomes, there was still not compelling and consistent evidence of a treatment-specific effect for acupuncture.

and

The GDG considered that there was a substantial body of evidence relating to acupuncture in this review and that further research was unlikely to alter conclusions.

As a meta-observation, it seems acupuncture is following the path that homeopathy has already trodden. Alexbrn (talk) 16:14, 5 April 2016 (UTC)

Is there any point to this? -Roxy the dog™ woof 16:27, 5 April 2016 (UTC)

Only that if/when this guidance is published it would be a top-quality source we'd need to use. Alexbrn (talk) 16:48, 5 April 2016 (UTC)

I'm sorry for my Pune, or play on words. However, are we now at a stage where we could get rid of the cruft inserted into the article by acupuncturists desperate to cling on to their livelihood? -Roxy the dog™ woof 16:55, 5 April 2016 (UTC)

No, but if the NICE guidance is indicative we will need to adjust the article to follow. Point taken ;-) Alexbrn (talk) 17:26, 5 April 2016 (UTC)

Its funny Roxy, I was going to post about how peaceful and stable this article has been lately. You haven't noticed anyone taking advantage of QG's absence by inserting POV material, which indicates that the edit warring that used to occur (constantly) was mainly due to QG's POV-pushing. Anyway, if you're bored, you could make snarky comments and we could react to that I guess. :) Thanks Alexbrn for helping me find the info you are referring to, I'm sure there will be much discussion to come. Herbxue (talk) 17:32, 5 April 2016 (UTC)

Get rid of the cruft? Well, from one point of view an article about acupuncture can consist of nothing but cruft, so we'll never get rid of it. If you mean getting rid of the various incomplete analyses of biased primary work, there are two problems. One, there's a lot of invalid work and it demands some sort of coverage by its sheer volume. And two, if you've seen the process by which NICE develops its guidelines, you wouldn't be quite so keen to hold up national guidelines as definitive. The development process is heavily small-p politicized and the results do not always coincide with the best available evidence. Richard Keatinge (talk) 14:48, 19 April 2016 (UTC)

Semi-protected edit request on 20 April 2016

could you please remove the "kinda probably" from the de qi paragraph? it probably doesn't follow protocol. 2602:301:77B0:5EB0:6182:A3E9:BB2A:CAC6 (talk) 01:11, 20 April 2016 (UTC)

Not done because it is not clear what the proposed edit is. Are you talking about the Acupuncture#De-qi sensation section? What is the precise wording that should be removed? I can't see where "kinda" is in this article or in its recent history. Johnuniq (talk) 02:08, 20 April 2016 (UTC)

Semi-protected edit request on April 23, 2016

Please remove the phrase "in favor of sticking needles into nerves." from the last sentence of the lead section. Acupuncture should not/does not generally involve sticking needles into nerves. This is not factual. Needles often pierce the skin or muscle. If they happen to touch a blood vessel or nerve, they will be painful and a practitioner should remove them. A skilled practitioner will avoid these situations by palpating before placing the needle. - Merriels — Preceding unsigned comment added by Merriels (talk • contribs) 00:25, 24 April 2016 (UTC) Do I need a citation to support these basic facts, or is it enough to ask for a review of the cited sources, that can not possibly say acupuncture is sticking needles into nerves? Merriels (talk) 00:28, 24 April 2016 (UTC)

Someone needs to look at the three sources and see what they actually say. It would be nice if you would do that and give a brief quote from each if you find any text to support the current wording ("tapping needles into nerves" which appears twice in the article). The point being made is that "Western practitioners abandoned acupuncture's traditional beliefs..." and adopted new procedures. Are there any better sources regarding that? Johnuniq (talk) 02:28, 24 April 2016 (UTC)

New Cochrane Review

Probably worth including in the article: "Moderate-quality evidence suggests that acupuncture relieves pain better than sham acupuncture, as measured at completion of treatment and at short-term follow-up, and that those who received acupuncture report less pain and disability at short-term follow-up than those on a wait-list. Moderate-quality evidence also indicates that acupuncture is more effective than inactive treatment for relieving pain at short-term follow-up." http://www.ncbi.nlm.nih.gov/pubmed/27145001 2001:56A:75B7:9B00:7CB5:825B:B173:AB66 (talk) 16:59, 6 May 2016 (UTC)

No mention of Maya acupuncture

I'm surprised this article has no mention whatsoever of traditional Maya acupuncture (called pirish in most Mayan languages). It is still practiced today, and there should be some sources about it somewhere. Kaldari (talk) 18:14, 8 May 2016 (UTC)

I had no idea this was a thing, will look around at sources and see if any are appropriate for mention in this article. Thanks for bringing it up.Herbxue (talk) 18:35, 9 May 2016 (UTC)

IPD meta-analysis: weight issue

Meta-analyses are pretty much unsurpassed as MEDRS's, and the "gold standard" for meta-analysis is the kind using individual patient data (IPD).[53][54][55][56][57] For research on acupuncture's efficacy, there is one such study, Vickers et. al. 2012. It was four large IPD meta-analyses in one and there is plenty there to discuss. It's cited once in the article and isn't in the lede. Other meta-analyses are cited multiple times and are in the lede. This is pretty obviously a WP:WEIGHT problem.

This being a controversial area of research, there were multiple criticisms directed at Vickers, and some of them were valid and are included in the article. However, most of them weren't MEDRS, and those that were were on the low end (e.g., letters to the editor), and to that extent, weigh modestly. One wouldn't guess this from the article, though. Ernst, for example, criticized Vickers in a comment to The Guardian [58], yet the article gives that about the same space as Vickers itself. It's possible that Vickers' critics haven't put their criticisms in stronger MEDRS's because their criticisms are weak. As it happens, Steven Novella, a fairly well-known alt-med critic, said that he'd prepared a full paper criticizing Vickers, but that it was rejected for publication.

So the article is all out of whack with respect to Vickers, which is to be expected when tigers are afoot, as they so often are in CAM topics. This needs fixing; thoughts? --Middle 8 (t • c | privacy • COI) 11:02, 26 October 2015 (UTC)

No comments again? All right, I'll work Vickers into the lede and try to make the 2nd para on efficacy less of a cut-and-pasted laundry list (which is what it, and much else, turned into while this page was effectively under the ownership of QuackGuru). --Middle 8 (t • c | privacy • COI) 07:24, 4 November 2015 (UTC)

Could you stick to the topic and refrain from poking people? You might also bear in mind that tigers are much more in keeping with Wikipedia's WP:FRINGE approach—we know people feel better when someone claiming authority pays attention to them, and we know that practitioners use Wikipedia to promote their beliefs, but there is no knowledge regarding how the insertion of needles might be useful. Johnuniq (talk) 10:18, 5 November 2015 (UTC)

I haven't been following edits and discussions lately - but Johnuniq come on - you cannot be paying much attention to the literature if you feel confident making such a sweeping statement. Even if you only accept Ernst's review of reviews as reliable research into efficacy (which would be ridiculous, since there is more to clinical and biological research than just RCT's), you still would see the potential "usefulness" and the need for more research.Herbxue (talk) 20:20, 5 November 2015 (UTC)

@Johnuniq: (a) Single mention of another editor ≠ poking. (b) True re tigers on WP, but still, they come in multiple stripes. (c) Agree with Herbxue re what is known about the field (and I don't think academic centers would use it if they didn't think it was useful).... but yes, let's stick to the topic. --Middle 8 (t • c | privacy • COI) 23:11, 5 November 2015 (UTC)

This section has been set to not archive for months, so in response to the above perhaps I should highlight the critical word in my earlier comment: there is no knowledge regarding how the insertion of needles might be useful. That makes the topic a bit of a head-scratcher from a scientific point of view. Johnuniq (talk) 09:42, 29 November 2015 (UTC)

You're referring to mechanism, I take it. We don't need proven mechanisms to reasonably consider efficacy, just plausible ones. [59][60][61][62] But please let's not stray too far from the question at hand, i.e. summarizing and weighting efficacy reviews... --Middle 8 (t • c | privacy • COI) 22:44, 2 December 2015 (UTC)

Note: I've refactored further discussion of mechanism into its own section, below. --Middle 8 (t • c | privacy • COI) 13:15, 25 December 2015 (UTC)

Improving the article tone & organization

Most of this article is really solid, and reflects a genuinely massive if reluctant collaboration. But isn't there a more professional way we can present this article, at least with the introductory paragraphs - as well as the ordering of sections? Regardless of one's opinions or even a particular consensus on what acupuncture is or isn't, the tone and the style should not differ much from say, an article on Opthamology: etymology, history, practice. And then you can dive into all the topics everyone seems to come here for. Anyways, I'll be here all week. Huangdi (talk) 11:15, 3 August 2016 (UTC)

Medical articles have some standard formatting, apparently Ophthalmology does not use the standard formatting. Tgeorgescu (talk) 11:22, 3 August 2016 (UTC)

Homeopathy would be a better article model (also a FRINGE topic). Alexbrn (talk) 12:39, 3 August 2016 (UTC)

I do not think it is appropriate to associate acupuncture with homeopathy. I agree that the article should have a more encyclopedic tone. Herbxue (talk) 17:48, 3 August 2016 (UTC)

Request edit on 4 August 2016

Origin section "The Yellow Emperor's Classic of Internal Medicine (Huangdi Neijing)" Huangdi 皇帝 = King is not "Yellow Emperor", 黄 huang = yellow. — Preceding unsigned comment added by 61.6.47.77 (talk) 07:42, 10 August 2016 (UTC)

Location of history section

A recent edit by Bloodyducklips moved the History section to be the first section in the article. I'm thinking that WP:MEDORDER would be a suitable guideline to follow, and the original order was fine. Any thoughts? Johnuniq (talk) 09:54, 26 August 2016 (UTC)

It depends whether you regard acupuncture as purely of historical interest, or as a significant modern medical practise. Since I see it as primarily of historical interest, I agree with Bloodyducklips. The lead is still hopelessly skewed. zzz (talk) 10:19, 26 August 2016 (UTC)

Follow WP:MEDORDER. Alexbrn (talk) 10:38, 26 August 2016 (UTC)

Have you seen the "Clinical practise" section? Are you proposing to fix it before putting it back at the top of the article? zzz (talk) 11:30, 26 August 2016 (UTC)

Follow WP:MEDORDER. The history of acupuncture is of secondary importance to it's (lack of) effectiveness. If you have a problem with the clinical practice section then fix it, zzz. Famous_dog (c) 11:54, 26 August 2016 (UTC)