Talk:Acupuncture/Archive 11

Archive 5

←

Archive 9

Archive 10

Archive 11

Archive 12

Archive 13

→

Archive 15

Medical procedure?

I wouldn't call its affiliated procedures (moxibustion, cupping etc.) medical, but acupuncture itself probably is... (it's also listed in WP's Medical procedure article). If no one objects I'd change the lead sentence accordingly. Cheers, --Mallexikon (talk) 06:09, 23 June 2013 (UTC)

I would object. While accupuncture is sometimes used by physicians, it is usually practiced by quacks, much like moxibustion and cupping. Calling the procedure medical would legitimize the practices of these quacks. Furthermore, the evidence for the effectiveness of accupuncture is limited and equivocal, and it still has not entered the medical mainstream. It is still more alternative medicine than medicine. Dominus Vobisdu (talk) 07:27, 23 June 2013 (UTC)

Push POV much Dominus? I don't care whether you call it a medical procedure or not, but cupping and moxa are typically practiced by professional acupuncturists, the Chinese term for acupuncture includes moxa (zhenjiu 针灸). I don't see a reason to differentiate, unless you are pointing out that MD's occasionally use acupuncture as a stand-alone therapy, separate from theory and associated techniques?Herbxue (talk) 19:41, 23 June 2013 (UTC)

Were you addressing me or Mallexikon? If me, you seem to have misread my comment. Yes, I do mean that "MD's occasionally use acupuncture as a stand-alone therapy, separate from theory and associated techniques". Nevertheless, it remains more alternative medicine that mainstream evidenced based medicine. Dominus Vobisdu (talk) 20:24, 23 June 2013 (UTC)

I was addressing Mallexikon. The article title "Acupuncture" could have very narrow or very broad meanings and I think different editors assume different things. Broad meaning would have acupuncture refer to the whole system of healing of which it is (usually) a part (which also could narrowly refer to "TCM" or broadly to Traditional East Asian Medicine) or narrowly to the insertion of needles into the body for therapeutic effect. I only mention this to explain my post above about "zhenjiu" including more than just needle insertion.Herbxue (talk) 21:00, 23 June 2013 (UTC)

So how about adding the word medical to procedures in the lede sentence? I kinda would, DV is against it... else opinions? --Mallexikon (talk) 02:13, 25 June 2013 (UTC)

I support using the term medical procedure. "Medicine" is not a term that exclusively applies to contemporary biomedicine, which itself is not exclusively evidence-based.Herbxue (talk) 03:32, 25 June 2013 (UTC)

Unqualified, "medicine" does indeed strongly imply modern medicine, and does exclude alternative "medicine" and traditional Chinese "medicine". We already have in the next sentence of the lede that the procedure is used in traditional Chinese "medicine", and shortly after that put its use in modern medicine in proper context. Adding "medical" to the first sentence of the lede is very misleading and would violate WP:GEVAL. Dominus Vobisdu (talk) 15:08, 25 June 2013 (UTC)

I think you go too far. "Medicine" is the diagnosis and treatment of disease. The idea that the word medicine is owned by conventional modern medicine is an opinion, not a fact. Herbxue (talk) 15:27, 25 June 2013 (UTC)

It is a very widespread opinion, and a very reasonable assumption. We use words according to common usage, and common usage is that medicne refers to modern medicine, and not alternative "medicine". See our article on Medicine. Quackery can call itself "medicine" to fool the gullible, but that does not make it medicine, as the article on Alternative medicine makes clear. The lede is fine as it is, and the proposed change would violate our policies. Dominus Vobisdu (talk) 15:56, 25 June 2013 (UTC)

If your point were stronger you wouldn't need ad hominem attacks. The definition of the word does not exclude practices outside of the mainstream. Even if it did, the argument presumes that no mainstream MD's use acupuncture, which is also not true.Herbxue (talk) 21:08, 25 June 2013 (UTC)

Again, you're confused. Read my post further up. And the fact that mainstream MD's occasionally use acupunture is, as I said, already mentioned in the lede in the appropriate context. You seem to misunderstand what an "ad hominem" is. I see none. Dominus Vobisdu (talk) 21:18, 25 June 2013 (UTC)

The question at hand - "Is acupuncture a medical procedure" - is not answered by your opinion that it is practiced by "quacks", you are labeling people with an insult in order to argue that the word "medical" is inappropriate. That is what I am calling ad hominem, acknowledging it is a group rather than a person you are attacking. I personally think many docs who take gifts in exchange for promoting certain medications are quacks and dangerous opportunists, but that does not mean that what they are doing is not an attempt at practicing medicine. The opinion on the group is irrelevant to the question at hand. Herbxue (talk) 21:44, 25 June 2013 (UTC)

The reason I'd tend to call it a medical procedure is the fact that we have evidence of efficacy (at least for some conditions). This would also be the reason why I'd oppose calling it "quackery". --Mallexikon (talk) 01:54, 26 June 2013 (UTC)

I'd like to see the sources we'd use to call it a "medical procedure". TippyGoomba (talk) 03:18, 26 June 2013 (UTC)

And high quality secondary WP:MEDRS sources only that confirm that it is widely considered a medical procedure within the medical community. Otherwise, it's OR or UNDUE. Dominus Vobisdu (talk) 19:44, 26 June 2013 (UTC)

I can't find any highly cited reliable sources referring to acupuncture as a medical procedure, these for example do not:

• K Streitberger, J Kleinhenz, MD. Introducing a placebo needle into acupuncture research. The Lancet, Volume 352, Issue 9125, 1 August 1998, Pages 364–365,
• Ji-Sheng Han. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends in Neurosciences, Volume 26, Issue 1, January 2003, Pages 17–22,
• NIN Consensus Development Panel on Acupuncture. Acupuncture. JAMA. 1998;280(17):1518-1524,
• Ted J. Kaptchuk; Acupuncture: Theory, Efficacy, and Practice. Annals of Internal Medicine. 2002 Mar;136(5):374-383.

All of which have hundreds of citations each. (Sorry for the formatting) Samwalton9 (talk) 20:10, 26 June 2013 (UTC)

"There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is 'Eastern' or 'Western,' is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for historical purposes and cultural interest. As believers in science and evidence, we must focus on fundamental issues - namely, the patient, the target disease or condition, the proposed or practiced treatment, and the need for convincing data on safety and therapeutic efficacy." - Fontanarosa P.B., and Lundberg G.D. "Alternative medicine meets science" JAMA. 1998; 280: 1618-1619. ... I'd like to point out that we have very good evidence for efficacy of acupuncture. Cheers, --Mallexikon (talk) 01:54, 27 June 2013 (UTC)

We're not exploring the evidence for acupuncture at the moment, we're talking about calling it a medical procedure. To do so, we need sources. Do you have any? Or are you now dropping your proposal to state that acupuncture is a medical procedure? TippyGoomba (talk)

Well, we have plenty of sources calling it alternative medicine... do you understand what I'm getting at? --Mallexikon (talk) 03:06, 27 June 2013 (UTC)

Draft a sentence or two complete with sources and we'll take a look. I predict we'll end up in WP:OR or WP:SYNTH land but I'm always ready to be surprised. TippyGoomba (talk) 03:29, 27 June 2013 (UTC)

As you wish... --Mallexikon (talk) 04:20, 27 June 2013 (UTC)

I wasn't suggesting you edit the article, clearly it would get reverted. I just wanted something concrete to discuss.

Two of the three references you give fail WP:RS. But this passes the smell test. It states Acupuncture is one of the oldest, most commonly used medical procedures in the world which it sources to nccam.nih.gov, which fails WP:RS. TippyGoomba (talk) 04:44, 27 June 2013 (UTC)

Careful with the quick reverts, man... this was sourced material, and not everybody is a fan of WP:BRD (luckily, I am)... anyway, the fact that Stanford sources an NIH statement means that they endorse it. So their credibility backs it up. Which makes this a reliable source. Cheers, --Mallexikon (talk) 04:58, 27 June 2013 (UTC)

Again, we're not looking for a single source or sporadic sources that call acupuncture a "medical procedue", but for a good source that acupuncture is WIDELY considered a medical procedure by the majority of the medical community. If it's just a minority position, that would violate WP:UNDUE. And that source has to be a reliable secondary source that conforms to WP:MEDRS, preferably an academically reviewed review article or book. Dominus Vobisdu (talk) 06:51, 27 June 2013 (UTC)

Well I don't know what you are looking for but your we certainly doesn't include me (so who are you talking about?)... And I'm not quite sure what you mean with secondary source when what we talk about are matters of terminology...? I'm also not quite sure why you are evoking WP:UNDUE since we're not dealing with a theory... But I can see where your unease is coming from... so for consensus' sake, how about calling it "alternative medical procedure" then? --Mallexikon (talk) 09:10, 27 June 2013 (UTC)

A secondary source would be something like a book or systematic review. Do you have a source for your new suggestion? TippyGoomba (talk) 15:20, 27 June 2013 (UTC)

The "we" of Dominus also does not include me. This seems like a pretty simple issue to me - do you also need a systematic review of RCT's to state that acupuncture is a "procedure"? No, its just a description not a medical claim of efficacy or safety. Really, its over the top what you are asking for to justify a simple and accurate description, and I think Mallexikon has satisfied your need for a source.Herbxue (talk) 15:53, 27 June 2013 (UTC)

Not even close. Sorry, but what you're proposing is OR and UNDUE. Ain't gonna fly. Dominus Vobisdu (talk) 00:38, 28 June 2013 (UTC)

I'm not proposing the edit, I'm supporting it - creating consensus.Herbxue (talk) 02:52, 28 June 2013 (UTC)

We don't count votes, we discuss, see WP:CON. So far your contribution the discussion has not even demonstrated an understanding of the objections raised, let alone addressed them. You are not supporting the edit, you are cheering for it. TippyGoomba (talk) 03:42, 28 June 2013 (UTC)

Tell me what I don't understand, please. I think my statements have been quite reasonable so I request that you assume good faith and address the content rather than make assumptions about me.Herbxue (talk) 05:24, 28 June 2013 (UTC)

My apologies, I assumed you'd read the entire thread. Essentially, we have no sources which support "acupuncture is a medical procedure" and to quote Vobisdu: we're not looking for a single source or sporadic sources that call acupuncture a "medical procedue", but for a good source that acupuncture is WIDELY considered a medical procedure. Mallexikon has since withdrawn his initial suggestion (I think) and is now suggesting "alternative medical procedure", sources pending. TippyGoomba (talk) 05:46, 28 June 2013 (UTC)

I don't have a lot of time right now, so I'll return to this discussion later... just wanted to point out that we've had quite a few editors banned from this article because of frequent ad-hominems... And thanks, Herbxue, for keeping your cool. Cheers, --Mallexikon (talk) 07:36, 28 June 2013 (UTC)

There was no ad hominem. Tippy was perfectly correct in pointing out that Herbxue has not addressed the policy-based objections raised and has apparently misunderstood what consensus means on WP. Dominus Vobisdu (talk) 07:42, 28 June 2013 (UTC)

@TippyGoomba: Even that proposal would be redundant, because of the next sentence in the lede. It already states that accupuncture is part of traditional Chinese medicine.

@Herbxue: What you are not understanding is the policies that are being cited in this argument, especially: WP:RS, WP:MEDRS, WP:NOR, WP:NPOV and WP:FRINGE. The bar is set VERY high on all medicine-related material, especially fringe-related material, here on WP. The sources have to be impeccable. Dominus Vobisdu (talk) 07:42, 28 June 2013 (UTC)

DV, I guess what you are not really understanding is the meaning of Wikipedia:No personal attacks. I suggest you read it again and change your tone. We're all very happy with discussing content here, but these ad-hominems gotta stop. Seriously. --Mallexikon (talk) 01:09, 30 June 2013 (UTC)

Are you still suggesting an edit? TippyGoomba (talk) 03:06, 30 June 2013 (UTC)

Yes. My suggestion is to change the first lede sentence to "Acupuncture is a collection of alternative medical procedures ..." Sources would be this Clinical UM Guideline, the NHS, the NIH, and the Stanford source we already discussed. Cheers, --Mallexikon (talk) 04:23, 30 June 2013 (UTC)

Not in sources. TippyGoomba (talk) 05:08, 30 June 2013 (UTC)

Quoting: 1.) "Acupuncture is one of the oldest, most commonly used medical procedures in the world..." 2.) "Acupuncture is a form of ancient Chinese medicine ... It is a complementary or alternative medicine.." 3.) "Acupuncture is one of the oldest and most commonly used forms of traditional medicine... " --Mallexikon (talk) 05:16, 30 June 2013 (UTC)

Looks good to me, clearly supported by the sources. I think TIppy is saying the "collection of...procedures" is not in the sources (correct me if I'm wrong). The statement in Mallexikon's proposed edit is accurate because acupuncturists typically employ at least several different "procedures" including cupping, gua sha, moxa, electrostimulation, etc.Herbxue (talk) 15:21, 30 June 2013 (UTC)

Mallexikon made three proposals, which are you referring to? IRWolfie- (talk) 15:34, 30 June 2013 (UTC)

No, that's a misunderstanding. I made an initial proposal and then altered it to this: change the first lede sentence to "Acupuncture is a collection of alternative medical procedures ..." Sources would be this Clinical UM Guideline, the NHS, the NIH, and the Stanford source we already discussed. Cheers, --Mallexikon (talk) 05:33, 1 July 2013 (UTC)

Nothing about "alternative medical procedures" in those sources. Furthermore, the statement is ambiguous. It has the potential to be read as "alternative (medical procedures)" as opposed to "procedures in (alternative medicine)". TippyGoomba (talk) 07:26, 1 July 2013 (UTC)

True... but we could avoid the ambiguity by wikilinking: alternative medical procedure. --Mallexikon (talk) 08:22, 1 July 2013 (UTC)

I take the lack of responses as a quiet agreement... About that "nothing about alternative medical procedures in the sources": no, not literally - that would be plagiarism. But the sources clearly say that acupuncture is alternative/traditional medicine, and that it is a procedure (one could argue that these two conclusions actually amount to common sense, but it's always nice to have sources anyway). Alternative medical procedure therefore is proper close paraphrasing. Cheers, --Mallexikon (talk) 01:30, 2 July 2013 (UTC)

No, there is still no consensus. What you are describing is classic WP:SYNTH. Furthermore, it adds nothing to the article that is not already in the second sentence. Your reading of plagarism is not correct, either. Dominus Vobisdu (talk) 06:50, 2 July 2013 (UTC)

Are you saying that going from "alternative medicine" to "alternative medical" is synthesis?Herbxue (talk) 14:47, 2 July 2013 (UTC)

How you came to that conclusion based on what I wrote above is beyond me. Dominus Vobisdu (talk) 15:01, 2 July 2013 (UTC)

Man, can't even ask you a simple question. I did not come to a conclusion, I asked you a question. Mallexikon presented sources calling acupuncture "alternative medicine", citing them to propose an edit calling it an "alternative medical procedure", then you said it is "classic synth" - now, I'm asking you, what is the synthesis you are referring to?Herbxue (talk) 15:50, 2 July 2013 (UTC)

See Mallexion's post immediately before mine. Then see Tippy Goomba's post last post to which Mallexion was replying. Cobbling something together that does not exist in the sources is the definition of WP:SYNTH. Furthermore, it's still superfluous. And ambiguous. Dominus Vobisdu (talk) 16:05, 2 July 2013 (UTC)

What you are saying is simply not true. The sources use the terms "alternative medicine" and "traditional medicine". Changing this to "alternative medical" is close paraphrasing, and where you see WP:SYNTH totally eludes me. Your concern about ambiguity has been addressed as well - we'll avoid it by using a wikilink... I got the feeling you just completely refuse to play ball here - you call for reliable sources, and as soon as I present them it's something else you don't like. Now you come up with a completely different issue, saying my proposed change was superfluous. I guess it's better to call for an outside opinion, so I'll take this to the DR/N (Talk:Acupuncture#Medical procedure?). Cheers, --Mallexikon (talk) 03:29, 3 July 2013 (UTC)

I've been saying the statement is redundant for over a week now, which you would know if you had taken the time to read my posts. It's always been one of my main objections. And I'm tired of this deadhorse discussion. I've been patient and considered your arguements and answered them fully. I remain unconvinced by them. As far as I'm concerned, there is no point in further discussion. Drop the stick already. Dominus Vobisdu (talk) 04:04, 3 July 2013 (UTC)

Unconstructive behaviour. Better to take this somewhere else. --Mallexikon (talk) 04:46, 3 July 2013 (UTC)

Korean invented acupuncture

Chinese steal everything. Acupuncture was actually invented by Korean during Gojoseon era. Ancient Chinese doctors traveled to Korea and learn from Korean master. — Preceding unsigned comment added by 99.225.190.42 (talk) 06:20, 27 June 2013 (UTC)

If you actually had a reliable source to back that up, that would be interesting -A1candidate (talk) 20:54, 5 July 2013 (UTC)

Medical procedure, part II

Since DR/N declined to deliver a judgement whether the sources I've contributed so far do or do not support the change I intended: let's start from scratch. I propose to change the lede sentence to: "Acupuncture is a medical technique involving..." My sources are:

1. Encyclopedia Britannica ("acupuncture, ancient Chinese medical technique for...")
2. The Skeptic's dictionary ("Acupuncture is a medical technique...")
3. Merriam-Webster dictionary ("Medical technique in which needles are inserted into the skin...")
4. Random House dictionary ("a Chinese medical practice or procedure...")
5. This Clinical UM Guideline & Stanford Hospital ("Acupuncture is one of the oldest, most commonly used medical procedures in the world...")

And no, trying to argue that "medical procedure" does not automatically imply "medical technique" will not fly. Cheers, --Mallexikon (talk) 10:43, 4 July 2013 (UTC)

If you're abandoning the WP:DR/N, please let them know. I don't think it's appropriate to start a separate but related discussion outside their framework while you have a case open there. TippyGoomba (talk) 15:56, 4 July 2013 (UTC)

Yes certainly, very thoughtful of you. --Mallexikon (talk) 02:04, 5 July 2013 (UTC)

I haven't been following this particular discussion, but this is a no brainer. Of course it's a medical procedure. It could also be qualified as a TCM medical procedure. Here are the current two first sentences, with TCM mentioned earlier:

• Acupuncture is a collection of traditional Chinese medical (TCM) procedures involving penetration of the skin with needles in order to stimulate certain points on the body. In its classical form it is a characteristic component of TCM, and one of the oldest healing practices in the world.

That could even be shortened to remove superfluous content that really says nothing:

• Acupuncture is a collection of traditional Chinese medical (TCM) procedures involving penetration of the skin with needles in order to stimulate certain points on the body, and is one of the oldest healing practices in the world.

How's that? Note that we're already calling it a "healing practice," which is far more dubious than just calling it a TCM procedure. -- Brangifer (talk) 16:57, 4 July 2013 (UTC)

BTW, is "collection of" really necessary? -- Brangifer (talk) 17:05, 4 July 2013 (UTC)

My objection to alternative is on the basis that it's a deceptive euphemism. TCM is descriptive, so I think it's fine. TippyGoomba (talk) 19:47, 4 July 2013 (UTC)

I see now (from above) that "alternative medical" is considered objectionable by some, even though it is the official classification by many notable sources. Why the objection? It's TCM and AM. Plenty of RS to support both. -- Brangifer (talk) 21:00, 4 July 2013 (UTC)

To me, it's just plain redundant. TCM is a subset of AM, so mentioning AM adds no new information. Dominus Vobisdu (talk) 21:05, 4 July 2013 (UTC)

"Medical procedure" makes it sound like it's part of medicine. Is prayer a medical procedure? Is prayer an alternative medical procedure? I'm fine with the term "alternative medicine" because that's the common name. It's locally redefined and not medicine. Without sources it's too much of a leap for me (ie WP:OR) to start using the locally defined term "alternative medicine" as an adjective. Sources which establish common use would change my mind. TCM is not a euphemism and it explicitly states the nature of the "medicine", so the same issues don't apply, in my opinion. TippyGoomba (talk) 22:20, 4 July 2013 (UTC)

I can see both points, so just mention TCM. How's my proposed wording sound to you? -- Brangifer (talk) 00:02, 5 July 2013 (UTC)

I have no objections. Thank you for the suggestion. TippyGoomba (talk) 00:53, 5 July 2013 (UTC)

Yes, thank you Brangifer. I'd like to stick to "Acupuncture is a medical technique involving penetration of the skin with needles in order to stimulate certain points on the body" though. Medical is a commonly used adjective regarding acupuncture (please see my sources above), and I'd like our wording to reflect that. --Mallexikon (talk) 02:04, 5 July 2013 (UTC)

??? "Medical" (alone) was not part of my suggestion. That could be misunderstood as making it a mainstream western medical technique that is not categorized as "alternative", which the categorization that makes it eligible for coverage by NCCAM. I'm seeking a compromise, and since it's a "traditional Chinese medical" procedure, that seems to qualify it enough to remove objections. That should be good enough, even for you. -- Brangifer (talk) 03:13, 5 July 2013 (UTC)

Well, as you said above: "...this is a no brainer. Of course it's a medical procedure." Tippy and Dominus have rejected my proposal of "alternative medical procedure", demanding that we have to stick very closely to what reliable sources say. So, I've consulted reliable tertiary sources (please see the beginning of this threat), and they are very clear about the usage of "medical technique" (or, "medical procedure"). So I guess that's what we should stick to. Tippy and Dominus can't have it both ways. --Mallexikon (talk) 03:48, 5 July 2013 (UTC)

Your sources mean diddly squat. as I wrote before "Again, we're not looking for a single source or sporadic sources that call acupuncture a "medical procedue", but for a good source that acupuncture is WIDELY considered a medical procedure by the majority of the medical community. If it's just a minority position, that would violate WP:UNDUE. And that source has to be a reliable secondary source that conforms to WP:MEDRS, preferably an academically reviewed review article or book." Claiming that acupuncture is a "medical procedure" is misleading and downright dishonest. Ain't going to happen. Dominus Vobisdu (talk) 05:52, 5 July 2013 (UTC)

Mallexikon, as I mentioned above, when I first commented on this thread I wasn't aware of the exact nature of the dispute, but when appraised of the situation I could see their point, which is not aligned with yours. It's a TCM procedure, which is already classified as an alternative medicine procedure. RS can be mustered for both POV. By using my description, we obviate the need for mentioning alternative medicine in the first sentence since TCM is a form of alternative medicine. -- Brangifer (talk) 05:55, 5 July 2013 (UTC)

Im the guy from DR/N, and the above proposal by brangifier looks like a reasonable compromise (and has wider acceptance amongst editors here). Ill close the DRN now -- Nbound (talk) 05:42, 5 July 2013 (UTC)

Can we decide whether we go with my version or not? -- Brangifer (talk) 06:50, 5 July 2013 (UTC)

Well, we're still discussing my version... @Dominus: As I already said above, my sources are:

1. Encyclopedia Britannica ("acupuncture, ancient Chinese medical technique for...")
2. The Skeptic's dictionary ("Acupuncture is a medical technique...")
3. Merriam-Webster dictionary ("Medical technique in which needles are inserted into the skin...")
4. Random House dictionary ("a Chinese medical practice or procedure...")
5. This Clinical UM Guideline & Stanford Hospital ("Acupuncture is one of the oldest, most commonly used medical procedures in the world...")

The majority of these are tertiary sources - and about the biggest heavyweights you can ask for when it comes to dictionaries. If you have a dissenting opinion from the Britannica, Webster's, and Random House, please show sources that prove that these dictionaries are wrong. --Mallexikon (talk) 06:57, 5 July 2013 (UTC)

None of those sources is acceptable per WP:MEDRS, and none of them support your position. Dictionaries and encyclopedias are worthless for determining what is medicine or not, and sporadic mentions are not equal to general opinion. Dominus Vobisdu (talk) 07:12, 5 July 2013 (UTC)

DM is correct. It's not a matter of them being wrong. It's a matter of giving a better description that can't be misleading, and it's based on the content of this article, as it should be. That's why we often create our own definitions which are better than those found anywhere else. Since your suggestion isn't getting any support, I have proposed a compromise, and it's gotten support. Why would you object to describing it more accurately as a "traditional Chinese medical procedure"? That cannot be misunderstood. -- Brangifer (talk) 07:18, 5 July 2013 (UTC)

As a TCM practitioner, I rather like the phrase "traditional Chinese medical procedure" - but it is problematic because not all "acupuncturists" use TCM theory for practice. I'd be ok with it on the grounds that the Chinese originated most, and utilize all techniques described as acupuncture - but I don't think Chiropractors, MD acupuncturists, or Japanese acupuncturists would agree with calling it a TCM procedure. "Medical procedure" or "alternative medical procedure" are more accurate and inclusive. Herbxue (talk) 18:38, 5 July 2013 (UTC)

Pretty much a moot question now. A solution has been achieved in the next section. Dominus Vobisdu (talk) 18:52, 5 July 2013 (UTC)

RfC: Should acupuncture in the military be included?

Acupuncture in the military

Usage in the United States military An officer assigned to the 11th Marine Expeditionary Unit of the U.S. Navy performs acupuncture aboard the USS New Orleans According to The Washington Times, the U.S. Military's first encounter with acupuncture occurred during the Vietnam War, when an Army surgeon wrote in the 1967 edition of Military Medicine magazine about local physicians who were allowed to practice at a U.S. Army surgical hospital and administered acupuncture to Vietnamese patients. In 1995, Dr. Richard Niemtzow, a retired U.S. Air Force colonel who had earlier practiced medicine as a radiation oncologist, began offering acupuncture to military personnel stationed at the McGuire Air Force Base in New Jersey. A few years later, Niemtzow became the first full-time military medical acupuncturist for the U.S. Navy. In 2009, the U.S. Air Force set up the Air Force Acupuncture Center at the Joint Base Andrews in Maryland to practice and teach "battlefield acupuncture" to physicians and other medical personal. That year, the Naval Medical Center San Diego reported that its pain management clinic had provided acupuncture to more than 2,600 beneficiaries. As of 2012, over a hundred medical professionals in the U.S. Air Force have been trained to use acupuncture techniques. A surgeon assigned to the 380th Air Expeditionary Wing of the U.S. Air Force is shown applying acupuncture needles to a patient's ear While the pratice of acupuncture was mostly limited to the U.S. Air Force, it soon spread to other departments of the U.S. Military including the U.S. Navy and the U.S. Army. In late 2012, the Office of the Secretary of Defense officially approved a visit by U.S. military physicians to the Beijing University of Chinese Medicine in order to strengthen Sino-American military relations and to "exchange acupuncture information". Usage in other military forces Since 2010, acupuncture has been practised by the German Bundeswehr in several military hospitals. In the People's Republic of China, acupuncture has been used by the People's Liberation Army to aid in the treatment of battlefield injuries.

Would the section above, regarding acupuncture in the military, be a desirable addition? -A1candidate (talk) 08:39, 17 June 2013 (UTC)

Threaded discussion

• Oppose. What the armed forces or the postal services think about acupuncture is not relevant here. --Mallexikon (talk) 10:15, 17 June 2013 (UTC)
• Oppose: Irrelevant to the topic of this article and adds nothing to understanding the topic of this article. The fact that a scattering of military forces have tried out accupuncture is of trivial significance. Essentially OR based on Google trawling of non-MEDRS-compliant popular news articles. Dominus Vobisdu (talk) 17:40, 17 June 2013 (UTC)
• Oppose 1. Irrelevant. 2. synthesis of sources to advance a point. 3. Most of the sources are primary, IRWolfie- (talk) 00:25, 18 June 2013 (UTC)
• Oppose - I recommend a separate article on "Battlefield Acupuncture" (this is notable enough) which can be linked to from a brief mention of this somewhere in the acupuncture article. The main issue for me is it is too much about the U.S. military and not enough of a broad-based section on the prevalence of acupuncture use. I would support a section on prevalence to address the "mainstream or fringe" question. Herbxue (talk) 20:52, 21 June 2013 (UTC)
• Oppose as per the points above. Samwalton9 (talk) 14:18, 22 June 2013 (UTC)
• Oppose following Herbxue's reasons. Rex (talk) 20:46, 26 June 2013 (UTC)
• Comment: The article Usage of acupuncture in the military was created by A1candidate (talk · contribs) and I have nominated it for possible deletion: Wikipedia:Articles for deletion/Usage of acupuncture in the military.-- Brainy J ~✿~ (talk) 13:36, 28 June 2013 (UTC)
• Oppose. As per other arguments. Looks like someone trying to legitimize their favorite topic. NinjaRobotPirate (talk) 01:30, 9 July 2013 (UTC)

"Alternative medicine" in the lead

TippyGoomba objects to "alternative ... on the basis that it's a deceptive euphemism." While I agree that it's a misuse of the term (per the standard skeptical position expressed here), RS still use that descriptor, so we must do the same. I have now checked the article for use of the descriptor "alternative medicine" and find it is mentioned far too little in the article, and should be mentioned more prominently in the lead. It comes far too late there. How can we mention it earlier in the lead? -- Brangifer (talk) 05:55, 5 July 2013 (UTC)

It's already mentioned implicitly in the second sentence as TCM, which is a form of alternative "medicine". What need is there to mention it explictly? Dominus Vobisdu (talk) 06:23, 5 July 2013 (UTC)

I'm making this its own thread (by adding a heading) since it's not necessarily related to the previous thread. The reason I think it's a good idea to mention AM early is because editors know, but readers don't always know, that TCM is a subset of AM. We should make that explicit. There are plenty of good RS that document it. -- Brangifer (talk) 06:50, 5 July 2013 (UTC)

Ok, I see your point. What about simply mentioning AM in the second sentence as follows: "In its classical form it is a characteristic component of traditional Chinese medicine (TCM), a form of alternative medicine, and one of the oldest healing practices in the world." ? Dominus Vobisdu (talk) 07:05, 5 July 2013 (UTC)

A very simple and effective solution. I have to run now. -- Brangifer (talk) 07:12, 5 July 2013 (UTC)

Mentioning AM earlier is a good idea. Your suggestion works for me as well. TippyGoomba (talk) 14:31, 5 July 2013 (UTC)

There is no such thing as "alternative" medicine - Either something works as a true medical procedure or its simply a placebo-based sham procedure, and should be labelled as such. The reality is that researchers do not really know how acupuncture works and this should be acknowledged in the article. For millions of people across East and Southeast Asia, TCM is less of an "alternative" medicine and more like the only treatment that is affordable to them. -A1candidate (talk) 20:22, 5 July 2013 (UTC)

Damn right, "there is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking." Tippy is likening acupuncture to prayer, and DV calls it quackery... this is heavily POV, but worse than that, it's unscientific and dogmatic. There's plenty of MEDRS in our article documenting that acupuncture is effective for certain conditions - it's just unscientific to ignore that. Have you noticed at all that one of the sources for my "medical procedure" proposal isThe Skeptic's dictionary? (And I do recommend to read that article, it's very rational). If you automatically dismiss what is written in the Britannica, I think you should stop for a minute and ask yourself whether your dogmatism got the better of you. - However, I believe in consensus, so I'll settle for "Acupuncture is an alternative medical procedure..." as suggested by Brangifer. --Mallexikon (talk) 21:00, 6 July 2013 (UTC)

You are misrepresenting Brangifer's position. Do I understand correctly that you're still suggesting this edit/sources? The objections regarding sources have been repeated several times, you're firmly in WP:IDONTHEARYOU land now. Time to move on. TippyGoomba (talk) 03:03, 7 July 2013 (UTC)

I'll quote that article. "The evidence does not support the claim that acupuncture is a necessary treatment for a single ailment, however. If acupuncture is beneficial on its own or as a complement to scientific treatment for any condition, it is so because of conditioning and placebo factors such as patient expectation and confidence in the treatment. It's also clear that sticking needles in people is irrelevant for acupuncture to work, but appearing to do so is apparently necessary for it to work." IRWolfie- (talk) 12:06, 7 July 2013 (UTC)

I'm certainly not misrepresenting Brangifer's position [1]. I'd settle for "Acupuncture is an alternative medical procedure..." as suggested by him. --Mallexikon (talk) 07:45, 8 July 2013 (UTC)

Per the diff you use to my comments, you are misrepresenting me. I agree with Dominus Vobisdu's suggestion above, or something like that. TCM gets the primacy, with AM added in there somewhere. Both are mentioned early. -- Brangifer (talk) 15:12, 9 July 2013 (UTC)

I'm implementing that suggestion now. Seems that no one has objected, except A1. Dominus Vobisdu (talk) 15:22, 9 July 2013 (UTC)

I prefer Mallexikon's more inclusive phrasing due to the fact that while acupuncture grows out of and is most common to Chinese medicine (itself a broader descriptor than the specifically 20th-century systematized "TCM"), it is not exclusively a TCM practice. Herbxue (talk) 18:00, 9 July 2013 (UTC) -Actually, the current wording is ok except for a couple things - most importantly the first sentence does not indicate that acupuncture is performed with a therapeutic/medical/healing intent, just that it is a procedure involving needles (which could imply things like tattoos or piercing). This is why I support Mallexikon's current proposal, even though I like "traditional Chinese medical procedures". Also, could we change "involving" to "including" - in most cases acupuncture does include moxa, cupping, electro, ion pumping, etc. Herbxue (talk) 21:08, 9 July 2013 (UTC)

Something worthy of mention regarding acupuncture's safety

According to the article, acupuncture "carries a very low risk of serious adverse effects." However, this does not seem to jibe with a review by Edzard Ernst, one of the most cited authors in this article, who was able to dig up 296 cases of traumatic events, and these are just in China. Furthermore, 201 of those were just from pneumothorax. Should we include mention of it here? Jinkinson (talk) 01:09, 20 July 2013 (UTC)

Theories?

We have a new section that implies that there are many "theories" that attempt to explain the mechanism of the alleged effects of acupuncture. My first concern is that, as presented, none of these could be called "theories" as they do not seem to present a cohesive, explanatory, widely supported synthesis of anything. Perhaps more important, they seem to have been presented many years ago and there is no mention about their current acceptance. I would either just remove this whole section, shorten it to a paragraph, or, at least, refer to these as "ideas" or "suggestions about mechanism of action". Do the sources refer to these as "theories"? Desoto10 (talk) 17:37, 2 August 2013 (UTC)

How about "hypothesis"? instead of "idea"? -A1candidate (talk) 17:50, 2 August 2013 (UTC)

Thanks for discussing - in my edit summary I said these are hypotheses that are supported by some evidence and not disproven by evidence. I thought that qualified as a theory per the WP article on theory. I am willing to admit being wrong, but what is the exact criteria? Dominus mentioned "lots" of evidence, or that a theory must be "widely" accepted. How do we determine that? It seems subjective. Nonetheless, these are important lines of inquiry into the physiologic effects of needle insertion so they belong in the article, regardless of whether we label them theories or hypotheses. Herbxue (talk) 17:51, 2 August 2013 (UTC)

A good test is whether something is widely discussed as a serious and supportive fashion in the secondary WP:MEDRS literature, that is, in several high-quality mainstream medical/scientific sources, and is backed up by a substantial amount of primary studies by different independent researchers who come to the same conclusions. By any measure, none of these come even remotely close to being a theory except for the placebo theory, and none are even quite at the hypothesis stage yet, so quibbling over the subjectivity of the words "a lot" is pointless. "Speculation" is probably the best word overall. For the best of them, "proposed explanations" may apply. For the rest, "clutching at straws" or "wild stabs in the dark" are even more accurate. Agree that the section should simply be removed. There's nothing really of encyclopedic interest here as far as we are concerned. If there were, it would have been substantially discussed in multiple independent reliable sources. Dominus Vobisdu (talk) 18:12, 2 August 2013 (UTC)

These probably all fail WP:MEDRS, but here you go:

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

• Peptides (journal):"..These data suggested that AVP (Arginine vasopressin) in the brain played a role in the process of acupuncture analgesia in combination with the endogenous opiate peptide system.." (Source)
• Radiology (journal):"...Results from human and animal studies (2,9–13) suggest that acupuncture acts as a neuromodulating input into the central nervous system (CNS) that can activate multiple analgesia systems and stimulate pain modulation systems to release neurotransmitters such as endogenous opioids..." (Source)
• The American Journal of Gastroenterology:"...The more remarkable modulation on the homeostatic afferent network, including the insula, ACC, and hypothalamus, might be the specific mechanism of acupuncture." (Source)

Obviously all these researchers are just trying to promote a form of pseudoscience that is based on nothing more than quackery -A1candidate (talk) 18:25, 2 August 2013 (UTC)

None even come close to being more than merely suggestive or speculative. Dominus Vobisdu (talk) 18:44, 2 August 2013 (UTC)

Theories do a lot more than "implicate" and "suggest", and the other two fail the correlation is not causation test. Aside form the placebo explanation, which is well supported, there are no other robust explanations. Dominus Vobisdu (talk) 18:34, 2 August 2013 (UTC)

Posted at WP:FTN. Dominus Vobisdu (talk) 18:41, 2 August 2013 (UTC)

Actually, the same can be said about the sources used to support the health risks of acupuncture at Acupuncture#Adverse_events. I dont have time to go through all of them but I'll just quote from the last references: "Acupuncture remains associated with serious adverse effects". Fails the "correlation is not causation test". Should it therefore be removed? -A1candidate (talk) 18:54, 2 August 2013 (UTC)

I think that the best solution would be to find a recent review article that actually summarizes the most significant current ideas about potential mechanisms and provide a summary of their summary in a paragraph. It would be best if these mechanisms had strong evidence from human studies, as opposed to animals or tissue-culture. Just for my own information, when they stick a needle in a mouse do they use a special "mouse acupuncture" needle, which would be much thinner than what is used for humans or do they just use a human needle? 66.201.49.79 (talk) 20:29, 2 August 2013 (UTC)Desoto10 (talk) 20:31, 2 August 2013 (UTC)

That's an interesting question. Acu needles come in a wide range of sizes. I assume they used thin needles on the mouse. A trial comparing results in humans using thin vs. thick needles would be interesting (I'm sure its been done in China).

Back to the question at hand, I am not interested in fighting about "theory". I do think hypothesis is supported by the definition of the work hypothesis. Regardless, we have already discussed the inclusion of the proposed mechanism section and consensus was that it was appropriate for the article as it describes the current status of the research. We should be careful not to extrapolate it into claims of medical efficacy, but we should also be careful not to eliminate useful information that is backed by RS and adds value to the article. Herbxue (talk) 21:08, 2 August 2013 (UTC)

It's been pointed out that the references given contain speculation rather than a explanatory framework. Adding this kind of speculation would violate WP:WEIGHT. Do you have better sources or an alternative edit? TippyGoomba (talk) 07:03, 3 August 2013 (UTC)

The same can be said about the sources used to support the health risks of acupuncture at Acupuncture#Adverse_events. I'll just quote from the last references: "Acupuncture remains associated with serious adverse effects". An association of acupuncture with serious adverse effects fails the "correlation is not causation test". Should it therefore be removed? -A1candidate (talk) 08:30, 3 August 2013 (UTC)

Hell, yes, it should be removed! And I was under the impression that you HAD removed it already. I've read the paper and that is not at all an accurate paraphrase of the original text, which states basically that sereious side effects are rare and rarely due to the treatment itself, but rather to the fact that practioners are often incompetent.

On the flip side, though, I'm removing the entire proposed mechanisms section, based on the same paper, which states that no plausible mechanisms have been proposed. As this is not only a top-notch secondary source, but, even better, a review of reviews, and is very recent, it carries a lot of weight. Far more than the inconclusive suggestive studies you mentioned above and currently used in the article. Dominus Vobisdu (talk) 09:22, 3 August 2013 (UTC)

Please don't do that. It is not appropriate to use one source to negate other's ongoing work. One paper's conclusion that there is no mechanism does not justify eliminating good sources that show the ongoing work to try to identify a mechanism. And by the way, the section is called "proposed" mechanisms, which they are. THis is important, ongoing research that adds to the article.Herbxue (talk) 19:25, 3 August 2013 (UTC)

What you are proposing would grossly violate a big bunch of our policies. WP is not the place to present "continuing research", especially if that research is at the speculative and suggestive stage. We are not a new service. Being a tertiary source, we are the third man on the match. The information we get is based on what secondary sources say, which are based on what the primary sources say. Which, in turn, are based on what the preliminary sources say, which are based on what the suggestive sources say, which are based on what the speculative sources say. The material you wish to include comes from too low down the food chain to be of any encyclopedic value. If ifs and buts were candy and nuts, it would be Christmas every day. Dominus Vobisdu (talk) 19:58, 3 August 2013 (UTC)

At what point does multiple violations of MEDRS to include tentative wordings from primary sources also constitute a violation of the whole idea behind WP:CRYSTAL? Seriously, we can't include guesswork about what the future holds, simply because so much (most?!) inconclusive research ends with wordings like "further research is needed". We really need to pare this down to what is actually known NOW, and use MEDRS compliant sources. -- Brangifer (talk) 19:51, 3 August 2013 (UTC)

If you take a closer look at the sources above, half of them are review articles and the first one is a medical textbook (not an acupuncture textbook). I don't see how MEDRS is being violated in anyway. -A1candidate (talk) 20:02, 3 August 2013 (UTC)

You already answered that question yourself. Speculation about possible connections is not acceptable regardless of the source. Even of the source meets our sourcing policy to a tee, as the above mentioned review of reviews does. That's why I deleted the sentence about acupuncture being asociated with deaths at your request. The problem is not the sources, but the type of material involved. Speculation is expressedly forbidden by WP:CRYSTALBALL. Dominus Vobisdu (talk) 20:08, 3 August 2013 (UTC)

If I may quote from the sources above: "In another recent study, Goldman et al. (2010) found that localized A1R activation UNDERLIES the antinociceptive effects of acupuncture. Manual stimulation of acupuncture needles RESULTED in localized extracellular increases in nucleotides (ATP, ADP, and AMP) and adenosine." This is not speculation but a direct cause and effect -A1candidate (talk) 20:26, 3 August 2013 (UTC)

Cherrypicking will get you nowhere. The sentence you picked is merely a summary of a primary study. Nothing more. Dominus Vobisdu (talk) 20:37, 3 August 2013 (UTC)

I support inclusion of a 'mechanism of action' section that can review the current theories. If we look at another controversial treatment, such as antidepressants, we see the mechanisms of action section start with an admission: "For depression, the mechanism of action of antidepressants is unknown.", before the section reviews current 'theories'. Note that primary sources and animal studies make up the basis of the discussion! Despite the low-quality sources, IMO it is still helpful for the reader to have access to current theories that are under investigation. Similarly, I think that including a discussion of the theoretical mechanisms of action behind acupuncture is appropriate and helpful - as long as it is qualified as theory (rather than fact) and not associated with any medical claims of efficacy. The section should also begin with a qualification, as does the antidepressant article.Puhlaa (talk) 21:05, 3 August 2013 (UTC)

If you want to be taken seriously, it would help if you took the time to learn what the word "theory" means before you carlessly bandy it about. After all, that's what this whole thread is about. It doesn't mean what you think it does. As for anti-depressants, WP:OTHERSTUFFEXISTS and is a not a very compelling argument, as is WP:ITSUSEFUL. Dominus Vobisdu (talk) 21:13, 3 August 2013 (UTC)

Acupuncture is based on the placebo effect. Period. End of discussion. (While there are studies that show otherwise, there's no point trying to reach a consensus on Wikipedia until consensus is first reached within the scientific community. All other discussion is futile) -A1candidate (talk) 21:32, 3 August 2013 (UTC)

Essentially, yes. By default. That is the only theory that has widespread support and is supported by the preponderance of the evidence, and data that contradict it are either inconclusive, tentative or unconfirmed, or originate from low-quality studies. Other explanations are not plausible or not supported by good evidence. Passing the "placebo" barrier is the first step that most alternative medicine methods, indeed all medicine methods, have to take, from homeopathy to zinc lozenges for colds. Passing the preliminary phases is relatively easy, as the experiments at that stage are designed to detect true positives at the cost of detecting false positives as well. Later stages are more rigorous. That's why we highly favor secondary studies over primary studies. Dominus Vobisdu (talk) 21:45, 3 August 2013 (UTC)

Attempts to recruit editors

Obviously, there's nothing wrong with asking other editors to give their opinions but please do it in a neutral manner and not like this , this, and this

-A1candidate (talk) 19:21, 2 August 2013 (UTC)

The guidelines on this are at WP:CANVAS. I don't see anything improper having happened. Alexbrn ^{talk|contribs|COI} 19:27, 2 August 2013 (UTC)

Well, WP:CANVAS says:

My main concern is that statements like these aren't neutral -A1candidate (talk) 19:37, 2 August 2013 (UTC)

I don't think raising concerns which are tied to WP's core policies (as seems to be the case here) is not "neutral" - quite the opposite, surely? Alexbrn ^{talk|contribs|COI} 19:42, 2 August 2013 (UTC)

the message presumes a violation of the policies, and encourages users to come redress those violations, and therefore is not neutral. Gaijin42 (talk) 19:46, 2 August 2013 (UTC)

It also preselects a population known to be looking for things to label as fringe, which could be an example of WP:Votestacking. Herbxue (talk) 20:22, 2 August 2013 (UTC)

The purpose of the fringe noticeboard is stated at the head of its page. This does not include "looking for things to label as fringe". In fact queries posted there are frequently resolved by determining that a topic in question is not subject to fringe guidelines. Posting to a noticeboard can never be an example of canvassing: they are specifically for "problems that editors encounter in writing and maintaining Wikipedia articles". Alexbrn ^{talk|contribs|COI} 20:34, 2 August 2013 (UTC)

Sorry, you are accusing wikiproject medicine and science of being a group "looking for things to label as fringe"? IRWolfie- (talk) 22:38, 2 August 2013 (UTC)

No, it was also posted at the Fringe notice board. By its nature, that board seeks to identify what is or is not "mainstream", so alerting editors that monitor that page will naturally result in adding a bias towards discounting reliable RS because it is associated with, or used to help explain an alternative medicine subject. Herbxue (talk) 02:54, 3 August 2013 (UTC)

Absolute nonsense. Sources which are not reliable will be discounted. That is all. IRWolfie- (talk) 21:50, 3 August 2013 (UTC)

A couple years ago I was accused of sockpuppetry and page banned for a similar recruitment attempt. The fact that you assume an air of authority as part of a noticeboard does not mean that you seek out unreliable sources in an unbiased manner. I am not accusing you of doing so, but Dominus did not assume good faith of the active editors of this page and recruited like-minded people. You can save the "we follow sources" lecture - I perfectly understand it - I just don't agree that it serves the project to censor out interesting and valuable information in primary sources if they are not making a claim of efficacy. Drug articles, for example, are loaded with primary sources. So the term "cherry picking" goes both ways. Herbxue (talk) 15:33, 5 August 2013 (UTC)

I got one too. I was pretty surprised to see the canvassing, given how illformed the suggested edit is. I'd be interested to hear from an admin on how canvassing should be done for pseudoscience/fringe topics. I'm not sure I understand the issue in this case, was there some set of users or wiki projects that should have been notified that weren't? TippyGoomba (talk) 04:45, 3 August 2013 (UTC)

No, I don't think anyone was intentionally left out. In my opinion what happened was an editor in good faith changed "theories" to "ideas" and I (in good faith) reverted them because they changed established text and their edit was not sourced, and I thought "theories" was appropriate based on the WP definition of theory. I quickly established willingness to compromise on the terminology, but Dominus had already begun a drama-filled escalation of rhetoric at that point. A1Candidate shared RS that backed the inclusion of the sources in the article which were already well established after discussion and much work by other editors. In my opinion, Dominus is introducing theatrical drama in this situation to get support to remove well-sourced content on proposed mechanisms in order to push a POV that there is absolutely no basis for believing that needle insertion does anything to the human body. I think the whole thing has been blown way out of proportion and should have just been discussed here, instead of recruiting like-minded POV pushers at the fringe notice board. Herbxue (talk) 05:25, 3 August 2013 (UTC)

I guess that's one version. Perhaps it's best if we all get back to discussing changes to the article, rather than user conduct. TippyGoomba (talk) 06:59, 3 August 2013 (UTC)

the lede needs atttn

THe first paragraph says it is one of the oldest healing practices in the world. The reference says no such thing. — Preceding unsigned comment added by 122.61.245.213 (talk) 02:05, 23 August 2013 (UTC)

You are correct, the cited source does not state that acupuncture is one of the oldest healing practices in the world. I do believe the statement is true, but it requires context and an appropriate source.Herbxue (talk) 06:07, 23 August 2013 (UTC)

"Its effects are due to placebo"

I have removed this statement from the effectiveness section because it is a definitive statement that is unproven, and only one of the 3 cited sources even suggests that its effects are due to placebo (the Ernst paper). None, even the Ernst, suggests that placebo is the only mechanism by which it works, therefore the statement is unsupported by the sources. Herbxue (talk) 19:42, 5 August 2013 (UTC)

Dominus keeps reverting the edit, so I proposed a compromise to the inaccurate blanket statement that is not supported by the sources cited. Herbxue (talk) 20:09, 5 August 2013 (UTC)

All three citations support the statement. Furthermore, it's the default position. Do you have more recent systemic reviews which demonstrate otherwise? TippyGoomba (talk) 05:28, 6 August 2013 (UTC)

Only one even comes close, and its the Ernst, which more than one other editor has expressed concerns about undue weight. Even his paper does not make the blanket statement "acupuncture's effects are do to placebo" - it is careful to say there is the evidence suggests acupuncture may be nothing more than placebo, which is an admitted speculation. Show me a quote in multiple reviews that support a sweeping generalization like that. Herbxue (talk) 06:17, 6 August 2013 (UTC)

You guys are still reverting me, returning to a version that is not supported by the sources. Its not even supported by Ernst, the man on a mission to discredit acupuncture does not even go so far as to say "it's effects are due to placebo" - if you ever intend to say "we follow the sources" with a straight face again, I suggest you read the fucking sources before reverting me, or propose and edit, supported by the sources. A1candidate made that edit erroneously and I have corrected it numerous times. Dominus and Tippy keep supporting the erroneous edit without actually reading the source that supposedly supports it, or intentionally misrepresenting what the source actually says. That basically means you are liars. Herbxue (talk) 03:15, 12 August 2013 (UTC)

no, u TippyGoomba (talk) 04:36, 12 August 2013 (UTC)

Looking at the sources again, I wonder if it is overstating their case to say the effects are due. Ernst's blog on the topic from earlier this year contains the wording: "the evidence from the most rigorous clinical trials seems to suggest that much, if not all of the effects of acupuncture might be due to placebo". Alexbrn ^{talk|contribs|COI} 07:31, 14 August 2013 (UTC)

Since things have escalated, I've taken Herbxue to ANI, see WP:ANI#Herbxue. Please correct me there if I've missed something. TippyGoomba (talk) 03:20, 15 August 2013 (UTC)

IMO, Dominus Vobisdu and TippyGoomba have not AGF at all and have continuously focused on the editor here instead of the edits. Interesting that neither Tippy or Dominus has felt it necessary to comment on the sources that Herbexue is referring to, they just keep drive-by reverting to a version that is not supported by those sources. TippyGoomba and Dominus Vobisdu have repeatedly restored the text in the lead that says "the effects of acupuncture are due to placebo", yet the sources do not support this text. The body of our article also does not support this text in the lead; our article says:

"A 2012 meta-analysis found significant differences between true and sham acupuncture, which indicates that acupuncture is more than a placebo when treating chronic pain (even though the differences were modest).[104] A 2010 systematic review also suggested that acupuncture is more than a placebo for commonly occurring chronic pain conditions, but the authors acknowledged that it is still unknown if the overall benefit is clinically meaningful or cost-effective.[105]"

As Alexbrn points out, even the well-known critic Ernst can only say that it "might be due to placebo". I would love to hear how Dominus or Tippy justify continuously restoring the text when it is not supported by the sources and refusing to engage in discussion here? and then have the nerve to report Herbexue to ANI? Puhlaa (talk) 04:47, 15 August 2013 (UTC)

Alt-med proponents love to take advantage of the public's lack of knowledge about what "placebo" is. Placebo is not something that has to be proved. It is the default conclusion of any medical trial, and remains true until it is disproved. The burden rests solely on alt med proponents to do so. They always try to shift the burden on scientists to prove that their method doesn't work, instead of providing credible evidence that it does work. So far, no convincing evidence has been produced. All of the studies to date have either been fundamently flawed because of faulty methodolgy or bias, or have produced weak, contradictory and non-reproducible evidence.

They also prey on the public's lack of knowledge about what "effectiveness" is. If the effectiveness of a method is no better than placebo, that means it is not more effective than holy water or beads and rattles.

None of the reliable studies performed to date have indicated that there is more at play than simple placebo efect, a fact that Ernst makes clear in his "review of reviews" www.dcscience.net/Ernst-2011-AcupunctAlleviatePainRiskReview.pdf‎, which has been removed from the article. The review of reviews states that recent high-quality studies indicate that the effects of accupuncure are due to "non-specific effects such as therapist conviction, patient enthusism, or receiving a treatment believed to be helpful", in other words, placebo. Or that "real" acupuncture works no better than sham (placebo) acupuncture. It goes on to state that if

The Madsen metastudy says very clearly that sham accupuncture (placebo} worked better than no treatment, and that the difference between "real" and sham accupucture (placebo) was not clinically relevant and could not be distinguished from bias [[2]].

There is a quibble also on "may be due to placebo", another common ploy used by alt med proponents. In normal English, this means "may be due to causes other than placebo". It's a banal statement that is true in all medical trials, as it can never be disproved (it's unfalsifiable), only proved. This does not imply that it is caused by other causes, nor does it lend any credence to such conclusions. It's mere speculation that is inherent in the scienific method. Until credible evidence is produced that identifies other causes, it is basically a meaningless statement, and the conclusion that any effects are due to placebo remains the only valid conclusion. Dominus Vobisdu (talk) 02:41, 16 August 2013 (UTC)

"Default position" of who? Can you show that conventional medicine holds drugs and surgical procedures to such a standard? You have a tendency to invent criteria for inclusion or exclusion of information based on your POV, yet you still have not acknowledged that the cited sources do not support your reversions of my edits. Ernst himself, a controversial figure, is far more careful to qualify and nuance his statements than you, and he is clearly on a mission. Have you read any of Kapchuck's work? You are trying to prevent the reader from coming to their own conclusions about issues that clearly do not have a definitive answer. I am amenable to the possibility that the general reader may have a bias towards "believing" in unproven things, but that does not justify falsifying the facts to prevent them from believing something that hasn't been proven to be false. The edit you defend does just that. Herbxue (talk) 05:03, 16 August 2013 (UTC)

Read Null hypothesis. Placebo is the null hypothesis of any medical trial, no exceptions. See Clinical trial. Bottom line, the effects of any treatment are by definition placebo effects until proven otherwise. Dominus Vobisdu (talk) 05:19, 16 August 2013 (UTC)

The NCAHF put is this way: "There is no physiologic rationale for why acupuncture should work other than for its placebo or counter-irritant and distracting effects." Alexbrn ^{talk|contribs|COI} 05:42, 16 August 2013 (UTC)

Alexbrn that statement is from an era where the Internet had not even existed yet. I prefer the MEDLINE database's consensus of scientific evidence, not because I support pseudoscience based on quackery, but because its updated frequently: Researchers don't fully understand how acupuncture works. -A1candidate (talk) 08:22, 16 August 2013 (UTC)

The statements are not incompatible. It seems many explanations are floating around, even regression to the mean. There is however, no accepted "physiologic rationale". Alexbrn ^{talk|contribs|COI} 08:41, 16 August 2013 (UTC)

"Mights" are dime a dozen in the world of science, the stuff pizza boxes and cocktail napkins are made for, and don't mean anything without evidence to back them up. Results talk, and bullshit walks. All we have here is a pathetic attempt to spin bullshit into results. Dominus Vobisdu (talk) 09:34, 16 August 2013 (UTC)

Your opinion is shared by many, but the writers of the systematic reviews are simply not willing to conclude that placebo is the only explanation for the positive effects of acupuncture. The edit you keep supporting is not supported by the sources (which is the topic of this thread). Herbxue (talk) 05:04, 17 August 2013 (UTC)

I think that concluding the sweeping statement that "General scientific consensus maintains that the effects of acupuncture has not been shown to be due to anything more than placebo, and is therefore dependent on a patient's expectation of treatment outcomes" from the sources Ernst 2006, Madsen et al. 2009 and Furlan et al. 2008 as stated in the article is a synthesis. Besides this, several studies that find statisticaly significant advantages of acupuncture over placebo seem to make this sweeping statement too generalized (such as Albrecht, Vickers, Crew, Manheimer) Ochiwar (talk) 19:47, 19 August 2013 (UTC)

A review by Hopton actually states " The accumulating evidence from recent reviews suggests that acupuncture is more than a placebo for commonly occurring chronic pain conditions" Ochiwar (talk) 20:15, 19 August 2013 (UTC) And Kong states "We believe our study provides brain imaging evidence for the existence of different mechanisms underlying acupuncture analgesia and expectancy evoked placebo analgesia" Ochiwar (talk) 20:29, 19 August 2013 (UTC)

• Note that this article and this particular statement is the subject of a discussion over at Wikipedia:ANI#Herbxue (permalink). To me this looks like a relatively extreme misrepresentation of sources and my hope is that out of the discussion over there, some action will take place to put pressure on the editors responsible to stick to sources in the future. I've already pinged the editors responsible (User:Dominus Vobisdu, TippyGoomba, and User:A1candidate) but so far none has really made a response. II | (t - c) 23:45, 19 August 2013 (UTC)

A few of the sources provided state that the effect may be nothing more than placebo. I have toned the wording down to reflect this possibility. Agree that the bit on "scientific consensus" is over stating things a bit but am happy to AGF. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:39, 20 August 2013 (UTC)

If there are still issues I would strongly suggest that those involved start a RfC rather than continue to revert. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:47, 20 August 2013 (UTC)

• Why can't we just be honest and admit that Researchers don't fully understand how acupuncture works? Because not doing so allows us to completely ignore a plethora of reliable sources and disregard numerous peer reviewed studies showing that acupuncture is more than placebo. -A1candidate (talk) 08:42, 20 August 2013 (UTC)

Stating that it is not clear how something works is different than stating that it is not known if it works or not. We should discuss both these aspects I agree. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:07, 21 August 2013 (UTC)

In that case, I hope other editors would also agree with us that if we include the placebo effect as a possible mechanism for accupuncture, then in order to be fair, we should ideally include other mechanism as well as long as the source is reliable. In other words, should this removal be restored? I dont see the point of only including the placebo effect as a possible mechanism while ignoring the others. If there are concerns about the reliablity of some specific sources, then those should be replaced with better sources, which isn't that difficult at all. -A1candidate (talk) 16:00, 22 August 2013 (UTC)

I'll just comment on the reversion back to include the list of potential mechanisms for the "efficacy of acupuncture". First, the items in that list are not "theories", but more similar to conjecture or ideas or proposals. Second, by and large, they are represented by one or two papers each from many years ago; we need to include current ideas that are based on significant replication and newer studies. In other words, how are these ideas accepted today? Third, a list of proposals for "how acupuncture works" presupposes that it does work. If we embrace the rather weak consensus that acupuncture has some efficacy for some indications, for example, some pain and some nausea, then the proposals can only relate to these indications. Another issue is the combining of studies where different forms of acupuncture are used, for example, electro-acupuncture. There is no reason to expect that simple needling and needling combined with electrical stimulation would have the same underlying mechanism. Until these points are addressed, it is not clear that including a list of "potential mechanisms" is going to be useful. Desoto10 (talk) 23:30, 1 September 2013 (UTC)

It does work, the question we are asking is whether it works by placebo or otherwise? Like I said, its not that difficult finding newer, reliable sources for that. And lastly, they do relate to pain and nausea (among others), and from what I know have nothing whatsoever to do with electroacupuncture -A1candidate (talk) 19:17, 8 September 2013 (UTC)

The Lancet paper referenced above is about electroacupuncture. The purine hypothesis (from the article that A1 refers to) does not explain "how acupuncture works" unless we are talking about just sticking needles into the skin anywhere. Note that the figures in that paper just have a needle poking the skin causing ATP release; there is no mention about special locations. I think we need to restrict the article to actual acupuncture explanations which require needling in specific locations and why those specific locations are important. The gate model of pain reduction by acupuncture, also referenced above, also does not directly relate to acupuncture as the effect can be elicited by stimulation anywhere. Desoto10 (talk) 03:42, 9 September 2013 (UTC)

Rant

Pain science - those who spend their lives studying the biology, psychology and sociology of pain - is open to the probability that needling will have some, probably minor, probably temporary, effect on pain. This is because of the well-attested phenomenon, diffuse noxious inhibitory control (pain, in some circumstances, raises the global pain threshold). If needling elicits pain, it may have a just-measurable above-placebo effect on the perceived intensity of pain resulting from another stimulus.

The pain of needling may also, plausibly, minimally affect the perceived "unpleasantness" (a different subjective phenomenon and neural network from "sensation intensity") of other negative homeostatic emotions such as nausea and itch too, because the "unpleasantness" of all homeostatic emotions is embodied in one common neural network and if pain diminishes global perceived "unpleasantness", which is uncertain, then it will affect the perceived unpleasantness of nausea, etc. too.

I realise this unsourced rant is probably outside Wikipedia:Talk page guidelines, but I'm hoping to pour a little oil on these troubled waters. I agree it is implausible that acupuncture may have an impact on bubonic plague or Down syndrome, but would appreciate it if the skeptics here could step back a little and exercise genuine objectivity when it comes to (a) the plausibility that the minimal pain of acupuncture may minimally affect the perceived intensity or unpleasantness of other pains or other homeostatic emotions, and (b) the scientific evidence (or lack of it) regarding this purported psychophysical effect. --Anthonyhcole (talk · contribs · email) 08:31, 20 August 2013 (UTC)

Thank you for this, Anthony. I have followed your posts about pain for a couple years now (you weighed in during PPdd's reign of terror, in a way that I perceived was not helpful to TCM), and although you have generally not expressed approval of acupuncture, I greatly appreciate your call for "genuine objectivity". Obviously I am a proponent of acupuncture, but I think this is an issue worth insisting on an honest appraisal of the sources, rather than a political "science vs. woo" battle. Herbxue (talk) 04:01, 21 August 2013 (UTC)

Sham Studies

There is considerable controversy about the validity of the methods used to study acupuncture. For instance, sham controls are highly controversial and while many outsiders view these as reasonable controls which equate with biomedical placebos, those in the industry seem to have a completely different opinion. STRICTA standards are a good example of this. There is a system of acupuncture, Master Tung-style, which needles acupoints in many different places: between traditional points, between meridians, etc. Every portion of the body, according to the system, is a potential acupoint. Several other styles, such as Kiiko-style Japanese acupuncture may also utilize any point on the skin. Therefore, studies which utilize sham-controls, could actually be seen as studying traditional TCM points versus random Tung-style points or Kiiko-style points, not "placebos". Given this fact, it seems a decision should be made. Since there is no "consensus" within the field, do we remove all talk about sham studies and acupuncture not being more than placebo, or do we instead confine all this interesting debate to another section or article titled "acupuncture studies" or the like? Egamirorrimeht (talk) 23:11, 11 September 2013 (UTC)

No, I don't see that a decision has to be made... we already have a section about the sham-acupuncture-problem. If you have (reliably sourced) material you'd like to add to it, please feel free to do so. Cheers, --Mallexikon (talk) 03:25, 12 September 2013 (UTC)

I suppose that's a valid point. My concern, really, is the page appears very low quality and obviously amateurish. Modern scientific research on acupuncture is a subject with which I am very up to date with, and as the page reads it is embarrassing to anyone familiar to evidence based medicine in general. In many instances, there are statements that read as though "the science is settled and acupuncture is no more than a placebo" yet most of these statements find their basis in very controversial sham controls. Further, many of the cited studies do not pass STRICTA checklist standards on multiple counts. Seeing that STRICTA is the gold standard for acupuncture research, purporting consensus with flawed research causes this article to reek of dilettantism. Further, the studies used as source material to purport consensus are isolated studies and not meta-analyses. Again, low quality. I can certainly add much reliably sourced material to the page, but what it first needs is to have all the unreliably sourced material removed. I just think its prudent to air these concerns on the talk page first before pruning the article with a chainsaw. Egamirorrimeht (talk) 05:07, 12 September 2013 (UTC)

As for adding material, perhaps you could add more about STRICTA standards?Herbxue (talk) 03:06, 13 September 2013 (UTC)

Absolutely, I believe it will help this page considerably. Egamirorrimeht (talk) 17:58, 13 September 2013 (UTC)

Yes, please provide the extent that STRICTA is embraced by the scientific community. Have major international scientific societies supported it? Is following these guidelines required for publication? Who has claimed that STRICTA is the "gold standard"? Thanks. Desoto10 (talk) 03:40, 13 September 2013 (UTC)

Hello! STRICTA uses reporting guidelines, not strict requirements per se that a researcher or group must adhere to. This allows full transparency in research. For instance, in many studies where acupuncture is performed, a nurse, medical doctor or even a research scientist is the person performing acupuncture and not a trained acupuncturist. In this example, publications which use STRICTA reporting standards report not only report the profession but also the number of years one has in practice. Another example would be the description of needling involved. Oftentimes, studies only outline the points used. Under STRICTA reporting standards, the type of needle--length, gauge, serration, etc. are reported, as well as depth of insertion, type of needle manipulation used, whether sensations of "de qi" (also known as the arrival of qi) are experienced by the patient or not, needle retention time, etc, etc. As for journals that support STRICTA standards, you can find the list here. Not all acupuncture research is equal, or even credible. On the Wikipedia page, I would suggest that all research should be up to this standard. That is not to say that the publishing journal must be on STRICTA's participating list--that would be too exclusive--but that the cited research ought to be transparent. In other words, if a study does not specify who performed acupuncture on subjects, or does not specify how long needles are retained, then it should not be cited. Instead, a citation of transparent research should be used in its place in support of the claim. Egamirorrimeht (talk) 16:42, 13 September 2013 (UTC)

Hi Egamirorrimeht, I think you're likely to find pruning the article with a chainsaw will be met with resistance unless you can give a better argument that the sources are indeed unreliable. Can you point to published reliable sourcing that questions the validity of the sham studies? That'd be a good start. Zad68 03:44, 13 September 2013 (UTC)

Hi Zad! Here is an article regarding research conducted by the Osher Institute at Harvard Medical School showing that Sham acupuncture is not equal to placebo pills Egamirorrimeht (talk) 16:09, 13 September 2013 (UTC)

That's an interesting result but it's an individual primary study. Can you point to a textbook or a review article or other such secondary source? Zad68 16:24, 13 September 2013 (UTC)

Absolutely.. A textbook that talks about this phenomenon in detail is Acupuncture Research: Strategies for Establishing an Evidence Base by Hugh Macpherson. Egamirorrimeht (talk) 17:25, 13 September 2013 (UTC)

This is all very interesting and relevant. Do you have specific changes for the article? I suspect that the best thing for you to do would be to make a change and see how it flies. I would advise against wholesale changes all at one time. Desoto10 (talk) 03:27, 14 September 2013 (UTC)

What is this even saying

I'm sorry, but I don't understand this sentence. Maybe it's the semicolon throwing me off? A semicolon works more or less like a period--whatever follows it should be a complete thought. But even when the semicolon is removed, the sentence doesn't make sense.

"A number of studies comparing traditional acupuncture to sham procedures found that both sham and traditional acupuncture were superior to usual care but were themselves equivalent; findings apparently at odds with traditional Chinese theories regarding acupuncture point specificity." — Preceding unsigned comment added by 2602:30B:8266:2759:C9A6:A59B:2619:204 (talk) 22:42, 12 September 2013 (UTC)

correct. TippyGoomba (talk) 04:14, 14 September 2013 (UTC)

Wording of lede needs to stick close to sources

The most recent revision to the lede is a substantial change to what had been stable wording consistent with sources. Now it says that the evidence says acupuncture is no more effective than placebo, and this statement is not sourced to the best quality MEDRS's, which also happen to be old ('05, '05, '08). The new wording uses these sources to rebut several sources saying acu is effective, but none mention the UK NHS source, a superior MEDRS that postdates them all; this is a bad change that introduces OR and strays from sources. Additionally, the article body cites better MEDRS's that says it is effective, e.g several at Acupuncture#Pain. Reverting to this revision from Oct. 27. Please get consensus here before making substantial changes. --Middle 8 (talk) 11:19, 30 October 2013 (UTC)

"Some scientists" is OR. So you are not sticking close to the source. Do all or any of the sources say "Some scientists". QuackGuru (talk) 17:37, 30 October 2013 (UTC)

I agree with QG. The previous version was alt med POV-pushing, and so I reverted back to the more neutral version to avoid the acupuncturist slant. jps (talk) 19:21, 30 October 2013 (UTC)

The blatant OR I tagged has been removed. QuackGuru (talk) 19:30, 30 October 2013 (UTC)

I'll take the blame for that one. ;) jps (talk) 19:47, 30 October 2013 (UTC)

"Independent researchers have criticized these "endorsements"...

Is there a better way to describe it than using the word "endorsements"? Maybe recommendations or reports will work. QuackGuru (talk) 20:01, 30 October 2013 (UTC)

"Recommendations" or "reports" is good. "Independent scientists" is fine. One-liner "rv alt-med POV pushing" ES's don't address the concerns I raised above, viz.: The new wording uses these sources to rebut several sources saying acu is effective, but none mention the UK NHS source, a superior MEDRS that postdates them all; this is a bad change that introduces OR and strays from sources. Additionally, the article body cites better MEDRS's that says it is effective, e.g several at Acupuncture#Pain. Let's not fall into WP:IDHT again. Comments? --Middle 8 (talk) 22:04, 30 October 2013 (UTC)

Actually, I think the discussion did deal well with your concerns, though you seem to not understand the problem with using poor sources as these. jps (talk) 00:33, 31 October 2013 (UTC)

Your IDHT is showing... NHS vs. other sources? Bueller? Bueller? --Middle 8 (talk) 05:52, 31 October 2013 (UTC)

Endorsements is descriptive. Why the change? IRWolfie- (talk) 23:59, 30 October 2013 (UTC)

But it's misleading. These groups didn't *endorse* acupuncture. They described standard practices for its use. The statements are quite broad. jps (talk) 00:33, 31 October 2013 (UTC)

I removed the OR. Don't know why it was restored. QuackGuru (talk) 02:49, 31 October 2013 (UTC)

There was no endorsement. Why is this continuing. QuackGuru (talk) 03:46, 31 October 2013 (UTC)

Hmmm. The problem is that some of them did actually endorse it, however, the NHS didn't... Alright, let's stick with "recognized". Cheers, --Mallexikon (talk) 03:55, 31 October 2013 (UTC)

NHS should be separate from that sentence; it's not what "some independent scientists" (or whomever we're calling them) are talking about. Heck, it postdates them, IIRC. --Middle 8 (talk) 05:52, 31 October 2013 (UTC)

Poor sourcing on the Pain section

Thanks to User:Middle 8 for pointing out that the Acupuncture#Pain section has been using cherry-picked and poorly-vetted sources to try to claim that there is something more to acupuncture than the placebo effect. I notice that the gold-standard study by Ernst is being marginalized. And the Journal of Saudi Medicine? Tsk, tsk. The lack of mechanistic basis is enough to preference a null hypothesis in a Bayesian sense, so Ernst's review remains the best. Sorry. I've POV-section tagged the thing until it can be cleaned up. There is no evidence for acupuncture being effective for anything but people who are wide-eyed and credulous believers in the subject. jps (talk) 02:06, 31 October 2013 (UTC)

I'll always cheer a skeptic stance. But if you try to ignore newer review results (like the one listed in the efficiency section) in order to deny "that there is something more to acupuncture than the placebo effect" that's not skeptic - that's just plain POV. --Mallexikon (talk) 02:24, 31 October 2013 (UTC)

The null result is the preference and there are no good studies (the newer ones are compromised and in shitty third-rate journals -- this isn't "JAMA", this is just an internal medicine journal under the umbrella of JAMA, but sorta a JAMA-in-name-only thing) that pass the WP:REDFLAG test. Wikipedia is not supposed to be innovative. There is no evidence that acupuncture is better than a placebo. Studies attempting to say as much have been roundly criticized by independent analysts. No omnibus review has gone past Ernst's conclusion that I stated in the first sentence. That's where this article will be fixed to say with the appropriate work. jps (talk) 02:27, 31 October 2013 (UTC)

FYI, JAMA Internal Medicine (formerly Arch. Int. Med). If it sucks as bad as you say, RS's will have said so. If you can meet the WP:BURDEN to make your Ernst quote the default position, great. Show (rather than assert the existence of an abundance of) the (non-blog) sources that outweigh the others. Try and do this civilly, without drama and edit-warring. --Middle 8 (talk) 05:52, 31 October 2013 (UTC)

I already showed it. And you accuse me of WP:IDHT? This is ridiculous. Ernst is the gold standard and he has pointed out that the Vickers source does not even contradict him, so by doing a this-and-that or this-or-that treatment, this article is extremely biased. jps (talk) 11:44, 31 October 2013 (UTC)

Safety

The entire article is littered with old references. There are newer sources on safety, for example. QuackGuru (talk) 03:01, 31 October 2013 (UTC)

This probably should be incorporated somehow. jps (talk) 03:09, 31 October 2013 (UTC)

The RAE is on the order of 5 in a million, which is why basically everyone agrees that it's safe. --Middle 8 (talk) 05:35, 31 October 2013 (UTC)

There are many people who have been injured. The rate is not well-calibrated and Ernst has pointed out that there are some very bad actors. The problem is that because acupuncture is not able to be regulated like normal medical practice, there are some opportunities for bad actors. Given the normal "minimal invasiveness" of typical acupuncture proceedures, the number of safety issues is alarmingly high. jps (talk) 11:42, 31 October 2013 (UTC)

Sounds like an assumption. You're basing this on....?Herbxue (talk) 15:43, 31 October 2013 (UTC)

@JPS -- who says the "rate is not well-calibrated"? According to whom is acu "not able to be regulated like normal medical practice"? In practice it may not be well-regulated, and IIRC most adverse events are in Asia, with poorly-trained practitioners -- bad actors, as you say. Most of the AE's are preventable. "Alarmingly high"? Are you sure? That's like the 10th thing you've said is alarming today. --Middle 8 (talk) 15:50, 31 October 2013 (UTC)

Hmm, did you read QG's citation? jps (talk) 17:26, 31 October 2013 (UTC)

There is no specific argument against including this source. So I am going to add the source to the article. QuackGuru (talk) 17:37, 31 October 2013 (UTC)

Removing Vickers

On the basis of this:

Edzard Ernst, emeritus professor of complementary medicine at the University of Exeter, said the study “impressively and clearly” showed that the effects of acupuncture were mostly due to placebo. “The differences between the results obtained with real and sham acupuncture are small and not clinically relevant. Crucially, they are probably due to residual bias in these studies. Several investigations have shown that the verbal or non-verbal communication between the patient and the therapist is more important than the actual needling. If such factors would be accounted for, the effect of acupuncture on chronic pain might disappear completely.”

jps (talk) 02:24, 31 October 2013 (UTC)

Source of quote? And is Ernst talking about the source you removed? Per NPOV we need to depict disputes fairly, not delete one or the other side. --Middle 8 (talk) 03:00, 31 October 2013 (UTC)

The claim that NPOV demands "two sides" is spurious because here one side is conflicted and the other side is independent. In this case we can say that acupuncturists and their supporters claim efficacy uncontroversially, but Vickers is not a MEDRS-quality source. Ernst is.

I should point out that MEDRS policy demands that we do this as well: Wikipedia:Identifying_reliable_sources_(medicine)#Use_independent_sources. The fact is that this source is promulgated by acupuncture supporters in a way that is highly problematic and very gaming-the-system. Ernst said this here: [3]. The source has been roundly impeached. It should be removed. jps (talk) 02:41, 31 October 2013 (UTC)

Hmmm, assuming stuff about editorial motivation is kinda NPA-ish. What is, and how does one idenfify, an "acupuncture supporter"? Good editors find good sources, and weight and stick close to them. And it would be better if you would propose changes at talk and seek consensus here rather than your current approach. --Middle 8 (talk) 03:00, 31 October 2013 (UTC)

Okay, let's leave it more simply: anyone here supporting the inclusion of Vickers is in violation of WP:MEDRS since the source is clearly not independent enough. I think it will be clear to outsiders that the current crop of editors here has created a page that is far too biased towards claiming efficacy of acupuncture. And I still think you need to tread more lightly in articlespace since you have a professional stake in making sure the subject is advertised well. jps (talk) 03:07, 31 October 2013 (UTC)

"... anyone here supporting the inclusion of Vickers is in violation of WP:MEDRS"? And trying to silence Herbxue? Interesting... --Mallexikon (talk) 04:38, 31 October 2013 (UTC)

No, we don't remove one source because another disagrees (where have I read that before...?). --Middle 8 (talk) 05:27, 31 October 2013 (UTC)

The source has been criticized. QuackGuru (talk) 06:04, 31 October 2013 (UTC)

This source you present is a mere letter to the editors... And it criticizes Vickers in such a general way that I have troubles even formulating its rationale... I'm afraid you'll have to come up with something a little more substantial in order to throw out a MEDRS that you don't like. --Mallexikon (talk) 06:17, 31 October 2013 (UTC)

There is a lot more criticism of the article. See Placing Acupuncture in Perspective. QuackGuru (talk) 06:23, 31 October 2013 (UTC)

This is another letter to the editors... It's not even criticizing Vickers et al. (on the contrary, it calls it a "well-conducted analysis"); it just says "that 2 important issues are not considered in their article or in the Invited Commentary that would help place acupuncture in better perspective for clinicians who wish to consider this modality as a possible treatment for chronic pain..." Your grasping at straws here. --Mallexikon (talk) 08:00, 31 October 2013 (UTC)

But the issue with the Vickers source is one of interpretation. These are straws, these are very real rejoinders which Vickers tried to address in the journal later on in the way fringe proponents often do, attacking the messengers as "skeptics" (as if such was a bad thing). Anyway, the source is duly impeached. We will be removing it or at least contextualizing it, it's clear to me. The question is now just how we will go about doing that. jps (talk) 11:48, 31 October 2013 (UTC)

Right now we have one RS (Ernst's quote -- from wherever it came originally) disagreeing with Vickers. In both EBM and MEDRS, expert opinion is at the lower end of the tier of evidence, while meta-analyses of RCT's are at the high end, so we'd weight accordingly. If the other sources (non-RS blogs) are making really good points, someone will publish them in an RS eventually. --Middle 8 (talk) 15:59, 31 October 2013 (UTC)

Shoddily done meta-analyses, I would hope, we would tend to avoid. As it is, Vickers has been roundly criticized by medical doctors and professors of complementary and alternative medicine for problems with interpretation. So, I'm unclear as to how you are declaring Vickers et al. to be reliable as anything other than an opinion of a credulous acupuncturist. Where is the evidence that this study is considered a good study? Where are the citations to it in the literature by independent sources? Because I see absolutely none. This is in contrast to Ernst's excellent track record and huge number of citations to his work from both believers and independent analysts alike. So I say it's pretty clear that Vickers et al. is impeached, and should only be used in context, not as some sort of declaratory work that acupuncture is effective, as the text currently reads. jps (talk) 18:22, 31 October 2013 (UTC)

Neither criticism, Barrett or the latter, truly refutes Vickers' conclusions. To say that NSAID's do better against pill placebos than acupuncture does against sham acupuncture is apples and oranges. Additionally, the GERAC study and others conclude that acupuncture beats standard of care (including NSAIDS) for knee and back pain. I still see nothing that convincingly discredits Vickers.Herbxue (talk) 06:33, 31 October 2013 (UTC)

The refutation is on the interpretation that Vickers irresponsibly provides. Much of their reporting of other work is true in the sense that the other work they report on exists. They simply aren't very good at meta-analysis, is all. That's Ernst and all the others' points. jps (talk) 11:46, 31 October 2013 (UTC)

"Funding/Support:The Acupuncture Trialists' Collaboration is funded by an R21 (AT004189I from the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) to Dr Vickers) and by a grant from the Samueli Institute. Dr MacPherson's work has been supported in part by the UK National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0707-10186). The views expressed in this publication are those of the author(s) and not necessarily those of the NCCAM NHS, the NIHR, or the Department of Health in England."[4]

It looks like the study was funded or ran by alternative medicine promoters. I am not sure. QuackGuru (talk) 18:05, 31 October 2013 (UTC)

Well, NCCAM funding is notoriously indicative of very shoddy research. There was an expose of this in the Skeptical Inquirer. [5]. jps (talk) 18:25, 31 October 2013 (UTC)

Proposal

Instead of reducing this article into a Vickers vs. Ernst quarrel, why dont we summarize the scientific consensus from reputable institutions instead? If we can't agree on using the World Health Organization's statement about acupuncture, than we should try citing from a similarly neutral institution like this one. I don't understand why Vickers or Ernst should be considered more trustworthy than a national health organization. -A1candidate (talk) 18:29, 31 October 2013 (UTC)

There isn't much that can be said about evidence for the efficacy of acupuncture in terms of institutions. Most institutions don't speak to the profound lack of evidence for its efficacy except to make unsupported nods in the direction that "we think it might work".... but invariably they cite poorly considered or even withdrawn studies. While I agree that institutional support for acupuncture is relevant to this page, the fact that institutions support acupuncture says nothing about the evidence for acupuncture's efficacy. jps (talk) 18:51, 31 October 2013 (UTC)

These groups have their own experts who are better qualified than self-selected groups of WP editors, which is why they are top-tier MEDRS's and WP isn't even an RS. --Middle 8 (talk) 00:20, 2 November 2013 (UTC)

@A1Candidate, yes, the larger bodies carry more weight, although we should still use other MEDRS's too, from meta-analyses to expert opinion. Another good independent, institutional source -- as big as they get, probably -- is the National Health Service, currently mentioned in the lede but incorrectly noted as being disparaged by some sources who criticized the older WHO source. --Middle 8 (talk) 00:20, 2 November 2013 (UTC)

Dr. Nancy Snyderman information repeatedly removed

The following information has been repeatedly removed:

Nancy Snyderman, chief medical editor for the Today Show, finds acupuncture to be safe and effective. She states that doctors have found it to be effective for treating chronic pain, nausea, and migraines; she also uses it in the treatment of many of her cancer patients.[6] Snyderman states, "We know that acupuncture, when the needles are placed correctly, can affect the nervous system of the body. Though the reason that acupuncture helps may be somewhat of a mystery, it is a serious study that deserves attention."[7]

The summary notes given were "Using anecdotes as evidence?" and the other called the information "nonsense". While a couple of Wikipedia editors may not agree with Snyderman, apparently the Today Show finds her opinions credible or they wouldn't employ her as the spokesperson for their medical information. It is not Wikipedia's place to censor the veiws of very well-known medical experts. Gandydancer (talk) 18:34, 31 October 2013 (UTC)

Why should Snyderman's opinions about a procedure she has neither researched nor actually done be relevant on this page? I think they make more sense to include on the Nancy Snyderman page. Please explain. jps (talk) 18:48, 31 October 2013 (UTC)

No, it would be WP:UNDUE to include this mention of this one individual's view. An independent secondary source demonstrating that Snyderman's view on this topic is particularly well-recognized, influential and notable would be required. Otherwise we run the risk of the article filling up with a huge list of hand-picked quotes. There are surely holders of named chair positions at top-tier universities who we should be citing for their opinions before we're looking for that of a TV personality. This kind of thing should fail WP:MEDRS under the "popular press" clause. Zad68 18:53, 31 October 2013 (UTC)

There is simply no justification for treating a spot on Good Morning America as a serious reference. Even if the individual speaking were (hypothetically) the foremost expert in the world, we have no reason to consider that the show's editing and fact-checking processes are reliable, or that the statements went to air fully intact. Then there's the minor point that Snyderman's expertise lies elsewhere. LeadSongDog come howl! 21:01, 31 October 2013 (UTC)

We can't delete this and then keep the other nonsense in the article. QuackGuru (talk) 03:19, 1 November 2013 (UTC)

QG, of course you're right those aren't MEDRS's. And I think I see what you're getting at. They may be OK as RS's, but we don't need RS's to criticize acu, because we already have MEDRS's that do. We only use RS's to clobber fringe topics that are so fringe they're not even in the sci literature.... that's the import of WP:FRINGE. Now, if we're gonna quote RS opinion to depict how acu is received culturally (which could be a small part of the article), then we should quote both proponents and critics, per usual WP:WEIGHT standards. regards, Middle 8 (talk) 00:31, 2 November 2013 (UTC)

News article about modern study on acupuncture

• Acupuncture Meets West: Harvard Med School Teams up with Korea for Research - It shows brain scan differences between acupuncture patients and control patients. It's a good source, but I don't know how people would choose to use it here. - Sidelight12 ^Talk 02:21, 2 November 2013 (UTC)

Could not verify the text

"A 2007 review article noted that superficial needling, the primary form of traditional acupuncture in Japan, can stimulate endogenous production of opioids which could result in non-specific analgesia.[119]"[8]

Not sure about the text. QuackGuru (talk) 16:49, 2 November 2013 (UTC)

Recommend reverting

This edit summary seems to be referencing Vickers which is a source that does not trump Ernst in the least. I recommend reverting the revert. This is terrible POV-pushing. Really disgraceful. jps (talk) 03:25, 31 October 2013 (UTC)

Well, I recommend you tone your language down a little, or we'll be having an argument about incivility at the appropriate place. Nobody's pushing a POV here. Your claim that Vickers' meta-analysis should be an unreliable source is just not well supported. If you think differently, take it to the Reliable sources noticeboard. --Mallexikon (talk) 04:20, 31 October 2013 (UTC)

I removed the OR in the sentence. QuackGuru (talk) 04:09, 31 October 2013 (UTC)

Ernst says the following: "Some findings are encouraging but others suggest that its clinical effects mainly depend on a placebo response." [9]. You just tried to distort a source here in order to push a certain POV. Now I'll assume Good Faith here - maybe you didn't do this on purpose, but just didn't read his article careful enough before stating that he can be used as a source for "Its effects are mainly due to placebo." Because, if you would have done this on purpose, this would certainly be a case for the noticeboard. --Mallexikon (talk) 04:31, 31 October 2013 (UTC)

Using Vickers without qualification is essentially POV-pushing because the source is SO bad. jps (talk) 11:40, 31 October 2013 (UTC)

The source does not say anything about "may be". QuackGuru (talk) 04:39, 31 October 2013 (UTC)

Then what would your close paraphrasing of Ernst's original sentence look like? --Mallexikon (talk) 04:49, 31 October 2013 (UTC)

"Most studies show its effects have not been reliably distinguished from that of a placebo."

Well, no. Ernst doesn't say most studies. --Mallexikon (talk) 05:24, 31 October 2013 (UTC)

"Its effects are suggested to be mainly due to placebo."

Well, only by some. Ernst himself writes that "some findings are encouraging".

There are different ways to write the text. QuackGuru (talk) 05:14, 31 October 2013 (UTC)

Yes, sure. But if you find that "may be" is not true to the source, you'd have to come up with something that is. Your above suggestions clearly are not. --Mallexikon (talk) 05:24, 31 October 2013 (UTC)

Source: "The majority of studies using such devices fails to show effects beyond a placebo response."[10]

Proposal: "Most studies show its effects have not been reliably distinguished from that of a placebo."

"Most" and "majority" mean the same thing. QuackGuru (talk) 05:30, 31 October 2013 (UTC)

Not enough context, and not close enough to the source. Source: "Some findings are encouraging but others suggest that its clinical effects mainly depend on a placebo response." - that statement is in line with a previous line in the abstract that there is "heterogeneity" in the research. The statement about a majority failing to show significant difference between sham and verum specifically refers to a specific subset of studies. Therefore, using Ernst to state that the "majority of studies suggest it is no more than placebo" is an example of original research and not true to the source. Herbxue (talk) 05:46, 31 October 2013 (UTC)

Yes. To complicate matters, this source of Ernst we talk about is from 2006... The high-quality reviews we have that show efficiency of acupuncture are much younger than, so he hasn't even taken them into account. --Mallexikon (talk) 05:57, 31 October 2013 (UTC)

I removed OR from two sentences. QuackGuru (talk) 06:02, 31 October 2013 (UTC)

"Research appears to imply ..." is weaselly. --Middle 8 (talk) 15:46, 31 October 2013 (UTC)

Source: The emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions. The close paraphrasing is supported by the source. The previous version without the context was OR. QuackGuru (talk) 17:17, 31 October 2013 (UTC)

The current text: Emerging research appears to imply acupuncture is effective for some but not all conditions.[8] Some research is encouraging but others suggest its effects are mainly due to placebo.[12]

Middle 8, do you still think the text is still weaselly or I was only being faithful to the sources? QuackGuru (talk) 17:08, 2 November 2013 (UTC)

I meant that the "seems to imply" part could just be pared down to "implies", but let me think about the broader context a little.... Thanks Middle 8 (talk) 02:31, 3 November 2013 (UTC)

Mass MEDRS violations

The dated references must go. QuackGuru (talk) 17:51, 31 October 2013 (UTC)

I agree. This is not good practice. We have some excellent meta-reviews by Ernst which should be explained clearly as the only basis for evidence (or, really, lack of evidence) and some controversies over whether governments should pay for acupuncture. That's about it, I'd say. jps (talk) 18:23, 31 October 2013 (UTC)

But you want to keep Ernst from 2006? What is your criteria? There is no justification for this edit. This is clearly cherry picking.Herbxue (talk) 22:50, 31 October 2013 (UTC)

Recent is almost always better, but some things don't change, and the inherent safety of needling (with proper training and precautions) seems like one of those things. Maybe there are better newer studies, but really good older ones ought to do, IMO. Anyway, a more recent source: "Acupuncture can be considered inherently safe in the hands of well trained practitioners." (WHO Bulletin, 2010, incl. everyone's favorite alt-med EBM guy as coauthor). --Middle 8 (talk) 01:42, 3 November 2013 (UTC)

Ah, QG added this already! Sorry, I missed that. --Middle 8 (talk) 10:14, 3 November 2013 (UTC)

Disagreement with Vickers

Just in case you missed it, I added the disagreement with Vickers. QuackGuru (talk) 19:05, 31 October 2013 (UTC)

A good start. Thanks, QG. jps (talk) 19:13, 31 October 2013 (UTC)

And a good end. QuackGuru (talk) 19:13, 1 November 2013 (UTC)

I have no problem "balancing" Vickers with Ernst as long as we don't do it this way: "A peer-reviewed meta-analysis concluded so-and-so, BUT Distinguished Professor X said he disagrees, and here is his exact quote ...(....)." --Middle 8 (talk) 02:00, 3 November 2013 (UTC)

I've tried to fix the weight issue; it's a start, anyway. We all know that meta-analyses have much more weight than statements of expert opinion -- that per MEDRS, and the EBM standards on which MEDRS is rightly based. No gurus in EBM. Rather than prune Ernst, I've expanded Vickers, including the finding of significant difference between sham acu and true acu. There are other reviews cited that find no difference between true and sham acu, and it's crucial that we depict the state of the literature fairly and cover details from both + and - studies.

I've mentioned before that I do not accept that acupuncture is fundamentally fringe and that it therefore follows that all positive findings are bunk. This view is putting the "conclusion-cart" before the "evidence-horse", and essentially anti-science. A robust debate and positive findings are what demonstrates that acu is not as fringe as some editors (and bloggers) imagine. I point to the discussion at WT:MEDRS, at which consensus emerged that Vickers was indeed a good source, and that the notion that it should be removed was perhaps facetious at best. --Middle 8 (talk) 11:21, 3 November 2013 (UTC)

"Significant", "effective", "improvement", "benefit"

I'm a bit concerned by the lack of clarity around the use of the above terms in the pain section of this article. For instance, in their review, Vickers et al. make it clear the significance they discern in the effect of acupuncture is statistical significance, and their comments about the modesty of the effect, while not saying anything explicit about clinical significance certainly allows that the effect is clinically insignificant. Laymen will read "effective" differently than researchers. A researcher will describe an intervention as effective if only a miniscule, clinically irrelevant, statistically-reliable improvement can be demonstrated. A layman is likely to read "effective" as meaning at least of some practical use. Similarly "improvement" and "benefit".

Saying blankly, "effective for some but not all conditions", "effective for the treatment of chronic pain", "effective for some but not all kinds of pain", "more effective than routine care in the treatment of migraines," "benefit for acupuncture combined with exercise in treating shoulder pain after stroke", "pain relief and improvement compared to no treatment or sham therapy", and "effective for chronic low back pain" without an indication of the clinical relevance of the effect, improvement or benefit is at best remiss, and almost certainly misleading most of our readers.

I really can't be bothered reading the above discussion, so if this has been touched on already, I apologise, but my superficial reading of the sources in the pain section tells me that they are surprisingly consistent, when you clarify what each author says or implies about effect significance. --Anthonyhcole (talk · contribs · email) 09:57, 3 November 2013 (UTC)

Interesting points, Anthony. Maybe we can look to the "plain text summaries" of Cochrane reviews for more layperson-accessible phrasing? And then work backwards from that to figure out how to extract it from full reviews? --Middle 8 (talk) 10:37, 3 November 2013 (UTC)

I can't do the reading needed just now - I shouldn't really be even looking at Wikipedia: I'm procrastinating. But the reviews I did read in the pain section are very clear about the kind of significance they're referring to, and its p value. If all of the reviews in that section are consistent about the strength of evidence, the statistical significance and the clinical significance, it should be possible to boil all that "this review said x but that review said y" down to a statement of what they all (or most) say in common about chronic pain (be sure they're all addressing chronic pain) with a paragraph or two giving specifics about reviews that differ from the common finding.

Maybe my random sampling has misled me, but I'll be surprised if you can't say in Wikipedia's voice that there appears to be a modest benefit above placebo from acupuncture in the treatment of at least some forms of chronic pain, though it's not clear if any benefit is significant enough to be worth the expense and effort. --Anthonyhcole (talk · contribs · email) 11:36, 3 November 2013 (UTC)

Dunno, I'm not good with statistics, but seems like it could be WP:SYN for us to say that... again, I'd be inclined to use the Cochrane plain-language summaries to guide our wording. Wouldn't their translation of the statistics to lay readers be reliable? (same here re procrastination btw; I should be checking in here less often) --Middle 8 (talk) 00:18, 4 November 2013 (UTC)

Duplication

The text is in effectiveness section: "A 2012 meta-analysis found significant differences between true and sham acupuncture, which indicates that acupuncture is more than a placebo when treating chronic pain (even though the differences were modest).[103]"

Since it is in the effectiveness section I removed the duplication. QuackGuru (talk) 17:30, 3 November 2013 (UTC)

Since "Pain" is a subhead under "Effectiveness", maybe it would be better to have the ref under "Pain"? And then simply se the paragraph above "Pain", etc., as an intro to that section, summarizing the subheads?--Middle 8 (talk) 00:08, 4 November 2013 (UTC)

"A 2012 meta-analysis found acupuncture is effective for the treatment of chronic pain, specifically back and neck pain, osteoarthritis, and chronic headache.[103]"

Here is the current text under "Pain". I'm not sure what you want to do. The ref is used in two separate places. QuackGuru (talk) 01:09, 4 November 2013 (UTC)

Low level details

Low level details are not encyclopedic. We are not going to add an author's name to every source. QuackGuru (talk) 06:06, 3 November 2013 (UTC)

Of course not. But since Ernst is now mentioned twice (each time at length, and with wikilinks) as an important critic of acupuncture, him co-authoring an overview that finds evidence that "acupuncture is effective for some but not all kinds of pain" is of interest to the reader. --Mallexikon (talk) 06:24, 3 November 2013 (UTC)

I think it would be better to avoid the unencyclopedic quotes and low level pointy details. Because Ernst is now mentioned twice is not a reason to add low level details. QuackGuru (talk) 06:44, 3 November 2013 (UTC)

The nonsense continues. QuackGuru (talk) 06:12, 3 November 2013 (UTC)

Don't be uncivil, please. It's not nonsense. I agree with Mallexicon. Ernst has written a variety of things and if we're only going to use his name with "acu is placebo" type statements, that's a WP:WEIGHT vio plain and simple. I'm reverting, but I'd rather we get consensus rather than edit-war, and it's obvious enough from the edit history who's edit-warring the most. --Middle 8 (talk) 10:30, 3 November 2013 (UTC)

Quotes

If possible editors should try not to add quotes. I rewrote the text without the low level details about Ernst. QuackGuru (talk) 06:44, 3 November 2013 (UTC)

Which policy says quotes are bad? Quotes are a good way of maintaining accuracy. And I don't know what a "low level detail" is; you seem to be saying that Ernst's name is a "low level detail" about him, which I find very strange. --Middle 8 (talk) 10:34, 3 November 2013 (UTC)

Adding Ernst's name to the review is wrong. The other reviews are not done this way. Quotes are a bad way to write text for an encyclopedia. Which policy says quotes are better than summarising the text? QuackGuru (talk) 17:00, 3 November 2013 (UTC)

"The other reviews are not done this way"? We wouldn't be having this discussion if we hadn't already mentioned Ernst's name elsewhere, right? Doesn't matter if it's a review or other source; we should have some consistency in whether we cite names of experts. Quotes: yes, I understand your expressed preference, but again -- does it say this in MOS? BTW, I noticed you did add Ernst's exact quote re Vickers; how is that different? --Middle 8 (talk) 00:29, 4 November 2013 (UTC)

"The study's conclusions are disputed by professor Edzard Ernst, who stated that the meta-analysis "impressively and clearly" demonstrated that the effects of acupuncture were largely due to placebo.[104]"

The text is a summary of the disagreement with a brief statement from the researcher. I noted who specifically disagrees with the review. The source is not a review. I can't say it was a review because it would be OR. It is different because a notable researcher publicly disagreed with a specific review. QuackGuru (talk) 00:56, 4 November 2013 (UTC)

But still, re quotes, you seem to be expressing a preference rather than following a guideline. That's fine but clearly up for consensus. Re naming Ernst in his comment re Vickers, we could easily have said "one prominent researcher" disagreed, and left it at that with no quote. But we didn't. Which is OK, but then we can't reasonably argue for the omission of other quotes, or naming of authors. And quotes are obviously fine on WP, QG... we see 'em all over the place; they add nuance and ensure accuracy. And re naming authors, again, we shouldn't put Ernst's name only beside his negative conclusions. He's had at least one review finding efficacy for pain in '11 (3 years post Trick or Treatment, btw). --Middle 8 (talk) 03:11, 4 November 2013 (UTC)

The quotes were deleted but now there is quotse with the reference. I can justifiable argue for the omission of other quotes, or naming of authors when it was not a specific response to another author or source. Quotes are good when it is from a specific person but not a review. QuackGuru (talk) 17:04, 4 November 2013 (UTC)

Not sure

"Proponents believe acupuncture can assist with fertility, pregnancy and childbirth, attributing various conditions of health and difficulty with the flow of qi through various meridians.[132]"

Not sure why this is in the article. QuackGuru (talk) 04:43, 1 November 2013 (UTC)

I think it is important and encyclopedic to cover what the proponents say it is useful for, however I am not sure this particular source covers that. At the very least the statement should be ascribed to Zita West, the author of the book cited, and not "proponents" (unless Zita West is making that general statement in her book, and the book is a reliable source for such a statement... the ref just cites the whole book and at 100+ pages that's not helpful). Zad68 14:26, 1 November 2013 (UTC)

I replaced the acupuncture book with a 2013 review. QuackGuru (talk) 01:23, 5 November 2013 (UTC)

References with quotes should be notes

The reference section is loaded with extensive quotes. It should be broken out into a notes section and a references section using for example the Refn template. If I have the time I will try and work on it but if someone else has the time by all means go for it. - - MrBill3 (talk) 00:26, 5 November 2013 (UTC)

I've done this and in the process found that there were unneeded quotes. It is not necessary to place a quote of the material paraphrased. Notes 3-6 are not needed and if there is no objection here I will remove them. They do not provide any additional useful details or clarification of the material in the article. - - MrBill3 (talk) 03:47, 5 November 2013 (UTC)

Thanks for the hard work, Mr. Bill. No objection from me. --Mallexikon (talk) 05:24, 5 November 2013 (UTC)

The specific dispute was deleted

The specific dispute with the conclusions was deleted. Now the reader will not know what was disputed. QuackGuru (talk) 03:01, 4 November 2013 (UTC)

I restored the text but did not restore the quotes. I summarized the dispute. The previews version did not tell the reader anything. QuackGuru (talk) 00:20, 5 November 2013 (UTC)

That looks better than the version I reverted, thanks.Herbxue (talk) 15:24, 5 November 2013 (UTC)

The text has been changed. See diff. Both diffs I can live with. Keep on editing if you can think of a way to make it better. QuackGuru (talk) 17:58, 5 November 2013 (UTC)

Note

https://www.ncbi.nlm.nih.gov/pubmed/23573135

If this source is not already in the article then we could it. QuackGuru (talk) 03:46, 1 November 2013 (UTC)

Sure, even if 294 adverse events had occurred in 1 year in the U.S. it would still show acupuncture is incredibly safe, BUT, the article actually shows 294 adverse events in 12 YEARS in 25 COUNTRIES! Acupuncture is obviously one of the safest interventions available to the public.Herbxue (talk) 03:53, 1 November 2013 (UTC)

Unless you are ill, and need something to fix it !! --Roxy the dog (resonate) 04:18, 1 November 2013 (UTC)

Don't conflate issues. Safety data is crystal clear - acupuncture adverse events are exceedingly rare, especially relative to conventional medical interventions. When it comes to efficacy, the most recent reviews are increasingly positive. No one is suggesting acupuncture for fractures or sepsis, so unless you have a sense of context and scale you will sound foolish making sweeping generalizations.Herbxue (talk) 04:39, 1 November 2013 (UTC)

The safety data has been updated. The text "acupuncture adverse events are exceedingly rare" is a MEDRS violation. QuackGuru (talk) 05:38, 5 November 2013 (UTC)

I removed the citation needed tag on the lead re "and carries a very low risk of serious adverse effects." I think this is supported adequately by the citations in the Safety section. If you (User:QuackGuru or others) disagree replace it with explanation here. Alternatively suggest (or boldly edit) a more appropriate phrasing. If the tag was in reference to the entire sentence which starts with "There is general agreement" and there is no source stating there is any such general agreement then by all means replace the tag. Not trying to be contentious just trying to keep the article readable. - - MrBill3 (talk) 14:01, 5 November 2013 (UTC)

I am also unclear on the MEDRS tag on the Adams 2011 article. Is it because it is a study on pediatric acupuncture being used on a more broad statement? Does using it to support the general safety of acupuncture (in conjunction with the other refs) WP:OR or not in keeping with policy for medical articles? - - MrBill3 (talk) 14:08, 5 November 2013 (UTC)

The Adams 2011 article passed MEDRS but was not about general safety of acupuncture. I recently updated the sentence in the lede with a newer source. QuackGuru (talk) 19:14, 5 November 2013 (UTC)

Adverse events needs updating

Serious adverse events are exceedingly rare—on the order of five in one million—[27][unreliable medical source?][11][12]

I added two newer sources to the article but I did not rewrite text or deleted the older sources. The text needs to updated and the sources need to be formatted. See Acupuncture#Adverse events. QuackGuru (talk) 16:59, 2 November 2013 (UTC)

There was no specific objection to updating the text using the newer source. QuackGuru (talk) 05:38, 5 November 2013 (UTC)

A large part of the Safety section was deleted

These mass changes deleted MEDRS compliant references and deleted relevant safety information. QuackGuru (talk) 16:45, 7 November 2013 (UTC)

I think I restored the relevant text. QuackGuru (talk) 17:16, 7 November 2013 (UTC)

Relevant details deleted

"The vast majority of adverse events from acupuncture are minor, and are estimated to occur in approximately 7% to 12% of treatments, both in adults and children.[174] The ones most commonly reported occur at the site of needle insertion: minor bleeding (3%), hematoma (2-3%), and pain from needling (up to 3%). Dizziness is reported in about 1% of treatments."

The text should be restored but rewritten using newer sources. QuackGuru (talk) 19:17, 7 November 2013 (UTC)

Sure, knock yourself out. For now, the text you restored is contradicting (and trumped by) the material from the newer source; I think the text would have to reflect that. --Mallexikon (talk) 03:45, 8 November 2013 (UTC)

The details like this one was deleted Dizziness is reported in about 1% of treatments.

The details about the numbers should be restored using newer sources. QuackGuru (talk) 03:52, 8 November 2013 (UTC)

I can't find a newer source with the specific numbers for the adverse events. QuackGuru (talk) 04:30, 8 November 2013 (UTC)

I moved the text around a bit and included the review's conclusion for proper context. Your last edit said that pneumothorax and subarachnoid bleeding were "routine" occurrences with acupuncture. I did not see that in the source. However, my edit summary "avoids OR" is referring to my own previous edit, not yours.Herbxue (talk) 08:18, 8 November 2013 (UTC)

"The most frequent adverse events were pneumothorax, fainting, subarachnoid haemorrhage and infection, while the most serious ones were cardiovascular injuries, subarachnoid haemorrhage, pneumothorax and recurrent cerebral haemorrhage."[13]

The most routine' or common can be used in the text. There are also more serious adverse events. QuackGuru (talk) 17:15, 8 November 2013 (UTC)

Ok, thanks for the explanation. I still think it suggests more than it means so if you don't mind I would prefer to leave the word 'routine' out.Herbxue (talk) 20:56, 8 November 2013 (UTC)

The word routine is out but I included a bit more context from the source. QuackGuru (talk) 21:25, 8 November 2013 (UTC)

Looks good to me.Herbxue (talk) 16:08, 9 November 2013 (UTC)

Templates

I don't see any more discussion going on... Can we remove the templates that were put up a month ago? Cheers, --Mallexikon (talk) 01:24, 7 November 2013 (UTC)

Alright, I'll take that as a yes. --Mallexikon (talk) 02:19, 12 November 2013 (UTC)

Needs updating

Both peer-reviewed medical journals, and acupuncture journals reviewed by acupuncturists, stated that acupuncture can be painful.[87][88][89][90][not in citation given]

The ones most commonly reported occur at the site of needle insertion: minor bleeding (3%), hematoma (2-3%), and pain from needling (up to 3%). Dizziness is reported in about 1% of treatments.[175][176][177][178][179][not in citation given]

These sentences need updating using the newer sources. The older sources must go. QuackGuru (talk) 01:59, 7 November 2013 (UTC)

Glad you mentioned these. I've long been dubious about some of them, as their discussion of the subject -- pain from needling -- is peripheral at best. For example, an article on post-operative dental pain might say "... and acupuncture is sometimes used as a treatment, but it is painful". A MEDRS for one topic isn't necessarily a MEDRS for another. IMO, the prose here is rather POINT-y (sorry) and OR-ish; the edit would never have stuck if the topic had been efficacy instead of adverse effects. We already have some good sources on the subject. I'll remove the poor ones unless someone else beats me to it, or objects. --Middle 8 (talk) 06:13, 13 November 2013 (UTC)

I think the older ones were recently removed and the text was rewritten. Of course, there could be some older ones left that editors missed. QuackGuru (talk) 06:18, 13 November 2013 (UTC)

Notes

AFD

German Acupuncture Trials seems to be non-notable. What is it doing in articlespace? QuackGuru (talk) 06:10, 3 November 2013 (UTC)

Yeah, usually we use reviews, but it was a very big study. (they used sham needling controls at verum points) --Middle 8 (talk) 02:55, 4 November 2013 (UTC)

Looks like a soapbox. All the refs fail MEDRS and there is nothing notable about it. QuackGuru (talk) 00:44, 5 November 2013 (UTC)

I think it is time to AFD it. QuackGuru (talk) 02:12, 19 November 2013 (UTC)

Certainly not. The GERAC are notable because on their basis, acupuncture was included in the services paid for by the German statutory health insurances. Good luck with AfD. --Mallexikon (talk) 03:03, 19 November 2013 (UTC)

That is not what the article is mainly about. QuackGuru (talk) 03:13, 19 November 2013 (UTC)

Lede

In the lede of Traditional Chinese medicine there are seven references to verify the text.[1][2][3][4][5][6][7][unreliable medical source?]

This seems pointy. QuackGuru (talk) 06:56, 3 November 2013 (UTC)

Refs in lede are optional but they may have been put there to discourage other editors from saying "hey there are no refs for this claim" --Middle 8 (talk) 02:55, 4 November 2013 (UTC)

You have not given a reason for 7 references to verify one sentence. It could be WP:SYN to use that many references. QuackGuru (talk) 17:06, 4 November 2013 (UTC)

It was recently fixed. No longer 7 references in the lede. QuackGuru (talk) 00:44, 5 November 2013 (UTC)

Notable critics

I tried a compromise. QuackGuru (talk) 19:26, 1 November 2013 (UTC)

As I mentioned above, I agree with QG that per WP:FRINGE, we don't need RS's to speak to acu's efficacy or lack thereof when we already have MEDRS's that do that. --Middle 8 (talk) 00:34, 2 November 2013 (UTC)

It looks like there was not enough support to delete the section so I must restore it according to WP:CON. I renamed the section and also have expanded it a bit. QuackGuru (talk) 18:39, 21 November 2013 (UTC)

A 2013 meta-analysis did not determine acupuncture is cost-effective

"A 2013 meta-analysis determined that acupuncture is a cost-effective treatment strategy in patients with chronic low back pain."

The source: "Acupuncture as a substitute for standard care was not found to be cost-effective unless comorbid depression was included."

• Taylor P, Pezzullo L, Grant SJ, Bensoussan A. (2013). "Cost-effectiveness of Acupuncture for Chronic Nonspecific Low Back Pain". Pain Practice: The Official Journal of World Institute of Pain. doi:10.1111/papr.12116.. PMID 24138020. {{cite journal}}: Check |doi= value (help)CS1 maint: multiple names: authors list (link)

The current text is not accurate. QuackGuru (talk) 21:35, 8 November 2013 (UTC)

Actually, it is accurate. The source distinguishes between acu being cost-effective according to a given WHO benchmark (it is), and acu being cost-effective as a substitute for standard care. Quote:

“ ....According to this threshold, acupuncture as a complement to standard care for relief of chronic LBP is highly cost-effective, costing around $48,562 per DALY avoided. When comorbid depression is alleviated at the same rate as pain, cost is around $18,960 per DALY avoided. Acupuncture as a substitute for standard care was not found to be cost-effective unless comorbid depression was included. According to the WHO cost-effectiveness threshold values, acupuncture is a cost-effective treatment strategy in patients with chronic LBP. ”

Should we leave text as is or elaborate? --Middle 8 (talk) 06:41, 13 November 2013 (UTC)

Current text: "A 2013 meta-analysis found acupuncture as a substitute for standard care was not cost-effective but as a complement to standard care it was cost-effective for chronic low back pain.[169]"

I did elaborate on it but left out the low level details. The old text was not accurate when it was taken out of context. QuackGuru (talk) 17:55, 13 November 2013 (UTC)

A little clearer grammatically, with respect to the "for chronic low back pain" prepositional phrase which modifies both kinds of cost-effectiveness (i.e. as complement and substitute to standard care): "A 2013 meta-analysis found that acupuncture for chronic low back pain is cost-effective as a complement to standard care, but not as a substitute for standard care." --Middle 8 (talk) 19:09, 21 November 2013 (UTC)

That is not how it was summarizes. It first said acupuncture as a substitute for standard care was not cost-effective. QuackGuru (talk) 19:20, 21 November 2013 (UTC)

Wrong, read the quote above, that's the order it uses and is what I followed. Yours was grammatically unclear, as I said. --Middle 8 (talk) 19:35, 21 November 2013 (UTC)

It was a study. Failed MEDRS. QuackGuru (talk) 19:45, 21 November 2013 (UTC)

"The objective of this study was to assess the cost-effectiveness of acupuncture in alleviating chronic LBP either alone or in conjunction with standard care compared with patients receiving routine care, and/or sham."[14] This study does not meet MEDRS. QuackGuru (talk) 19:45, 21 November 2013 (UTC)

The study failed MEDRS. QuackGuru (talk) 19:50, 21 November 2013 (UTC)

Not true; don't be deceived by semantics. The source is a meta-analysis and does meet MEDRS. See the abstract keywords. "Study" is a general word that can be used to refer to meta-analyses, as does the author of the piece quoting Ernsts's comments on Vickers.[15]. --Middle 8 (talk) 19:56, 21 November 2013 (UTC)

"For acupuncture and standard care vs. standard care and sham, a weak positive effect was found for weeks 12 to 16, but this was not significant."[16]

They state "for weeks 12 to 16...". That is what studies do. The source says study not meta-analysis. You have not shown it passes MEDRS. This was OR and a MEDRS violation. QuackGuru (talk) 20:07, 21 November 2013 (UTC)

QG, you're simply wrong, and I hope you self-rv (if applicable). Read the abstract: "The objective of this study was to assess ... To determine effectiveness, we undertook meta-analyses which found ...."

All this is right there in the abstract, the same one that you read and found the word "study" in.

I don't appreciate having to spell this all out to an editor who's been around for years. It is disruptive to IDHT and ignore what the eye can plainly see. If you're having a hard time focusing on stuff, please take a break from editing instead of wasting other editors' time. If you don't have the scientific literacy necessary to know what "study" means, etc., why make things difficult for those who do? WP:COMPETENCE. --Middle 8 (talk) 21:19, 21 November 2013 (UTC)

From the full text of the the article: "Study Design: We sought to establish the effectiveness of the interventions over the comparators described in Table 1 by undertaking a literature review and meta-analysis. The literature review included clinical trials and systematic reviews. Search terms included...". The study is indeed a meta-analysis and thus is consistent with MEDRS. Puhlaa (talk) 23:32, 21 November 2013 (UTC)

This may need expert comment from someone who has access to the full study. The abstract of the study states, "For acupuncture and standard care vs. standard care and sham, a weak positive effect was found for weeks 12 to 16, but this was not significant." Does this mean when an analysis was done of studies that included sham treatment there was no significant effect? Wouldn't that mean the analysis this study used to draw conclusions was not one based on comparison of actual vs sham treatment studies? The abstract states, "we undertook meta-analyses" note the plural. Did the authors of the study cherry pick amongst analyses? What was the methodology of the "meta-analyses" and how did the authors choose which of them to base their results on? In my opinion any citation of this study should include that, "standard treatment with acupuncture vs standard treatment with sham acupuncture showed no significant results." Again I think someone with research expertise needs to examine the full text of this study. To me it is clear that this study is not "A Meta-Analysis" but used multiple analyses to find specific results. - - MrBill3 (talk) 05:36, 22 November 2013 (UTC)

How is that clear to you if you haven't read the paper? --Middle 8 (talk) 12:03, 22 November 2013 (UTC)

Because the abstract spells it out. How could they have used the meta-analysis that showed no significant effect to demonstrate cost effectiveness? Cost effective at having no effect? Also the abstract say, "we undertook meta-analyses" that means multiple and clearly as before the meta-analysis showing no significant effect could not have been used, thus they must have selected out that meta-analysis among the multiple meta-analyses they undertook. All stated in the abstract. I will read the paper at my earliest convenience. - - MrBill3 (talk) 12:19, 22 November 2013 (UTC)

I share your puzzlement at how they found cost-effectiveness without much in the way of effectiveness. I don't think the plural "meta-analyses" likely implies cherry-picking; sounds more like statistics-talk. But sure; TBD (FWIW.... probably not that big a deal as sources go). regards, Middle 8 (talk) 13:31, 22 November 2013 (UTC)

Removed from article & sticking here, pending resolution (re cost effectiveness vis-á-vis efficacy).

“ A 2013 meta-analysis found that acupuncture for chronic low back pain was cost-effective as a complement to standard care, but not as a substitute for standard care. ”

--Middle 8 (talk) 01:31, 23 November 2013 (UTC)

I have added some excerpts from the full-text of the article for your review. It seems to me that this is a MEDRS-compliant source that carried out 3 different meta-analyses and is quite acceptable for inclusion in this article:

• METHODS
• "Study Design: We sought to establish the effectiveness of the interventions over the comparators described in Table 1 by undertaking a literature review and meta-analysis. The literature review included clinical trials and systematic reviews. Search terms included keywords “acupuncture”, “chronic low back pain”, and “nonspecific low back pain”. We searched PubMed from its inception to 30 Jan 2012. The bibliographies of seven systematic reviews were searched for additional references. We included all randomized controlled trials that included acupuncture with manual or electronic stimulation. Clinical trials were included if a comparator of standard or usual care was utilized in the study. Standard care included one or more of the following:... Most of the studies were not relevant to this analysis because of the comparator; for example, studies were excluded that compared acupuncture alone with sham alone or placebo. All studies included in the analysis were randomized controlled trials. We excluded studies without intention to treat analysis."
• "Meta-Analysis Methodology': To estimate the health gain that could be attributed to each intervention, we conducted a meta-analysis to determine the efficacy of the interventions. We undertook three meta-analyses (one for each category in Table 1) to investigate the differential impact of the intervention vs. the comparator using Comprehensive Meta-analysis software (Version 2.2.050. 2009, Biostat Inc., Englewood, NJ, USA... We use effect size as the main measure of efficacy. We calculated standardized mean differences (SMD) using Hedge’s g, because it includes an adjustment to correct for small sample bias and is used in Cochrane Collaboration systematic reviews. Random effects models were applied because of expected heterogeneity. Studies were grouped according to length of follow-up."
• "Cost-Effectiveness Analysis: Cost-effectiveness ratios were determined as the incremental cost of the intervention divided by the incremental benefit and presented as incremental cost ($A)per DALY saved. The incremental cost is defined as the difference between the cost of the intervention (for example, the cost of acupuncture as a complement to standard care) and the cost of the comparator (for example, standard care). Higher incremental cost-effectiveness ratios indicate lower cost-effectiveness (ICER) . The DALY was chosen as the outcome measure of health gain as it captures both morbidity and mortality effects, and the DALY is used in baseline information on health status for Australia..."
• RESULTS
• "Cost-Effectiveness Analyses: The cost-effectiveness analyses are summarized in Table 5. Acupuncture as a complement to standard care is cost-effective, with a mean cost per DALY avoided of $48,562 (90% confidence interval $28,500 to $76,900). Where comorbid depression is alleviated at the same rate as pain, it is even more cost-effective, with a mean cost of $18,960 per DALY avoided (90% confidence interval of $11,100 to $30,000). In general, acupuncture was not found to be cost-effective when used as a replacement for standard care based on the trial conducted by Cherkin (32). However, when comorbid depression is included in the analysis by Haake (33), acupuncture is cost-effective compared with standard care ($62,946-well below three times GDP per capita)."

Puhlaa (talk) 21:39, 23 November 2013 (UTC)

Thank you for those excerpts. I think the article does qualify as MEDRS and supports the statement, thus it can be replaced in the article. Perhaps some caveat or explanation of the fact that there was no difference between sham and non sham should accompany it. The authors did find it important enough to place it in the abstract. - - MrBill3 (talk) 15:45, 26 November 2013 (UTC)

Yes, thanks for those excerpts, and I agree, restoring with explanation makes sense. --Middle 8 (talk) 15:00, 28 November 2013 (UTC)

However

The same review concluded that acupuncture can be considered inherently safe when practiced by properly trained practitioners.[168] "The same review also stated: However, there is a need to find effective ways to improve the practice of acupuncture and to monitor and minimize the health risks involved."[17]

The text may not summarise the source accurately. The text does not explain the "however" part. QuackGuru (talk) 19:59, 27 November 2013 (UTC)

Do you have a proposal for explaining the statement? I think one may be appropriate. We should provide a paraphrase and explanation per policy (IMO). - - MrBill3 (talk) 11:06, 28 November 2013 (UTC)

Looks good, QG. --Middle 8 (talk) 15:35, 28 November 2013 (UTC)

"exceedingly" rare is original research

"One might argue that, in view of the popularity of acupuncture, the number of serious adverse effects is minute. We would counter, however, that even one avoidable adverse event is one too many. The key to making progress would be to train all acupuncturists to a high level of competency."[18]

A 2011 meta-review showed that serious adverse events, including death have been reported, are frequently due to practitioner error, is rare, and diverse.[16]

I removed the original research. I recommend we keep this source. A 2004 cumulative review should not be used to replace the 2011 meta-review. See WP:MEDDATE. QuackGuru (talk) 18:09, 28 November 2013 (UTC)

I think you might be pushing the definition of OR too far. 5 in one million can fairly be called "exceedingly rare", IMO, compared to the rates of SAE's in other areas. How else to summarize it without just saying it directly (which is OK, but sometimes grammatically unwieldy)? --Middle 8 (talk) 02:30, 29 November 2013 (UTC)

The 2011 meta-review did not cover say anything about the 5 in one million. I read the full text. Please don't try to delete this 2011 meta-review against MEDRS. You don't have consensus to delete the 2011 meta-review. The current text is now accurate. QuackGuru (talk) 03:21, 29 November 2013 (UTC)

White 2004 -- remember that one? -- is the source for the 5-in-one-million number, and you're misreading the diff. Your "not getting it" is classic IDHT, and the effect (intentional or not) is trollish. Nobody wants to haggle over distracting misunderstandings. This is just too disruptive. --Middle 8 (talk) 04:00, 29 November 2013 (UTC)

"A 2004 cumulative review showed that serious adverse events (SAE's) are frequently due to practitioner error, exceedingly rare, and diverse.[168]" The dated source was added by Middle 8.

"A 2011 meta-review showed that serious adverse events, including death have been reported, are frequently due to practitioner error, is rare, and diverse.[16] Current text.

I object to using the 2004 cumulative review. Obviously no reason was given in this thread to replace the 2011 meta-review. I support the current text using the newer source. I object to the MEDRS violation. QuackGuru (talk) 04:29, 29 November 2013 (UTC)

More repetition and IDHT. Please stop disrupting this page. --Middle 8 (talk) 10:03, 1 December 2013 (UTC)

Where is your explanation for deleting the 2011 meta-review against MEDRS? This source was not about the numbers. Did you make a mistake when you edited the article? QuackGuru (talk) 18:26, 1 December 2013 (UTC)

You misread the diff. --Middle 8 (talk) 05:43, 2 December 2013 (UTC)

Seems like both sources are fair game, which means that "exceedingly rare" is not original research. Quack Guru, please don't insult everyone else's intelligence. Just add good new info if it is sourced well, but don't dick around with the other good, well-sourced material before discussing it here first. Herbxue (talk) 05:51, 2 December 2013 (UTC)

Both sources are not fair game according to WP:MEDDATE. I don't see a good reason to delete the text from the newer 2011 review and replace it with text from a dated 2004 source. It seems like you did not provide verification for the text that failed verification. The part "exceedingly" is indeed unsourced when no editor provided verification. QuackGuru (talk) 05:59, 2 December 2013 (UTC)

There are separate issues here: First,whether the 2004 source is reliable or not. The link you provided is in a section titled "basic advice" not "strict policy" - the goal is reliability. Does the 2011 source meaningfully and convincingly contradict the 2004 source? No, they both basically say acupuncture is generally safe, but you prefer the wording of the 2011 source. That is the second issue: Does the more recent source automatically trump the older source? Not really but of course the newer source should be included. I am not for deleting new sourced material in favor of old, but deleting material that is still valid and not specifically disproved by recent work should be discussed here first.Herbxue (talk) 08:17, 2 December 2013 (UTC)

Agree. --Mallexikon (talk) 08:21, 2 December 2013 (UTC)

Agree, and just to be clear: contrary to QG's repeated description of my edit that added White 2004, I didn't delete the Ernst 2011 review, I simply moved it to a place where it better fit the text. Ernst 2011 doesn't discuss and shouldn't be cited for rate of SAE's; what he does is give a raw number for SAE's -- that is, a numerator but no denominator. (And as mentioned, his # is consistent with White and other reviews.) The first sentence appearing in the diff was originally sourced to White; I know, because I wrote it, and consensus at the time supported it. Today, all but one of us seem to be fine with including White 2004, so I will redo/improve upon this edit. (Re MEDDATE's guidelines -- the bullet points that say to use < 5.y.o. reviews happen to come immediately under the sentence that says we can user older ones when not many are extant.) struck; already made that point; once is enough... don't feed the IDHT --Middle 8 (talk) 10:14, 2 December 2013 (UTC) (edited 13:11, 2 December 2013 (UTC))

Significance

Just looking at Acupuncture#Pain. I'm finding an unacceptable vagueness in our portrayal of the significance of treatment effects. Can someone who has access to the Saudi review [19] please tell me whether they are using "significant" in their conclusion to refer to statistical significance or clinical significance, and whether they (or anyone else commenting on their review) say anything about the clinical significance of the difference between acupuncture and control? --Anthonyhcole (talk · contribs · email) 05:34, 8 December 2013 (UTC)

Without looking at that source, there's very few trials caring about clinical significance. It's not usually a term appearing in efficiency discussions. --Mallexikon (talk) 05:53, 8 December 2013 (UTC)

In my limited experience, recent good medical studies and reviews make it very clear whether they are using "significant" to mean statistical or clinical. Given the vast difference in meaning, it's important that we convey to the reader which meaning to assign to the term wherever we use it. --Anthonyhcole (talk · contribs · email) 06:12, 8 December 2013 (UTC)

I'll see if I can get the Saudi review. TimidGuy (talk) 15:46, 8 December 2013 (UTC)

Their meta-analyses found that acupuncture was both clinically and statistically significantly better than sham acupuncture, usual care, and wait list controls. I can send it to you, if you like. TimidGuy (talk) 17:18, 8 December 2013 (UTC)

You've got mail. :o) --Anthonyhcole (talk · contribs · email) 18:24, 8 December 2013 (UTC)

I went ahead and added that the reduction was clinically significant. TimidGuy (talk) 11:41, 12 December 2013 (UTC)

New meta-analysis

• PMID 24146995
• Some commentary from Ernst

Alexbrn ^{talk|contribs|COI} 08:22, 15 December 2013 (UTC)

Vickers's reply to Ernst

Vickers published a reply to Ernst and other critics in the journal Acupuncture in Medicine[20], which is a journal published by BMJ. Here's what he said:

(possible copyright vio removed)

Passing along in case it's useful. TimidGuy (talk) 11:46, 8 November 2013 (UTC)

Thanks for this! (an aside, fwiw -- we don't need to include Vickers' remarks on the laser study; that's a job for a review article.) --Middle 8 (talk)

Seems like Vickers's response could be included in the article. (Note that Vickers's remarks were refereed and published in a journal, whereas Ernst's remarks were simply a quote in a newspaper.) Perhaps we could add a sentence: "Vickers responded by citing evidence that suggests that the effect is not the result of a placebo." TimidGuy (talk) 11:20, 15 November 2013 (UTC)

What evidence did Vickers cite? Vickers response was his own opinion that has not been proven. QuackGuru (talk) 17:15, 15 November 2013 (UTC)

Well, so was Ernst's. --Mallexikon (talk) 04:20, 16 November 2013 (UTC)

Vickers cited a double-blinded study by Irnich that found a statistically significant difference that couldn't be attributed to a placebo effect, thus refuting Ernst's speculation. TimidGuy (talk) 11:58, 16 November 2013 (UTC)

Well, so was Ernst's? You are correct but what is included in the article is the opinion of Ernst that passed V. Vickers response was also his own opinion. But the proposal made by TimidGuy failed verification. You putting words in Vicker's mouth. "Vickers responded by "citing evidence that suggests"... That is original research. Editors do not make up there own conclusions about what Vicker's said. Where in the text did Vicker's say he "suggests" there is evidence.

"Vickers cited a double-blinded study by Irnich" Did Vicker's say this or are editors conducting there own review.

This is closer to the source: "Vickers responded by saying there was no bias in the study because investigators found a way around the problem of therapist blinding.[21]"

This is what Vickers said but Middle 8 said we don't need to include Vickers' remarks. There could of been consensus if Middle 8 did not reject the response by Vickers. But consensus can change. QuackGuru (talk) 19:42, 16 November 2013 (UTC)

"....we don't need to include Vickers' remarks on the laser study" was what I said, because we don't usually discuss single studies, and a letter to the editor isn't a good springboard for doing so (compared to a review article). But aside from that, I am in favor of summarizing Vickers' reply. --Middle 8 (talk) 18:45, 21 November 2013 (UTC)

However we word it, I think the essential point of Vickers is that the results can't be attributed to a placebo effect. Let's check with Middle 8. I didn't get the impression that he thought we should exclude Vickers's response. There's no policy reason for excluding it, and NPOV would suggest it be included. Also, it's unclear that a quote in a newspaper satisfies MEDRS, which disallows popular media as sources. And personally, I don't understand the opposition to Vickers, since the section already cites a number of research reviews that found a reduction in pain. TimidGuy (talk) 11:38, 18 November 2013 (UTC)

Middle8 only said that we wouldn't have to include Vickers' remark about the laser study, I think QG misunderstood him. Of course you can include Vickers' response if you want to. I personally don't think it is necessary, though. --Mallexikon (talk) 01:54, 19 November 2013 (UTC)

Why don't you think it's necessary? As it stands, it gives the impression that treatment is no better than a placebo, but Vickers study showed otherwise, and Vickers effectively refuted Ernst's speculations regarding why it might not be better than a placebo. TimidGuy (talk) 10:56, 20 November 2013 (UTC)

It would help your cause if you rewrote your proposal without putting words in Vicker's mouth. QuackGuru (talk) 16:54, 20 November 2013 (UTC)

Of particular importance is that Vickers is citing a single study, this does not apply to the Meta Analysis overall. Also clinical significance is of primary importance. A back and forth between two individuals should be limited in a WP article. Does Vickers allege that the Meta Analysis is not compromised by the general lack of blinding or that the results indicate clinical significance? These would be important points. Has another source commented on the Meta Analysis? - - MrBill3 (talk) 05:44, 21 November 2013 (UTC)

Hi, to clarify, I certainly believe Vickers' reply to Ernst should be cited in just as much detail as Ernst's comment. That is simple WP:WEIGHT. But in summarizing Vickers' reply, I do not think we should touch on his remarks about the later study. BTW -- let's not lose sight of the fact that Vickers' meta-analysis vastly out-weighs the followup comments of either Ernst or Vickers. So we might end up with 2-4 sentences on the meta-analysis, and then a single sentence on the back-&-forth. And sure, we can use expository text in footnotes, per an earlier edit by Mallexicon. -Middle 8 (talk) 17:10, 21 November 2013 (UTC)

Considerable undue weight to Ernst

At the moment (this version), we have a big undue weight problem: Vickers' meta-analysis is dwarfed by Ernst's remarks. (Vickers' reply to Ernst does not yet appear.) Remember that in the evidence-tier for both evidence-based medicine (EBM) and WP:MEDRS, meta-analysis ranks at the top and expert opinion at the bottom. Vickers' review is mentioned twice, and each time Ernst's reply gets not less weight, but considerably more. Note also WP:WTA in framing Ernst ("however"; "commented"), not to mention stating the title and position (when a wikilink would do) for one party but not the other.

• First instance:
  • Text devoted to meta-analysis: A 2012 meta-analysis found significant differences between true and sham acupuncture, which indicates that acupuncture is more than a placebo when treating chronic pain (even though the differences were modest).[22]
  • Text devoted to expert opinion: However, Edzard Ernst, emeritus professor of complementary medicine at the University of Exeter, disagreed with the study's conclusions and commented that it demonstrated that the effects of acupuncture were principally due to placebo.Footnoted text: In an article in The Guardian, Alok Jha stated:[23] Edzard Ernst, emeritus professor of complementary medicine at the University of Exeter, said the study "impressively and clearly" showed that the effects of acupuncture were mostly due to placebo. "The differences between the results obtained with real and sham acupuncture are small and not clinically relevant. Crucially, they are probably due to residual bias in these studies. Several investigations have shown that the verbal or non-verbal communication between the patient and the therapist is more important than the actual needling. If such factors would be accounted for, the effect of acupuncture on chronic pain might disappear completely".
• Second instance:
  • Text devoted to meta-analysis: A 2012 meta-analysis found acupuncture is effective for the treatment of chronic pain, specifically back and neck pain, osteoarthritis, and chronic headache.(source as above)
  • Text devoted to expert opinion: However, the study is disputed by professor Edzard Ernst, who commented that the meta-analysis demonstrated that the effects of acupuncture were largely due to placebo, since the difference in results from real or sham acupuncture were small and clinically irrelevant. Footnoted text: (cites to same footnote as above)

Enough said. Of course this is easy enough to fix; I'm just out of time right now. Will try later, or if someone else wants to, go for it. --Middle 8 (talk) 18:37, 21 November 2013 (UTC)

Ernst is not the only person to comment on Vicker's meta-analyis. Which of these comments, published in JAMA Internal Medicine, warrant inclusion? An "Invited Commentary" (this seems to give some weight) by Andrew L. Alvins, Needling the status quo: Comment on “Acupuncture for chronic pain” which has the text, "The conclusion that most of acupuncture's observed clinical is mediated by placebo effects..." and "...critics correctly note that a new pharmaceutical agent that fails to show superiority over placebo will not be approved. Why should the bar be lowered for acupuncture?" Placing acupuncture in perspective by Ziegelstein which questions the lack of context in comparison of effect size (and has another point behind the paywall). Acupuncture's elephant in the room by Barrett and London which points out the difference between study and practice as does Complexity of sham acupuncture (Huang et al.) which also notes some issues with the sham controls.

In terms of weight Vicker's reply to Ernst mentioned ONLY ONE study among those in the meta-analysis this does not support the entire analysis as using double blinded studies that overcome the placebo effect. As above Alvins seems to have the same opinion as Ernst. I know in general we use substantially stronger MEDRS but criticism of the meta-analysis published in the journal which published it seems applicable. Note Vickers also had a reply in JAMA Internal Medicine to the above (I don't have access to it right now).

Regarding the balance of meta analysis vs Ernst's commentary I think you have a valid point we should be able to reach some consensus on editing down the material from Ernst. I do think material in the notes section should be allowed but I remain open to input on that (everything else too for that matter).

refs

Best. - - MrBill3 (talk) 07:56, 22 November 2013 (UTC)

Here's the text of Vickers's reply:

(possible copyright vio removed)

With all these published, refereed sources available, it seems unnecessary to use a newspaper as a source. We can probably leave out Ernst (which in fact may not comply with the MEDRS proscription against popular media). TimidGuy (talk) 11:30, 22 November 2013 (UTC)

Of all the criticisms it seems Alvins is the one that has weight and bearing. Ernst may still qualify as expert opinion. - - MrBill3 (talk) 11:53, 22 November 2013 (UTC)

More great finds, thank you! (Boy do I wish I lived closer to a good library.) Agree, we should cite (and properly weight) the most substantive reply or replies, i.e. those that explain their positions, ideally in a journal. To be continued.... regards, Middle 8 (talk) 13:19, 22 November 2013 (UTC)

Still not clear in what way Ernst complies with MEDRS. Non-evidence-based expert opinion is nearly at the bottom of the MEDRS hierarchy. Ernst doesn't offer any evidence. He is simply speculating about what future studies might show. In addition, MEDRS says, "The popular press is generally not a reliable source for scientific and medical information in articles." TimidGuy (talk) 12:11, 25 November 2013 (UTC)

I tend to agree with TimidGuy's argument. Ernst's newspaper statements deserve low weight. He is a highly published, well recognized authority so a mention of his statement might still be warranted. BTW most of the text of the other refs I gave is available on their "preview" pages. - - MrBill3 (talk) 15:40, 26 November 2013 (UTC)

Thanks. Send me an email if you'd like to see pdfs of any of the sources. TimidGuy (talk) 11:25, 27 November 2013 (UTC)

I'll propose some new wording. And in the spirit of compromise, I'm open to including Ernst's statement. But I just wish there were something in MEDRS that supports using it. I can't see that there is. Non-evidenced-based opinion is at the bottom of the hierarchy. TimidGuy (talk) 12:06, 2 December 2013 (UTC)

Thanks for refocusing on this; I'll have a closer look. Agree re deprecating Ernst; I'd prefer to include something else, something with substantive criticism/comment, not just opinion. And not overdo the commentary's weight relative to the source (something I'm pretty sure you already agree with; just saying). --Middle 8 (talk) 13:05, 2 December 2013 (UTC)

So maybe we should go ahead and replace Ernst with the Avins commentary that appeared alongside the Vickers review. TimidGuy (talk) 15:53, 8 December 2013 (UTC)

This is a notable controversy and there is a disagreement with Vickers. There was a previous discussion to include the disagreement. See Talk:Acupuncture#Disagreement with Vickers. NPOV policy seeks some form of balance. When there is an opposing POV, we try to let each get the coverage according to RS, without allowing the article to become either a hit piece or a hagiographic sales brochure. The WP:SECONDARY source used in the article is a critique of the Vickers meta-analysis reported in The Guardian. The Ernst statement is the opinion of an expert which does have WP:WEIGHT. QuackGuru (talk) 18:03, 8 December 2013 (UTC)

The Ernst source simply doesn't comply with MEDRS. It's at the bottom of the hierarchy. Avins is a much better source for the disagreement. It complies with MEDRS and the criticism is more substantial. TimidGuy (talk) 12:07, 9 December 2013 (UTC)

The article is summarising a real world controversy which included comments from Avins. "At least in the case of acupuncture, Vickers et al have provided some robust evidence that acupuncture seems to provide modest benefits over usual care for patients with diverse sources of chronic pain," wrote Avins.[24] Avins is mostly in agreement with Vickers. The conclusion that most of acupuncture's observed clinical is mediated by placebo effects..." is not really explaining the controversy and the article is also supportive of Vickers.[25] QuackGuru (talk) 21:02, 10 December 2013 (UTC)

Ok we obviously have a pundits' controversy here... And I see two questions: 1.) If we want to include this controversy, what rational criteria do we chose in regards to which opinion to include? (Because we obviously can't include all letters to the editors we can find. And while Avins probably ranks very high in terms of MEDRS criteria... not sure where Ernst would be placed) 2.) We don't usually include commentaries about reviews and I'm a little concerned about creating an original precendent... Should we maybe leave this controversy out altogether? --Mallexikon (talk) 03:18, 11 December 2013 (UTC)

Are letters to the editor compliant with MEDRS? No. Some people think that every utterance from Ernst should be the main body of every article on CAM subjects. Thats ridiculous. Either we only accept secondary sources (systematic reviews) on the subject of efficacy or we don't. If we don't, then primary sources are fair game right? Ernst's letter is a fucking letter and does not belong as a source here. Herbxue (talk) 06:05, 12 December 2013 (UTC)

Well, it's not a letter as far as I understood it, it's a quote from him in a newspaper article... thus, the newspaper article would constitute a secondary source. --Mallexikon (talk) 06:13, 12 December 2013 (UTC)

MEDRS says not to use popular media as a source, so The Guardian shouldn't be used. Ernst simply speculates that future double-blinded studies may show that acupuncture is no better than a placebo. It seems silly to include this speculation in the article. On the other hand, while I disagree with Quackguru, who characterizes this review as controversial, I do feel there are clarifications and qualifications that could be added. For example, Vickers says that the results compared to treatment as usually are clinically significant. The commentary (which is not a letter) by Avins questions whether the results are clinically significant. Also, Vickers emphasizes the finding that acupuncture has a statistically significant effect compared to a placebo, but his characterization of the effect as "modest" glosses over the fact that it's not clinically significant. I vote for clearly stating Vickers's findings and then citing Avins to qualify them somewhat. TimidGuy (talk) 11:36, 12 December 2013 (UTC)

Thank you for pointing this out. I believe that this is an issue of undue weight (WP:UNDUE) and dispute that, in the midst of so many great sources used in the article, an editorial like this would be used (WP:MEDRS). I can't think of any articles of GA or B class in WPMed which use this structure: "A metaanalysis found that... However, in an editorial, X said...". I had a look at this article following the discussion on WP:MED and have left a comment below to this regard. Kindly, --LT910001 (talk) 10:49, 16 December 2013 (UTC)

Alright, that kind of answers my questions... So do we have consensus to leave the Vickers/Ernst controversy out altogether? --Mallexikon (talk) 11:29, 16 December 2013 (UTC)

I support leaving out Ernst. I just don't see how it possibly complies with MEDRS. It's not clear to me that Avins isn't compliant, but I'd go along with leaving it out. I would, however, like to reword the presentation of Vickers so it's clear that he found a clinical significant reduction in pain and that there was a statistically significant difference between acupuncture and a placebo. TimidGuy (talk) 12:19, 16 December 2013 (UTC)

I fixed the structure and weight concerns. The text is shortened to satisfy weight. QuackGuru (talk) 16:54, 16 December 2013 (UTC)

Well, no, the weight concern is not fixed. So far, consensus indicates to leave Ernst's comment out altogether, for the reasons given above. --Mallexikon (talk) 05:00, 17 December 2013 (UTC)

Commentary from individuals

I had a look at this article based on a discussion in WP:MED and found this article's use of quotations very odd. In particular, it seems to selectively quote from individuals in several places, which not only is an issue under WP:UNDUE and WP:MEDRS but also somewhat strange to read in a medical article. Here is a list of the quotations:

• "A report for CSICOP on pseudoscience in China written by Wallace Sampson and Barry Beyerstein said:...". This particularly concerns me: "A few Chinese scientists we met ..." (?!!)
• "Acupuncturist Felix Mann, who is the author of the first comprehensive English language acupuncture textbook Acupuncture: The Ancient Chinese Art of Healing,[73] has stated in lectures that ..."
• "A delegation of the Committee for Skeptical Inquiry reported in 1995:[48]"
• "but it remains controversial among medical researchers and clinicians.[10] In 2006, a BBC documentary Alternative Medicine filmed a patient "
• "Psychologist John Jackson stated that, "Acupuncture, both as a field of study and in practise, contains many of the hallmarks of pseudoscience. It is based on untenable principles and the small amount of evidence there is to support its use in pain relief can also be called into question"
• "Steven Salzberg, director of the Center for Bioinformatics and Computational Biology and professor at the University of Maryland stated that,"
• " Steven Novella, Yale University professor of neurology, and founder and executive editor of the blog "
• "However, Edzard Ernst, emeritus professor of complementary medicine at the University of Exeter, disagreed with the study's conclusions "
• "The consensus statement and conference that produced it were criticized by Wallace Sampson..."
• "Brent Bauer comments on the Mayo Clinic website that it "it may be worth trying acupuncture" if other, more conventional treatments haven't helped in the treatment of low back pain, while noting that there was no difference in effectiveness between sham and real accupuncture.[187]"

Acupuncture may be effective in some domains, however there appears to be enough medical evidence (WP:MEDRS) for the lack of efficacy in many areas that many of these selective quotes could be replaced with sources more in keeping with WP:MEDRS. Kind regards, --LT910001 (talk) 11:04, 16 December 2013 (UTC)

Thanks for your input. I'm not sure if you a aware of the situation here though... We do have enough MEDRS for both effectiveness of acupuncture in some fields and non-effectiveness for other fields already. However, most skeptics still find the article somehow too pro-acupuncture. Almost all the quotes you listed above were included in order to satisfy the skeptics camp and to present more criticism. I don't see how we can remove these quotes without starting another edit war. --Mallexikon (talk) 11:25, 16 December 2013 (UTC)

Have flagged this on WP:MED. I understand this may be a matter of some contention, but I would point out that MEDRS is not a threshold for an article as a whole, but a guideline for the use of every single source in a medical article. Sources from individuals are not reliable medical sources, and including full quotes from such sources is an example of WP:UNDUE. There appears to be enough reliable sources in the article that reliable sources and quotes could be substituted instead of these claims. --LT910001 (talk) 12:57, 17 December 2013 (UTC)

To be picky MEDRS is not quite "a guideline for the use of every single source in a medical article" but (to quite the guidance) for "biomedical information in all types of articles". Articles on "medical" topics may contain material that doesn't need MEDRS sources, and conversely articles on "non-medical" topics may contain health information which does. Alexbrn ^{talk|contribs|COI} 13:09, 17 December 2013 (UTC)

Editorial discretion is involved in articles. For example, discredited studies from dated German acupuncture trials are allowed to remain in an article. Editors know the primary sources fails WP:MEDRS and low levels details fails WP:WEIGHT. It was is not simply background information dumped into the coat rack article. See WP:COATRACK. QuackGuru (talk) 16:51, 17 December 2013 (UTC)

I think LT910001 made his case very clear and there's actually no rational argument against it. I'll start removing the material he cited. --Mallexikon (talk) 07:59, 22 December 2013 (UTC)

Absolutely not, on ALL counts. LT910001 is wrong about the application of MEDRS, and you would do well to not remove any properly sourced material without consensus. Alexbrn is quite correct about MEDRS. -- Brangifer (talk) 08:11, 22 December 2013 (UTC)

You've got to be f****g kidding! You make such an absurd statement of intention, and one minute later you actually dare to do it! Have you no idea what vandalism is? Deletion of properly sourced material amounts to vandalism. Don't do it. EVER. Discuss your intentions first, and wait (a long time) to see what reaction you get. You must have extremely good reasons for deleting properly sourced material, and usually it's better to tweak the content, rather than delete it. Violating NPOV by deleting opposing POV is very wrong. -- Brangifer (talk) 08:19, 22 December 2013 (UTC)

And you do it again, after I had reverted you with a BRD notification. To make sure the record is clear, I have notified you about edit warring/vandalism on your talk page. -- Brangifer (talk) 08:29, 22 December 2013 (UTC)

Comment - Agree with User:LT910001. Commentary fails WP:MEDRS -A1candidate (talk) 08:58, 22 December 2013 (UTC)

They are flat out wrong. You don't understand MEDRS. It does not cover all content, only direct medical claims. Commentary, opinions, and controversies are not covered by MEDRS. -- Brangifer (talk) 09:15, 22 December 2013 (UTC)

@Brangifer: I made 2 different edits based on the rationales raised here and at Wikipedia talk:WikiProject Medicine#Arbitrary section break - rationales that show very clearly that the material is not properly sourced. Now you've both used profanity ("You've got to be f****g kidding!") and accused me of vandalism. WP:IDENTIFYUNCIVIL comes to mind, and I feel that you try to intimidate me. Would you bother to apologize? --Mallexikon (talk) 09:18, 22 December 2013 (UTC)

It would be stretching it to say this is covered by MEDRS; this is really a case of two academics having a slight difference of opinion on the emphasis given in presenting a conclusion, and not directly "biomedical information" as such. As has been pointed out before, Ernst is not disagreeing with Vickers et al. They say "... acupuncture is more than a placebo. However, these differences are relatively modest ..." and Ernst says "... the effects of acupuncture were principally due to placebo ..." (my emphases). As expert opinion it seems perfectly okay to me as a gloss. I don't see any strong case for its removal (and certainly not without consensus: there's too much edit warring going on here). Alexbrn ^{talk|contribs|COI} 09:22, 22 December 2013 (UTC)

Exactly. Discussion is good, edit warring is bad. Mallexikon, I have explained quite clearly on your talk page why I didn't consider your edits vandalism, even though the appearance and effect was the same, and that continuing to make such deletions would be considered vandalism, since you are now warned. Otherwise we're not children. -- Brangifer (talk) 09:37, 22 December 2013 (UTC)

Edit warring is bad; would encourage consensus-building where possible. For editors who have arrived from WP:MED, I have expressed a previous opinion about the article here (Wikipedia_talk:WikiProject_Medicine#Concerns_of_LT910001) that elaborates on my concerns. --LT910001 (talk) 10:05, 22 December 2013 (UTC)

The comments in question seem to be a clear reflection and exposition of the mainstream scientific consensus and are properly sourced. They are not the type of specific "biomedical information" referred to in MEDRS. They should not be removed unless and until there is material that indicates this is not the mainstream scientific consensus. WP policy is clear that the mainstream scientific consensus is due most weight and should be clearly expressed. Even valid MEDRS of details and results that contradict the consensus should be constricted by due weight. Comments and explanations that reflect the mainstream scientific consensus belong in the article and should not be removed.

Having presented my opinion I urge collegial consensus building. - - MrBill3 (talk) 12:55, 22 December 2013 (UTC)

MrBill3, regarding your statement here: "They should not be removed unless and until there is material that indicates this is not the mainstream scientific consensus." - There are tonnes of mainstream academic sources indicating that the material being added is a false claim. I would be happy to show my sources to you, as well as anyone else who is willing to listen. -A1candidate (talk) 15:33, 22 December 2013 (UTC)

My sense from having looked at research reviews is that mainstream consensus is generally that acupuncture reduces pain. See, for example, Berman in the New England Journal of Medicine, which recommends it for low back pain. I don't think there's mainstream consensus that it's the same as a placebo, since some meta-analyses find it the same, others find it statistically significantly better than a placebo, and at least one recent meta-analysis finds it clinically significant compared to a placebo. We should be using these sources, not what someone says in a newspaper. TimidGuy (talk) 15:45, 22 December 2013 (UTC)

Alexbrn is correct regarding the application of MEDRS. A1candidate, if you have sources we are not using, please do present them. Thanks!   — Jess· Δ♥ 16:32, 22 December 2013 (UTC)

Ernst's expert opinion is the mainstream POV. It must be kept to maintain NPOV. If editors want to tackle the real MEDRS violations they should look here. QuackGuru (talk) 19:50, 22 December 2013 (UTC)

@A1candidate: First "the material being added" material is not being added. Second "is a false claim" please be specific what is being claimed in which statement and what is said in what source that falsifies it. Please refrain from invoking tonnes of sources without specifying the source and the content that supports your assertion. Remember as has been explained what is being discussed is the mainstream scientific consensus.

@TimidGuy: Please give citation for Berman that you refer to. Mainstream consensus seems reflected by the included comments. A few analyses wavering between equal to placebo or somewhat better than placebo do not seem to have swayed mainstream consensus. However if as you say NEJM has an article actually recommending acupuncture as treatment that should be included. Expert commentary that represents mainstream consensus belongs in the article if you have multiple sources that seem to indicate mainstream consensus is different from the comments in the article, provide the sources, identify the comments they contradict and propose new content. - - MrBill3 (talk) 00:35, 23 December 2013 (UTC)

There does not appear to be the consensus among users for inclusion of certain content, regardless of whether the content does or does not reflect scientific consensus. On my current read of this situation: --LT910001 (talk) 00:47, 23 December 2013 (UTC)

• In support of inclusion: QuackGuru, MrBill3, BullRangifer, Alexbrn)
• Objecting to inclusion: LT910001, TimidGuy, A1candidate, Mallexikon

As pointed out in my comment to A1candidate. This is not a discussion about inclusion or not. This is a discussion started by LT910001 objecting to content that has been present in the article for quite some time. Consensus was reached when the material was added and has stood until this recent objection. The lengthy bulleted list represents 8 comments, specific edits regarding each comment have not been discussed. So far I have yet to hear a policy based argument that these comments do not represent mainstream scientific consensus either. - - MrBill3 (talk) 01:01, 23 December 2013 (UTC)

Can you point me to any evidence of consensus on the talk page? I have had a very quick look through the archives and can't find the consensus to which you refer. --LT910001 (talk) 01:10, 23 December 2013 (UTC)

MrBill3, the false claim is this:

"Commenting on this meta-analysis, professor Edzard Ernst stated that it demonstrated that the effects of acupuncture were principally due to placebo."

Ernst's commentary is a fringe viewpoint that is not accepted by the mainstream academic community. Are you willing to let me show you why? -A1candidate (talk) 01:24, 23 December 2013 (UTC)

A1candidate, you're forcing me to repeat myself. If you have sources, present them. Please stop edit warring. You don't need to request permission to state your case, and even if you felt you did, you shouldn't be edit warring to your preferred version in the meantime. Either demonstrate what you're claiming, or move on, please. Well sourced content should not be removed from the article, amid opposition on talk, without attempting to reach consensus first.   — Jess· Δ♥ 01:45, 23 December 2013 (UTC)

What he said. - - MrBill3 (talk) 01:52, 23 December 2013 (UTC)

1.) The only rationale I've seen here for including Ernst's comment is that it's an "expert opinion reflecting mainstream consensus". Well it's definitely an expert opinion, but can you prove with a MEDRS that it's also "mainstream consensus"? 2.) Vickers study is a scientifically well done meta-review. Ergo, it's a MEDRS. Ergo, its conclusions already are mainstream consensus (because they're scientifically proven). The question here is, do we want to set a precedent? And have some professor's commentary added to the conclusions of every meta-review, just because those conclusions don't fit some people's world view? --Mallexikon (talk) 02:33, 23 December 2013 (UTC)

I've just added the result of a more up-to-date meta-analyasis of the same data set, from a less conflicted source (i.e. not the Acupuncture Trialists' Collaboration). This too is emphasizing "little evidence" between sham and true acupuncture (and some interesting things besides). As I said above, there is really no great dispute here: all the sources agree in substance and only differ in how they emphasize certain aspects of their findings.

Incidentally, this whole section is very poor content: largely a shopping-list of undigested conclusions from papers. It would be better replaced with a paragraph or two simply saying what needs to be said here: MrBill3 said it nicely: "A few analyses wavering between equal to placebo or somewhat better than placebo". Alexbrn ^{talk|contribs|COI} 02:47, 23 December 2013 (UTC)

@Mallexikon: 1)I think the more recent meta analysis and edit by alexbrn validate Ernst's commentary and place it in appropriate context. MEDRS do no provide mainstream consensus they provide biomedical information. 2) "Ergo, its conclusions already are mainstream consensus" is simply not true. Mainstream scientific consensus is built over time across a broad spectrum of studies, replication, analyses and exploration of mechanisms as well as meetings of professional organizations etc. etc. A single meta analysis does not automatically create mainstream scientific consensus with its results. In this particular case another meta analysis was done and the results were different. - - MrBill3 (talk) 02:58, 23 December 2013 (UTC)

1.) The new study Alexbrn included is not helping us here with the Ernst comment problem. This new meta-analysis might use the same data set as Vickers (I haven't checked whether that's true) but it doesn't look for efficiency difference between verum and sham acupuncture - it takes the efficacy of acupuncture as a fact ("Background - Recent evidence shows that acupuncture is effective for chronic pain...") and only studies in which way the characteristics of verum acupuncture influence the outcome. Please read the whole text and not just the summary (the cherry-picked quote "When comparing acupuncture to sham controls, there was little evidence that the effects of acupuncture on pain were modified by any of the acupuncture characteristics evaluated" can be a little misleading... It gets clearer in their conclusion: "There was little evidence that different characteristics of acupuncture or acupuncturists modified the effect of treatment on pain outcomes.) This study doesn't belong into the "efficiency" subsection, since it's not an efficiency analysis.

2.) Alright, I find your definition of mainstream consensus "built over time across a broad spectrum of studies, replication, analyses and exploration of mechanisms as well as meetings of professional organizations etc. etc." acceptable, however, Ernst's comment doesn't fit it. It's a single man's single comment on a single meta-review, and we shouldn't set this kind of precedent. --Mallexikon (talk) 04:09, 23 December 2013 (UTC)

Mallexikon, thank you for your considered response. I concede that I should take some time and read the new study in its entirety and that I have not done so. IF (and it seems there is some contention) Ernst's comment is expert commentary reflecting mainstream consensus it should remain and is by no means a new precedent. A1candidate is presenting some information to support the contention that Ernst does not reflect mainstream consensus. I think some material to support that it is mainstream consensus is reflected in one of the sources I provided in the prior discussion of Vickers v. Ernst. I will recheck that and await possible additional material from A1candidate. As I said a full reading of the newer study may help clarify the issues for me. - - MrBill3 (talk) 04:42, 23 December 2013 (UTC)

I think Mallexikon is right about the thrust of the newer study not being directed at the sham/real difference, and have clarified accordingly. Nevertheless, its emphasis on this issue seems aligned with Ernst's: "Given the results of the primary research [1] showing small differences between real and sham acupuncture, it is not surprising that the current analysis showed little evidence of substantial differences between alternative approaches to acupuncture". Alexbrn ^{talk|contribs|COI} 04:48, 23 December 2013 (UTC)

I'd like to emphasize once more that this study has the statement "Recent evidence shows that acupuncture is effective for chronic pain" in its Background section. Regarding the discussion about what the mainstream consensus on acupuncture efficiency is, this sentence is actually the closest thing to evidence I've seen here so far. --Mallexikon (talk) 06:29, 23 December 2013 (UTC)

I think the National Health Service is the most mainstream-ish source I've seen. WP:MEDRS "in a nutshell" says to look for "reputable medical journals, widely recognised standard textbooks written by experts in a field, or medical guidelines and position statements from nationally or internationally recognised expert bodies". Isn't the NHS an example of the latter? The NHS says: "There is some scientific evidence that acupuncture is effective for a small number of health conditions." This exquisitely hedged statement is an almost perfect summary of where the literature stands. The lede has been wobbling (example diff, not necessarily illustrative) around language like: "Existing evidence { is consistent with | does not rule out } acupuncture being no more effective than a placebo". Equally, existing evidence is consistent with there being a small effect beyond placebo. It sounds like we need to come up with a non-weaselly way of saying, in the lede, that there's disagreement over whether or not it's a placebo -- like I just did, maybe -- as opposed to playing the semantic glass-half-full-or-empty word games. --Middle 8 (talk) 10:26, 23 December 2013 (UTC)

Middle 8, I like your reasoning. Would you please formulate a wording we could use? We might be able to hammer out a compromise here. -- Brangifer (talk) 16:11, 23 December 2013 (UTC)

Extended discussion

@MrBill3 and Mann_jess - The challenge for me, really, is to decide what type of sources to present to both of you, whether it is the consensus of international health authorities, national health authorities or mainstream medical journals. For starters, let me quote from a mainstream medical textbook for physiology students:

"...Because the Chinese were content with anecdotal evidence for the success of AA (acupuncture analgesia), this phenomenon did not come under close scientific scrutiny until the last several decades, when European and American scientists started studying it. As a result of these efforts, an impressive body of rigorous scientific investigation supports the contention that AA really works (that is, by a physiologic rather than a placebo/psychological effect)..."

— Human Physiology: From Cells to Systems (2013)

My experience of editing this page and my previous debates with many of the same editors have taught me that in most cases, it is futile to even start a discussion for various reasons. Having said that, I sincerely hope that both of you keep a fair and open mind, and I believe that both of you are willing to do so. Otherwise, we'll just be wasting all of our precious time. If you have any honest questions or issues which you would like to raise, I'll be happy to address them. -A1candidate (talk) 02:49, 23 December 2013 (UTC)

This source seems to present at least marginal support for your contention. I see two substantial issues with it. First is that the material is provided in "boxed content" with the heading "Concepts, Challenges and Controversies" and the title "Acupuncture: Is It For Real?" it is not presented as mainstream consensus or accepted biomedical information included in the text. Second it also states, "In the United States, AA [Acupuncture Analgesia] has not been used in mainstream medicine [...]". That seems to contradict your assertion. Also the support it cites is for the "acupuncture endorphin hypothesis" not for qi, meridians or much of what acupuncture is purported to do.

@A1candidate: Thank you for presenting this information and I look forward seeing what other sources you (or others can provide). As for your quandary regarding what information to provide I suggest you start with the strongest, particularly those which explicitly state there is a consensus in the scientific community. You addressed your comment to myself and another editor and you stated your experience with "many of the same editors". Two specific/many of the same? If you are frustrated by prior seemingly futile attempts you should have used the appropriate processes. In posting here and now please proceed with good faith and an assumption of such. In other words skip the complaints about the past, hope for fair and open mindedness and concerns about wasting time and stick to discussion of editing content and the policies that apply. - - MrBill3 (talk) 05:36, 23 December 2013 (UTC)

"Several Cochrane reviews of acupuncture for a wide range of pain conditions have recently been published. All of these reviews were of high quality. Their results suggest that acupuncture is effective for some but not all types of pain." Source: Lee, MS; Ernst, E (2011). "Acupuncture for pain: An overview of Cochrane reviews". Chinese Journal of Integrative Medicine 17 (3): 187–9. [26] --Mallexikon (talk) 07:31, 23 December 2013 (UTC)

@Mallexicon, ahem, that's a fringe journal ... oops... gulp... ZOMFG it's Ernst.... (brain explodes). (/snark) As Alexbrn linked to above, Ernst himself thinks acu is a placebo (doesn't he?). And scientific consensus may well end up there. But sci consensus lags the opinions of whoever turn out to be right, just as WP lags the science. I don't think the article should assume consensus in any direction, although it's amusing to see (as we sometimes do) better MEDRS's for the it's-not-just-a-placebo side than the yes-it-is side. --Middle 8 (talk) 10:45, 23 December 2013 (UTC)

I wouldn't call the text A1Candidate cites a sci-consensus-level source; only statements from scientific academies and comparable bodies rank at that level (see Scientific opinion on climate change and List of scientific societies explicitly rejecting intelligent design for examples of such sources). But is an entirely acceptable MEDRS, and on the high end (i.e. closer to a meta-analysis of blinded RCT's than to a statement of expert opinion, because it's from a mainstream textbook and therefore has substantial editorial oversight). --Middle 8 (talk) 10:45, 23 December 2013 (UTC)

MrBill3 - Whether it's "boxed content" or non-boxed content seems to be a rather trivial issue to me. I don't think we should be arguing over how the authors decided to design their textbooks. Either the source is reliable, or it isn't. As for the part about acupuncture in the United States, the authors used the past form ("has not") instead of the present form ("is not") because they assert that the field of acupuncture has been accepted in recent years. Nobody (neither me nor the textbook authors) is claiming that acupuncture is scientifically proven to be based on meridians or whatsoever. -A1candidate (talk) 18:06, 26 December 2013 (UTC)

Use this primary source?

An editor recently added material on the cost-effectiveness of acupuncture that was sourced to this large RCT conducted in Germany and published in 2008 in the European Journal of Health Economics. [27] There are some errors in the material added, but I don't want to take the time to fix the errors if the material will eventually be deleted due to this being a primary source. Thanks. TimidGuy (talk) 12:05, 5 December 2013 (UTC)

The previous text was: A 2008 German study found acupuncture was cost-effective for chronic osteoarthritis pain.[175] There are other reviews in the Acupuncture#Cost-effectiveness section. Is there a reason to keep this primary source? QuackGuru (talk) 22:19, 26 December 2013 (UTC)

Another null-result from a sham acupuncture controlled study

http://onlinelibrary.wiley.com/doi/10.1002/cncr.28352/abstract

Consider adding it to the article.

jps (talk) 00:03, 28 December 2013 (UTC)

A small primary study; it adds little to the picture painted by the strong secondary material we've got. Alexbrn ^{talk|contribs|COI} 03:55, 28 December 2013 (UTC)

The article states, "research suggests that it is helpful in relieving some symptoms of cancer or the side effects of cancer treatment." And this study directly contradicts that. jps (talk) 04:11, 28 December 2013 (UTC)

@jps - This study actually supports, not contradicts, that statement from our article -A1candidate (talk) 05:24, 28 December 2013 (UTC)

jps, yes, it does contradict, but the source is not MEDRS compliant, so the text should be changed using other means and sources. It's still instructive, so thanks for sharing.

I just finished reading Paul Offit's book, Do You Believe in Magic?: The Sense and Nonsense of Alternative Medicine. Very interesting and well-written. Among many things he writes about acupuncture, he tells about Steven Novella's appearance on the Dr. Oz Show:

Dr. Oz: "I just think it's very dismissive of you to say that because we couldn't take this idea [acupuncture] that exists with a different mind-set and squeeze it into the way that we think about it in the West, that it can't possibly be effective."

"Novella knew that acupuncture was by definition a sham, a trick, a deception; yet he never once said, "Acupuncture doesn't work." Rather, he questioned why it worked. "It's the ritual surrounding a positive therapeutic interaction: a comforting, caring [clinician]," he said. "You're relaxing for half an hour or an hour. That's where the effect is. There's no effect to actually sticking a needle through the skin." In other words, the placebo effect." (p. 224)

So, that's where it's at. It's the placebo effect, a very non-specific effect. When a method, like acupuncture, does not rise above the placebo effect, it is a universal truth in science and medicine that the method is itself considered ineffectual. In common parlance we just say that it doesn't work as claimed, and the claims are false. Something else is going on that could just as well be induced by numerous other methods. Since other, truly helpful, methods exist which actually do far more than stimulate the placebo response, they should be preferred, and failing to do so is to practice below the expected standard of care, and that's dead wrong, unethical, quackery, and in some cases illegal.

It really worries me (for their own sake, and especially for their patients' sake) that A1candidate doesn't understand this. This failure means they are practicing deception and substandard practice, which can have serious and even fatal consequences for their patients. As far as editing here is concerned, it also means they don't understand the workings of the scientific method well enough to be competent in understanding and editing the medical and scientific aspects of subjects. -- Brangifer (talk) 06:55, 28 December 2013 (UTC)

Again with the over-the-top drama-Queen rhetoric. Even if most acupuncturists didn't realize that much of their clinical success came from non-specific effects of acupuncture (the "relaxation response"), they still would not being doing any more harm than collecting a paycheck for ineffective service. You suggest that their ignorance may have "fatal consequences" - really? Other than that Canadian massage therapist (a non-acupuncturist) practicing acupuncture without proper training or licensure, show me one bonafide example in the US or Canada of danger from a properly trained and licensed acupuncturist in the west. There is a reason why an acupuncturist's malpractice insurance costs $500 US per year while a typical MD pays $200,000 per year. Its because acupuncture is safe and often effective therapy.Herbxue (talk) 08:25, 28 December 2013 (UTC)

Didn't you read what I wrote?: "Since other, truly helpful, methods exist which actually do far more than stimulate the placebo response, they should be preferred, and failing to do so is to practice below the expected standard of care, and that's dead wrong, unethical, quackery, and in some cases illegal." Acupuncturists "treat" AIDS, cancer, diabetes, and myriad other conditions for which there are proven, effective, methods, methods which they often recommend against with claims that acupuncture will help. Failing to use effective methods can cause great harm. This applies to many more so-called "alternative" methods than acupuncture. Diversion from effective methods is one of the greatest weaknesses and dangers of using so-called "alternative" medicine. If it were used solely for treatment of relatively innocuous, self-limiting, conditions, the only harm would be the robbing of the pocketbook, but that's only part of the problem. -- Brangifer (talk) 17:52, 28 December 2013 (UTC)

I don't know the laws state-by-state, but AFAIK it's against the law in quite a few states in US for acupuncturists to claim to treat such things. And acupuncture schools teach that it's unethical to make such claims. --Middle 8 (talk) 01:43, 29 December 2013 (UTC)

That's good! Unfortunately many places that is not the case, and it doesn't apply just to acupuncturists. -- Brangifer (talk) 06:31, 29 December 2013 (UTC)

Sorry, why is the source not WP:MEDRS compliant? jps (talk) 10:58, 28 December 2013 (UTC)

It's one single piece of primary research, not a review or meta analysis. We rarely allow use of such sources. -- Brangifer (talk) 17:52, 28 December 2013 (UTC)

Have you read this article lately? It's full of references to such studies. jps (talk) 20:53, 28 December 2013 (UTC)

I could only find one such source (a null result for drug detox; we already have two reviews on the subject), and removed it. I didn't count the total number of reviews in the article, but it's on the order of dozens. User jps is perhaps thinking of a different article -- maybe the TCM one? --Middle 8 (talk) 04:19, 29 December 2013 (UTC)

That' probably true. I suspect the TCM article has such problems. -- Brangifer (talk) 06:31, 29 December 2013 (UTC)

I just checked, and the TCM article is also OK in terms of using reviews instead of individual studies. I could have missed a couple, but I saw only Cochrane-type reviews cited for efficacy. I have no idea what jps is referring to. --Middle 8 (talk) 23:31, 29 December 2013 (UTC)

That is problematic. Please tag each instance, and after that's done we can work on deleting them one at a time. That will allow specific objections and specific reversions to be dealt with appropriately. It needs to be done individually because it will likely demand revision of content. -- Brangifer (talk) 21:20, 28 December 2013 (UTC)

While we're on the subject of non-specific effects, a parallel study about homeopathy makes the same point as with the acupuncture study:

• Homeopathy has clinical benefits in rheumatoid arthritis patients that are attributable to the consultation process but not the homeopathic remedy: a randomized controlled clinical trial, Rheumatology, Volume 50, Issue 6, Pp. 1070-1082

I suspect this is the case with many methods where one sees an effect, but where there is no difference between control arms. "Doing something is better than doing nothing, but not better than doing anything else, and is worse than doing something effective." (you can quote me ) -- Brangifer (talk) 18:23, 28 December 2013 (UTC)

Therein lies the problem with this article and the TCM one - the average reader will come away with the impression that both treatment modalities are worthwhile, and might help what ails them, when in reality nothing could be further from the truth. It is really bad that they have been allowed to get this bad. --Roxy the dog (resonate) 21:01, 28 December 2013 (UTC)

That's what happens when scientifically illiterate editors are allowed to get their way unopposed. Giving equal weight to sources that are unequal also causes these problems. We need to find the problem statements and copy them here, then deal with them to fix these systemic problems where bias in favor of ineffective methods and unreliable sources has taken over. -- Brangifer (talk) 21:24, 28 December 2013 (UTC)

The reason the article gives the impression that acupuncture may have an effect -- and the reason some editors argue that the article should reflect that -- is because there are good sources that say so. See Ernst's summary of Cochrane Collaboration reviews, among others. (While he thinks acu is a placebo, that review-of-reviews shows he acknowledges that the literature at this point doesn't say that.) Most of the sources in the article, last time I read it carefully anyway, discussing efficacy are good, secondary ones.

Brangifer, are you really claiming above [28] that it's problematic -- and suggestive of editorial incompetence -- if A1Candidate does not believe acupuncture is a placebo?

I don't think that Roxy the dog and many other editors (based on comments I've seen around WP) understand the literature -- either that, or they're not giving due weight to the good sources that find acu is more than a placebo. (My comments about weighting sources apply to this article, not the TCM one.) --Middle 8 (talk) 02:51, 29 December 2013 (UTC)

I know that you understand this, but some here don't. Something can cause an effect (and the literature - and quote from Novella/Offit - shows that acupuncture does cause effects) and still be a placebo, because placebos do cause effects and draw forth placebo responses. This fact that there is an effect seems to be misunderstood as meaning that the effect of placebo/acupuncture/homeopathy/etc. is meaningfully comparable to a proven medical treatment which has a far greater effect, much further than the placebo effect one would expect from any action taken or exposure to a sympathetic practitioner. Again: "Doing something is better than doing nothing, but not better than doing anything else, and is worse than doing something truly effective." (you can quote me ) -- Brangifer (talk) 06:31, 29 December 2013 (UTC)

Your point would be well taken if we were discussing the primary sources on proposed mechanisms (that an effect of acupuncture, like triggering inflammatory cascade and endorphin release, is not equivalent to a clinically significant result). But we are talking about systematic reviews that compare acupuncture to placebos, so your point is not well taken. Acupuncture is shown to have an effect greater than inert placebo for certain types of pain. The ongoing insistence on using the word placebo in reference to acupuncture is based on an emotional feeling towards acupuncture that people have rather than the evidence. And by the way, ever wonder why MD's give antibiotics for obvious viral URI? Or dermatologists give steroids for everyrthing regardless of diagnosis? When you say that acupuncture does not rise to the standard of accepted biomedicine, what exactly is that standard? It is definitely not the utopian science based rational brilliant medicine you seem to think it is. Herbxue (talk) 09:12, 29 December 2013 (UTC)

@Brangifer - When Ernst's review of Cochrane reviews says that they find acupuncture is effective for pain, it means "effective beyond placebo", and this should be obvious from context. You didn't answer my question about what you meant, but the reason I asked was to give you a chance to walk it back, because it leads to a conclusion that's over the top. Your comment is pretty clearly saying (a) acupuncture is a placebo (i.e., only a placebo), (b) A1candidate doesn't understand this, and therefore (c) A1candidate lacks the scientific literacy necessary to edit WP sci + med articles (and is practicing deception and substandard medical care). Well, if that's true, then any editor/doctor who accepts Cochrane reviews, and believes Vickers' 2013 review etc., is guilty of the same things (or just the lack of WP-competence part if they're not a doctor). That's an absurd conclusion, since Cochrane reviews and sources like Vickers are indicators of mainstream opinion and (for that reason) among the best MEDRS's we have. I must be missing something... --Middle 8 (talk) 09:23, 29 December 2013 (UTC)

Nausea and vomiting section

(Meant this to be about nausea; was tired and typed "pain" above instead). The section on efficacy for nausea and vomiting has got some outdated cruft and could use a cleanup. Most recent Cochrane source on PONV is straightforward enough: P6 acupoint stimulation prevents postoperative nausea and vomiting with few side effects. Will suggest wording later. --Middle 8 (talk) 20:24, 31 December 2013 (UTC)

Legal and political status recent edits

In 2006, German researchers published the results of one of the first and largest randomized controlled clinical trials.[194] As a result of the trial's conclusions, some insurance corporations in Germany no longer reimburse acupuncture treatments.[194] The trials also had a negative impact on acupuncture in the international community.[194]

"...some insurance companies in Germany stopped reimbursement for acupuncture treatment]."[29]

• He, W.; Tong, Y.; Zhao, Y.; Zhang, L.; Ben, H.; Qin, Q.; Huang, F.; Rong, P. (2013). "Review of controlled clinical trials on acupuncture versus sham acupuncture in Germany". Journal of traditional Chinese medicine. 33 (3): 403–7. PMID 24024341. {{cite journal}}: Unknown parameter |displayauthors= ignored (|display-authors= suggested) (help)

As you can see from reading the 2013 review, the text is obviously sourced and is accurately written. Recently, I have noticed editors disagree with me every single time I start a new thread related to acupuncture. Let's see what happens this time. Remember, it does constitute a reliable source according to Mallexikon. QuackGuru (talk) 02:13, 27 December 2013 (UTC)

Avoid WP:TE and WP:IDHT and you'll find less disagreement arising. --Middle 8 (talk) 11:10, 30 December 2013 (UTC)

As I said, the text is neutrally written and it is also WP:MEDRS compliant. This review overrules primary sources and outdated sources. I object to deleting this relevant source. QuackGuru (talk) 19:22, 31 December 2013 (UTC)

@QG: I replied some at FTN, where you cross-posted about the issue. [30] My comment is about pushback in general, not this specific proposal, re which I haven't developed an opinion. What can I say that I haven't said before re: my hope that you'd take a new approach to editing? --Middle 8 (talk) 22:19, 31 December 2013 (UTC)