Talk:Acupuncture/Archive 8

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Diversion from primary care

Perhaps I've missed it, but I can't recall seeing any source that discusses a rather glaring omission in Ernst (2008): the complications come down to the "puncture". Are there any sources that discuss complications pertinent to the other forms (accupressure, lasers, etc.)? Other CAM modalities, broadly viewed, are responsible for diverting patients from effective treatment, with consequent harm of omission. PMID 11955028 (a review) and PMID 15741385 (not) pertain. LeadSongDog come howl! 19:06, 7 June 2011 (UTC)

Hope you don't mind LSD, I've split this to a separate section than the already-lengthy above. Natch, feel free to replace if you'd prefer the two together.

Since the jury is still out regarding whether acupuncture is actually effective beyond placebo effects, it's a bit premature to proclaim it completely useless and therefore a dangerous diversion of patients from real medicine. In addition, acupuncture's evidence-based indications are for symptoms such as pain and nausea rather than disease-modifying such as curing cancer, treating diabetes, etc. Accordingly, it's generally used as an adjunct to treatment rather than a (substitute for) treatment itself, so it's greater concerns, if it's naught but placebo, would be "wasting time and money" rather than "killing people due to improper treatment" like the Gonzalez regimen for cancer or homeopathy for eczema.

And in terms of pure sources, I can't recall seeing any references to acupuncture specifically; though that's an overall problem with CAM, I'd be reluctant to endorse mentioning it here without a specific mention. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:15, 7 June 2011 (UTC)

Discrepancy in Lede and the Easy Fix

The lede first paragraph read: The efficacy of acupuncture, beyond the placebo effect has never been unequivocally demonstrated.

The lede third paragraph read: The evidence for acupuncture's effectiveness for anything but the relief of some types of pain and nausea has not been established.[16][17][18][19]

Obviously both statements cannot be true and the second statement is well established so I have deleted the first one.

~~ mb — Preceding unsigned comment added by Metabradley (talk • contribs) 16:30, 10 June 2011 (UTC)

Both statements can be true, and as far as I'm familiar with the sources, they are. The key is "unequivocally", which in this case applies to the level of support for pain and nausea present in the literature. AFAICT, the nearest we have to effectiveness when it comes to acupuncture studies is for treatment of pain and nausea, and in those cases, its efficacy has not been "unequivocally demonstrated". That said, the lead could due with some consolidation, and there might be a better way to combine these two sentences.   — Jess· Δ♥ 17:38, 10 June 2011 (UTC)

BTW, I reverted before I saw you'd started this discussion. However, this really should be left in until consensus forms. All the best,   — Jess· Δ♥ 17:39, 10 June 2011 (UTC)

Agreed. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:04, 10 June 2011 (UTC)

Obviously it is better to read the discussion before making an edit, it is never a good policy to shoot first and ask questions later; it makes it seem like one is less interested in justice and more interested in pulling the trigger. Nonetheless, for the sake of the clarity in the article, until these statements do not sound contradictory, it is best to remove the first statement. (i forgot to sign in first ~~mb) — Preceding unsigned comment added by 204.187.140.30 (talk) 20:44, 11 June 2011 (UTC)

It doesn't really matter. If your argument wasn't convincing enough for a self-revert by Mann_jess and I don't support it either, then the whole point of timing is rather moot. There's no justice on wikipedia, just reliable sources. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:08, 12 June 2011 (UTC)

the first statement lacks reliable sources while the second one has it hence removing the first and keeping the second. — Preceding unsigned comment added by 204.187.140.30 (talk) 18:30, 12 June 2011 (UTC)

Meta-studies should have a key position

Meta-studies are more reliable than separate experiments. I suggest that this article should point out the conclusions of the latest meta-studies, and put some of the minor studies aside. The problem with this article is that someone has tried to match every positive result with a sceptical source, and vice versa. That is not the same thing as neutrality. The article should clearly point out the concensus among main-stream/established scientists regarding in which applications acupuncture are considered efficient and which not. And let's leave to authors of meta studies to decide what can be concluded from the full picture. The article may also mention interesting contradicting scientific studies, and if possible present the status of sources research, for example as of historical interest, newer, alternative or marginal science. Poor science, for example studies that are not large randomized blind tests, should not be mentioned at all.

The article should also point out decisions by authorities, and the practice in modern state-funded health care, i.e. what forms of acuptuncture that are considered as evidence-based treatment, (for example for pain relief in childbirth), and for what applications it is not used in main-stream health care. Mange01 (talk) 11:07, 26 June 2011 (UTC)

Per WP:MEDRS we should be relying in on secondary sources anyway, and I believe the article does so - most are pretty diligent about ensuring primary sources are for the most part excluded. The main problem for believers is that the meta-analyses tend to be negative, or at minimum show little efficacy beyond placebo. If there are studies that are missing, please present them for review because I don't think you're saying much that most editors of the pages would disagree with. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:28, 26 June 2011 (UTC)

Nausea in lede

[1] Seems reasonable to stick closer to source. --Middle 8 (talk) 17:01, 1 July 2011 (UTC)

I agree. OrangeMarlin's revert says it about getting closer to NPOV, but it look to me like he's putting a very negative spin on a report of a positive result. Dicklyon (talk) 23:15, 1 July 2011 (UTC)

Yes, the source is very clear. Various procedures were reviewed, all of which were verum (not placebo) and found to be active compared to placebo (some different point on the body). It's OR and POV to say "A is no more active than B" when the source says "A, B, C, D and E are equally active". This is undisputable.

Orangemarlin's edit summary is meaningless: it lazily asserts "the NPOV version" with no explanation, along with a big dish of WP:KETTLE in complaining about edit-warring when he, in fact, is the one doing so (I improved the edit in my reversion). I think a reversion is amply justified, and I'd be happy if anyone who agrees would do so. --Middle 8 (talk) 09:07, 2 July 2011 (UTC)

I think some editors are assuming the source says one thing when it really says the opposite. If editors would just read the source, we wouldn't be having a series of reverts based on misunderstanding.

It's also possible that some of these reverts are made in bad faith, per User:Middle_8#How_to_abuse_WP_process, but I hope that's not the case. --Middle 8 (talk) 18:25, 4 July 2011 (UTC)

I, for one, have read the source in question, so please stop accusing other editors of editing in bad faith or not being aware of the literature, Middle8. Its in... um... bad faith. My thoughts on this matter: This is not an article about whether there is something "special" about acupoint P6. It is an article about acupuncture. Stimulation of P6 non-invasively is as effective as acupuncture. Surely that is important information for an article about acupuncture. Yes, both are more effective than sham treatment. That should be noted too. See my new edit. Famousdog (talk) 09:12, 5 July 2011 (UTC)

It seems Noformation has reverted my changes without explanation, despite his earlier pleas to discuss things on the talk page before making edits... said Mr Pot to Mr Kettle... Famousdog (talk) 10:31, 5 July 2011 (UTC)

Hi FD -- oops, I missed your comments here and commented on your talk page. I'll just paste it in here since it's germaine:

• (begin comment) Hi Famousdog -- as I guess you surmised from the source, this edit was not accurate but this one was. (The latter may have gotten reverted because the edit summary was unclear.) Anyway, your more recent edit seems to have stuck, as it should. (end comment)

Other comments re your note above: as I said, your second edit was good. Your first was not, because you were reverting to a version that didn't properly summarize the source. It's not an accusation of bad faith to ask someone to read a source because they are reverting to a wrong version, or to point out a factual error. But we should move on. It's now a slightly better article than it was before. cheers, Middle 8 (talk) 10:27, 6 July 2011 (UTC)

Important post

I love ScienceBasedMedicine (really deserves its own article!) in large part because it addresses in plain language many of the flaws of alternative medicine, including acupuncture. The latest post by Harriet A. Hall addresses acupuncture in part, but mostly it contains a list of why it can be expected to have a huge placebo effect to boost any specific effects it may have.

[2], the section titled "acupuncture's makeover" contains the list. It's a must-read for anyone who argues for the effectiveness of acupuncture's specific effects. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:43, 17 May 2011 (UTC)

I read it all the time. Two of the authors are Facebook friends of whom I ask questions when I run into some odd statements here. We can't use them as a reliable source, but they analyze and use reliable sources, so I find them very useful in editing alternative medicine articles. I'll be reading it with my coffee this morning! OrangeMarlin ^{Talk• Contributions} 15:23, 17 May 2011 (UTC)

"ScienceBasedMedicine" is a great idea. Unfortunately, the reality is substantially different. Massive funding & publication biases, ensure that dangerous pharmaceuticals like COX-2 inhibitors (Vioxx) get promoted -- while diet & exercise, being far more cost-effective & far less profitable, are ignored.

Also, the enormous numbers of injuries/fatalities caused by medical error, and the vast negative effects (across the population) of prescription-pharmaceutical side-effects, toxicity, and addiction, are very often not included/or considered in comparison.

Statements, for example, that "acupuncture is risky" are almost certainly factually incorrect -- acupuncture would appear to be about 10,000 times safer than surgical procedures, 100s of times safer than taking (say) mid-strength opiate or synthetic opiate painkillers.

As WLB says, the above does require that acupuncture have some effect -- I don't know for sure, but enough Chinese & scientists are trying to find out why it works, for me at least to keep an open mind. Twhitmore.nz (talk) 04:03, 1 June 2011 (UTC)

And once again, you're just sitting here preaching and not providing any actual, you know, verification for your claims. Try citing some reliable sources to back up your claims sometime, per wikipedia policy. SuperAtheist (talk) 19:55, 1 June 2011 (UTC)

Twitmore, Not sure where to start. Let's see, there's that old logical fallacy of appeals to conspiracy. One of my favorites. Oh, and that surgical procedures, which actually work, compared to something that doesn't work. A strawman argument of massive failure. Oh, and keeping an open mind does not mean you should keep an uncritical mind. Openmindedness does not mean anyone should accept any crap without evidence. Openmindedness, in fact, is attempting to determine the accuracy or substantivity of a statement. You are so closed minded because you refuse to listen to the real clinical science which shows that acupuncture is slightly unsafe for NO benefit at all. There is a risk of surgery, but you get a good chance of actually curing a disease. You see, the best you can offer for acupuncture is that it might suppress some pain. It can't cure cancer, or mend a broken bone, or do anything useful. Twitmore, logic is so useful. OrangeMarlin ^{Talk• Contributions} 01:45, 3 June 2011 (UTC)

I'm going to be cruel, because these are all pet peeves of mine. BlahblahblahconspiracytheoryblahblahblahBigPharmablahblahblah is not an argument, nor is it a source, and is completely useless for the purposes of adjusting any page on wikipedia. The claim that doctors ignore diet and exercise is the worst sort of bullshit CAM talking point - good luck finding a doctor who doesn't promote diet and exercise. The fact that patients don't follow this advice is not the fault of primary practitioners. Claiming that medicine is bad because it is dangerous and acupuncture is good because it is safe is the rankest nonsense since it is a requirement that medication be demonstrated safe and effective before it is used, while acupuncture is simply assumed to be effective. As SBM itself says - any risk is excessive when the effectiveness of an intervention has not been established. The fact that Chinese scientists are the only ones who consistently find positive effects is actually a flaw, not a strength - as is discussed in Trick or Treatment and the page proper. Twhitmore, you are repeating empty talking points that have been spoonfed to you by health freedom advocates and CAM proponents who willfully ignore results they don't like. We're familiar with and have already dismissed this sort of rank nonsense, please don't bother repeating it again. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:19, 3 June 2011 (UTC)

I want some cheese. Moon certified cheese. OrangeMarlin ^{Talk• Contributions} 02:29, 4 June 2011 (UTC)

Funding & publication biases in Western medicine:

• [3]
• [4]
• [5]
• [6]
• [7]
• [8]

No hidden conspiracy -- just an outright weighting of vested interest, producing outcomes that favour those multi-billion-dollar interests.

I've already posted some number of links to clinical studies on PubMed. So, with reputable evidence *for* and possible reviews *against* -- my position is, to hold an open mind. That's not uncritical. What I'm really critical of, is attempts to drive a POV.

'Claiming that medicine is bad because it is dangerous'? That's not a claim I made, and have been clear that my goal is *not* to reduce Western medicine pages to the (poor) standard & combatative nature, of this page.

'Acupuncture is good'? No, that's not my intent either. Mainly I am interested in reading an acupuncture about *acupuncture*, not *skepticism*. I don't regard the existence of a page about Chinese this-and-that as requiring me to believe in it -- I just have an open mind. 'Because it is safe'? I believe that statement, is actually fairly much correct. If I try acupuncture, which I have no intention in the forseeable future of doing, I'll have some more data-points with which I can form my own opinion.

'Medication be demonstrated safe and effective before it is used'? Demonstrate how this statement works, in respect of Vioxx. Three of you have used plenty of words replying -- why have you been unable to address reasonably clear points, in a concise or logically sound manner? T.whitmore 202.37.64.48 (talk) 01:57, 4 June 2011 (UTC)

You do realize that this doesn't prove any point with regards to acupuncture. In fact, I would use it to debunk any positive result for acupuncture. Well, if there were any of note. OrangeMarlin ^{Talk• Contributions} 02:34, 4 June 2011 (UTC)

Once again you conflate openmindedness with believing in fringe theories. Openmindedness is willingness to accept new ideas. It does not mean a willingness to accept invalid causal connections or to reject evidence. You have not brought one tiny bit of evidence of not only the efficacy of acupuncture, but you fail miserably to explain how it might work. You are making us accept a supernatural explanation for how acupuncture works, which is simply unrealistic. So, acupuncture fails on two levels. No evidence of efficacy and no proposal of a mechanism for it that can be falsified. You can't. And what fuck does Vioxx have to do with the stupidity of Acupuncture? It has nothing to do with it. By the way, given that you are totally unknowledgeable about pharmaceuticals, I propose that the simpler answer to Vioxx is that lawyers want to make money. But then again, I don't want to go down that conspiracy road that many use. OrangeMarlin ^{Talk• Contributions} 02:43, 4 June 2011 (UTC)

By "western medicine" you mean "medicine", I assume? Because medicine simply works, it doesn't just work in "the West", a stupid term since the earth is a sphere and China is "west" of North America.

Do any of those links have anything to do with acupuncture? If so, please separate them out and suggest an improvement to the page based upon them. This page isn't about how "western medicine" is allegedly flawed and "eastern medicine" is awesome. It's about acupuncture, which has been tested by science and found wanting in the best quality studies. Vioxx for all of its flaws, is an effective pain reliever, and an independent panel concluded it should be returned to the public. Not to mention it was voluntarily withdrawn by Merck, not by the FDA. Not to mention it's side effects are about equivalent to other NSAIDS. So how was Vioxx demonstrated safe and effective? Well, they tested it and it reduced pain. They continued testing it and found that a small number of people had more heart attacks. So small, it was not immediately obvious in the smaller trials. But again, this has fuck all to do with acupuncture, so why are we talking about it? I wonder if your open mind is sufficiently open to the possibility that it may simply be an elaborate placebo? WLU (t) (c) Wikipedia's rules:^simple/_complex 01:01, 5 June 2011 (UTC)

Wow, the vehemence and causticity of you guys OM and WLU is astonishing. You are really very bitter about acupuncture for some reason. The fact is though that acupuncture IS NOT A PLACEBO. It is IMPOSSIBLE for that to even be the case. Why do some people seem so intent on conflating acupuncture with some aspect of a pharmaceutical drug trial? Acupuncture is a discipline, one of the oldest on earth, and it is in no way appropriate to compare it to pharmaceutical drugs, or to use methods of testing that are appropriate for pharmaceutical drugs, not physical disciplines. All of your Cochrane reviews etc. are invalid, and have no place (or at best a minor place) in this article. You don't use the IELTS test to measure someone's proficiency in speaking French, likewise you don't use randomised controlled double blind clinical trials to measure the efficacy of acupuncture, its simply not appropriate.Dickmojo (talk) 06:08, 14 August 2011 (UTC)

Once again, you guys seem incapable of addressing the core arguments -- false standard of comparison between acupuncture risks (say, 100 per 10 million) and Western medicine (above 1 per 10,000), undue weight & outright misleading emphasis on risk, and funding/inclusion biases in the key research (Cochrane Review) which you use to justify your claim, that acupuncture has zero benefits.

Zero benefits is a strong claim. To be used against a system which has been around for thousands of years, has substantial numbers of reputable research from Western institutions supporting it, and an entire body of Chinese research as well. What's your problem with the University of Kansas Cardiology department, anyway? Twhitmore.nz (talk) 02:59, 10 June 2011 (UTC)

No, you seem incapable of grasping the core issue - the alleged failings of real medicine do not magically justify acupuncture. Acupuncture stands and falls on its own merits. Your approach is akin to the one used by creationists against evolution - if evolution can be proven a theory with flaws, then therefore creationism is right. This is a false dilemma. Acupuncture is either effective, or it is not. Comparing it to "all other medicine in the world" is inappropriate. Claiming that acupuncture is old means it is right is also false. For one thing, acupuncture has changed considerably throughout it's lifespan. So which acupuncture, Chinese, Japanese, Korean, British? Which points? Which manipulations? Some of these are mutually exclusive, so how can you tell which is right? And just being old is no guarantee. Egyptian medicine is verifiably older, should we start praying to the Egyptian ibex-headed god of medicine because it's old? Or perhaps we can use the Babylonian system and base interventions on the positions of stars, the shape of liver lobes in goats, and the movement of ink in clear water. Age is no indication of effectiveness, and often works against an intervention. Popularity is also not an argument. Homeopathy is extremely popular, but does it work? Putting butter on a burn was a popular remedy, now it's contraindicated. The belief the sun orbited the earth was popular, but it doesn't. The false arguments have been presented by yourself, thanks. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:31, 10 June 2011 (UTC)

Core argument is the false standard of comparison applied & argued here, against acupuncture vs Western medicine. It's you & certain groups making claims in the negative and trying to disprove acupuncture, not me. I make no claims.. I merely point out that perfectly good scientific research is finding positive effects, in a range of areas.. including modern Western studies in the area of cardiology :-).

I've proved my point as to relative complication & fatality rates, I've proved my point as to undue emphasis & misleading impression. I've indicated benefits in at least one "real" critical area of medicine -- wouldn't expect acupuncture to be indicated for cancer, but cardiac illness is a major issue. As far as logical & reasoned argument goes, I've clearly proved my point.

Strawman arguments as to Egyptian and Babylonian medicine are irrelevant -- and some of their treatments, probably did have some effectiveness. You are welcome to try. Twhitmore.nz (talk) 23:49, 24 June 2011 (UTC)

As said before - this is the acupuncture page, if you want to talk about cardiology, go to talk:cardiology. This isn't a forum to compare the two. If you've got studies that illustrate that acupuncture and cardiology interventions have been compared head-to-head for saving people from heart attacks, feel free to integrate them into the article. But without sources, you're wasting everyone's time. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:45, 26 June 2011 (UTC)

Tag: Questionable statement about deaths in lead section

I am challenging the following two sentences and suggesting that they do not belong in the lead, and that the second ("statistically significant") sentence is probably false and does not belong in the article at all:

"A 2011 review of review articles concluded that, except for neck pain, acupuncture was of doubtful efficacy and accompanied by serious risks and adverse effects, including (since 2000) 38 cases of infection, 42 cases of trauma and 5 cases of death. The authors considered the adverse events to be statistically significant."[9][10]

Note: To attract editorial attention, I've tagged the statement with {{clarify}}. Per WP:TAGGING, since an adequate explanation for the tag has been made, please leave the tag until the issue is resolved.

Now, as to why the two sentences don't belong in the lead, the answer is simple: talking about death in the lead for something as safe as acupuncture is undue weight. The article reports 5 deaths in the literature from 2000 till 2010. One death every two years. That makes acupuncture very safe compared to other medical interventions as well as most other activities. There are articles on far riskier activities where we don't talk about deaths in the lead section, and undue weight is the reason.

Finally, I don't believe that the second sentence is at all an accurate summary of the article. I ask for unambiguous proof that it is, in the form of a quote, with ample context, from the article. The reason I doubt that this sentence accurately reflects the source is that there is no such thing as statistical significance when the sample size is unknown. A survey of adverse events reported in the literature by definition does not have a sample size. No sample size, no statistical significance. At best, one might say something like "the authors saw fit to bring attention to the issue of adverse effects in light of their conclusion that there is little evidence that acupuncture effectively treats pain".

(sidebar: It's odd that the authors, in purporting to compare risk vs. benefit, addressed only pain. Doesn't the alleviation of other types of suffering count for something? The best MEDRS on the planet states unambiguously that "P6 acupoint stimulation prevented PONV" (post-operative nausea and vomiting) as well as antiemetic drugs, and "There was no evidence of publication bias".[11] I'll add these statements to the article later.) --Middle 8 (talk) 09:23, 5 June 2011 (UTC)

I'm not surprised at this revert without discussion, a more accurate edit summary for which would have been "I reverted this before[12][13][14] without serious discussion[15], and I'm doing it again." In other words, the editor ignored WP:DR before, and is doing so again (see also WP:IDHT). Also, no reason was given for removing this simple and accurate edit[16]. I'm restoring the tag. --Middle 8 (talk) 19:58, 5 June 2011 (UTC)

Acupuncture is portrayed as safe, risk-free and adverse affects - a point made in the meta-analysis itself. Hence, the meta-analysis makes the counter-point that this is not the case, hence the lead does since that sort of source is the best one available for medical information. For any medical intervention, an inclusion of adverse effects is something that would appear in the lead, even rare ones. Acupuncture is not 100% safe and one of the adverse effects is death. We aren't comparing the "effectiveness" of acupuncture versus adverse effects to real medicine, we're just talking about acupuncture. I'm pretty sure any intervention that has "death" as a regular side effect would have that information in the lead.

If you want the proof from the article, perhaps you should request it from a library or find it in paper form and read through it yourself.

I support the inclusion of the "from 2000" if we are including the raw numbers - it underscores that those figures are from only a decade of research, suggesting a large number of unrecorded side effects from before that time. The "statistically significant" part I also fail to see the point of and would support removing it unless I can be convinced otherwise.

The Ernst, Lee & Choi article is about acupuncture and pain, not nausea. That's why they don't talk about nausea. You'd have to see the detailed Cochrane Review to see why there was no evidence of publication bias - it's possible that there is no bias because the selection methodology excluded a large number of results from China for quality reasons. WLU (t) (c) Wikipedia's rules:^simple/_complex 21:22, 5 June 2011 (UTC)

Hi WLU -- regarding the source, I just discovered that I can check at WP:LIBRARY. OTOH, it would take you less than five minutes to copy, paste and email me the source. Why not help a fellow editor? I've done the same.

Also, is there any good reason not to have the tag there, given that more editorial eyes are generally good for an article that generaly has very few active editors? If so, would you mind restoring the tag?

Acupuncture is not portrayed as "risk-free and (free of) adverse affects". Rather, it is said that these are relatively low (just read the sources). Ernst's raw number doesn't change that.

Glad you agree with adding the time frame to the and removing "statistical significance".

You're quite wrong about how deaths are handled in lead sections on Wikipedia, but I assume you'd agree that standards should be consistent. For example, see Serotonin_syndrome#Cause, and click on any of the compounds listed: the large majority do not mention the deadly serotonin syndrome in the lead. There are plenty of similar examples. Apparently, this article is failing to follow standards that are widespread in articles on medicine. I'll ask about it at Wikiproject Medicine, and we can follow the guidelines (de facto or not) that they use. Sound good?

In any case, whether in the lead or note, we need to mention that deaths are due to practitioner-error (pneumothorax, dirty needles), just as, e.g., we note that fatalities for a given compound are caused by overdose.

Regarding Ernst, efficacy for pain and deaths: the point is that the comparison, which he insinuates to be somehow meaningful, is a half-truth because it doesn't include other benefits in the equation. Risk-benefit doesn't mean jack-squat if you ignore any important risks or benefits. On top of that, the risk is a meaningless raw number. Students learn not to make such errors in college. What a foolish thing for Ernst to say.

Re nausea, my only point was that it's a strong and pretty much unequivocal source. regards, Middle 8 (talk) 03:28, 6 June 2011 (UTC)

I don't have a copy. I could get one if I need it, and you probably could to. Normally I request sources from specific editors so I can't help you with WP:LIB.

Tags are not badges of shame. If there is a genuine reason to question whether the authors actually consider these adverse events statistically significant, tag it. If there's not (and I don't see any reason to suspect such a basic thing is not true but only checking the actual source will make it clear) then don't bother tagging it.

In the absence of specific guidance, we use common sense. Common sense to me suggests we include serious adverse effects in the lead, particularly when a major review article makes a point of highlighting these adverse effects. If you think adverse effects including death should be included in the lead of other articles, feel free to include them. When I rewrote natalizumab, I included death in the lead. Certainly, pages like Celecoxib, Tylenol and probably many other pages should have it included in their too-short leads. Aspirin, a featured article, does mention it. WP:MEDMOS doesn't provide much guidance, but WP:LEAD does, and it indicates including prominent controversies which would include information on effectiveness and adverse effects in my opinion.

Ernst's whole point is that while we can't be sure of acupuncture's benefits (i.e. it's still equivocal whether inserting needles into the skin has specific effects or if it's due to non-specific effects) we can be sure of its adverse effects like death. The lead also closes with a note that acupuncture is safe when administered by well-trained professionals using sterile needles. Beyond the modifications I have already suggested, I see no need to further alter the lead. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:22, 6 June 2011 (UTC)

Hi WLU - since you agree that the tag is acceptable, I'll ask again: would you mind restoring it (along with my other edit adding "since 2000")? Another editor has been removing it without discussion. But it does no harm, and in fact does good.

You say "Ernst's whole point is that while we can't be sure of acupuncture's benefits...", but he's not including all of the benefits in the equation. Nor are risk numbers meaningful.

As for the lead section's treatment of adverse effects, let's wait to see what global consensus is. Given the the vast majority of medical articles don't include death in the lead (perhaps because it's rare in so many cases), I suspect it may differ from your position. TBD. regards, Middle 8 (talk) 17:25, 6 June 2011 (UTC)

I don't think the tag is acceptable, I think it's stupid and unnecessary. I don't support restoring it. Is this an acceptable wording to you?

Again, Ernst is talking about pain. His point is acupuncture hasn't been conclusively proven for pain, thus presenting uncertain benefits with certain, and possibly completely unnecessary risks. If benefit to risk is expressed by a ratio of one over the other, if the top number is a zero, it doesn't matter what the bottom number is - the net result is a zero.

Again again, because other articles don't discuss deaths in the lead doesn't mean this one should or shouldn't. The only way you can really compare articles is if you are comparing featured articles, and even then it's not necessarily a good idea. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:16, 6 June 2011 (UTC)

Hi WLU -- good news, an editor at WP:LIBRARY came through with the source[17]. Grab it if you like, but do it soon; the link will expire.

Re the tag, what could be wrong with attracting more editors, which is all a tag does? Anyway, I think your edit is an improvement. I still have problems with not quantifying risk, even in a ballpark way -- readers should know that these events are rare and caused by poorly-trained practitioners. Readers should also know that many sources consider acupuncture to be relatively safe (see other sentences in the lead), and I'd prefer to tie into those somehow. The lead is kind of fragmented and repetitive. I'll suggest changes when time allows.

And I still think it's undue weight to mention deaths in the lead. As I mentioned before, I don't think global consensus supports the idea that every adverse effect, including death, belongs in the lead. Among featured articles in health and medicine, only one --Treatment of multiple sclerosis -- includes death as an adverse effect, and it's not mentioned in the lead. So we're zero for one in that small sample set. WP policies and guidelines evolve with the whole encyclopedia, not just featured articles, so non-featured articles still weigh in global consenus. As I said, I'll ask at Wikiproject Medicine.

Regarding Ernst and the risk-benefit ratio, I think we're talking past each other. I understand what you're saying, but I don't know if you grok my point. Ernst is implying that his benefit/risk ratio is somehow meaningful, but it's flawed top and bottom. The numerator includes only pain and is therefore incomplete (and acu's efficacy in treating nausea is unequivocally real per the most recent Cochrane review; this would go in any serious assessment). His denominator is of course a raw number, not indicating frequency of adverse effects, and not very informative. The source is flawed and its implication that acupuncture is relatively unsafe is contradicted by several other sources in the article. So including deaths in the lead is doubly undue weight: other articles don't use Ernst's dubious "logic", and other articles estimate a relatively low frequency of adverse events. regards, Middle 8 (talk) 21:34, 6 June 2011 (UTC)

@WLU -- I just tweaked your edit. If we're going to mention death in the lead for now, we need to say something about why they occur and how often. Ernst said "minute" (which is true, relatively) and then went on to say that even one avoidable adverse event is one too many (also true). Nothing in there about "statistical significance", though, from my reading so far. --Middle 8 (talk) 21:57, 6 June 2011 (UTC)

(edit conflict)

Did you understand the meaning of "not badges of shame" above? Template:POV/doc elaborates, but the same principle is broadly applicable to other templates indicating a dispute. Their utility rests in attracting more editors to a hitherto-neglected page for discussion. Using them on page such as this, which is broadly watchlisted, is unnecessary and unproductive. Simply discuss the issue on the talkpage, there's no need for tagging it. LeadSongDog come howl! 18:37, 6 June 2011 (UTC

Hi LeadSongDog - yes, I understand what tags are for. How do you know this article is broadly watchlisted? All I know is that at any given time, the article usually has a very small number of editors -- often as little as two. So it does no harm to have the tag, and attracting more editors is good. At the same time, the editor who keeps removing the tag is abstaining from any discussion here, and when I mentioned this on his talk page, he was rude and said I should take it up on this page, which he is ignoring. Seems like we could use some fresh editorial input, no? regards, Middle 8 (talk) 21:34, 6 June 2011 (UTC)

As of now there are 245 editors that have watchlisted this page. How many would satisfy you?LeadSongDog come howl! 18:36, 7 June 2011 (UTC)

@LeadSongDog -- cool widget, thanks. Lot of lurkers, apparently. I wish more than the usual half-dozen (dozen on a rowdy day) editors would show up. Dunno if tagging would improve that situation or not, but I can't understand why some editors freak out over straightforward, non-WP:POINT-y ones. regards, Middle 8 (talk) 03:32, 9 June 2011 (UTC)

Middle8, good job. Now you've actually produced an edit I can like. My job in mentoring you in writing to NPOV has been fruitful. OrangeMarlin ^{Talk• Contributions} 22:48, 6 June 2011 (UTC)

OM, I know you will not fail to be proud that your patient and unstinting work has borne fruit. Now if I can only mentor you into using talk pages, The Force will have prevailed. Om Saraswati Om, Middle 8 (talk) 03:54, 9 June 2011 (UTC)

FYI: I partially undid the most recent edit by Middle 8 here, and have proposed a new structure incorporating his wording in the same edit. I'm uncomfortable with Middle's proposal because it changes the wording from presenting the risks to solely downplaying them; Instead of saying "there are risks including X", it says "any risks (even X) are improbable". My new wording bypasses that issue by presenting the risks, and then incorporating his wording discussing their frequency. However, it's worth noting that I don't have access to any of these sources (or really, the time to check them anyway), and as such, I'm not fully comfortable supporting even my proposal. If we have any sources which discuss risks without emphasizing their infrequency, that should be reflected better in the wording. I don't know if we do. Any input on this would be great.   — Jess· Δ♥ 23:43, 6 June 2011 (UTC)

I'm fine with the current version. I have copies of the articles, and right now they're available at WP:LIB for a limited time only. I've tagged the section with {{resolved}} because I'm sick of discussing it. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:59, 7 June 2011 (UTC)

@WLU -- I'm a bit tired of discussing it too, but I wouldn't consider it fully resolved yet. There's no pressing need for intense discussion now and you can always take a wikibreak. regards, Middle 8 (talk) 08:43, 7 June 2011 (UTC)

Hi Jess -- actually, per the source, the risks overall are low -- "minute" was a term used (one death every two years from a literature survey -- compare that with other medical interventions). The thing is that a large number, possibly the majority, of these risks are due to malpractice. Acupuncturists needle in places where they are taught (over and over again) not to needles, or (again against training) they use dirty needles (more often in 3rd-world countries; in the Western(-ized) world, needles are disposable). Therefore, properly training acupuncturists is vital and should reduce risk even more. (The original wording, especially the "statistically significant" bit, wasn't that close to the source.) How about this? regards, Middle 8 (talk) 03:55, 7 June 2011 (UTC)

To summarize, it looks like we're at or very close to agreement on the current discussion of wording in the lead. I still have serious reservations about putting extremely rare deaths in lead. We should be able to resolve this with additional editorial eyes and investigation of global consensus. regards, Middle 8 (talk) 08:43, 7 June 2011 (UTC)

Consensus doesn't mean everyone is happy, and everyone but you seems to think including deaths in the lead is appropriate.

I added my own qualifier about under reporting. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:11, 7 June 2011 (UTC)

@WLU - With all these additions it's getting too granular for the lead and would be better in the body. As for putting very rare deaths in the lead, I haven't seen anyone else comment besides you (pro) and I (con). Have you got diffs showing what I may have overlooked? In any case, we still could use more editorial eyes. Gee, what would help that? Oh yes, a tag would. The benefits of a tag far outweigh any disadvantages (all of which run along the lines of simple personal preference, with no appeal to guidelines or policy). --Middle 8 (talk) 15:18, 7 June 2011 (UTC)

Well, I am not happy. The lead currently says this: "A 2011 review of review articles concluded that, except for neck pain, acupuncture was of doubtful efficacy in the treatment of pain and accompanied by serious risks and adverse effects including death." While technically correct, there is a weight problem with this statement as this holds acupuncture to a much higher standard than conventional medicine. The article Aspirin says nothing at all about deaths from incorrect use of salicylate, even though it is a significant problem:

"Salicylate intoxication remains a common problem in Britain; about 10 percent of adult hospital admissions for deliberate self-poisoning involve these drugs. [...] In the United Kingdom, the annual number of salicylate-related deaths has fallen slightly between 1967 and 1980. [...] The mortality rate from acute salicylate poisoning in hospital-treated adults is about one percent; death is usually preceded by neurologic features and a dominant metabolic acidosis." [18] (I am sure there are better sources, this is just a random source I found via Google while avoiding anything that looked remotely like a crackpot site. Given the large number of known problems that can occur with salicylate, it would be astonishing if there were not hundreds or thousands of related deaths worldwide every year.)

Exactly. When I researched aspirin & paracetamol, (some time ago now), I found that the complication/fatality rates were between 1 in 3,000 and 1 in 8,000. This illustrates *exactly* what degree of double-standard is being applied -- Western medicine is treated as though 'normal, thus risk-free'; while acupuncture has extreme undue weight & false emphasis given, to it's generally accepted low-to-minimal risks.

Twhitmore.nz (talk) 02:43, 10 June 2011 (UTC)

That's not a weird omission, it's the standard treatment of such topics. Of course every single death is too much, and it makes sense to stress serious complications of unnecessary therapies and practices such as needling (or riding motorcycles, to take a non-medical example) than those of best practice approaches such as the best known medical therapies. But I wouldn't be surprised to learn that more people die from malpractics related to salicylate every year than from acupuncture. After all, it's often prescribed as a placebo – presumably often without checking for contraindications – and has also been implicated in the high mortality of the Spanish flu, for example. Hans Adler 14:57, 7 June 2011 (UTC)

Hans -- I agree. There are quite a few double standards here. For example, from the lead, "The efficacy of acupuncture, beyond the placebo effect has never been unequivocally demonstrated." How many things in medicine are unequivocally demonstrated? Usually we settle for p < 0.05 or 0.01. And certainly any procedure, like surgery, has never been unequivocally demonstrated (because you can't blind the practitioner, among other reasons). But we don't say that in the lead of any surgery article. It's a little like saying "It has never been unequivocally demonstrated that President James Buchanan (d. 1868, so not a BLP) was hetereosexual." Or the old saying "have you stopped beating your wife?" Such statements basically violate WP:NPOV, WP:VER and WP:OR all at once. Standards should be consistent across articles. The vast majority of articles on medical interventions say nothing in their lead sections about a real but tiny risk of death. undue weight is likely a big reason for that. regards, Middle 8 (talk) 15:18, 7 June 2011 (UTC)

Middle, I'm okay with your proposed addition of "especially", (of course) assuming that's in line with the source. I'm also supportive of keeping the adverse effects in the lead, as it's something I've seen discussed repeatedly in reviews of acupuncture, and therefore appropriate to quickly summarize when discussing the topic. If the asprin article doesn't cover that sort of coverage in reliable sources, then it should. In any case, does anyone have a direct link to this source that I can look at? Thanks,   — Jess· Δ♥ 15:38, 7 June 2011 (UTC)

This is why comparing pages to pages on a wiki, rather than pages to policies, guidelines and standards, is problematic. The two article leads do not match up. Should we adjust acupuncture to remove adverse effects, or adjust aspirin to include more adverse effects in the lead? I would argue for the latter; the one featured article I reviewed which was aspirin, did mention some in the lead. If it needs to be adjusted to include more, then we should continue that discussion on talk:aspirin and probably reference this source. A substantial scientific controversy is whether acupuncture works as anything but a placebo (this is mentioned explicitly in the Ernst, Lee & Choi article). Part of that controversy is whether its "effects" are worth the risks - which exist and can be serious; this is also explicit in Ernst, Lee & Choi.

Incidentally, I've edited to shorten the wording (also, risks aren't "frequent" they are likely or unlikely, serious or minor). I don't think we need an extremely granular lead, but I do think the fact that serious adverse effects are recognized should be included. And for that matter, if we're going to include it I think it's worth discussing Ernst, Lee & Choi's corollary - that any risks just for a placebo effect are too many risks. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:54, 7 June 2011 (UTC)

@WLU - One thing about guidelines (etc.) is that they sometimes evolve from the botom up, i.e. from what seems acceptable and workable in a broad range of articles. How to handle adverse events in a lead section may be such a guideline in progress. OTOH, WP:LEAD alone could easily be read to say that truly low risks aren't important enough to be in the lead. I strongly suspect that this is the rationale we will find if we start poking around other articles and asking other editors.

I like your edit to the lead. BTW, I understand the point that "any risks for a placebo are too many risks" (although that's technically true only if we have at hand truly risk-free placebos that are as strong). It seems to be generally understood among editors that the jury is out on the question of whether acu is no more than a placebo, so I hope that we will qualify that point adequately and not weight it too much. regards, Middle 8 (talk) 03:54, 9 June 2011 (UTC)

Great, why don't you suggest a change at WP:MEDMOS to explicitly mention adverse effects in the leads of medical articles and get back to us. And again, the two main points of Ernst's article is that the highest quality tests of acupuncture suggest it's either solely, or primarily an extremely effective placebo (placebos are not unitary either, pills are less effective than injections which are less effective than sham surgery, and all are enhanced by factors like a lengthy consultation, "exoticness" and drama) and that the adverse effects exist and are serious for an intervention of such dubious merit. As for "truly effective procedures that are as strong" - how about acupuncture with toothpics? No penetration, just as effective. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:47, 9 June 2011 (UTC)

@WLU - Yes, as I mentioned, I'll seek further opinions on this issue; MEDMOS is a good suggestion. No need to go over Ernst (PMID 21440191) again; I grok it and have already mentioned some caveats above.

Thanks for bringing the other study to my attention; I've seen it, and agree that nonpenetrating treatment of acupoints is worth studying. That modality is particularly important in Japanese acupuncture, though it's part of Chinese medicine as well. regards, Middle 8 (talk) 07:13, 10 June 2011 (UTC)

The "jury" is not out about acupuncture being anything more than a placebo, the jury is completely, dismissed, and sitting at the bar having brewkies celebrating another piece of junk medicine proved to be nothing. As WLU says, it has a placebo effect of very minor usefulness, but has a defined risk. It is unethical to provide a medical procedure that has a placebo effect and significant risk. There's another junk medicine called Zicam. It uses zinc to treat or prevent colds. It has a some small effect in reducing the length of a cold (which is almost impossible to define, because of the placebo effect). However, it also had one small, but highly significant side effect, which the company hid–it could permanently destroy your sense of smell. Not worth it. Acupuncture is the same. OrangeMarlin ^{Talk• Contributions} 15:01, 9 June 2011 (UTC)

According to Cochrane, the best MEDRS there is, P6 acupoint stimulation prevents post-operative nausea and vomiting. Full stop. No evidence of publication bias. Works just as well as anti-emetic drugs. Acupressure at that point works too, just as TCM says it should; if true, no dirty needles, which is nice. Nothing in biomedicine predicts the effects of P6 stimulation. And -- once again -- Ernst is wrong to compare it to placebo, because it works for PONV. The risks from needling are really quite small, probably smaller than other anti-emetics.

So.... you are quite wrong about "where the jury is at". Doesn't bother me that you feel that way, but we shouldn't slant the article according to these opinions of yours. The fact is that the highest-quality sources say acu works for PONV, and that for other conditions there is a spectrum of evidence, and often not enough to draw a conclusion. Saying anything more than that is just opinion. --Middle 8 (talk) 07:13, 10 June 2011 (UTC)

I wonder what the shams were. Nonpenetrating needles? Toothpicks? Alternate acupuncture points? Were they compared to modern antiemetic drugs? Acupuncture presents a unique set of challenges to a proper research protocol, and those challenges are still being sorted out, refined and addressed. So nothing is closed, but the evidence base for acupuncture has been considerably eroded, to the point that it stands now on two legs - pain and nausea. Time will tell. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:33, 10 June 2011 (UTC)

Oh wait maybe Cochrane has its head up its ass. Besides, who said Cochrane is the best piece of MEDRS out there? They seem to withdraw a lot of papers? One article helps the POV, yet we can find dozens of real science that states otherwise. Because real science doesn't quote mine, it looks at the totality of evidence. That's why I stand so rudely to you Middle8. You try to seem like you're doing real research, and try to come across as so neutral, but you're not. You're trying to find anything to prove your point, and you FAIL every single time. Acupuncture does nothing but placebo, it is so clear. The quality of sham controls has improved in the 5 years since that review was written, and probably 8 years since the studies it reviews were published. There has been no real research published in quality medical journals, one that meets the highest level of MEDRS, that support the hypothesis that acupuncture does anything but harm people while giving a negligible placebo response. So, if you want to be a truly neutral editor, you can do it buddy, you could write: blah blah blah according to Cochrane reviews, but numerous studies, better designed, contradict this conclusion. But quote mining is so much easier. OrangeMarlin ^{Talk• Contributions} 15:12, 10 June 2011 (UTC)

OM, here is where I think you and I will part ways. MEDRS does identify Cochrane as among the best MEDRS out there, and given their continual re-evaluation of the evidence, withdrawing papers on a regular basis can be seen as healthy. Though I think the results for nausea are probably just as flawed and over-hyped as those for pain, none the less the Cochrane Review was positive and as an editor I am reluctant to simply dismiss it despite its flaws. SRAM I would like to use as a source in the page, but I wouldn't put it in the lead I don't think. I personally agree with much of what you say about acupuncture (though I disagree that ti's a negligible placebo response, clearly it's a strong, but still placebo response) as an editor I have to, pending the inclusion of further sources, support the inclusion of the Cochrane review. Seen over the long term, it's obvious acupuncture is losing it's evidence base but until it is lost we are bound to report what is current and I think that includes Cochrane (as well as MEDRS that are critical of course). WLU (t) (c) Wikipedia's rules:^simple/_complex 15:34, 10 June 2011 (UTC)

How dare you accept Middle8's cheese theory! But here's where you and I part ways. Always be skeptical of anything. There has been a lot of discussion about the sham controls, and when done properly, show that acupuncture doesn't do anything. And I'm going to trust Kimball Atwood's analysis of this than Middle8's (and even you), since he is an anesthesiologist and has been studying acupuncture forever. Finally, yes I understand that good, trustworthy scientists, in an open process, must withdraw papers, like Cochrane does. My point is with the data from the past 4-5 years (probably the amount of time since the last article published that was reviewed in their 2008 update) no longer supports the Cochrane POV. THAT is real science, in that we don't quote mine a 5 year old study, but look what has been written subsequently. I'm critical of the high level of support of Cochrane in Wikipedia because people think it's the final word. Mostly it is, because newer research confirms it. But in this case, it does not. That's why I wrote my suggested statement that you does not give undue weight to the review. And, in fact, it appears that Cochrane gives extra weight to the most flawed and poorly designed studies, ignores anomalous data, and doesn't adequately describe the vast majority of patients who didn't even show the placebo effect. Cochrane can be criticized, as long as that criticism is in a MEDRS source, like I've given. OrangeMarlin ^{Talk• Contributions} 15:47, 10 June 2011 (UTC)

I agree as a skeptic, as an editor I must conceed that as flawed as the evidence base may be the consensus appears to be that the P6 point for nausea is as of now established as effective. There's still a ton of caveats, and personally I think Atwood's analyses in general are close to a gold-standard for medical research, but you can't always get what you want and even as the rules may give a stupid outcome in this instance I still think overall they are responsible for higher-quality content on wikipedia. As I say to many a credulous editor though, science will win in the end, we just have to be patient. And when they do a new analysis with better controls and the evidence base changes, I'll be here to edit accordingly. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:10, 10 June 2011 (UTC)

I don't like Cochrane. I don't consider a review of research, which applies a 0% weighting to the entire body of research from the culture of origin, to be academically sound.

As we know, many many primary-source papers have found benefits for acupuncture. They have been investigated it, as a productive avenue of research (not just debunking it, as some falsely & illogically claim) for several decades now.

We see above, clear evidence of POV from certain editors. Science is about the evidence determining what's right, not assumptions & knee-jerk biases (late 60's reductionist science) determining what evidence to accept. Grow up. Biological sciences are more complex than whatever tedious physics-101 course, you're studying.

Twhitmore.nz (talk) 23:38, 24 June 2011 (UTC)

And, I'd like to point out -- if research over the next say, 10 years, does find that acupuncture really & unambiguously have no parasympathetic nervous system effects, that it really has no electrical or other biological effect on the body -- MRI should show these up -- then I'll be quite happy, to re-write this page.

But as of now, I feel that certain people are trying to select & re-write the EVIDENCE to fit their BELIEFS. And that's completely unscientific, bigoted, and frankly it disgusts me. Like trying to shout the theory of evolution, or continental drift down. The science will speak for itself in about 10 years or so.. right now we just don't have a good enough understanding of biological systems.

Twhitmore.nz (talk) 00:00, 25 June 2011 (UTC)

MEDRS stats that Cochrane reviews are among the best medical sources we have.

Why would culture matter, since humans are all of the same species? Your statement comes across as rather racist, akin to Hitler not liking "Jewish" science. Primary sources may support acupuncture, but the higher-quality the sources, the more the evidence base erodes. The fact that science has not found much merit in acupuncture suggests that, like many old beliefs, it's probably not that effective - not that there's anything wrong with science. If there's evidence of POV here, it goes both ways - some people simply don't want to believe that acupuncture is marginally effective at best, possibly nothing more than placebo.

If acupuncture's evidence base reverses trends in the next ten years and starts to support acupuncture rather than refute it, then the page should change. In the mean time, wikipedia is not going to wait around until if and when acupuncture is supported - it will report the current status of the field. If we are missing high-quality MEDRS that support acupuncture, feel free to point them out. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:41, 26 June 2011 (UTC)

The idea that its appropriate to test the efficacy of acupuncture with randomised, controlled double-blind clinical trials is ludicrous! Acupuncture is a physical, tangible, pragmatic intervention. Its a very real practical process, there is no way that its valid to test the efficacy of acupuncture with a methodology that was designed for drug trials and is only really suitable in a pharmaceutical context. I mean "sham acupuncture", preposterous! There are entire schools of Japanese acupuncture with hundreds of years history practising exactly what you orthodox drones want to denigrate as "sham acupuncture" (superficial needling/non-penetrative needling/alternate meridian and acupoint location/etc). Blinding the practitioner? Anyone that thinks that it would actually be possible for a blinded practitioner to administer effective acupuncture is obviously entirely ignorant about what the whole process of acupuncture entails in the first place. Acupuncture is not just popping a bunch of pins in and walking away, that is such damningly shallow conception of a process that is fundamentally an intimate interaction and communiqué between two human beings. The idea that all this biased and flawed evidence you refer to WLU has "refuted" the efficacy in any way is laughable, and the joke's on you.Dickmojo (talk) 10:46, 13 August 2011 (UTC)

Without randomized, controlled trials you can not attribute causation to any medical claim. You can run RCTs of surgical interventions, which revealed that some surgical interventions are actually worthless even though patients reported feeling better. The issue, which is discussed on the page, is that it is hard to create a placebo for acupuncture because it's such an obvious intervention. In fact, once such a placebo was invented (the retractable needle, roughly the year 2000), the evidence base for acupuncture eroded considerably. To date, scientific testing has demonstrated that needle placement is irrelevant (use of a "true" acupuncture point gives the same result as a "fake" point), needle penetration is irrelevant (use of a retracting needle gives the same results as a penetrating needle), needles are irrelevant (twirled toothpics give the same results as penetrative needles), but practitioner characteristics is relevant (a confident practitioner has better results than one that projects a more skeptical attitude). Despite this, people still adhere to TCM theories (unproven, prescientific understanding of biology and medicine) to determine where to needle, when to needle, how deep to needle, etc. People still use needles. People still penetrate the skin. In addition, acupuncture is almost custom-designed to have a strong placebo - lengthy consultation with a compassion-projecting practitioner, superficially convincing qualification process, an elaborate ritual, the use of needles (which are more effective than pills but less effective than sham surgery), the use of multiple needles (two needles is more effective than one, thee more than two, etc.) and a presentation that is both futuristic (an unknown mechanism involving energy, possibly quantum) and ancient (acupuncture has been around for over 2000 years, but more accurately the current form was resurrected by Mao when he couldn't get enough real doctors). Science has studied all these things, acupuncture consistently shows questionable results. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:41, 17 August 2011 (UTC)

WP:MEDRS violation

WP:MEDRS states: "Therefore, it is vital that the biomedical information in articles be based on reliable, third-party, published sources and accurately reflect current medical knowledge.

Ideal sources for such content includes general or systematic reviews published in reputable medical journals, academic and professional books written by experts in a field and from a respected publisher, and medical guidelines or position statements from nationally or internationally recognised expert bodies."

The book, Trick_or_Treatment, while notable enough to have its own Wikipedia article fails WP:MEDRS. We strive to use only the highest quality sources on biomedical articles, and this book doesn't come close to the reliability of a narrative review, systematic review, medical guidelines, or academic book. Some may even see the authors as experts in their fields, (and indeed if it were a peer-reviewed article that was authored by them or even an academic text, I would say it passes MEDRS) however just because one writes a book does not mean it meets MEDRS. If this information cannot be verified from a high quality source, it should be removed from the article. DigitalC (talk) 03:38, 11 June 2011 (UTC)

The passage in question is the following sentence:

Edzard Ernst and Simon Singh state that (as the quality of experimental tests of acupuncture have increased over the course of several decades through better blinding, the use of sham needling as a form of placebo control, etc.) the "more that researchers eliminate bias from their trials, the greater the tendency for results to indicate that acupuncture is little more than a placebo."

Per WP:MEDRS, "popular science and medicine books are useful tertiary sources" (with some exceptions). This book is almost certainly not an exception, so it can be used as a tertiary source on medical claims. The source is clearly sufficient (and in fact of very high quality) for the purpose of documenting the comments of an expert (Ernst) on the background of the current state of knowledge.

But there is a problem: The sentence is getting too much weight in its current position. The difficulties of acupuncture must have been known to the Cochrane reviewers, and it is the purpose of such reviews to take these things into account. A valid use of Trick or Treatment is for explaining the difficulties. An invalid use is for obliterating the rest of the section Acupuncture#Evidence-based medicine. The sentence currently gives the impression that the Ernst/Singh statement makes the Cochrane review obsolete. Now, if Trick or Treatment actually criticises the review, then that should be clearly and with appropriate weight. If it doesn't, then this is a case of WP:SYN. ("Do not combine material from multiple sources to reach or imply a conclusion not explicitly stated by any of the sources. If one reliable source says A, and another reliable source says B, do not join A and B together to imply a conclusion C that is not mentioned by either of the sources.") The same principle also applies to the previous sentence ("Positive results from some studies on the efficacy of acupuncture may be as a result of poorly designed studies or publication bias."). I am not sure what precisely should be done now. I would have to read the four sources in question. If they do not actually make stronger claims than we are using them for, the paragraph could be moved to the beginning of the section, where it would motivate the long discussion of details. Hans Adler 05:29, 11 June 2011 (UTC)

A book co-authored by Edzard Ernst on complimentary and alternative medicine passes muster as a MEDRS in my mind.

The entire "Scientific basis and research on efficacy" section, in fact the whole page, needs a thorough rewrite and I don't envy the poor bastard who has to do it. Hans, I revisited TorT on google books and they do specifically reference Cochrane, stating they expect the reviews done by them to change their position as new evidence based on better-controlled trials to produce a more negative conclusion (essentially, the best-controlled trials were not included in the Cochrane reviews because the reviews were done before the new controls had been integrated and new trials incorporating them completed - see page 81). So the phrase might be appropriate left where it is. However, I do agree that moving it to the beginning of the section is acceptable, in fact I think it makes more sense than putting it at the end. The general criticism should probably appear before the specifics. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:10, 11 June 2011 (UTC)

How do we prove that 'sham needling' is not accidentally causing, non-skin-penetrative positive acupuncture effects? After all, much TCM is actually done with 'moxa' -- burning herbal candles over the points, generating an infra-red thermal effect.

If so-called 'sham needling' actually causes some significant degree of genuine effect, then that produces a false equivalence between acupuncture and placebo. How has this possibility been disproved? Twhitmore.nz (talk) 01:35, 26 June 2011 (UTC)

How do you prove that "true needling" is accomplishing anything? Science is based on the positive proof - you can't ask people to disprove acupuncture, it's up to proponents to demonstrate it has merit. Which, to date, has not happened for the most part. No specific points have been identified that have actual specific effects. Acupuncture points vary from system to system. No anatomical structures exist to support acupuncture points or meridians. Also, if you truly support the idea that any point is just as good as another and penetration is not necessary, then I assume you will immediately stop using nonpenetrative needles in your practice, and restrict your choice of points to only those that stand no risk of causing injury. And will abandon the complex, and apparently nonsense pseudoknowledge of qi, acupuncture points and meridians that accompany it. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:35, 26 June 2011 (UTC)

Breathtaking ignorance WLU. ALL of the literature shows that acupuncture has a statistically significant effect. Its only when compared to the "placebo" (sic), i.e. "sham" acupuncture techniques, that the statistical significance subsides. Now, in this context, Twhitmore's point is entirely valid. I mean, you're the one who's trying to argue that bio-electrochemical energy is "pseudoknowlege", you obviously haven't read any physiology textbooks... So what if the Ancient Chinese Taoists, who were the first scientists in history, described their discoveries in a different language? How dare they! I'm sure they would apologise to you profusely for mislabelling bio-electrochemical energy as "qi". You do realise that scientific instruments which detect areas of reduced galvanic resistance on the skin unerringly locate regions which coincide exactly with acupoints, don't you?Dickmojo (talk) 11:02, 13 August 2011 (UTC)

You don't appear to understand scientific control. If "real" acupuncture and "fake" acupuncture give identical results, what can you conclude? When needling "real" acupuncture points versus randomly chosen points give the same results, what can you conclude? When not penetrating the skin gives the same results as penetrating the skin, what can you conclude? Yes, any form of true or mock acupuncture is better than doing nothing, but that is true of any intervention. Sugar pills are better than doing nothing.

The body generates heat, kinetic energy, a small amount of light, and yes, electrical energy to transmit nerve impulses. Qi is which of these? Have you read Napadow et al 2008 which concludes that there is speculative, but no firm or agreed on evidence for meridians? How about Ahn et al 2008 which states "Based on this review, the evidence does not conclusively support the claim that acupuncture points or meridians are electrically distinguishable. "? If you want to adjust the page, provide a source. Your opinion is not sufficient. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:51, 17 August 2011 (UTC)

POV warning

{{POV}}

I'm not sure why this hasn't been added yet --it probably should have happened a year ago! POV has been a contentious issue for a really long time and many of the talk page topics deal with POV either directly or indirectly so it seems more than reasonable to add this. — Preceding unsigned comment added by Metabradley (talk • contribs) 20:15, 12 June 2011

If you're going to add the tag then you should state why you're adding the tag. Just putting the tag there doesn't explain what we can do to help the article. As such, until you give a justification I'm reverting. Let's try to find consensus here first. N^oformation ^Talk 21:47, 12 June 2011 (UTC)

Just FYI, the statement "The efficacy of acupuncture, beyond the placebo effect has never been unequivocally demonstrated" is not a POV violation. NPOV does not mean that we give equal weight to all sides, that we say nothing negative about something, or that we write it from the perspective of the supporters; rather, NPOV means that we report what reliable sources state on the matter. In the case of acupuncture, that essentially means peer reviewed, scientific journals; peer reviewed science has found that acupuncture is no more effective than placebo, and thus that is what we will report. It would be a POV violation to not report that. So please take a minute and read WP:RS, WP:NPOV and WP:MEDRS, and in the future, please do not remove sourced content without an explanation in the edit summary, and if it is likely to be controversial (like this edit), please discuss here first. Thanks! N^oformation ^Talk 22:09, 12 June 2011 (UTC)

Also, please read Talk:Acupuncture#This article is inappropriately negative. It's meant to be about Acupuncture, not 'Acupuncture Skepticism'. on this very page so we don't have to rehash an old argument once again. Thanks. N^oformation ^Talk 22:34, 12 June 2011 (UTC)

i think that even bringing up that topic shows that POV is in dispute. the idea is that we can't come to consensus and until we do the page should have a label. the talk page history is full of dispute check it out and while you are at it you should read http://en.wikipedia.org/wiki/Wikipedia:NPOV_dispute page before removing the label again. Metabradley (talk) 15:42, 13 June 2011 (UTC)

Tags are intended to draw editors into an active discussion, not "mark" the article. There appears to be consensus on these issues. Feel free to participate in the discussion further, but please stop edit warring on the page. Thanks.   — Jess· Δ♥ 16:39, 13 June 2011 (UTC)

If you have reliable sources that show that the NPOV of this article is wrong, please do. But just saying it is POV based on your opinion, well that's not how it works around here. Ignoring the medical science, published clinical trials, and the lack of any scientific theory that would support how acupuncture might work means that you just want to make it into an Acupuncture advertisement. Well, we're not doing that, but there are places on the internet where you can. Again, if you've got some reliable sources that are convincing, then we'd be glad to review them. But remember, most of us here have read most if not all of them.OrangeMarlin ^{Talk• Contributions} 16:46, 13 June 2011 (UTC)

@Metabradley BTW, please read WP:CON; Consensus is not a vote.   — Jess· Δ♥ 16:49, 13 June 2011 (UTC)

Disabled the tag. Claims that acupuncture is not neutrally described need to cite reliable sources to the point. To date, it looks like the best sources indicate many aspects of acupuncture don't pan out - penetration, the utility of specific points, the traditional "theory" behind it, etc. Just editors disliking the page doesn't make it NPOV, but as I've said before that doesn't mean the page doesn't need a rewrite. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:13, 13 June 2011 (UTC)

I agree on a top-down rewrite of the article, because it seems to read like.....a bunch of editors wrote it. I once agreed to that in a CAM article, and a certain twit decided that meant he could change the POV of it. It turned out not so well, and the editor got banned by the community. However, Homeopathy turned out pretty well, if I may say. Had to have Dana Ullman thrown out of the project, but it worked out all right. Just know if we rewrite this, every CAM-supporting editor will show up to use the babblings of their local acupuncturist as a reliable source. OrangeMarlin ^{Talk• Contributions} 23:20, 13 June 2011 (UTC)

As part of his "minor" edit, Metabradly removed the following:

The efficacy of acupuncture, beyond the placebo effect has never been unequivocally demonstrated.

Is there consensus to leave that out?Desoto10 (talk) 21:48, 21 June 2011 (UTC)

No, which is why it was reverted, and he was blocked for disruption.   — Jess· Δ♥ 23:20, 21 June 2011 (UTC)

The POV in this article is outrageously negative. There are some serious haters of acupuncture among you guys. I mean, what the hell? Did acupuncture poison your dog and rape your sister and kill you first born son? There is no excuse for the sort of negativity that permeates this entire post. For example: the sentence "Reston believed he had pain relief from the acupuncture and wrote it in The New York Times" is disgraceful. Pain is a subjective experience, if the subjective experience of Reston's pain was relieved, then the only accurate way to write that sentence is, "Reston received pain relief from the acupuncture and wrote about it in the New York Times". I'm changing it now. And I also changed a section in the middle history which was needlessly nasty towards acupuncture to be a little bit more neutral. You guys from the Skeptic project or whatever are really pushing a barrow over here, and its not acceptable. I mean, there isn't this sort of negativity over on the Chinese Martial Arts page, and acupuncture is just as culturally significant as that.Dickmojo (talk) 14:08, 13 August 2011 (UTC)

This is nonsense! How did this article get hijacked by a clique of people who know almost NOTHING AT ALL about acupuncture? This is an article about acupuncture, not an article about how inferior and useless acupuncture is and how awesome and wonderful western medicine. Its a false dichotomy, the two are not in conflict with each other! Acupuncture is a TRADITION! Treat it with respect! Thousands of years of history and philosophy should be given more weight than your petty little tantrums about randomated, convoluted, double deaf and dumb trials. Not everything has to be "debunked" you guys. For example, the sentence "Heart-qi is believed to be a force that causes the blood to circulate through the body, whereas in science-based medicine, the blood is propelled by the heart pumping it." What a stupid sentence! Obviously written by someone who knows NOTHING AT ALL about acupuncture who's mind is COMPLETELY SHUT. Let me explain it to you: qi is force, qi is energy. The pumping of the heart generates kinetic energy, and it is that kinetic energy (i.e. that "heart-qi") which propels the blood. Why did that have to be explained to you sceptics? How dumb are you?! Honestly, you are all betraying a disgraceful attitude. This article needs a complete rewrite, and I suggest that it be re-written by those who have years of experience in studying, receiving and administering acupuncture, as they are the only ones versed enough to grasp all the subtleties and nuances involved. We can have a separate sub-heading called "Acupuncture Scepticism" if you want, where the orthodox drones can go wild with their frothing at the mouth hatred of acupuncture, but the main article must be more balanced, and more writing responsibility given to those people who practice the art everyday, compared to those whose only knowledge of acupuncture comes from websites devoted to burning "quacks" at the stake.Dickmojo (talk) 00:26, 14 August 2011 (UTC)

The short answer is WP:RS. Without sources to back you up, your opinion is worthless. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:52, 17 August 2011 (UTC)

Problematically, the article is correct, especially as far as actual science is concerned. The sources used in the article aren't "websites dedicates to the burning of quacks" but rather published books and academic articles by doctors and other experts in the field of medicine. I'm sorry reality does not conform to your traditions, but that doesn't mean the article is coming from a point-of-view other than a factual one. Please cite specific things you think are wrong in the article, and preferably bring up sources that support that assertion. i kan reed (talk) 17:59, 17 August 2011 (UTC)

Dickmojo, don't even bother if you have a day job. Editing this article isn't worth it. I attempted this in 2009 and just came back to check up on what it's become- more of the same of course. If you check the discussion history in October 2009, certain editors (Hi WLU!) were adamant about removing any source that supported acupuncture, including scientific ones. Reasons given? They found a review that was 2 years more recent that had negative results but had different authors. I also got called on for reverting without discussing first, as I created topics post-revert. I was wrong in that, sure. Then the same editors would revert without discussing first, knowing they wouldn't get hit by the 3RR because they had more numbers. A directly quoted conclusion from a scientific review supporting acupuncture use was reverted because it was too "flowery"- what did that mean? I'll never know. It was then paraphrased to make the conclusion seem more negative. Something I was told was a big no, no just a few days before. Positive reviews were removed because the extra footnotes made the article too messy. Statements from Trick or Treatment were given more priority over statements from the NIH. The two didn't align w/ each other 100%, so only the (100% anti-acupuncture) statement from ToTr was left in despite editors telling me that the credibility and neutrality of the source should be considered. ToTr is GOSPEL on here. It overrides everything else on here. Seriously. This is just a sample of the kind of treatment you'll receive if you try to take on the people directing this article's POV.

Oh and you see that statement about the Osteoarthritis Research Society International with regards to OA in the knee? It was a battle to get that planted on the page. It was reverted the moment I posted it with the only explanation: "please discuss on talk". The user (Verbal) who was one of the anti-acupuncture fanatics defending this page never discussed. Of course none of the other editors ever criticized him for reverting without ANY reason or for not following up with discussion despite the offense they took when I did the same days prior, except I actually discussed. Of course the consensus statement by OARSI could not be called "expert" (it was reverted even though that's what OARSI called its statement) because it was "unnecessary" so even today we still don't know which kind of people made that statement.

In summary, go see the discussion page on Oct 2009 to see the details of all the garbage that was dished out during that time by the "guard" here. My advice? Find peer-reviewed articles on acupuncture and post them. If they are removed for frivolous or even blatantly incorrect reasons (and they will be), then go to dispute resolution. I ended up doing this at the end my little battle here and it worked. It's extremely time-consuming but it worked. You'll find your opposition editors magically going on vacation when don't have anything to revert so it might take a while. And monitor the change once you win as well. I see someone has since reverted the AMA statement that I had worked so hard to edit after going through Wikipedia's dispute resolution system and winning. PS it was about mentioning the fact that the 1997 AMA statement was based on studies in in 1993 or something. The editors here refused to allow that to be mentioned. And now I see that it's gone again despite dispute resolution siding with me. Kind of despicable actually. Anyway, good luck and don't lose hope in Wikipedia. Not all pages are this bad.99.231.120.164 (talk) 06:22, 12 September 2011 (UTC)

Oh and for god's sakes: "Although evidence exists for a very small and short-lived effect on some types of pain, several review articles discussing the effectiveness of acupuncture have concluded it is a placebo effect." You guys have the gall to write this even as some of the Cochrane reviews cited in EBM section say its effect is at least as effective as conventional medicine for conditions like migraines? The source mentioned for chronic low back pain doesn't even say "very small". It says "small" effect. The other source is from 2006. And the third source (study on placebo vs real acupuncture) from 2008 does NOT conclude it's a placebo effect as so eloquently paraphrased by the editor. It states: " A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias. Whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact of the treatment ritual is unclear." <--- this is NOT the same as an absolutely conclusion that it's the same as the placebo. In fact, the difference was statistically significant but possible bias clouds the conclusion. I see the same kind of garbage is STILL going on here. Misparaphrasing or misattribution of information to sources. Use of old articles despite availability of newer evidence (ALREADY PRESENT IN THE EBM SECTION) as long as it's anti-acupuncture. Oh and of course the 2011 review of review articles is the only article noteworthy enough to mention in the lead despite it disagreeing with Cocrhane reviews (which I was told was the gold standard) or consensus statements on migraines, chronic low back pain, OA, etc. If I wasn't actually aware of the scientific evidence or the low methods of the editors on here, I'd have thought it DIDN'T work for migraines, low back pain, OA,etc. simply because of cherry picking of sources used to back up opinionated statements. I'm not even going to bother editing this article because I know it's a lost cause that will involve a lot of dispute resolution and A LOT of time. But just know that this kind garbage editing on Wikipedia is a disservice to those who use it as their best source of information.99.231.120.164 (talk) 06:59, 12 September 2011 (UTC)

and PS. very nice of you guys to use the conclusion from the 2011 review of reviews by Ernst in both the lead in the article and the lead in the EBM to pretty much discredit acupuncture (with misparaphrasing/misattribution.. you don't even mention that Ernst admits it works for neck pain in the EBM lead. For god's sakes!!!), yet you make NO mention of the thrashing it is getting via letters to the editor by conventional medicine MDs from all over for methodological error. And I'm not going to look up which editor pulled off this sneakiness but it's kind of amusing the usually so watchful editors on here missed all this. How surprising. Not.99.231.120.164 (talk) 07:03, 12 September 2011 (UTC)

Hi! WLU (t) (c) Wikipedia's rules:^simple/_complex 23:29, 14 September 2011 (UTC)

And you've got nothing to say about the obvious misattribution of information to a source and misparaphrasing in the lead of course. It's a shame the cadre of editors here are more eager to remove pro-acupuncture sources because their footnotes make a page "messy" (which is about the most ridiculous thing I've seen on Wikipedia, yet will make absolutely no effort to correct actual errors if they may make the article a little less anti-acupuncture.99.231.120.164 (talk) 17:34, 17 September 2011 (UTC)

Nope! WLU (t) (c) Wikipedia's rules:^simple/_complex 18:48, 17 September 2011 (UTC)

I didn't ask you a question. What are you saying "Nope!" to?99.231.120.164 (talk) 18:48, 18 September 2011 (UTC)

He was referring to putting forth effort to make the article less "anti-accupuncture". The data and academic material on the subject say pretty much what the article does. Being less factual does not remove bias. Again, the rule is simple: good sources and evidence can be used to justify changing the article. Whining about the content will make zero progress. i kan reed (talk) 13:37, 19 September 2011 (UTC)

Actually, no the data and academic material clearly does NOT say what this article says. Read the last 2 paragraphs of my essay. In fact, I clearly pointed out several obvious errors of misattribution to a source and misparaphrasing in just the introduction of this article. The fact that you think I'm just "whining about content" proves you never ever read what I wrote.99.231.120.164 (talk) 03:04, 21 September 2011 (UTC)

The sentence in question: Although evidence exists for a very small and short-lived effect on some types of pain, several review articles discussing the effectiveness of acupuncture have concluded it is a placebo effect.[9][14][15]

Redirects

This page is being redirected from accurateness. acupressure and acupuncture are different Gauravjuvekar (talk) 17:52, 16 August 2011 (UTC)

Need reliable sources to support that assertion. I'm not opposed to a page on acupressure existing but it's not enough to merely assert, you have to demonstrate with citations. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:37, 17 August 2011 (UTC)

Possible Mechanisms section needs work

The section reads like a repeat of the multiple statements regarding limited efficacy demonstrated in RCT's, which is not what this section is about. This section should not make conclusions about "efficacy" but rather report the multiple approaches taken to understand what happens physiologically when needles are inserted in the body. There should also be a statement about mechanisms in the lede. I will add some verbiage but I do not know how to add links to citations yet so will reference my sources on the talk page.Herbxue (talk) 15:51, 24 August 2011 (UTC)

Please see WP:FOOT and WP:CITE. Also note that WP:MEDRS applies. Sources should be of high quality, and review articles or related texts. To date, there is no known mechanism for acupuncture "working" that I'm aware of, though many have been claimed. Since there is no final consensus on a mechanism, the lead should say, at best, that there are numerous possible explanations for how acupuncture "works" but no claim that any one is right. Nor should there be a list. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:09, 25 August 2011 (UTC)

Thanks. Primary sources are appropriate as there will not be a medical claim of efficacy in this section but a snapshot of the current research on "possible" mechanisms.Herbxue (talk) 15:58, 26 August 2011 (UTC)

Primary sources are not appropriate, please review WP:MEDRS and WP:PSTS. Primary sources are easily abused, wikipedia represents the scholarly consensus, it is not a crystal ball that preducts what will or might be found in the future. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:22, 26 August 2011 (UTC)

I just did read the guidelines and primary sources are not prohibited as long as they are not being used to make a novel conclusion. As you yourself stated, no definitive conclusion has been made so I am not trying to debunk an accepted mainstream theory backed by systematic reviews by using a few primary sources. The science is still in its infancy so one cannot claim there is no physiological response to needle insertion but the reader should be introduced to the fact that scientists are trying to understand acupuncture and that there are some interesting findings in recent years. This does not violate MEDRS.Herbxue (talk) 16:49, 26 August 2011 (UTC)

I would have to see your sources and proposed text to give a concrete opinion. MEDRS makes it quite clear that primary sources are to be used with great care (WP:MEDREV) and with respect to due weight. If the science is still in its infancy, then per WP:CRYSTAL we shouldn't be predicting anything, particularly anything that assumes that acupuncture points and meridians actually exist. It's not up to science to prove that meridians don't exist, it's up to people who claim they do exist to demonstrate it - such is the burden of proof. There are an endless set of theories of what meridians could be - leftover magic dental floss from when the tooth fairy takes your teeth; hitherto-unrecognized structures like the Bonghan ducts; nothing at all - but merely because a claim is old doesn't mean we get to claim it's right.

Claiming that there is such a thing as meridians and acupuncture points in the absence of evidence is itself violating mainstream claims. But again, until I see sources and text, I can't give an opinion or point to why an edit may be a good or bad idea. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:36, 26 August 2011 (UTC)

Understood. I am not interested in doing original research here or making a point through the back door. Only to show some interesting research being done (such as the "mechano-transduction" along fascial planes in Langevin's work). Although I am a practitioner and teacher I am not really interested in showing that meridians and points are real outside of the context of TCM's internal logic. I am not interested in grasping at straws to make 1 for 1 analogies between the theories of TCM (developed empirically) and modern physiological processes.Herbxue (talk) 18:51, 26 August 2011 (UTC)

Source

• [19] - of dubious reliability, would need to dig more. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:42, 31 August 2011 (UTC)

Inappropriate descriptions of acupuncture as "placebo"

This Wikipedia article is riddled with erroneous descriptions of acupuncture as "placebo" and numerous unflattering comparisons between acupuncture and so-called "scientific" medicine. This is unhelpful and WRONG. The term "placebo" in its current usage was brought about by researchers trying to isolate the physiological effects of a pharmaceutical compound from any psychological effects that are rendered from the patient receiving care, because in the process of conducting their trials, they discovered that some patients had a measurably positive change in their health simply by ingesting a sugar pill. In other circumstances, perhaps this "placebo effect" would have been marvelled at, and researched further, I mean its quite amazing that patients can recover from actual diseases through the nothing else but the administration of a sugar pill. But understandably, the pharmaceutical industry can't make money out of practitioners rendering good care to their patients, so they tried to eliminate all quantifiable effects of this from their results.

However, this duality between psychological and physiological, between mind and body, is only applicable in an approach to medicine derived from Western scientific thought and culture. In Traditional Chinese scientific thought and culture, mind and body are inexorably linked, and any compound or procedure that affects one will necessarily affect the other by virtue of this close inter-relation. Once examined from this paradigm, you can all now see how preposterous it is to describe acupuncture as "placebo". Of course the practitioner attempts to influence both psychological and physiological aspects of the patient's being! If through Western scientific eyes, it seems like its the mind affected first, then the body: no matter. Through Traditional Chinese scientific eyes, cause and effect is far less relevant anyway than the field of associations and correlations that mutually depend on each other.

It is apparent that this article has been butchered by a vocal number of "sceptics" who are unable to view these issues from a perspective other than their own narrow euro-centric western scientific culture derived bias. Its not appropriate for a Wikipedia article which is supposed to be written from an informed neutral point of view, to be hijacked by these people who are neither informed, nor neutral. To be truly informed about acupuncture, one must have studied Chinese thought and philosophy, and be prepared to think about it through that paradigm. One must have both received and administered acupuncture hundreds of times, to have a true empirical understanding of what they're talking about.

Wikipedia isn't the place to perpetuate the same trite orthodoxy over and over. It is the place for informed experts in their fields to disseminate knowledge and make it available to the general populace. How many of you sceptics are truly informed experts on acupuncture, with the necessary accumulated lore, skill, and empirical knowledge to truly understand this exotic, foreign discipline? I'd wager that none are, and are just mindlessly attacking that which they don't understand. — Preceding unsigned comment added by Dickmojo (talk • contribs) 07:00, 14 August 2011 (UTC)

I agree with you that WP's coverage of alt med topics has been hijacked by a cabal of editors with a "narrow euro-centric western scientific culture derived bias". Indeed, they even rewrote policy to say that only western medical style publications can be treated as "reliable sources" for such topics. I'd rather see unbiased articles on alt med topics. But I don't know enough about these topics to help much, and I know it would probably be a losing fight, so all I can do is sympathize. Dicklyon (talk) 07:06, 14 August 2011 (UTC)

What is the rationale for this article to be examining acupuncture from a euro-centric western scientific culture derived bias? Obviously, acupuncture can only be properly examined from a viewpoint consistent with its own context. If you isolate acupuncture from its whole supporting structure and context, and then try to examine it as if it were a mere drug, totally devoid of its is philosophy and cosmology, totally devoid of its methods of diagnosis, etc., I don't know how any one could justify that as a valid process of examination. This article is very wrong. What is this sentence doing in the article: "Since this discovery, evidence-based medicine treats bacterial infections with specific antibiotics targeted to kill the specific bacteria, and bases diagnoses on a laboratory analysis to determine the type of bacteria."? This is not a WP entry about EBM, or even a WP article about the comparisons between acupuncture and EBM. That sentence seems to be there purely for the purpose of being spiteful. In fact that whole section on Bacterial infection is erroneous. TCM "proponents" do NOT state that "acupuncture cures some bacterial infections, which they believe are caused by problems in the flow of qi," at all. What western scientific culture derived medicine refers to as bacterial infection has always been thought of as being caused by an invasion of exterior pathogenic factors (i.e. Wind-cold, wind-heat, damp-heat, etc.) This theory is one of the foundations of TCM, how can the editors have gotten this so wrong? Read the Shang Hun Lun, honestly, what planet are you guys on? Also, the sentence "An analysis of 13 studies of pain treatment with acupuncture, published in January 2009 in the journal BMJ, concluded there was little difference in the effect of real, sham and no acupuncture.[15]" is not accurate. You read the actual study, it says "Substantial heterogeneity was present in the comparison between acupuncture and placebo acupuncture (P<0.001, I2=66%)" and also, "Substantial heterogeneity existed in the comparison between placebo acupuncture and no acupuncture (P<0.001, I2=66%)". I can't believe the negativity in this article. I am going to do something about it.Dickmojo (talk) 11:45, 14 August 2011 (UTC)

Science is not eurocentric western scientific culture. Science is universal as it uses empirical results as the way of resolving disputes. It originated in Europe, but every culture, country and individual that has adopted it as an approach has seen massive gains in every single field. If qi can't be demonstrated empirically, that suggests that like most prescientific wisdom, it's based more on imagination than reality. Happened with every other prescientific culture, China's no different. If acupuncture has a genuine effect, it should be easy to demonstrate it scientifically. Wikipedia is based on reliable sources. For a historical discussion of acupuncture, that means history journals and books. For medical claims that means peer reviewed medical journals and books. Such are the rules, if you want to edit here you have to follow them. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:55, 14 August 2011 (UTC)

Science did NOT originate in Europe. It originated in China. And among the very first systematic scientific disciplines was Traditional Chinese Medicine. They observed, deduced, hypothesised and tested. The did not measure for the "placebo effect", because in the context of acupuncture that is meaningless. The practice is INTENDED to influence patients psychologically. As soon as you try to separate the psychological effect from the physiological effect of acupuncture, you are no longer talking about real acupuncture, you are no longer testing real acupuncture at all, which is why your euro-centric based "quack-busting" is not relevant, and has no place in this article, and will be removed.Dickmojo (talk) 21:31, 14 August 2011 (UTC)

WLU you are extremely ignorant and xenophobic. Qi is nothing else but a Chinese word that translated means "force" or "energy". How on earth could you try to argue that qi doesn't exist? Are you ignorant of all physics, all chemistry, and all biology? And acupuncture works, categorically, in EVERY SINGLE STUDY. If you read the literature, you will see acupuncture having significant impacts every single time. Its only when compared to so-called "placebo acupuncture" that the effect is less noticeable. But as I have said, attempting to separate the psychological effects and the physiological effects is counter to the spirit of TCM, which considers the patient's being as a unified whole, mind and body, and addresses their treatment to affect both. If you try to conduct acupuncture in a way designed to affect the patient physiologically but not psychologically, well that's not real acupuncture, and therefore that study is not relevant in any discussion ABOUT real acupuncture, such as this WP article. Also consider Twhitmore's point up the page about so called "placebo acupuncture" being precisely similar to many authentic Traditional Japanese styles of acupuncture. You read the literature WLU, acupuncture when compared to the non-treatment group is ALWAYS significantly effective, and all else is spin by sceptics to try to explain away what they're not prepared to accept at face value.Dickmojo (talk) 21:42, 14 August 2011 (UTC)

The common problem that sceptics like WLU suffer regarding the definition of 'qi' is that, in the Chinese written language, the characters themselves are pictographic and convey meaning through their own inherent nature, as opposed to western language where the symbols and words themselves are essentially abstract and devoid of inherent meaning. Therefore, the word 'qi', when written in Chinese, expresses poetic and philosophical connotations just by its shape and calligraphy alone. However, if you are only capable of thinking in reductionist terms, then its quite accurate to say that the word 'qi', in its most rudimentary rendering, means "force" or "energy". Armed with this understanding, we can now see how absurd it is to accuse the Taoist scientists who discovered and systematically categorised TCM of being wrong when they, for instance, suggest that it is "heart qi" that propels the blood. Now of course they knew of the heart's pumping action, from a very early period they conducted dissections, even live dissections on condemned men. They knew their science. What they were saying was that the pumping of the heart creates "force" or "kinetic energy", and this force/energy was what propelled the blood through the circulatory system. I really think these sceptics that have written this article are very ignorant about the actual nature of TCM and acupuncture, and they should step back and let the experts take over. I will begin to re-write this article very soon, and I suggest that if anyone has serious objections then they should speak up now.Dickmojo (talk) 12:12, 15 August 2011 (UTC)

The placebo effect is quite real and there are numerous reliable sources that suggest acupuncture is primarily a dramatic placebo. Wikipedia is based on reliable sources. Talk pages are not a place to debate. Calling me xenophobic doesn't justify any change to the main page and isn't a reliable source. Qi has absolutely no relation to the technical understanding of energy in modern science. Acupuncture is not a disease-modifying intervention, it "works" for pain and nausea but it doesn't matter where you put the needle, whether you penetrate the skin, and there is no evidence that acupuncture points or meridians exist. Your no true Scotsman argument is not helpful. Cite sources, please, don't simply post opinions. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:38, 15 August 2011 (UTC)

I am not here to debate, I am here to bring balance to the article, which I will be doing, do not doubt it. As I have shown, the concept of 'placebo' is not relevant to any discussion about acupuncture, Scotsmen notwithstanding. In fact I think its more likely that all the negativity that you and your ilk perpetuate has a far greater 'nocebo' effect any 'placebo' effect that might be rendered. But I mean what really is 'placebo' anyway? Is it the proposition that the mind plays a role in facilitating healing in the physical body? Well, what is the mind? Is it not just a construct of patterns of electrical energy firing through neurons? So, if you're saying that Acupuncture is placebo, then aren't the implications of what you're saying really mean that acupuncture causes physical healing by affecting the flow of electrical energy in the body? I mean... duh!~ that's what acupuncture is all about! But you're wrong, acupuncture is not just placebo, unless you are going to suggest now that its plausible that people can 'think' themselves pregnant: http://www.adelaide.edu.au/news/news11641.html. Trying to claim that "acupuncture is not a disease-modifying intervention" is an inappropriate way to conceive of acupuncture. You are so caught up in your western paradigm of "drugs and surgery, drugs and surgery, nothing other than drugs and surgery", that you try to fit acupuncture into that same box, but it won't fit, so you call it nonsense. But ITS not nonsense, its your conception of it that's nonsense. Acupuncture is not about "disease-modification", it never has been. Its about "patient-modification", about strengthening the patient's own capacity to heal themselves. That's the critical disconnect here, and this is why your opinion about acupuncture should not be taken into account in this article WLU, because you are not an expert. You've never studied acupuncture, certainly not studied it for the years and years it requires to acquire a proper understanding of it. I doubt you've even ever received acupuncture. Therefore, step back, and allow me to do my work.Dickmojo (talk) 11:33, 16 August 2011 (UTC)

You need to back your "balance" with reliable sources that do not give undue weight to minority claims. You also have to learn what a WP:MEDRS is, since not all sources are equal. Pay attention to the parts of MEDRS that discuss primary versus secondary sources (and see WP:PSTS). You haven't demonstrated anything regarding placebos, because demonstration requires sources. Your opinion is not sufficient. Acupuncture for fertility is already discussed, and I believe there is some question whether those results are due to data dredging.

And as a final point - if acupuncture is truly effective, it should be easy to demonstrate irrespective scientific controls. This has consistently not happened. The latest findings suggest that it doesn't matter where you put the needle (acupuncture points and meridians don't exist), it doesn't matter if you penetrate the skin (retraction needles work just as well as "true" needles and toothpicks work as well), the practitioner's attitude matters more than the approach, and the only things it "works" for are pain, nausea and perhaps infertility. Pain and nausea are symptoms, and specifically the symptoms that are most susceptible to the placebo effect (which is not itself one thing). WLU (t) (c) Wikipedia's rules:^simple/_complex 11:47, 17 August 2011 (UTC)

Apart from being an acupuncture therapist, I also consistently and diligently train in Chinese martial arts. I think that article is worth a read for you, WLU; especially the discussion on qi. Now here's the thing: over in that article, no one feels the need to point out the fact that, if you're in a life or death situation of self defence, you're better off having a loaded firearm in your hands and knowing how to use it than you are having been trained in kung fu. Likewise, no one would dispute the fact that if you're are dealing with a real disease, you're better off consulting a Medical Doctor and following his orders to the strictest letter than you are going off to see an acupuncturist. BUT, knowing kung fu does not imply that you are thus unable to bear a firearm, and infact there may be circumstances under which you're better off to bear a firearm AND know kung fu than you would be just wielding the weapon alone. Likewise, there is no mandate that prevents a patient from seeking therapeutic treatment from both a Doctor AND an acupuncturist, and infact there are some situations in which this protocol might be beneficial. There is one other comparison I would like to draw: you will notice that the title of that article is called Chinese martial ARTS, not Chinese martial science. The inference in this distinction is that: the skill of the practitioner matters, and so the case is the same in acupuncture. When I was in college this situation become apparent to me from observing my colleagues. There was one girl who was hopeless, dead hopeless. Sure she put all the needles in the right places and twiddled them around and stuff, but there was no 'force' behind her treatments, there was no impetus to healing, and she didn't have much therapeutic success. Meanwhile there was this other guy who could achieve startling outcomes with out even touching a needle at all, using merely a zinc disc, a copper disc, and some japanese moxa. You probably don't believe me but that's immaterial, the point is that acupuncture can't be tested in the same way as a standardised drug can be, where consistent results can be expected every single time. Its an ART, skill matters, and each situation, each client, each day is different. Thus acupuncture does not lend itself well to standardised clinical testing, but I think its a little callous to attribute ALL of its effects to placebo.Dickmojo (talk) 11:37, 18 August 2011 (UTC)

Your own experience and theories are original research. Wikipedia is an encyclopedia. It reports verifiability, not truth, that is, what can be verified in reliable sources. Wikipedia uses, but is not itself, a reliable source. If you wish to express your own ideas and beliefs about qi and acupuncture, you are free to download the wikimedia software and start your own website, or use a blog, or generally do anything but use wikipedia itself since it is not a webhost. Flaws in another page don't justify this page being shoddy.

Do you want to know why you can't use your own experience? Because I've trained in martial arts for more than 4 decades, across three continents. I have trained in acupuncture and moxibustion. An Amazonian shaman taught me the secrets of the rainforest and a Dogon medicine man instructed me on the energies transferred to earth from the alien overlords on Sirius. I'm an expert in all things esoteric, and therefore you can trust my opinion. And my opinion is that qi doesn't exist. You say qi does exist, but clearly I have more experience and training than you do, so that means what I think should be represented on the page.

Have I made my point? Get a source, then we can talk.

And do you realize your hopeless anecdote about one girl who sucked and another guy who could do it with basically no equipment whatsoever is "evidence" for either the existence of hidden mystical forces or nonspecific effects induced by practitioner confidence? Only one of those doesn't violate the laws of physics.

Bottom line, one more time - get a source. That's how wikipedia is written. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:06, 18 August 2011 (UTC)

Here you go once again with the myth that qi is some hidden mystical force. It is not. It is a Chinese term, which can only be understood in its correct context by adopting a particularly Chinese mode of thinking. If you want to translate it into sceintific english, then it means "force" or "energy", that's it. There is nothing mystical or hidden about it. How can you argue that force and energy do not exist? That is preposterous. Get over your own stubborn assertions that your way of thinking is the only way of thinking. Introduce some flexibility into your mentality. If you would read "The Tao of Physics" by Fritjof Capra, you would discover that the oriental concept of qi is a hell of a lot closer in accuracy to modern physics than the sort of circa 1687AD conception of a mechanistic universe that you seem to be stuck in. This whole article seems to be about your obsession with randomated, convoluted, double deaf and dumb trials. Well as I have demonstrated with REASON and LOGIC, that particular methodology is not an appropriate protocol for dealing with acupuncture. Not at all, not in any way. No therapy is 100% effective. In my own clinic I see the results of patients who have been absolutely butchered by orthopaedic surgeons so they're worse off now than they were before-hand. I see this with my own eyes on a weekly basis. No intervention is 100% effective 100% of the time, but there is benefit to be derived from acupuncture, and its not appropriate to try to frame that benefit in terms of "placebo", because a) hardly anything is known about the placebo effect anyway, and outside of the bounds of pharmaceutical trialling, it is a complete irrelevancy, and b) the TCM explanation has not been disproven. Absence of proof does not equal proof of absence, and one must only abandon the old, stubborn and inflexibly unscientific model of Newtonian mechanics and embrace modern physics and quantum science to see that Chinese theories of force and energy make more sense than all your idle speculations about "placebo" and what not.Dickmojo (talk) 04:46, 25 August 2011 (UTC)

That's great. The body is full of forces and energy, and there's no scientifically justified mechanism by which jamming needles into the body can affect any of them. Citing The Tao of Physics doesn't seem to support your case since it's apparently not well received by actual physicists who criticize it for shoehorning obscure concepts into precise technical ones. Also, please comment on content, not contributors. This isn't my page, it's the work of hundreds of editors over nearly a decade. I don't own it.

Claiming "you can't study my medicine" is nonsense. If acupuncture has a genuine effect, a randomized, controlled trial (or some of the hundreds that have been run) woudl have discovered the effect. Either acupuncture works, or it doesn't. Please see Snake Oil Science by R. Barker Bausell, or Trick or Treatment by Ernst and Singh. You may want to consider confirmation bias as at least one of the reasons why your personal treatments appear to work. That's what you're using, not logic. Logic would suggest you ask "would this person have gotten better anyway? What part of my treatment is working? How can I be sure my treatment is working?" In addition, you may want to look into the philosophic burden of proof. It's up to promoters of TCM to prove it does work, I can't prove a negative.

Modern physics is a modification of Newtonian physics, which works very well at human-level scales. Quantum mechanics and quantum mechanical effects exist only at subatomic scales. Anything beyond a molecule and the different effects wash out and cancel each other out. "Quantum" does not mean "whatever I want to believe is true", though numerous practitioners of CAM seem to think so. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:21, 25 August 2011 (UTC)

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Yes, the body is full of forces and energy, specifically bio-electrochemical energy. As the needle is made of metal, it is a good conductor, and is thus a suitable instrument for what's really going on, which is the energetic interaction between the practitioner and the patient. THAT is the real therapy, THAT is the critical matter: the qi, not the needle itself. The efficacy of surgery is not about the scalpel, its about what the surgeon does with the scalpel. Likewise, the efficacy of acupuncture is not "jamming needles into the body", it is the manipulation of qi, which is unseen. Thus we cannot tell whether the scientists who conducted the trials you speak of were manipulating the qi or not: the only way it is possible to tell is by the results. If the results indicate that no effect was elicited, as you seem to be saying, then the only reasonable conclusion to draw (considering the overwhelming weight of level 4 empirical clinical evidence, stretching back thousands of years across billions of cases) is that the person conducting the experiment was not skilled enough. You cannot draw any conclusion about whether or not it is valid to use acupuncture by using a RCT, anymore than you can draw a conclusion about whether or not its valid to use a scalpel in surgery. The needle does not even have to be used: qi can be manipulated with massage and qi gong techniques, with moxa, with zinc and copper discs, etc. The real therapy is the interaction between the practitioner and the client. Its like a psychologist. Is the efficacy of psychology completely and wholly due to placebo? What a ridiculous question! The concept of placebo is not relevant in that context, in fact the ONLY context the concept of placebo is relevant in is the context of pharmaceutical trials, as I have demonstrated.

As for whether or not this is "your" page, you're right it isn't, but you certainly are very attached to it. According to you, every other page in Wikipedia is flawed, this is the only one that isn't. It hasn't crossed your mind that all the others are actually the accurate ones and this is the flagrantly dogmatically, stubbornly flawed page, as is most certainly the case. By the way you are the one who ought to be admitting your confirmation bias, seeing as though you tried to state that physicists dispute the similarities between ancient taoist mysticism and modern quantum physics, even though Niels Bohr himself personally incorporated the yin/yang symbol into his family coat of arms when he was knighted. As for my logic: it is impregnable. You have not even begun to refute it. Your questions such as "would this person have gotten better anyway?", "What part of my treatment is working?". "How can I be sure my treatment is working?", betray your complete ignorance about the true nature of acupuncture. To answer the first, you should realise that the purpose of acupuncture is to gently and naturally aid the body to utilise its OWN healing mechanisms. You seem to think acupuncture is like a drug or surgery, like a dramatic intervention designed to drastically alter the course of a disease. It is nothing like that, not at all. There is no "part" of the treatment that is working, such a reductionist mindset can not be applied to acupuncture therapy. It must be conceived of holistically, the treatment is an interaction between two people, nothing more nothing less, but exactly that, in its entirety. As for how I can be sure my treatment is working, hahahahahaha :) When something works, you know it. The patient knows it. They can feel it. And then they tell all their friends about it. And then their friends come in. And then it works again. And now business is thriving. You see you cannot fool the free market. In a free market, no one is forced to enter a transaction. People will only conduct a transaction if they derive benefit from it. The very fact that people willingly, repeatedly, enthusiastically, without coercion, seek the services of acupuncturists is proof that acupuncture is a valid therapy. Acupuncture is becoming more and more and more popular, truly it is booming, and that piece of evidence itself is far more relevant than any of your beloved randomated convoluted double dumb and deaf trials; because the free market, by its own inherent nature, aggregates and synthesises all knowledge across the entire scope of the market and signals to its participants (via the profit mechanism) how they may most valuably serve one another's needs and best interests. The fact that acupuncture is such a profitable business right now is proof that it is fulfilling a valuable role in our society.Dickmojo (talk) 14:22, 26 August 2011 (UTC)

That's a whole lotta words that say nothing at all about improving the article. You've gone on to mindlessly defending accupuncture, rather than giving legitimate, clear, concise ways this article can be improved. You still haven't cited any reliable sources, making this a whole lot of sound and fury, signifying nothing. Also, you've clearly demonstrated the placebo effect in your own words, which is somewhat amusing. i kan reed (talk) 15:23, 26 August 2011 (UTC)

Dickmojo - I am also a practitioner and I understand your points and your frustration here, but the current path you are on is not helping the article at all. What would help is finding some good quotes from Katchuck's placebo research or others that explains the issues regarding "placebo", "non specific effects", "relaxation response" - stuff like that. The other editors are not trying to just shout you down, they are explaining that on WP you have to have a reliable source for everything you add into the article. A good argument cannot drive content, only good sources (I know, I should listen to myself). If you continue to use this as a forum, you will get blocked by an admin, and then you will not be able to add to the article at all. Less lecturing, more referencing please.Herbxue (talk) 15:53, 26 August 2011 (UTC)

Qi isn't unseen, it's unmeasurable. I wasn't aware that practitioners are electrified. I also wasn't aware that metal was a universally good conductor of "energy". Typically I find it works well for electricity and heat, but it's pretty poor at conducting light. You've also nicely built in another "No True Scotsman" (if the intervention fails, its because the person wasn't manipulating the qi) which perfectly allows you to pick and choose from the random results we expect from any intervention in order to attend only to the ones with positive results. It's a great way to justify your practice, it's terrible science. If the only thing you measure is the interaction between client and practitioner irrespective practice, you're pretty much asserting that acupuncture is based on nonspecific effects (i.e. placebo). A perfectly valid means of controlling symptoms, so long as it's safe and not used as the sole treatment for non-self-limiting conditions.

You can fool the free market, see Bernard Madoff, homeopathy, bloodletting was extremely successful for many year, and religion managed to quite handily accumulate large amounts of wealth and property despite a complete lack of evidence for efficacy. Incidentally, the logical fallacy you're using here is the argument from popularity. Snake oil was extremely popular for many years, as was heroin.

Anyway, sources can only be added to the page if they are specific to acupuncture. Simple opinion is not enough. Amusing as it is to point out confirmation bias (i can reed, I noticed that too ) I must insist that changes to the page be based on reliable, secondary, medically relevant sources. Either edit according to our policies or leave wikipedia, either way the talk page is not a forum for discussion and you're not actually venturing any information that will result in an improvement to the page. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:36, 26 August 2011 (UTC)

Yes WLU, when when using electrical energy (such as with a TENS stimulator), or when using heat energy (such as with ondan needle head moxa) the metal is appropriate. Yet when using light energy, the metal is not useful, and thus the LASER is used instead. This is simple stuff. Look I'm not here to introduce my own evidence or sources, I am here to prove using reason and logic that your sources are inaccurate and irrelevant. And I have done so by showing that: a) so called "sham acupuncture" is actually a valid treatment protocol in and of itself, and therefore not appropriate to be used as a baseline analogous to "placebo", and b) Acupuncture is an artful skill, and its efficacy always and in every case depends entirely on the skill of the practitioner, and the interaction between practitioner and client. Therefore, any study which attempts to measure the efficacy of acupuncture without allowing for this fundamental tenet to be accounted for is and must be invalid. Incidentally, I find it very interesting that those studies which right from the start understand the fundamental nature of acupuncture most correctly, conducted by those practitioners most likely to possess high levels of skill, i.e. Chinese studies conducted by Chinese practitioners, are the very ones that you sceptics want to discount as invalid. In fact the reality is that its actually the studies conducted using the Western paradigm, which don't account for the skill of the practitioner, and don't account for the uniqueness of each different client, that are invalid.~dickmojo120.23.51.28 (talk) 06:51, 15 September 2011 (UTC)

Given "sham" acupuncture is as valid as "real", I'm assuming you're advocating for the abandonment of all deep needling, diagnostics and training on the use of meridians and acupuncture points? Instead, I assume it will be replaced with teaching practitioners to maximize their apparent confidence, since that's where you seem to believe the effect is coming from. Will you also advocate for the use of nonpenetrating needles because they're safer?

Also, you're misreading why Chinese studies are treated skeptically.

Finally, no sources = no changes. WLU (t) (c) Wikipedia's rules:^simple/_complex 10:12, 15 September 2011 (UTC)

Well that's an interesting point WLU, because when its conducted by low-skill practitioners, then indeed it would expected that there was not much difference between "sham" and "real" acupuncture. However either discipline, whether its superficial/non-penetrative Japanese acupuncture using their alternative meridian system with extra meridians, or Traditional Chinese Medicine acupuncture with deep needling and the orthodox meridian system, in the hands of a true master of the craft, is observably effective. Now the difference here is not in the practitioners "apparent confidence": when I talk about the critical dynamic being the interaction between the practitioner and client, I am not talking about the interaction between their personalities, I'm talking about the energetic interaction between their respective fields of biochemical electro-magnetic energy. Now I do not need to produce a source to prove that human beings possess bio electric-energy in their bodies, this is common knowledge, a fact of science. Nor do I need to produce a source to prove that metal is a conductor of such electrical energy. I am not here to introduce my own sources, I am here to show that your sources are not the be all and the end all, because they do not take into account the skill of the practitioner in drawing their results. Because of this, their results are untrustworthy.Dickmojo (talk) 01:34, 16 September 2011 (UTC)

Yes, dm, we would need sources for those claims. WLU is correct, as he is paraphrasing from WP:V and WP:OR. Please also see WP:NOTFORUM. We should not (and cannot) discuss the topic of acupuncture here. This page is for discussing the article, and without sources, we cannot make a change to the article.   — Jess· Δ♥ 04:11, 16 September 2011 (UTC)

Again, sources > opinions. For instance, this study suggests that practitioner characteristics play a tremendously important role in acupuncture. However I wouldn't suggest citing it until there has been a review article incorporating it (though I would love to see replication and extension for other conditions and with other factors - "real" acupuncture on meridians and acupuncture points versus "sham" acupuncture on random points, further sub-divided into confident and neutral practitioner characteristics, that would be an interesting study). It would certainly clarify what skills practitioners should be trained on - ability to determine which acupuncture points to needle versus how to project an image of confidence while choosing points based on distance from vital organs, nerves and blood vessels.

Also, you do need a source to claim humans have a bioelectric field, particularly one that can be meaningfully manipulated using non-electric needles. Naturally, the use of electrified needles isn't acupuncutre. It's a transcutaneous electrical nerve stimulation unit - which didn't exist in ancient China as far as I'm aware.

Finally, sources are very much the be-all and end-all on wikipedia. If you wish to write articles that don't use sources, start a blog. WP:RS is a core content policy, one of our most vital. Ignore it, and you'll eventually be blocked. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:45, 16 September 2011 (UTC)

Hi WLU, that certainly is an interesting Kaptchuk study, and I indeed AM very interested in the mystery of the "placebo effect", and the benefits of hypnosis, and the ability of the psychological mind to cure physical symptoms etc., however it is entirely irrelevant to the discussion we are now having, because the ancient theory of Traditional Chinese Medicine PREDICTS such a phenomenon. It is said that the yi (mind) leads the qi (energy), and that the qi leads the blood. Therefore, how can the modern confirmation and an ancient principle empirically known to TCM be used in an attempt to discredit acupuncture?!? Your zeal would commendable if this was the inquisition... As I said before, acupuncture is a holistic therapy, and all that study confirms is that physical benefits can be elicited through means other than just physical treatment, i.e. implicitly backing the validity of holistic treatments. But once again in your angsty crusade to destroy acupuncture, you've gone too far when you talk about "choosing points based on distance from vital organs, nerves and blood vessels", because even your beloved Ernst review unequivocally upholds the efficacy of acupuncture for the treatment of neck pain. Yet the points invariably used for neck pain (Bladder 10, GB 20, GB 21, etc) are among the most dangerous acupuncture points commonly used, and can cause lung puncture/brain stem trauma and death. However, because Acupuncturists are so well trained, such accidents never occur. Despite the millions upon millions of acupuncture needles inserted into potentially dangerous locations every year, there are basically no confirmed reports of death at all, such is the high standard of training for professional acupuncturists.Dickmojo (talk) 03:34, 2 October 2011 (UTC)

Additionally, the repeated threats to block or ban me smack of concerted effort to quash dissent. Why is it not acceptable to point out the flaws in your sources? Say for example that this was actually the wikipedia article on the moon. Now lets say that you introduced a source, very rigourous in its methodology, that examined the moon through a magnifying glass every night and concluded that the diameter of the moon was 50 mm. Now if I went on to the discussion page and pointed out that a magnifying glass is not an appropriate tool to measure the moon with, I suppose you would be threatening to have me banned off there as well! You would say, "uh uh, my hero Edzard Ernst got out his monocle every night and systematically measured the moon and his word is infallible so I'm going to get you banned". But the self-evident truth is that the wrong tool was used for measurement, and this is the exact same situation in the case with this article. The trials conducted use a methodology that is appropriate only for testing pharmaceutical compounds, and with the vastly more sophisticated practice of acupuncture, which incorporates techniques derived from Lore millennia old, such a methodology is simply not applicable. A more appropriate methodology would be for example the comparison of acupuncture treatment and physiotherapy treatment for the treatment of sciatica. I guarantee that acupuncture would be shown to be more effective in such a study.

Btw, if you don't think electro-acupuncture is real acupuncture, well I guess you'll be removing all references to your beloved Ernst reviews then, seeing as they all contain trials using electro-acupuncture. You ought to be doing that anyway, since they are inappropriate in this context, but I mean, how ludicrous. Next you'll be saying that MRI machines aren't a part of real medicine because they didn't exist in the time of Hippocrates, I mean weren't you the one sanctimoniously lecturing me on real Scotsmen or something not so long ago?Dickmojo (talk) 03:45, 2 October 2011 (UTC)

Walls of text go nowhere on WP, sources do. So unless you have better sources to present than what we already use, you're wasting your time and the time of other editors. As was said above: opinions mean nothing here, only reliable sources matter. You can spend the next ten years arguing your opinion here, it will not change the article. Did I mention sources? N^oformation ^Talk 04:06, 2 October 2011 (UTC)

Once again Noformation, I will reiterate. I do not intend to introduce my own sources, all I'm doing is showing that the sources used by sceptics to try to discredit acupuncture are deficient and inappropriate.Dickmojo (talk) 04:09, 2 October 2011 (UTC)

Once again, your opinion is irrelevant. If you have sources that say that then we have something to talk about. But it doesn't matter how strongly you feel about the sources unless you go out, do research and get it published and reviewed in a medical journal. Until then we take the word of the secondary source over the word of the WP editor; such is the very definition of NPOV. N^oformation ^Talk 04:13, 2 October 2011 (UTC)

Let me try to explain this with an extreme example. If all reliable sources said that the sky was red, our article on the sky would reflect those sources. Even if you could walk outside and clearly see the sky was blue, a claim of the sky being blue would not be allowed in the article. We only publish what reliable sources say, and we do so within the policies and definitions that have been established. An editor on the sky talk page arguing for an inclusion of the color blue in the article would be told to present sources that says the sky is blue. That's how much RS matters and how little editor opinion matters on WP. Get it? N^oformation ^Talk 04:18, 2 October 2011 (UTC)

"I do not intend to introduce my own sources" - OK, we're done then. If the only way you can integrate your own thoughts on acupuncture is to re-interpret the meaning of sources already used, you're engaging in original research. You are free to post your own thoughts on your own blog or start your own wiki, but wikipedia is not the place to do it and you're wasting everyone's time. WLU (t) (c) Wikipedia's rules:^simple/_complex 10:22, 3 October 2011 (UTC)

I am NOT engaging in original research, and pointing out the obvious errors in your interpretation of data not constitute as such. We are not finished here. To use Noformation's example, that analogy can only be applied if we suppose that to perceive the colour of the sky correctly, the viewer needs skill: "viewing" skill as it were. So to the unskilled eye, the sky might actually appear red, but to a trained, skilled eye, it is clear beyond all doubt that the sky is actually blue. This is the objective truth. Now when the vast, vast majority of evidence, overwhelmingly, shows that the sky actually is blue, the billions upon billions of cases of level 4 clinical empirical evidence, the great bulk of level 1(b), 2 and 3 evidence (which incidentally comes from China, where, for cultural reasons, the level of viewing skill is more likely to be higher) and even the balance of level 1(a) evidence, (apart from the evidence produced by only 1 prominent "sky" sceptic, who doesn't even consider the role of "skill" in his work at all), is overwhelmingly in favour of the sky being blue, it is a bit ridiculous for you two to stand here and claim so sanctimoniously that the sky is red, and then try to shut down all dissent to boot! You two guys are treating this article like your own personal fiefdom. Its not, and the truth will out in the end, with you two kicking and fighting against it the whole way no doubt.Dickmojo (talk) 05:15, 6 October 2011 (UTC)

If you have sources that meet WP:MEDRS then by all means, present them. We have MEDRS sources now, and thus we report what they say and will continue doing so until something better comes along. I think you missed the point of what I was saying with my color example. The point was to explain to you that it doesn't matter what's WP:TRUTH, it only matters what's verifiable. WP:MEDRS determines what is verifiable; this is a simple equation. N^oformation ^Talk 05:20, 6 October 2011 (UTC)

To concur with WLU, we're done here, meaning that me and I assume him are done explaining the same thing to you over and over again. Consensus is obviously not in your favor, so you can move on or, to quote you, you can stay here kicking and screaming, but until you present sources nothing is going to change and I believe we're both done responding to you. Consider yourself shunned - at least by me - until you come back with sources. To make it clear one more time: sources are the only thing that matters. N^oformation ^Talk 05:25, 6 October 2011 (UTC)

Re-interpreting the meanings of sources is very much original research. Editors don't get to do that. If you can find a source that does it for you, that may be viable for inclusion provided it is a high-quality source. Otherwise, you're wasting your time, my time, and the time of everyone who reads this. I'm not going to bother commenting further unless you say something meaningful. WLU (t) (c) Wikipedia's rules:^simple/_complex 10:55, 6 October 2011 (UTC)

WLU you are the one who has re-interpreted the vast amount of evidence in favour of acupuncture to favour your dubious theory that acupuncture is "placebo". But what I have been saying this entire time, which is a very valid point that you have not been able to refute, is that the concept of "placebo" is not relevant to the discipline of acupuncture. You asked for sources and I gave you sources. I quoted the Huang Di Nei Jing which states that "the mind leads the qi, the qi leads the blood". Therefore, a property of acupuncture therapy which was known dozens of centuries ago, which is predicted by the theory of TCM, is not a relevant property for you then to try and turn around and use to disprove the efficacy of acupuncture. You are trying to re-interpret the whole mythology and cosmology of an entire cultural train of scholarship, dozens of centuries long, into a very narrow interpretation of science derived from pharmaceutics. Such a gross distortion of the true nature of acupuncture by you is simply unacceptable in a NPOV article like this is supposed to be. If you two are done with fighting against the unassailable logic I am speaking, then I will begin to modify the main article. Thankyou for discussing this with me and agreeing that you are done here.Dickmojo (talk) 23:34, 10 October 2011 (UTC)

If you make any changes to the main page, I will review them according to our policies. If they are inappropriate, I will revert them. WLU (t) (c) Wikipedia's rules:^simple/_complex 09:50, 11 October 2011 (UTC)

Nope, wikipedia does not focus on applying subject specific domains within articles. All topics should be approached from a general academic perspective. Also, you can't say that acupuncture lacks the idea of a placebo, because lots of scientists who have actively studied the success of acupuncture use that exact terminology in their papers. Just because the quacks say the term is irrelevant doesn't mean it is to all people doing active study. i kan reed (talk) 19:39, 12 October 2011 (UTC)

The legitimate problem that dickmojo alludes to is that it may, in fact, be inappropriate to write an article on "acupuncture" from the viewpoint of scientific inquiry. WP is not a science or medical journal. The bulk of the article, and importantly the lead paragraph, should be mainly descriptive of the practice rather than critical statements, good or bad. Look at the lead paragraphs in articles describing various surgical techniques such as Dilation and Curettage or Whipple Procedure - they are mainly descriptive, with risks and effectiveness addressed within the body of the text.

So, there are two main problems here: A double standard in which procedures and drugs used by MD's are not written about with a critical eye at all, while alt med articles are a place for skeptics and chronic disease-suffering cranks to air their grievances and make a case for quackery. The other problem is Orientalism - the article describing the practice views it as something exotic, while for those who know about it firsthand have very different assumptions about its theories and different expectations regarding effectiveness.Herbxue (talk) 21:03, 12 October 2011 (UTC)

That's bullshit special pleading. Everything that is a genuine effect can be studied by science. That includes purely mental and purely physiological interventions, like acupuncture appears to be. The history of acupuncture uses the best historical sources we can muster, but the medical aspects get the best medical science we can find. Practice should be described, but effectiveness gets rendered according to the results of the best studies in the highest impact journals. Comparing acupuncture to surgical interventions is bullshit as well - for one thing, the surgical procedures fall squarely into mainstream modern medical thought and rely on biology, not magic and appeals to history to work. For a second thing, both have been demonstrated as unequivocally effective. Claiming two different standards for surgery and acupuncture would indeed be a double standard, and we should apply one - a mainstream medical one. Claiming other articles aren't critical is flatly wrong since many contain sections called 'criticisms' and 'side effects'. Acupuncture stands and falls on its own merits, it is not a false dichotomy between either acupuncture or medicine. Research is de-orientalizing acupuncture and trying to understand it in terms of human universals. Those studies are finding that the TCM system of acupuncture is nearly worthless, since you don't need meridians, points, or even needles - it doesn't matter where you poke, it doesn't matter if you penetrate the skin and it doesn't matter if you use toothpicks. What does matter is confidence of the practitioner - which strongly, strongly suggests placebo, which is an idea well-represented in the appropriate scholarly journals. No double standards, and no special pleading that science can't study acupuncture. It can, even if acupuncturists don't like the results. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:15, 13 October 2011 (UTC)

I agree the article needs to include info about effectiveness, or lack thereof, but not in the lead paragraph. The article is not titled "Effectiveness of Acupuncture". What I call for is the opposite of a bullshit double standard. The Whipple Procedure is not "unequivocally effective" because the purpose is to cure pancreatic cancer and it mostly fails. But the lead paragraph does not say pancreatic cancer patients are still more likely than not to die from the disease. Also, you seem to making my Orientalism argument if you think that "Comparing acupuncture to surgical interventions is bullshit" - didn't you say they should be covered by the same standard?Herbxue (talk) 02:12, 13 October 2011 (UTC)

The lead paragraph should summarise the article. One of the most important characteristics of acupuncture is the ongoing discussion over its effectiveness and the large amount of research done on this topic (most of which, as other editors have pointed out, suggests that it doesn't "work"). As such, a large portion of the article is devoted to effectiveness and therefore mention should be made of this in the lead. Famousdog (talk) 09:26, 13 October 2011 (UTC)

Do you have a reliable source that says "One of the most important characteristics of acupuncture is the ongoing discussion over its effectiveness"? Who decides that this is the priority for the article? Also, there are plenty of cochrane reviews that conclude that acupuncture is a valuable adjunct treatment for various conditions (occasionally superior to conventional care). Whether or not the placebo effect is at work is an important topic, but placebo is also at work when a urologist or dermatologist give cipro for non-bacterial chronic conditions. My point is we have an issue of undue weight in this article, and as such, a neutrality problem.Herbxue (talk) 14:20, 13 October 2011 (UTC)

The lead (which summarizes the article) should obviously feature discussion of acupuncture's effectiveness, one of the most discussed and important aspects of any medical procedure and acupuncture in particular due to the complexity of the debate. The multitude of ongoing research and literature reviews/meta-analyses are obvious indications of ongoing discussion of its effectiveness, as is the continued focus on teasing out the actually effective parts of the intervention by developing and manipulating different placebo procedures. Acupuncture is a medical procedure, and therefore requires a discussion of effectiveness. To suggest otherwise is absurd. Please cite the "plenty of Cochrane reviews", as it's generally only found useful for pain and nausea, and possibly fertility (though that is thought to be due to fishing and bad methodology). Regards Cipro, there's no debate that Cipro benefits from placebo for subjective symptoms, but there's also no debate it works for killing non-resistant bacteria. Acupuncture, however, still lacks a solid evidence base indicating it's not solely placebo and there is extensive debate over this very fact. Also, the placebo effect is not unitary, and comparing a pill to an elaborate, exotic, salient, quasi-surgical procedure is inappropriate. If you feel the Whipple procedure lacks appropriate discussion of its effectiveness in curing pancreatic cancer (one of the deadliest cancers out there) then feel free to add it. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:15, 13 October 2011 (UTC)

I'm not terribly attached to the outcome, and not uncritical of acupuncture, but your posts show clearly that you approach the subject from a non-neutral perspective. What is exotic about putting needles in the body in an attempt to alter the body? How does cipro's clear anti-bacterial effect justify its use for non-infectious conditions? My issue is that this particular modality is treated with undue weight on criticism compared with other medical articles. Given the elaborate cultural milieu that comes with the study of acupuncture, it just seems odd to treat this subject with greater scrutiny than modalities that were created supposedly with scientific methods rather than empirical ones. The fact that the debate regarding placebo's role in acupuncture is still being debated shows that this is not a fully answered question (the science is incomplete) so the article should not present it as established fact.Herbxue (talk) 16:14, 13 October 2011 (UTC)

That other medical articles are written in a certain way is not relevant here. We have guidelines and policies to guide us when writing any given page, and given the nature of an encyclopedia that anyone can edit, not all pages are going to be up to par or even of the same format. If you feel that the Cipro page in specific needs a better lead that includes information on its efficacy, then that is something that should be brought up on its talkpage, but it has no bearing here and nor does any other page. This page has as much criticism as it does because it is proportional to the published literature on the subject. Since it's a big part of the article it's also summarized in the lead. In twenty years if the literature shows that acupuncture is less controversial and is more efficacious, then this article will likely have a history section talking about the early controversy and the rest of the article will be address the subject as though it's juts another every day medical procedure. However, that's not what the literature says now. N^oformation ^Talk 19:29, 13 October 2011 (UTC)

That argument's extremely stupid. No insult to you personally, but the idea that "there is disagreement, therefore the argument is legitimate" is just terrible. Placebos are critically important to understanding the effectiveness of treatments. End of story. If there is a section on effectiveness it should be fact based, not nonsense based. i kan reed (talk) 16:28, 13 October 2011 (UTC)

Boy, are you guys missing my point or what?! I am not arguing about whether or not acupuncture's effects are due to placebo effect! Maybe I shouldn't have chimed in under this thread. I also have no beef with a section on effectiveness that is only sourced to reliable systematic reviews. But read what I wrote, not what you think I think. Its an issue of weight and its effect on the overall neutrality of the article.Herbxue (talk) 18:01, 13 October 2011 (UTC)

Noformation, you point is well taken and I am dropping the issue for now. But indulge me for a moment and consider: You say the weight of topics in the article should reflect the available literature. If that were true the article would be almost completely descriptive. The bulk of the literature on the subject was written before sources WP would consider MEDRS existed.Herbxue (talk) 21:10, 13 October 2011 (UTC)

Correct, and we should certainly make great use of those sources for the history and descriptive sections, but as far as medical efficacy goes we have to use our best MEDRS sources, which at the moment we do. It's not a matter of giving undue weight because in the context of medicine, due weight means using the best quality secondary scientific sources we can muster. In the context of history, using the best historical sources are necessary, etc. N^oformation ^Talk 21:29, 13 October 2011 (UTC)

Yes, I suspect that, viewed with an uncritical eye, the bulk of what has been written about dragons would give you the impression that they exist, but when it comes to discussion of whether they actually DO exist, you have to go with the most reliable sources, which (I imagine) is pretty conclusive regarding their non-existance. That conclusion might appear POV if you base your decisions on simply looking at which side of the "discussion" produced the largest stack of papers... Famousdog (talk) 11:35, 14 October 2011 (UTC)

Your metaphor is very clever and funny, but acupuncture does exist and people have gotten enough relief from it for it to continue being practiced. I know you don't like it, but sorry, many people do, and many people credit it with helping them in cases where conventional care failed and/or gave up. WP is not the arbiter of truth, and RCT's are not the only source of verification we have available as sources for articles.Herbxue (talk) 14:29, 14 October 2011 (UTC)

Except what you just said is false according to the facts. Acupuncture does not provide relief in any measurable quantity. If the empirical data supported that statement, we would not be having this discussion. Look, I'm not sure how else to put this, nothing you say here is going to invalidate all the real, honest research on the subject that's out there. Nothing you say here is going to override the opinions of medical experts. Wikipedia is not the arbiter of truth, but the sources wikipedia does consider the arbiters of truth have not been supportive of your argument. I'm sure you really believe acupuncture isn't nonsense, but that belief is irrelevant to the facts contained in the article. i kan reed (talk) 16:41, 14 October 2011 (UTC)

I haven't seen anything here that convinces me of the need to ignore the policies and guidelines, most of it is "your science can't measure my woo" which is demonstrably false (and more accurately, "I don't like the results of science measuring my woo"). WP isn't the final arbiter of truth, but if you want to edit here, and in particularly if you want your edits to last longer than a couple hours, you need to follow the rules. If you don't, you'll get blocked. If you find this disagreeable or want to do something different, start your own wiki. Stick with sources, the highest quality we can find, summarize and cite them per usual. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:58, 14 October 2011 (UTC)

This really seems to touch a nerve with you guys. As I said, probably wrong section for the point I am trying to make (I am not asking you to ignore research that finds that acupuncture's results are not better than placebo). But, within the world of my "woo", results are measured by a different method. My "woo" does not claim to be a science. This article is about my "woo". It is odd that WP editors do not treat supposedly "scientific" medical interventions with nearly as much scrutiny. Science has what it has to say on the subject, and it is mixed, messy, and inconclusive, so far. That's where we're at right now, if you sincerely look at the studies. If cochrane reviewers find that there is reason enough to consider it a viable treatment for some conditions, there is something to it, even if it is just placebo (and again, take a deep breath, I am not arguing that it is not placebo, even though in clinical reality, it doesn't fucking matter).Herbxue (talk) 21:55, 14 October 2011 (UTC)

Because we've heard this line before and I'm sick of it at least. If acupuncture doesn't claim to be a science, it shouldn't claim to be medicine. Cochrane doesn't consider prior plausibility, and the lack of a reasonable placebo means research is difficult. Finally, there is a limited number of things for which acupuncture might be effective - pain and nausea, two of the symptoms that are most amenable to placebo effects. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:22, 15 October 2011 (UTC)

I'm going to need some time to review this discussion, but let me make a couple of points clear:

• Scientifically speaking, the placebo effect is simply a catch-all term for any effect which is not due to the treatment under study. In that sense, equating acupuncture with a placebo is literally nonsensical. That's more a wording issue than anything else - it would be fine to suggest that acupuncture is no better than a placebo (i.e., not measurably different than random effects), but please do not suggest that acupuncture is a placebo.
• Acupuncture predates modern medical science by a good millennium, and should get a modicum of respect for what it does do well. Modern medical science did not invent splits or casts, antacids, aspirin for fevers, applying ice to bruises and sprains, bed-rest, stitches, liniments, or a host of minor medical procedures that are still commonly used by GP's in even the most advanced nations, and wikipedia does not discredit those despite the fact that they were not developed under rigorous trials. Acupuncture is never going to sit up there with chemotherapy or anti-virals in terms of sophistication, obviously, but going to an acupuncturist for some minor ailment no less effective than going to a GP for the same issue.

Please keep in mind that the better part of a billion people still rely on acupuncture for their conventional treatment. I don't suggest that it's better than equivalent modern treatments, but if it didn't work at all it would have ceased to exist long before the West came into regular contact with Asia. --Ludwigs2 04:04, 15 October 2011 (UTC)

Scientifically speaking, a true placebo effect is quite distinct from other random effects. Medicine can improve many minor ailments, acupuncture can't, though it may have an effect on pain and nausea. Bloodletting has a 2000 year history of use. Your above post is nothing but vague and false generalisations and not appropriate for this talk page. Make or propose an edit. --Anthonyhcole (talk) 07:05, 15 October 2011 (UTC)

The science you sceptics want to use as the central feature of this article is flawed, because it strives to measure in a purely objective way. But in reality (i.e. real reality, not the abstractionism of your "science") people's experience is SUBjective, indeed necessarily so. So if you take the subjectivity out of the science, you take the humanity out of it. Acupuncture can never be considered in the same way as a pharmaceutical compound can be i.e. "it either works or it doesn't", because everything depends on the interaction between the two people involved, the practitioner and the patient. The entire efficacy of the treatment not only depends on the practitioner's skill at obtaining de qi and effectively manipulating it in a manner specifically appropriate for that unique patient presenting with that unique collection of conditions, it ALSO relies TOTALLY on the participation of the patient as well. The patient MUST be open to the manipulation of their qi in this way, and they must actively and enthusiastically allow themselves to be swept up with the practitioner's intent, or else if they resist the treatment, it will be ineffective. As a practitioner myself, its so obvious to me, so its really frustrating to try to convey the essence to you sceptics. You're like frogs who live in a well and I'm trying to explain the ocean to you, you're like a summer insects who I'm trying to explain winter to, you are just so unbelievably ignorant its frustrating.Dickmojo (talk) 14:08, 15 October 2011 (UTC)

@Anthony: as I said, I'm reviewing the talk page and the article, to get up to speed. I'll begin making functional revisions later today or tomorrow. And I do not believe that you are using the term placebo in its proper scientific context. but more on that later.

@Dickmojo: That was not a helpful post. It would be nice if you edited out the more aggressive comments so that we can lower the level of hostility on the page. I think you make some good points, but they are lost in the ad hominems. --Ludwigs2 14:38, 15 October 2011 (UTC)

Highly respected researchers publishing in high-impact journals use the word "placebo". If anyone wishes to correct their use of the term, please do so in the appropriate peer-reviewed outlet. Correcting it on wikipedia is inappropriate, the use of idiosyncratic definitions of "placebo" won't help. The sources matter, and many sources make the claim that there is minimal or no specific effects from poking needles into people, either in general (i.e. sham acupuncture) or in specific (i.e. choosing the location to needle based on traditional theory) and thus that acupuncture is within the realm of effects generally referred to as placebos - itself not a unitary phenomenon. The best way to deal with this is to accurately summarize the best, most reliable sources and above all for acupuncture the most recent sources because it is only within the last 10-15 years that a realistic placebo has been invented to account for the needle-penetration aspect. If people defined "acupuncture" as "the use of nonpenetrating skin stimulating objects used on nonspecific points far from organs or blood vessels for the purpose of reducing the symptoms of pain and nausea", much of the debate wouldn't be an issue. The multiple definitions of acupuncture incorporating varying degrees the importance of needle placement, depth, penetration, practitioner characteristics, diagnostic interview, ritual, historical origins, cultural significance and attempted effects makes our job hard to do, but we're best served by sticking to the sources.

Dickmojo, your own experience is worthless as a source. Please dig out the books and materials that were used for your classroom instruction and use those sources to justify any edits you may make on the page. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:44, 15 October 2011 (UTC)

convenience break

WLU: I'm not exactly sure whether you're agreeing or disagreeing with my point. I agree with you that placebo has a specific meaning and we want to keep our discussion within those boundaries. Remember, however, that the placebo effect is a form of null hypothesis, not an active hypothesis in its own right. Saying that some treatment is not statistically different than a placebo means only that there is no reason to believe that the theory works in the way in which it was tested. The common complaint on this page, however, is that modern tests are testing the wrong thing, and so the results, while valid, are effectively meaningless.

We can go back and forth over that point endlessly and we will get absolutely nowhere (in fact, we have gone over that point endlessly and gotten absolutely nowhere, right?). The proper way to handle this on Wikipedia, IMO, is to stop trying to assert the truth or falsehood of the medical results, and simply report what they say without (1) presenting them as a definitive condemnation of acupuncture and without (2) minimizing their importance as scientific research. If we can manage to do that, then all of this talk page back-and-forth will disappear because we will have satisfied due diligence for science without appearing like we're trying to debunk the topic. All of the conflict here is because of the efforts of one side or another to present a convincing refutation of the perspective of the other sides, and that is what we need to stop. --Ludwigs2 18:17, 15 October 2011 (UTC)

Ok, that received no response, so I'll assume it is a convincing argument. I'll make some revisions along these lines today. --Ludwigs2 16:45, 16 October 2011 (UTC)

Better to assume no one is convinced, and that many are turned off by the Argumentum ad populum, Ad nauseam, Appeal to tradition, Special pleading, etc; instead of discussions focusing on sources and applicable policies/guidelines. --Ronz (talk) 00:50, 17 October 2011 (UTC)

If you disagree with my reasoning, Ronz, you are more than welcome to discuss the matter. If you choose not to, then the only good faith assumption I can make (per the silence=consent rubric) is that you accept my basic idea on the merits and are willing to see what I do with it. If you have objections, it would be better to discuss them now rather then edit the page; no sense doing something if you're unwilling even to consider it. I'll give you some time to respond before beginning. --Ludwigs2 02:18, 17 October 2011 (UTC)

"then the only good faith assumption I can make" I certainly hope you don't feel so constrained in your choices.

Please WP:FOC and follow WP:CON and WP:DR please. Thanks! --Ronz (talk) 02:55, 17 October 2011 (UTC)

I agree with Ronz and would add that most of us are probably just sick of having the same discussion over and over again (as you pointed out) and you didn't really make any specific recommendations regarding changes, so really there was nothing to discuss. The sources in this article are good sources, in fact they are the best sources available on the subject from a medical perspective, and so that is what the article must represent. Rather than go in and unilaterally stard changing the article may I suggest that if you have any changes you start a new section and we can discuss them there? I know that isn't a policy requirement, I just think it would lead to a calmer atmosphere, because let's face it, an edit war is easy to start on an article like this so it's best to tread lightly. N^oformation ^Talk 03:32, 17 October 2011 (UTC)

Two points:

• This is not a medical encyclopedia, and this is not solely and specifically a medical article. your 'best sources' argument doesn't really hold up under NPOV, though obviously good medical sources need to be included.
• You cannot simultaneously suggest that you are sick of discussion and that I should open a new section for discussion of changes. If you don't want to discuss, I can make changes to the article for you to review and edit; if you do want to discuss, then begin by discussing what I said above, because that will be the thrust of my revisions, to "stop trying to assert the truth or falsehood of the medical results, and simply report what they say without (1) presenting them as a definitive condemnation of acupuncture and without (2) minimizing their importance as scientific research."

it's easiest and most natural for me to simply edit the article there and discuss the changes I've made in talk here, assuming you are up for that. I'm simply trying to avoid conflictual situations, which means (a) proper discussion first, or (b) proper discussion after. up to you which. --Ludwigs2 04:15, 17 October 2011 (UTC)

P.s. Ronz. This is wp:FOC and wp:CON, and wp:DR isn't yet necessary. --Ludwigs2 04:18, 17 October 2011 (UTC)

Ludwig, you've been on wikipedia long enough to understand the need for adequate sourcing, no OR, no "reinterpretation" and the other content policies. I may not agree with you, but unlike the newer editors who need to realize the rules, I expect you know them. I'll comment or edit based on how you alter the main page, but I'm not wasting time debating the reality of acupuncture further. I will comment on two things however. First, though we are not a medical encyclopedia, any medical claims (i.e. acupuncture is an effective treatment for anything) does require medical sources. Second, I am indeed sick of "discussing" the same arguments by individuals ignorant of our policies without any relevant sources being presented. As I've said repeatedly, Dickmojo's experience is worthless, Herbxue's statements can't source anything, and grand claims on the talk page adds exactly nothing to the actual main page. I'm fucking sick of debating in circles when not a single damned source has been provided. Want to change the main page? Get a new source, or demonstrate that a currently cited one is mis-quoted. No re-interpretation, no adding personal insights, no claims based on experience, verification based on reliable sources only. This page needs to stop being treated as a forum because that is not what it is for. I have no problem with the main page changing so long as there is a valid, source-based, policy-compliant reason for it. Please discuss specifics in a new section. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:30, 17 October 2011 (UTC)

WLU: I asked a simple question - do you want me to edit the article first or discuss changes first? I take it you prefer I edit first, or am I misreading your post?

With respect to the rest: I can only read your statement as saying that you are sick of the consensus process. No one ever said that coming to a consensus was easy or pretty, but that doesn't mean we can discard the process entirely. What I'm personally after is open-minded discussion of the article content. If I cannot achieve open-minded discussion any other way I will edit the page, wait for the inevitable revert, and then try to leverage that to create open-minded talk page discussion (per wp:BRD and wp:CON). But I'd rather it be a more genteel process.

I have in fact made a policy-based argument which you have - unfortunately - failed to acknowledge (and yes, I expect you to know policy as well; we're all experienced editors here). I will explain precisely how the logic you used above fails wikipedia policy, just so it's clear:

1. The logic implicitly asserts that 'medicine' is a solid and uniform entity comprised entirely of 'modern medicine'. That assertion violates wp:V and wp:SYN: there's no way that one can credibly assert that 'modern medicine' is the only medicine via sources. 'Medicine' is a broad, vague, multi-cultural and multi-faceted concept.
2. As a consequence of that error, the logic subsumes acupuncture entirely under modern medicine, when in fact acupuncture is a separate construct which (while it overlaps modern medicine in some places) is independently derived and carries incommensurate presumptions and ideals. This is a violation of wp:NPOV: it effectively takes sides in a real-world dispute between acupuncture and modern medicine (a dispute, incidentally, which is nowhere near as hostile in the real world as it is on wikipedia), and asserts one side as the victor. It does not matter that the assessment is most likely correct: that can only be reflected by sources, and cannot be reflected in such a way as to make inferences or conclusions that sources do not and cannot justifiably make.
3. As a consequence of that error, the logic forces a violation of wp:RS and wp:NPOV by insisting that only 'modern medical' sources are reliable. This precludes any possibility of a balanced, neutral article because it literally and actively denies one side of a real-world debate any voice in the debate.

In short, the logic starts from the premise that 'modern medicine' is 'true' and everything else is 'false', and uses that unfortunate premise in a self-fulfilling way to ensure that article content gives the impression that 'modern medicine' is 'true' and everything else is 'false'. Once one recognizes that bad premise, and discards the idea that 'medicine' is a uniform entity comprised entirely of 'modern medicine', then the logic falls apart. At that point we can have a little 'policy reset' party which will ultimately allow us to write a balanced and neutral article. But you have to see that bad premise first. Do you understand my perspective now? --Ludwigs2 16:27, 17 October 2011 (UTC)

I'm content to use the BRD cycle, so I don't think it's necessary to discuss uncontroversial edits before making them. Something like a re-interpretation of an existing source would probably require justification before implementing such a change on the main page. I'm sick of inexperienced editors who don't understand the sourcing, POV and consensus requirements of wikipedia claiming there are problems with the article without presenting anything but opinions to substantiate this. As an experienced editor, I expect is that you substantiate your edits with sources rather than debating semantics, semiotics or postmodern ontology.

I'm not going to get into a debate over whether traditional medicine has any merit. Wikipedia's policies clearly require sources to make changes, we both know this, so why are we debating? I've already said, twice now, that any source-based edits will stand or fall based on the source. I don't really care about your perspective, but if you try to cite The Web That Has No Weaver to claim acupuncture is effective at treating a specific condition, you better have a Cochrane review to back it up per WP:MEDRS, or clearly attribute it as Kaptchuk's opinion per WP:ATTR and WP:NPOV. Naturally a discussion of the history of acupuncture does not require MEDRS. There's no point in commenting on hypotheticals or abstracts without knowing the specific edit and the specific source. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:43, 17 October 2011 (UTC)

Hm. It sounds as though you've just ignored my argument. That's fine if that's what you want to do, but the misinterpretation of policy that runs through your logic isn't going away just because you refuse to face it. I'll make my edits to the article as you prefer, and we'll see what happens. However, sooner or later you are going to have to address the policy argument I made above, either by accepting its validity privately or discussing it publicly; it is not dismissible on the grounds of semantics, semiotics, or any other term pulled out of an undergraduate philosophy texts. It is a concern based in the core principles of the project and needs to be evaluated on those grounds.

unless you want to discuss this more, I'll just get to editing. give me a couple of hours to get to it. --Ludwigs2 17:23, 17 October 2011 (UTC)

How about we hypothetically ignore the policy briefly, since you seem to think that we don't understand it, and just discuss how exactly the article as it stands is lacking as an encyclopedia article? How exactly does drawing comparisons to placebos fail to inform or misinform the reader in a meaningful way? Failing to mention that, given the amount of material written on exactly that subject, would be a serious omission. The change you're suggesting only really makes sense if your goal is to promote acupuncture's validity. I honestly don't get how this whole discussion was supposed to make any headway in being more informative. i kan reed (talk) 20:12, 17 October 2011 (UTC)

My only concern with the placebo issue is where people try to use 'placebo' in an assertive sense, suggesting that acupuncture is somehow only a placebo. That is scientifically meaningless, and ends up being little more than defamatory rhetoric. correct use of the placebo concept does not bother me at all. I'm more concerned, however, with the argumentative statements that I find in the article. just for an example, paragraph 2 of the lead reads like a series of jabs in a boxing match, and then you get absurdities like the last two sentences:

A 2011 review of review articles concluded that, except for neck pain, acupuncture was of doubtful efficacy in the treatment of pain and accompanied by small but serious risks and adverse effects including death, particularly when performed by untrained practitioners. There is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles.

What this means, of course, is that acupuncture is safe: 'untrained practitioners' in any medical field can kill you - is modern medicine bad because an untrained practitioner doesn't know how correctly stitch a wound or remove an appendix? argumentative moments like this make the article look very bad. --Ludwigs2 21:54, 17 October 2011 (UTC)

I've seen this said asked a lot now, but I guess it bears repeating: Is this criticism of the "placebo" label borne by the sources, or is it an original interpretation carried on for the sake of discussion? To quote ikanreed: "Failing to mention (the placebo label), given the amount of material written on exactly that subject, would be a serious omission." I'd fourth (or fifth, or whatever) the suggestion that, if you want discussion before editing, you make specific proposals. This page isn't intended for discussion of the topic. Bring sources, or make a proposal, or we can't get anywhere.   — Jess· Δ♥ 22:15, 17 October 2011 (UTC)

Jess - I don't believe you read my last post. No one is suggesting removing the placebo language, but rather simply removing synthesis that misuses the placebo language. Further, I gave a specific example of the kind of change I was going to make, which we could discuss if you want to. And even more to the point, all I've really been trying to discover here is whether editors would rather discuss changes first, or whether I should simply edit and discuss the changes after.

The talk page is for discussing potential article changes. However, you're the fourth or fifth editor I've encountered here who has seen fit to dwell on the frustrations of the talk page rather than on the article or topic. I understand that there is a great deal of frustration floating around this talk page; can we all simply take that as a given, step back from it in AGF, and refocus on the article itself? --Ludwigs2 00:45, 18 October 2011 (UTC)

@Ludwig I missed my chance to get this response close to your original post and I don't want to refactor any comments so I'll post here regarding your quote:

The logic implicitly asserts that 'medicine' is a solid and uniform entity comprised entirely of 'modern medicine'. That assertion violates wp:V and wp:SYN: there's no way that one can credibly assert that 'modern medicine' is the only medicine via sources. 'Medicine' is a broad, vague, multi-cultural and multi-faceted concept.

I'm not going to debate the merits of your argument that medicine is multifaceted because it's not really relevant (and this isn't a forum of course). MEDRS is clear regarding what sources "count" as medical sources, I quote from MEDRS:

Ideal sources for such content includes general or systematic reviews published in reputable medical journals, academic and professional books written by experts in a field and from a respected publisher, and medical guidelines or position statements from nationally or internationally recognised expert bodies.

It goes on to state that this is very much in line with WP:V and applies equally to alternative medicine as it does to anything else. With that said, the policy we have in place demands that this article be presented, at least medically, based on modern medicinal sources. I'm not sure if you disagree with this or not, but it seems from what you've written above that you believe that either we can use sources that aren't based on the aforementioned criteria, and/or we can present the information from said sources in such a way that it is more "fair" to acupuncture, with "fair" meaning that it obfuscates the sourced negativity. I apologize if I misread you, but if I didn't misread you then I'm left with nothing to say but that I think your interpretation of WP:NPOV is incorrect, in that you seem to think that we should "present the facts and let readers decide for themselves," which is not what neutral means in the context WP uses it. N^oformation ^Talk 00:42, 18 October 2011 (UTC)

Noformation: In fact, as I pointed out, the point about medicine being multi-cultural and multi-faceted is entirely relevant, because making the assumption that it isn't introduces a strong and inappropriate bias on the article. I'm not suggesting that modern medicine is not appropriate on the article; I'm simply saying that trying to force acupuncture to be viewed solely through the lens of modern medicine violates wp:NPOV and wp:V. I don't have an objection to medical sources, properly used, and believe they are a great asset to a proper description of the topic. I object to the improper use of medical sources in order to induce a judgement or bias. I hope that distinction is both clear and agreeable to you. --Ludwigs2 01:02, 18 October 2011 (UTC)

I'm sorry but I don't understand exactly what you mean so I will have to wait and see when you make some edits. I'll also say that WP:MEDRS implicitly forces WP to look at all medicinal concepts through the eyes of modern medicine by limiting the kinds of sources we can use to make medicinal claims to modern medicinal sources; if we were supposed to look at it differently then I imagine it would have included perspectives aside from those stated. Lastly, bias and judgement are not prohibited by WP:NPOV, rather our judgement and bias as editors is. Our article should be biased and judgmental insofar as our sources are biased and judgmental, if we don't present what the sources state then that is the NPOV violation. N^oformation ^Talk 01:36, 18 October 2011 (UTC)

My reading of MEDRS guidelines does not reflect the degree of restriction you suggest. Certainly all claims of medical efficacy need appropriate Med RS, but that does not mean every source for every statement in any med-related article is forced to be viewed through the lens of modern medicine. Following that to the letter would lead to absurd articles.Herbxue (talk) 02:53, 18 October 2011 (UTC)

No, of course not, MEDRS is for medical claims only. Other non-MEDRS sources are of course appropriate for history, etc, sections, as has been stated by myself and others multiple times N^oformation ^Talk 02:57, 18 October 2011 (UTC)

I've explicitly made that point several times, which is aggravating. MEDRS only applies to medical claims and information. If we're discussing history of acupuncture, we go to journals of sinology and/or history. If we're looking at cultural impact, the same. If we're explaining the assumptions and theory of acupuncture, we go to the best sources we can find for that information which is often the publications of acupuncturists. Naturally, any claims that the anatomical structures or biological functions included in the theory actually exist requires some sort of substantiation; consistently there has been a failure to find any objective evidence for points and meridians despite much looking. Multiple lines of evidence converge on this - it doesn't matter where you insert the needles, the effects are roughly the same; different cultures have identified different points; they were originally based on the number of days in the year rather than anatomy; their number has expanded arbitrarily; no anatomical structures exist that correspond with either points or meridians. However, if science ever identifies a strong correlation between points, lines and either anatomy or effect, we can and should mention this. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:05, 18 October 2011 (UTC)

(e/c) Nofo: To the extent MEDRS does that, then MEDRS needs to be revised or IAR|ignored. Any guideline which contradicts NPOV is problematic at best (though I think perhaps Herbxue siad it better above). And you are correct in your second point, but it is precisely editorial bias (the misuse of sources by editors) that I am objecting to, not the bias implicit in sources. Remember, NPOV tries to balance various different perspectives against each other to achieve an overall neutral stance; that is not happening on this page.

But enough of that. I think what I will do is open a new section below and suggest a rewrite of paragraph 2 of the lead (as I noted above). that should provide a clear idea of what I'm after, and why, and should be a good starting point for introducing the other revisions I want to make. can't do it right this instant, but I'll get to it soon. --Ludwigs2 02:56, 18 October 2011 (UTC)

You're of course welcome to attempt to change MEDRS on that talk page though I don't think you'll find consensus to do so but it's your prerogative. I also doubt you'll find consensus here to ignore MEDRS. I completely disagree that it contradicts NPOV, I just think you might have a different idea of NPOV than I do. Either way, onward with the editing! N^oformation ^Talk 03:00, 18 October 2011 (UTC)

Agreed, MEDRS is adhered to until the page changes. Arguing for special dispensation for acupuncture is akin to the "you can't measure my woo" argument I mention above - science can measure pretty much anything that actually exists.

NPOV means adhering to the representation in the best sources, it doesn't mean "false balance" or "tell both sides". We don't portray evolution and creationism as "two sides" - one is a substantially true scientific theory and the other is a political strategy aimed at forcing religion into school curriculum. We don't portray Holocaust denial as "the other side" of WWII history. We don't portray AIDS denialism as "another viewpoint on AIDS". We don't pretend Birthers have a point. 9/11 controlled demolition is not an equally valid viewpoint to planes being flown into the WTC by religious zealots. Similarly, we may describe the beliefs of acupuncturists, but we must state that their beliefs have been tested and (in most case) failed. We must state this immediately, prominently, and accurate to the sources that are cited. If there are equally authoritative sources which appear from the pro-acupuncture side of the discussion which criticize this conclusion, that can also be included - but they must be authoritative and appear in respected sources. No websites, no blogs, and no fifth-tier, non-PUBMED indexed, non-peer reviewed journals. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:05, 18 October 2011 (UTC)

First, please allow me to introduce you to the concept of wp:IAR: rules which interfere with the core principles of the project - the construction of an informative and unbiased encyclopedia - can and should and must be ignored. We do not wait clean up policy messes that other editors have made before we edit for neutrality; we edit for neutrality, and clean up the messes when we get a chance. I'll get to MEDRS when I have the time, but I'm not going to wait until that's done to remove biased language. see wp:NOTABUREAUCRACY.

Second, NPOV is not some over-simplified dichotomy where either everything is equal or one side dominates. NPOV is a subtle policy which asks us to present topics as clearly and neutrally as possible while keeping opinions about the topic in proper balance. Even with something like creationism or holocaust denialism we are not here to abuse the topics. We describe the topics properly without allowing them to take on an 'aura of truth', but also without allowing opposing positions to corrupt or ridicule them. If you cannot accept any realistic description of acupuncture, but can only allow descriptions which are filtered through an incommensurate and sometimes hostile worldview, then you are unable to follow NPOV on this article and probably you should not be editing here. I'm not asking you to leave, mind you; that's between you and your conscience. But it is something I think you should reflect on. --Ludwigs2 19:04, 18 October 2011 (UTC)

Discussion regarding lead

Let's go through it. Source 9 was published in 2005, and Ernst has since published a new critic of acupuncture which has since been thrashed by other scientists. In any case, in his article it states: "Thus the majority of these [new, sham-controlled] trials suggests that the effects of acupuncture could after all be mostly due to a placebo response." Note he said "could", "majority", and "mostly", 3 words that do NOT imply certainty and totality.

Source 14 states: "For short-term measures of pain, there is strong evidence (two higher quality trials, 138 people) (Carlsson 2001; Molsberger 2002) that acupuncture is more effective than sham therapy for patients with chronic low-back pain, with a WMD of -17.79 (95% CI -25.5 to -10.07)" and "Of five trials that measured pain immediately after the end of the sessions, four trials could be pooled (Mendelson 1983; Leibing 2002; Molsberger 2002; Kerr 2003). The pooled analysis (two higher and two lower quality RCTs, 314 people) shows that acupuncture is more effective than sham therapy with a WMD of -10.21"

Doesn't sound like a definite conclusion that acupuncture is all placebo to me. The article also states: "The pooled analysis (comparison 12.1) shows that the addition of acupuncture to other interventions is more effective than the other intervention alone for pain, measured immediately after the end of the sessions"

Their conclusion? "Compared to sham therapies, there is evidence for pain relief at shorter-term follow-up, but these effects were not maintained at the longer-term follow-ups, nor were they observed for functional outcomes. Compared to other conventional or "alternative" treatments, acupuncture is no better for measures of pain and function. There is evidence that acupuncture, added to other conventional therapies, relieves pain and improves function better than conventional therapies alone. According to these results, acupuncture may be useful as either a unique therapy for chronic low-back pain or as an adjunct therapy to other conventional therapies. Although the conclusions show some positive results of acupuncture, the magnitude of the effects were generally small." Perhaps this article was just used a (misparaphrased) source stating that acupunture's effects are "small" (i.e not "very small"). Since it does nothing to support a conclusion that acupuncture is placebo.

Doesn't sound like they conclude it's due to placebo or that the effect is "very small" so I don't even know why this is a reference.

Next: source 15. "A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias. Whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact of the treatment ritual is unclear." Again, nowhere does it say the effect is "very small". Nowhere does it conclude with certainty that the effects are due to placebo. In fact, it states that it's UNCLEAR. If you look beyond the conclusion, it even states: "We found a small difference between acupuncture and placebo acupuncture" So why is this a source for supporting a statement that concludes with certainty that acupuncture is all placebo and has very small effects? 99.231.120.164 (talk) 03:55, 21 September 2011 (UTC)

And hey, let's examine the next sentence in the intro. "A 2011 review of review articles concluded that, except for neck pain, acupuncture was of doubtful efficacy in the treatment of pain and accompanied by small but serious risks and adverse effects including death, particularly when performed by untrained practitioners.". Let's look at what they say in the discussion of the article: "A similar overview, covering 1989 to 2000, included 17 systematic reviews of acupuncture for pain [85] . The interest in acupuncture is evidently increasing. The majority of the early reviews arrived at negative conclusions [85] , while the majority of the 57 recent reviews were positive. Yet there are many contradictions and doubts. For instance, there is no plausible reason why acupuncture should reduce pain in some conditions while failing to work in many others." Of course I'll certainly bet this trend of increasingly positive reviews is never going to be mentioned in this article anywhere. Or how about this: "The majority of the (high-quality) reviews were positive for low back pain and osteoarthritis." Nope. Of course not. Instead this source is used for the statement: "2011 review of the literature on pain concluded "numerous systematic reviews have generated little truly convincing evidence that acupuncture is effective in reducing pain." If you read through the article itself, you'd realize it's contradictory everywhere, with the most anti-acupuncture statements all plastered on the abstract ready for Wikipedia editor pickings! 99.231.120.164 (talk) 04:17, 21 September 2011 (UTC) presumably based on this version

Ah. Now we have something to talk about. Ernst's new review should be used, but reliable sources that criticize his review can be included - please provide citations. I'll have a look at those references and provide comments. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:35, 21 September 2011 (UTC)

Reference 9 is used 4 times in the article, twice in the lead. I'm assuming your comments relate to "Although evidence exists for a very small and short-lived effect on some types of pain, several review articles discussing the effectiveness of acupuncture have concluded it is a placebo effect". The abstract of reference 9 (Ernst, 2006) states, in reference to the use of sham needles, "The majority of studies using such devices fails to show effects beyond a placebo response." You appear to be suggesting the body text is more equivocal. If anyone has it, could they e-mail it to me?

Reference 14 is to the Furlan et al. 2008 Cochrane Review. Though there are indeed isolated positive mentions of acupuncture, overall it is pretty negative. You are correct in that it doesn't seem to justify the statement that acupuncture is solely placebo; though I have no doubt that there are sources concluding acupuncture can be completely explained as placebo effect, this does not seem to be one of them. There are other sources that could be used to verify a modified version of this statement, such as "It has been suggested that the positive results reported for acupuncture can be explained by placebo effect and publication bias", sourced to Trick or Treatment and references 92, 120 and 121. References 9, 14 and 15 seem more to source the first part of the sentence ("Although evidence exists for a very small and short-lived effect on some types of pain...") and I would suggest keeping the idea and references, but removing the "very" (and including the second sentence I suggested above).

Reference 15 is to Masden et al. 2009 and it is pretty clearly stating that acupuncture could be completely based on placebo. That's my reading of it, "the psychological impact of the treatment ritual" is simply a way of restating "placebo" in my mind.

Regards the sentence sourced to Ernst, 2011, stating that the majority were positive neglects the more meaningful analysis as it says later that the reviews were contradictory. So the majority may have been positive, but obviously some of them were balanced by negative reviews. There were only 4 conditions for which reviews agreed - fibromyalgia (acupuncture didn't help), neck pain (acupuncture helped), postoperative pain (results for two reviews were inconclusive) and herpes zoster (trials were too low quality to really say). The lead states that acupuncture does appear to help with neck pain. I don't think it's worth including that the review said it didn't help with fibromyalgia, was inconclusive for postoperative pain and the only remaining condition for which there was agreement was of low quality. The review of reviews also talks about the quality of evidence and trials, including that a significant portion of the poor-quality reviews were from China (including both herpes zoster reviews). Ernst 2011 is a complicated paper to read and difficult to summarize clearly - stating that it found acupuncture to be effective for neck pain but not mentioning the myriad qualifications and negative results is problematic in my mind. Neck pain is only really mentioned because of the ability to compare reviews of reviews, it was one of the few that had multiple reviews with the same conclusion. It also has a long list of pain conditions for which acupuncture is not effective. Shall we mention them in the lead? Ultimately I'm OK with how Ernst 2011 is currently used, mostly because I can't see a better way to summarize it. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:29, 21 September 2011 (UTC)

Even if you don't trust the article text that I quoted is real, the Ernst abstract itself states: “Some findings are encouraging but others suggest that its clinical effects mainly depend on a placebo response”. That doesn’t sound supportive of an definite conclusion that acupuncture is placebo as so eloquently (mis)paraphrased by the editor.

I am indeed correct that Furlan doesn't state acupuncture is placebo considering they conclude the near opposite: it's more effective than sham acupuncture.

I do find it odd that you conclude reference 9, 14 and 15 source the first part of the sentence as if you're dismissing the obvious and irresponsible paraphrasing of the articles' conclusions to state that acupuncture is placebo.

I never disputed that Reference 15 stated that acupuncture COULD be completely based on placebo. I'm disputing how reference 15 is used to support a statement that in this article that acupuncture's effect IS placebo, which reference 15 doesn't state. Reference 15 actually states quite clearly that it's unclear, and I do acknowledge that they are referring to placebo in their conclusion... and that it's unclear whether acupuncture's effects are placebo. I don't understand why we couldn't just conclude that whether acupuncture's effect is due to placebo is unclear, as per reference 15 and implied by reference 9 (reference 14 says it's better than placebo so I won't go there). Reference 15 is a 2009 review published in the BMJ so why not use it rather than modify the sentence to state: "It has been suggested that the positive results reported for acupuncture can be explained by placebo effect and publication bias" and back it up using ToTr (which is surely not as reliable a source), 2 decade-old reviews and one review that is specific to acupuncture in nausea and vomiting. Why use 4 less reliable sources if not to warp the lead's tone to make it more negative?

And my point was not I think we should mention that Ernst (2011) thinks it's effective for neck pain (or any other condition) or not. My first point on that article is it's a bit shady to mention his conclusion that only acupuncture for neck pain is not of "doubtful efficacy" when he states in the same article that the majority of high quality reviews were positive for low back pain and osteoarthritis. Of course acupuncture for OA is implied to be still of "doubtful efficacy" according to his conclusion statement because not ALL of the reviews were positive. Seems like a bit of weasel word endulgence going on but whatever. This is not the real issue.

My main point is that it's important to mention that majority of recent reviews are positive compared to the older, largely negative reviews. I do not deny that there are some recent negative reviews and that there's no 100% agreement (when is there not in medicine?) on any topic except neck pain but it seems to me that it's a pretty important development that should not be censored. I don't think it's worth including in the lead any conclusions from Ernst about specific conditions since we have a variety of targeted, higher quality literature on it, and I can say the same about his reports of low quality studies as this article already mentions those issues in depth with other sources cited. But it does seem worthwhile to note that the majority of evidence on pain coming out recently is in favour of acupuncture since I don't believe it's mentioned in the article anywhere yet. If not in the lead, in the EBM section. If you disagree, why is it not worthwhile to note? I've been told before that it's better to include information than exclude it if it's backed up by high-quality sources so why not?99.231.120.164 (talk) 05:12, 22 September 2011 (UTC)

PMIDS 21783323, 21778019, 21723038, 21550173 are all responses/letters detailing criticism of Ernst's article.

Oh and I see we included his quote in the EBM section lead: "numerous systematic reviews have generated little truly convincing evidence that acupuncture is effective in reducing pain."<-- which is what he stated in his abstract despite noting in the article there's positive agreement on neck pain and strong evidence for OA and low back pain. Oh Ernst... And you've got to wonder why the part of his article noting the trend to positive reviews wasn't mentioned along with it, yet a very strong (and unsupported even by his own article) statement gets quoted. Surprise, surprise right?99.231.120.164 (talk) 05:29, 22 September 2011 (UTC)

suggested revision, lead, para2

alright, here's a suggestion for how I would revise paragraph 2 of the lead, mostly for the sake of discussion here. Note that the entire lead needs rewriting - it has been destroyed by an excessive focus on details and what is obviously petty infighting over sources. it reads like mud, and stinks to high-heaven from a composition perspective. but one thing at a time.

revison (explanation follows):

Acupuncture treatments are generally held to be safe, but have only been demonstrated to be effective for nausea and some types of pain. Several reviews have suggested that these positive pain relief results are artifacts of experimental bias.

Most of the citations and all of the argumentative points will be moved down into the body of the article where they can be developed in a balanced fashion. This summary captures the meaningful points of the current paragraph without indulging in excesses. in particular:

• it avoids giving undue weight to the risk of death by untrained practitioners, since we can assume in the lead we are discussing the proper practice of acupuncture
• It avoids making arguments in the lead, which should properly be made in the body
• It avoids the tendentious (and ugly-looking) back and forth between positive and negative claims that currently infest the lead
• It gives a nice, neutral statement of the experimental standing of acupuncture without indulging either side of the dispute

In short, it sets a properly encyclopedic tone from which further discussion of the issues can proceed without the need of pointed language. --Ludwigs2 04:59, 18 October 2011 (UTC)

Ludwig, despite the fact that I disagree with virtually everything that you've said on this talk page, I agree with your attempt to strip the lead down to a source-free, readable, summary of the article. It is currently unreadable and disrupted by citations that are repeated in the body of the article. As for your recommendation for para 2, I suggest:

Acupuncture treatments are generally held to be safe, but current research suggests that they are only effective for nausea and some types of pain. Several reviews have suggested that these positive results for pain relief are artifacts of experimental bias.

The rather weighty "demonstrated" in your version is immediately contradicted by the next sentence. Famousdog (talk) 13:18, 18 October 2011 (UTC)

That turns a six-sentence paragraph into two sentences, which is too short. What sources would be used? Ernst's review of reviews highlights the risks of untrained practitioners, which isn't something that can be ignored, and the fact that death is a possible adverse effect is important enough to be in the lead in my opinion. "Some reviews" is weaselly. I think it's worth mentioning explicitly that acupuncture is not effective for anything but pain and nausea. There's no mention of either publication bias or placebo.

The thing is, those "positive and negative claims" are the state of the art. Acupuncture is still highly investigational with a lot of difficulties involved in the research. Finding an effective placebo alone was highly problematic, particularly considering the number of variables - needling location, type of acupuncture, practitioner characteristics, skin penetration, skin stimulation, expectation, objective versus subjective effects. The body already discusses the details of the back and forth regarding acupuncture, at minimum it must include the significant part of the argument that acupuncture could be placebo as that is the position of a large number of highly respected skeptics, researchers and doctors. To not include placebo and publication bias as explanations for clinical effectiveness and research results misrepresents the scientific debate. NPOV does not mean "present this subject in the most possible light and sweep criticisms under the rug". Criticisms are a major part of the debate on acupuncture. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:22, 18 October 2011 (UTC)

A short, 2 sentence statement in the lead would be more in keeping with the idea that the lead summarizes the article. Keeping it as-is (over half of the lead) and adding in more citations seems either pointy or like it is a summary of an article titled "Efficacy, Risks and Debates on Acupuncture". And to say acupuncture is placebo is technically incorrect, as Ludwigs indicated earlier. You can say that a number of reviews found effects that were not superior to placebo (preferably in the body of the article), but not that it is placebo.Herbxue (talk) 14:33, 18 October 2011 (UTC)

(reindented after edit conflict)

@Famousdog: Those revisions would be acceptable. and as an aside, I suspect you disagree with what I've said less because of what I've said and more because we are talking past each other. What this comes down to for most editors here is producing a neutral, readable article. We have relatively minor differences colored and compounded by having to deal with vocal extremist views from both sides. it's an unfortunate factor in discussions everywhere on the internet.

@WLU: As I said, the entire lead needs to be rewritten, so these two sentences would be combined with other material. That being said, however, two neutral, direct sentences are always preferable to six congested, conflicted sentences. volume of text is not what matters.

With respect to sourcing, I don't necessarily expect to remove any sources (maybe a couple that are not particularly valuable, but that can be a matter for further discussion). The point is this: sources are important to build a discussion, but discussion should normally be built in the body of the article, where there is room to expand and expound on particular points. While there's no real problem with having sources in the lead, the lead should really be a summary of discussions in the body, and whenever I see a lead like this (which has something like 30 sources for three paragraphs), what it means is that editors have been mistakenly trying to argue points in the lead rather than in the body. Front-loading everything into the lead is a poor compositional style and makes the article feel high-pressure and conflicted (usually it's more of an issue with new editors, who don't understand proper composition, but even experienced editors like us trip over it sometimes). Most of the sources are duplicates of sources used in the body, those that aren't can be moved there, and in the body we can discuss these sources properly (in a normal paragraph style) rather than trying to compress complex ideas into line-by-line sound-bites. I don't disagree with most of what you say, but most of what you say should be said in the body.

With respect to your other comments: Again, what I'm trying to avoid here is a super-picky super-detailed jab-fest. to whit:

• Saying that A is 'only effective for nausea and pain' is accurate with respect to current research; saying it is 'not shown to be effective for anything else' is synthesis (making inferences about what has not been published from publish researched); and please, it's an obvious effort to shade acupuncture in a negative light.
• All medical procedures carry a risk of death. Small number of people die every year because a doctor tells them to take aspirin and their livers fail, or a minor procedure like draining a boil goes bad. This goes against WEIGHT by exaggerating a small but general risk inherent in any medical procedure as though it were a prominent feature of acupuncture (which it isn't, since acupuncture is generally considered safe).

The lead of any article should focus on defining features of the topic, it shouldn't be used to try to establish an attitude about the topic. Articles like acupuncture have huge, ugly talk pages almost entirely because of nit-picky word games of this sort, where editors from one side or another try to create impressions that the topic is good/bad rather than simply describing the topic and allowing it to show itself as good/bad. In particular, the sorry state of the lead of this article is clearly due entirely to this kind of word game: everyone has been running around finding sources that say good/bad things about acupuncture, and using sourcing policy to force good/bad attitudes into the lead to create positive/negative impressions. The result is a lead which is a clunky, over-sourced, self-contradictory tug-of war. IMO, we need to go the relaxed, simple route: say what acupuncture is, note that it does not have much empirical support from medical research, then leave all the detailed back-and-forth for discussion in the body. --Ludwigs2 15:53, 18 October 2011 (UTC)

Defining features of acupuncture: Needles, Chinese origin, alternative medicine, medically useless, spiritual origin. Did I miss anything? i kan reed (talk) 17:54, 18 October 2011 (UTC)

Nice work! Good points by Ikanreed that need to be addressed.

Additionally, de-emphasize "Acupuncture treatments are generally held to be safe." It certainly doesn't need to be at the start. Why does it need to be in the lede at all? --Ronz (talk) 17:59, 18 October 2011 (UTC)

@Ikanread: Uh, yeah you kinda missed a lot. My bother editing here? Skepticism and critique add value, but outright dismissive attitude can not add anything of value to the article.Herbxue (talk) 18:14, 18 October 2011 (UTC)

@Herb, it's merely inappropriate humor. I left a note about it on his talk page; it's best to ignore it here and encourage him to make a more productive contribution

@ Ronz: the safety of acupuncture is well-sourced, and as with any medical procedure safety is an important and legitimate concern for readers. a good summary of the literature is: 'there is no real evidence that it does much, but there's no significant risk in doing it'. --Ludwigs2 18:33, 18 October 2011 (UTC)

Ronz might be kidding.

The point to remember is that we have to summarize the body of literature - a considerable portion of the literature on this ostensibly medical procedure is dedicated to debate over whether there is a genuine effect or not. The current lead doesn't say "acupuncture is placebo", it says "...it has been suggested that the positive results reported for acupuncture can be explained by placebo effect and publication bias." Regards actual conditions other than nausea and pain, acupuncture has been tested for many, many conditions and there is yet to be one that it is actually effective for (infertility might be an exception). I also can't understand how any lead of this ostensibly medical procedure can not include a relatively lengthy discussion of effectiveness, and how that discussion could not incorporate a broad-strokes summary of the controversies. Think of the opposite - if acupuncture were effective in the treatment of a variety of conditions, would they not be listed in the lead?

Regards the inclusion of six "congested" and "conflicted" sentences, the literature is complex. Research on acupuncture is congested, conflicted, complex and nuanced and it's not to the detriment of the lead to include this. The current structure of paragraph 2 is essentially:

• What acupuncture is effective for (pain, nausea, little else)
• How effective acupuncture is for nausea
• How effective acupuncture is for pain
• Whether these results are reliable
• Adverse effects
• Safety

One sentence each to summarize. This looks reasonable to me, the only suggestion I see merit in would be to trim some detail in the nausea section. However, in reality what we should be doing is seeing if the lead summarizes the body, not whether the lead summarizes our preconceptions of acupuncture. We then adjust the lead to include more (or less) detail than what is in the body, or adjust the body to expand to include more detail of the lead. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:37, 18 October 2011 (UTC)

That all sounds reasonable, but I actually think your sentence "Research on acupuncture is congested, conflicted, complex and nuanced" would work better in the lead, then flesh it all out in the body.Herbxue (talk) 18:55, 18 October 2011 (UTC)

That's my analysis, we would need a source to include it. I don't think it does readers any favours to simply say "research is complex" then not give a brief summary of why - like the current version. The page itself is very long, the lead should scale accordingly; with a 60K+ page it is not unreasonable to have a three or even five paragraph lead of 5-10 sentences each. I don't want "it's too long" to turn into a dumbed-down version that doesn't indicate just how problematic acupuncture research is. We flesh things out in the body, but the lead is meant to be a skeleton. Leaving out the research controversies would be like omitting both femurs and the jaw. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:09, 18 October 2011 (UTC)

I agree with Herb; the lead is not the place to hash out the details of the article. This - again - is a matter of proper composition. if you want to expand the two lines to three with something like "Several reviews have suggested that these positive results for pain relief are artifacts of experimental bias, and the results of research into acupuncture are often conflicting and contested", that would be fine - that would signify to readers that they need to read the body to get more details without prejudicing the information. but pushing beyond that into more detail seems unwise.

And please, we are all aware that the lead needs to reflect the body, and nothing suggested here violates that principle (nothing is lost or gained in this discussion except focus, clarity and weight issues). lets not confuse things.

If you ask me, the lead as a whole should cover the following:

• What acupuncture is in itself (general concept, origins, basic procedures used - essential descriptive material that gives the reader the nuts and bolts)
• How acupuncture is viewed from the larger perspective (the 2-3 sentences we've been discussing, plus maybe some over-view material about different forms of acupuncture)
• A closing paragraph dedicated to its acceptance by things like the medical community, NCCAM, and etc (this seems to be pretty standard on project, at any rate)

I can write out a full draft if you like.

And yes, I recognize that Ronz was probably joking, but is was a joke with a possibly serious root, so it merited a response. --Ludwigs2 19:26, 18 October 2011 (UTC)

The two sentences suggested here for the second paragraph of the lede do not seem to be an improvement. In the first sentence, the reader will not understand that, although acupuncture is prescribed for a wide range of ailments, it has only been proven to have any effect in a very limited number of cases, such as nausea and some kinds of pain. Equally well the second sentence would leave the reader puzzling over the words "artifacts of experimental bias". Care has to be taken not to misrepresent a potential treatment to the general public (the readership of wikipedia). In the case of this paragraph, the previous sourced content, now ommitted, was unambiguous. The two sentences proposed as a replacement are full of ambiguity. Writing about the long history of acupuncture is one thing; describing its current use and effectiveness, however, must follow WP:MEDRS. Wikipedia has a number of qualified medical experts contributing; in the circumstances it might be wise to seek their input on matters like this. Mathsci (talk) 20:15, 18 October 2011 (UTC)

so, Mathsci, your argument is that the phrase "but current research suggests that they are only effective for nausea and some types of pain" will not inform readers that acupuncture has only been shown to be effective for nausea and some types of pain? That literally makes no sense; it's like saying the phrase '1+1=2' does not inform people what 1+1 equals. You must be reaching for some other point, but I can't figure out what that is. can you clarify?

I'll grant that 'artifacts of experimental bias' is a little jargony; how would you word it better? --Ludwigs2 21:27, 18 October 2011 (UTC)

The details should be discussed in the body, but the lead must reflect the fact that there is controversy and considerable disagreement on nearly every point. Even the acceptance by the medical community has been heavily criticized, not to mention the fact that it's not really "acceptance", it's generally "there is some evidence acupuncture might be effective but more research is needed".

"Artifacts of experimental bias" needs to be spelled out and this is pretty simple to do - it's hard to design controls for something as invasive and salient as inserting needles into a conscious individual (i.e. lack of a proper placebo control) and publication bias. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:52, 19 October 2011 (UTC)

WLU: I agree with that, except for one caveat. I am opposed to your emphatics: the italicized 'must', and 'heavily', and similar elements of rhetorical argument. Scientific research never relies on emphatics to carry the weight of its arguments; that kind of socio-political rhetoric is the province of advocates and skeptics, and both advocacy and skepticism need to be constrained and balanced under wp:WEIGHT. right? --Ludwigs2 20:33, 19 October 2011 (UTC)

Edits

I've made a fairly significant number of edits to the lead and body if anyone wants to review them. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:29, 20 October 2011 (UTC)

Lead citations

After finally getting the editors here to alter the statement that concludes acupuncture is placebo and that it has a "very small effect", I thought the page had finally gotten a bit more sensible. But lo and behold here we are again just like I predicted with my experiences here a few years ago of certain editors misusing sources and misparaphrasing to push their own POV. Let's go on with it.

The statement "It has been suggested that the positive results reported for acupuncture can be explained by placebo effects and publication bias" uses citations 8, 20, 22, 23, 24. I see some problems immedeiately. Why on earth is article 20 "Acupuncture and dry-needling for low back pain" used as a reference? First, it's specific to low back pain. Second, it never mentions publication bias and it never states the positive results (in chronic back pain) could be due to placebo.

Second, article: "Publication bias affected the estimate of postoperative nausea in an acupoint stimulation systematic review" is used as well. It concludes: "Publication bias affects the published estimate of postoperative nausea, not vomiting." It said publication bias only explained ONE of the positive endpoints of the particular acupuncture review they were looking at for one of the indications for acupuncture so how can it be used as a reference for a blanket statement that "the positive results reported... can be explained by... publication bias"? Would you not note that only SOME of the positive results can be explained by placebo if we were go by this article's conclusion which I note again only relates to one particular review and even then it notes that publication bias didn't overturn all the positive results of the review.

Third, article: " "Review of randomised controlled trials of traditional Chinese medicine" is from 1999. We have plenty of more recent articles discussing placebo/publication bias in the past decade. I've been told before by veteran editors here that if we have newer high quality reviews, we do not need to keep using old ones. Not only that, it's not even talking about acupuncture as a whole but specifically acupuncture for stroke, and more specifically trials conducted in China. How on earth can this can be generalized to positive results in acupuncture in general? What on earth...

Fourth, article: "Do certain countries produce only positive results? A systematic review of controlled trials." talks about certain countries publishing strangely high proportions of positive results. It concludes some countries in East Asia produce very high numbers of positive acupuncture trials compared to other parts of the world. It does not in any way state the positive results found in other countries are due to publication bias or that acupuncture's positive results as a whole "can be explained by... publication bias". It also does not state the positive conclusions in say Cochranes Reviews which are highly regarded around here and used a lot in the EBM section are due to publication bias.

The only source that I don't have major critique for is Trick or Treatment, the holy grail of scientific evidence around here, because I don't have the book and I'm sure it says something of that sort anyway knowing its slant.

Anyway I suggest the sentence to be changed to: "It has been suggested that some of the positive results reported for acupuncture may be explained by placebo effects and publication bias, but this is controversial"

I also suggest to remove the sources I noted as references for this sentence. They either do not support it or cannot be generalized to all "positive results" in acupuncture as the sentence implies. I suggest removing ToTr as a source because we have better sources available as seen below:

I suggest to include source 15 as a reference for the fact that whether the positive results are due to placebo are controversial. In the article it states: "Whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact of the treatment ritual is unclear."99.231.120.164 (talk) 02:31, 23 October 2011 (UTC)

Also, "and it has been questioned whether research on acupuncture is a good use of limited research funding." cites source 36. Somebody please tell me where source 36 suggests that in any way because I can't find it. A quote of what this sentence is based off of would be good. In addition, it's the same article as source 20 but in a different site. I'm honestly confused about why all this misattribution of sources where 6 sources can be cited for a bold statement (usually negative) about acupuncture and then it turns out the majority of those sources don't support the statement or have nothing to do with the statement even.99.231.120.164 (talk) 02:57, 23 October 2011 (UTC)

When PPdd went through the article he did some things that I would find...questionable. This might be an example. I'll try to review but one article alone is over 100 pages. This should be reviewed, though removing the odd reference doesn't really change the overall message. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:20, 23 October 2011 (UTC)

Well if few of the sources supporting the statement are even valid for that purpose and all we have left is Trick or Treatment, I'd say the strength of the overall message is severely decreased. And it's not the "odd reference". It's the majority of the references for this statement. Don't downplay it.99.231.120.164 (talk) 15:46, 23 October 2011 (UTC)