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Question That Has Still Not Been Answered!

• Question:

What exactly is accupuncturing and how does it work and what good does poking needles in someones body do?

Still missing - what is it good for

The article has been rewritten but still has a major problem - nowhere does the article say what acupuncture is actually good for. For the sake of argument, let's all agree it works. Great! But work for or against what? Post-operative nausea? That's rather limited isn't it. Methinks balancing your Qi is a bit vague. Medications and medical procedures have indications and counter-indications, or when to use them and when NOT to use them. There seem to be plenty of people working on this article that think using the human body like a Voodoo doll is a valid medical procedure. Can't anyone of those people answer this simple question: what is acupuncture good for? What are it's indications and counterindications? Come on people, it's real and serious medicine, and every other form of medicine has these, so what are they for acupuncture. It can't be something like 'just try it when you feel sick and see what happens' - at least I hope not. Every 'Western' doctor can tell you what your prognosis is with his methods. Acupuncturists (if acupuncture is the real proven medicine they say it is) should be able to do the same. Let's see some of it (or do acupuncturist have no idea what they're doing?).

Makes you wonder, doesn't it? ;-)

In a more constructive vein, on http://www.itmonline.org/arts/acuintro.htm the last section, A FEW COMMONLY USED ACUPUNCTURE POINTS, gives a shopping list of ailments treatable using 14 different "points used repeatedly, because of their versatility". Since evrything turns up in the list except the kitchen sink, I don't know if it is useful in the article. I also don't know how representative it is. On http://www.quackwatch.org/01QuackeryRelatedTopics/acu.html in the Dubious Claims section you can read, "The conditions claimed to respond to acupuncture include chronic pain (neck and back pain, migraine headaches), acute injury-related pain (strains, muscle and ligament tears), gastrointestinal problems (indigestion, ulcers, constipation, diarrhea), cardiovascular conditions (high and low blood pressure), genitourinary problems (menstrual irregularity, frigidity, impotence), muscle and nerve conditions (paralysis, deafness), and behavioral problems (overeating, drug dependence, smoking)." That is, for "believers", acupuncture is good for everything, for "skeptics" it is good for nothing. The only middle ground I see is for sympatheic skeptics it might be good for ailments like pain and nausea with a high psychological component. Can we write that in the article? Art Carlson 10:23, 2005 Feb 21 (UTC)

An Answer

The problem I see here is that Chinese medicine and acupuncture are not "good for something" or "against what", this is not how it is thought about. This is a western way to think about it! We acupuncturists look at it like this.

You have a person that is a system. You have the universe that is a second system. Both the person system and the universe system are ONE. So if there is a problem with one or the other then they both have a problem. Sickness in a person is from that person being out of balance so to fix the patient you need to bring them back into balance. There really is not something to be against. Chinese medicine is used to fix all problems IE bring the patient back into balance or really to not let them get out of balance in the first place. If your patient is sick then you have already failed! Even during the black plague some people stayed healthy. Why? Chinese medicine would say because they were very well balance and had gotten good jing qi (DNA) from their parents.

Chinese medicine is used to fix all problems. It has no limits. The same can be said for western medicine. We use it to tackle all problems from cancer to bipolar disorders to car crashes. This is not to say that Chinese medicine is the best choice for all problems but that during it's long history it might have been the best and only choice at the time. In thousands of years you are challenged by a lot of problems.

So the next question is what treatment works best for what problem. Learning the answer to that question has taken me four years of intense post graduate study and there is still much to learn. It is also still being researched using modern science. Unfortunately the experiments are often very poorly designed by hostel parties and run by lowly qualified acupuncturist, but that is off topic.

Trying to understand this medicine from outside the system is like trying to understand computer programming without believing in logic. Understand logic and programming is easy to learn. Understand qi, blood, fluid metabolism, five element, the organs and the system of changes that happen with it and you will understand what can be treated.

In short needles are used to fix problems with the qi flow (more yang problems) and their resulting issues. Herbs are used for more material (more yin) problems such as blood deficiencies like a lack of iron, vitamins or vital liquids. Tui na is used for setting bones and relaxing muscles. Of course there is much overlap and also other many other techniques to a system that is thousands of years old.

Another way to look at it is that a “sickness” has a root and it has leaves. The leaves are the symptoms. The root is what is causing it. For example a patient has a headache. The pain is a leaf. The root can be harder to find but for the example we will say it is tension. In Chinese medicine you will find that the source of the pain starts in the top of the shoulder half way between the neck and the top of the arm. This point is called Gall Bladder 21. The Gall Bladder is related to the thought of making decisions and is a yang organ. The yin organ that goes with it is the liver. It's sick emotion is anger. One way to look at it is that the person has a weak Gall Bladder and thus is not making decisions well. Thus their anger gets stuck and tension builds up within this yin yang subsystem. This system effects all other system because the person is a whole and the person and the universe are a whole. This sickness effects their environment, their partner and the car they smash thinking about the anger.

To fix this problem the doctor must get the energy to move. To do this a needles would be place in Gall Bladder 21 to fix the leaf. Also a needle might be placed in Liver 3 and Large Intestine 4 to move the energy of the liver. An herbal formula maybe given and tui na may be used to relax the muscles too. On top of all this the patient will be told not to do stressful activities and maybe to take a vacation as well as exercise. The avoidance of caffeine and alcohol is helpful as is getting a good nights sleep, avoiding stressful TV shows, meditation and healthy eating.

Acupuncture Article Needs Serious Attention

I’m quite taken aback by this so-called “encyclopedic” article. It is my understanding that an encyclopedia is a comprehensive body of knowledge, but from what I’ve read, this article is nothing but a few people trying to make sense of acupuncture and fear that it is only quackery. The impression I get is that the people writing this article, in general, do not know what they are talking about and need to be educated about acupuncture and traditional Chinese medicine (TCM). The only information that I found informing was the history, some of the theory, and the potential risks. There is absolutely no need for the sections “controversy as to effectiveness”, “purported benefits” or any links that do not educate people on the theory of acupuncture. In other words there should not be anything biased in the article that leads a person to choose for or against acupuncture. And by all means, the article itself should not be used as a means to debate the effectiveness of acupuncture. (Hence the need to remove the sections, “controversy as to effectiveness” and “purported benefits” as well as removing any non-informative links

Thank you for your comments, but on this one point I totally disagree. When I read an encyclopedia article, I don't want to only hear what the subject says about itself. I want to know the source of the knowledge and how it fits into the rest of human knowledge, and in particular what science can say about it, if anything at all. There may be many ways to improve the article, but a discussion of the “controversy as to effectiveness” must be included in some form somewhere in Wikipedia. Art Carlson 09:11, 2005 Jan 24 (UTC)

Instead of using “purported benefits”, I recommend using “Benefits: According to TCM” and using only TCM, or other forms of Acupuncture theory, rather than trying to legitimize or incriminate acupuncture.

Currently, I am in my first year of studies at the Canadian College of Acupuncture and Oriental Medicine CCAOM in Victoria, BC, Canada and for those that wonder about specific information on the effectiveness or what it is good for, all I can tell you is that I need to study for four more years to know. I can, however, tell you that I have seen treatments work for facial paralysis, arthritis, various joint injuries, sciatica, herpes zoster and tinea versicolor.

Acupuncture is good for: heart rhythm, pain from sciatica, stiff necks, lung congestion, sinusitis, upset stomach, bleeding nose, depression, insomnia (those are all the conditions that it has helped me with)

• Well, if anyone in this college of yours can show any of these cures or effects is real, I feel a Nobel Prize for medicin coming! Did any of these cures make it into some real medical journals? I've got access to about all of them, so please tell me which one and which issue so I can look it up. FYI, herpes zoster is an asymptomatic disease, meaning you be infected without showing any symptoms. Then it comes and goes, on its own. You have simply seen the normal diseaseprocess as it would have been without any treatment whatsoever. I have my suspicions that goes for the other examples you mentioned as well.

• • I don't mean to butt in here, but if you're interested in reading some articles that have made it to "real" medical journals, I'm surprised you haven't found any yet. I suggest that if you have access to an online database such as PubMed or Academic Search Premier that a search on the term "Acupuncture" will yield a very large number of results (over 18,000 articles on Academic Search Premier 12th Jan 2006). Only if you're interested that is.... Piekarnia 08:43, 12 January 2006 (UTC)

In British Columbia, acupuncture and TCM is regulated and governed by the CTCMA and there are specific licensing requirements. In order for me to be a Doctor of TCM, I need to two years of prerequisites, and five years of study; I also need to have the core competencies that are listed by the CTCMA and pass the licensing exams. Not all places have set regulations for the practice of acupuncture, so it is best to make sure the acupuncturist you see is qualified. It is also important not to judge acupuncture or TCM itself based on a treatment you receive from someone that is not competent.

• You can regulate, license and qualify all you want, it doesn't change the fact that something does or doesn't work! That is something most people who are into alternative medicin miss completely. You can study something worthless for years, and it will remain worthless.

To answer the question about Qi: I actually wanted to study herbology and not acupuncture because I knew nothing about acupuncture, but after I received an acupuncture treatment, I experienced what is called “de qi” (a very difficult to describe sensation). Then I wanted to study acupuncture. I had not studied many meridians at all and I actually told the intern the exact pathway of a meridian I did not know. It felt like a wire moving inside my body and it was very pleasant. So now, I believe that the term “qi” is a name for a sensation that the Chinese played with and documented the results of what happened. Since western medicine has not explored this sensation, I think there is no proper translation and therefore, it seems like bogus.

Wow, so you felt the sensation... I can strongly recommend watching Penn and Tellers 'Bullshit'. In season one they have a lady who can just feel the energy flow all through her when they wave a magnet over her arm - a magnet that they demagnitized before taping!! She feels even more when they wave a huge magnet over her, made from aluminum raingutter. Do not underestimate the power of The Force, err, I mean, suggestion. They do a lot more to various people that seems to ridiculous to be true, but plenty of them feel all kinds of great and wonderful things. The power of suggestion is an explanation of what you felt without the need for Qi and meridians, things that no scientist has ever seen. And the power of suggestion can be experimentally repeated by anyone. Check the scientific method and Occam's razor and you might understand why Qi and meridians are not the scientific explanation for the sensation you (and that lady) felt. Oh, and Western medicine has explored that sensation and came up with, guess what, the power of suggestion as explanation and then moved on to real and more promising things. While you and other acupuncturists where out in Woowooland, they developed a number of new organtransplant-techniques, new keyhole operation methods, new treatments for AIDS, new anti-cancermedicin, new ways of fighting resistant germs and so on. All this in maybe just the last 5 years. I do pray, tell me, what has acupuncture achieved in that time? Or the last 500 or 1.000 years for that matter? (besides finding ever more places to safely stick needles into).

As for the question about when to see an acupuncturist, [edit: I ask myself if I] can wait to see a doctor. If I am losing a lot of blood, I might die shortly. Therefore, I can’t afford to book an appointment sometime later in the week to see a doctor of TCM. That would be silly. Instead, I would go to the emergency room. Now, if I knew I had a condition that could wait a while or I hear the phrase, “let’s wait and see if it goes away on its own” or, “there is no cure” or my personal favorite, “would you like some pain killers?” then I would definitely see a doctor of TCM.

• Whoa, wait a minute here! Ask yourself: Can I wait to see a doctor???? That's about the dumbest and most dangerous advice I've heard in years. One of the major dangers of quackery is that it keeps people away from effective medicin until it is too late. You are giving advice that effectively has that result. People without medical qualifications should not try and make a diagnosis, not on themselves or anyone else. They simply do not have sufficient knowledge. There are many things where you're not losing blood (like shock, which does not have any severe symptoms, or meningitis, that looks like flu) that'll kill you pretty quickly none the less. How about warningsigns of a cardiac arrest? No bloodloss. Without proper diagnosis, you can't tell if it can wait or not. Don't they teach you that sort of thing in TCM school? I guess not.

• • Yes, they do teach this stuff at my school, and you are right, I should not have told people to ask themselves if they can wait to see a doctor. That was wrong of me. I must also strongly emphasize that I am only in my first year of studies and I DO NOT know a whole heck of a lot right now. I need more schooling. Besides which, it is illegal for me to give any advice because I am not licensed. So, it is not advice. It is my own personal experience and my own views toward health.

For a really good introduction to TCM read “The Web that has No Weaver” by Ted J. Kaptchuk OMD.

And for a standard textbook about acupuncture read “A Manual of Acupuncture" by Peter Deadman, et al.

For some good websites online, try http://www.sacredlotus.com (was internalhealers.com) , http://tcm.health-info.org/index.htm , and http://www.acuxo.com/index.asp

Well, I took your advice and visited the websites. I'm not going to be accused of having an opinion without having looked up the relevant information. Just two gems I picked up from tcm.health, under diagnosis:

1) falling hair: in TCM, that apparently means blood deficiency. I'd think of things like side-effects of chemotherapy, hormonal problems, poisenous substances etc. but no, it's all simple blood deficiency. What that means in TCM, I haven't been able to find out from the site yet, but I suppose a transfusion with a few pints of blood will do the trick. After all, transfusions do involve needles!

2) Diagnosis by taking someones pulse by palpatation. That was a revelation, an epiphany! I'll never look at an ICU the same way again. I thought all those state-of-the-art machines, monitoring every detail of the patients circulation gave all the info one could ever need. Now I see it as a complete waste of money, since all I have to do is feel the pulse by hand and I know all about them! Seems I can even feel the kidney position. Silly me, I thought my anatomyclasses taught me where the position of the kidneys was. Apparently I've been lied to, and I need to feel the pulse to find out where in the body they're hiding.

(I do hope you can recognize sarcasm when you see it). I don't think I'll check out those sites any further, because the few hours I've spent reading them where a total an utter waste of my time, and I do have a life. If that is the best TCM can present for itself, it's not just a load of bullocks, but utterly pathetic as well. I simply can not fathom how anyone with the slightest knowledge of medicin can take any of it serious. Or anyone with a functioning brain to tell you the truth. I'm not sorry if I sound asinine, rude or whatever, since TCM (as one can see on the mentioned sites) is so obviously a load of crock that being polite and trying to discuss it seriously is pointless.

It doesn't take a rocket scientist to see that the TCM definitions of things like "Blood" (xue) and "Kidneys" (shen) aren't intended to function as equivalents of the anatomical organs or tissues with the same names (which is why the TCM terms are capitalized: no acupuncturist would argue otherwise). But thanks for pointing that out anyway; there's always someone around who just has to bayonet a straw man, and aim for the lowest common denominator in discourse just to score a sound bite.

The value of TCM theory, to the extent that it is valuable, lies in its ability to guide treatment (as the NIH consensus statement notes; see my comments under the Pseudoscience section). TCM theory predicted the efficacy of LI 4 at treating orofacial pain [1], and of moxa at UB 67 in turning a fetus from the breach position [2]. Could biomedicine have predicted these things? No, which is why it's good that people continue to study TCM theory; there is stuff of value there. It represents the accumulated knowledge of some very smart people from an earlier era, encoding their knowledge according to their prescientific cultural paradigm. This point recollects stories of healers of yore rubbing a piece of moldy bread on a wound to speed healing (the mold, of course, contained penicillin-like antibiotics).

Sorry if all this is too nuanced for the knee-jerk. politically-motivated, anti-CAM skeptical types, but I've found that most open-minded people don't have much difficulty understanding the point I'm making here. (P.S., please sign your posts out of consideration for readers.) -Backin72 (n.b.) 03:42, 15 February 2006 (UTC)

I hope this helps and I seriously hope to see a complete revamp of this article so that the article can deserve to be in an encyclopedia. As for me rewriting the article, I would, but right now I’m only learning the locations of the acupoints and I'm too busy studying to for upcoming tests. However, I may just add a few things once the semester is over, or when I just want a break from studying.

• Years of your life for studying acupuncture and you do not seem interested in information about its effifacy? Wouldn't you just hate it if you read an article on Wikipedia about acupuncture and think 'hey that's great, I'm going to be an acupuncturist' only to find out after wasting years of your life that it's complete nonsense? I'm not saying it is, but information that acupuncture is controversial to say the least should really be included. It is a fact, and facts should be in encyclopedias.

• • Thanks for bringing all this stuff up; it is good to get people thinking critically. However, I must say that Chinese thought is completely different from western thought and it is pointless for me to adequately argue against your comments now because I need to focus on passing exams and learning. I hope that by the time I graduate I may know enough to write a book on the subject and argue in favour (or against) TCM, depending on my experiences. I am, after all, only in my first year. Here is a brief example of how difficult it is to try to explain how TCM theory works (or doesn’t): The word Blood in TCM is not the same as blood in western medicine, just as vomit is not called vomit in TCM, but "rebellious qi of the stomach" or the literal translation of headache is "wind in the head". Besides which, there is more than one direction to the path of knowledge. There is induction vs. deduction, for example. Try proving, using the "scientific method", that body is not is not separate from the mind (Descartes), or whether it is possible to know anything (epistemology) and you'll get a minor glimpse at what it is like trying to explain TCM. Moreover, I am very much interested in doing research once I graduate.

• • • • FYI, there is scientific proof the body and the mind are not separated. In some patients with severe epilepsy, the connection between the 2 halves of the brain is surgically severed. After the operation, patients at first have a hard time functioning because both halves of the brain function independently, they take independent decisions and each try to control the body. Only after a while, they become aware of eachother and people will function fairly normal again. If the mind were separate from the physical body (and thus the brain), this should not happen. Severe changes in personality and behaviour due to certain braindamage (stroke and trauma) also show that the mind is a pure biological function. The idea of a mind or soul separate from the physical body is a matter of faith, since there is no proof for it, and all the more against it. You're of course free to believe in it, but please don't call it science.

• • • The claim that Chinese thinking is sooo different and that Western science therefor can not judge is complete bull. FYI, there is such a thing as 'absolute truth'. 5+5 = 10, wether by 'Chinese' or 'Western' thinking. Anyone who says different has a serious problem and needs professional psychiatric help. Whatever name TCM gives to things like a headache or vomit does not change the validity of the claims that TCM makes, or their testability. English just seems to me more economical in expressing the subject. And TCM fails the tests, specifically the underlying concepts of Qi and meridians. The TMC folks themselves can not even prove their claims, once experiments are properly blinded. And TCM practioners are just as susceptible to all the psychological mechanisms that can fool people as anyone. Also, claims like 'I know Qi exists because I can manipulate it with TCM and I know TCM works because I can manipulate Qi with it' are circular and fallacious reasoning by any method of thinking. And why would anyone in China use 'Western' medicine at all if TCM is so fantastic? People in countries with all these fantastic forms of non-Western medicine are always screaming for Western medicine if they have a problem - just look at what kind of medicine the countries that have been hit by the Tsunami are literally begging for, no Ayurvedic, TCM or whatever alternative medicine, they only want the stuff that works.

• • • Absolute truth?? 5+5=10?? Are you sure?? I think that 5+5=A. Or it could be that 5+5=12. All this is true. One is base 10, one is base 16 and one is base 8. Truth is only truth if we agree on what we are talking about and how to look at it. So do I need help? Or are you just attacking a system that you refuses to or are unable to understand?

Why do you believe that water is made of subatomic particles? Is it because you know this to be true or because someone showed them to you or because some of the smartest people in the world told you it is true or do you believe in them without ever seeing the truth yourself because you were told by your father when you were 10? Most of a persons reality is belief. Are you sure that it is really partciles? Do you have what it takes to prove it to me? Can you win a fight about this with me? Do you have the math? I think it is waves myself.  :-)

I have never read a science article that was written with a view point that was from outside of science. Why should Chinese medicine have to be view from sciences point of view to be valid? It is well known that science tends to reject, laugh about and ridicule its own ideas before they become excepted by the mainstream. This acceptance often only happens after the old guard dies out. Much of this whole page is a showcase of the war between old guard western medicine and the incoming foreign view point. It is filled with emotion and demands for proof in the emotionally comfortable view point. Not much here is unbiased , fair, scholarly or anything but an attack from the skeptical western majority.

Also western medicine is not totally scientific and unbiased. It is controlled and researched by big business at the expense of the end users and tax payers. The drug companies are not so different from the cigarette companies of the past. Profit is the goal not universal health and happiness.

I once went to a talk on a new source of bioavailable calcium for patients to take. I asked about the bioavailability of calcium in seaweed or almonds or milk in comparison to the new pill and was told that the research for most food products had not been done because the people paying for the research saw no profit in it.

This is not to say that all doctors are greed monsters or that they do not want to help their patients. It is just that they do what is traditional, conservative or backed by big companies. If doctor did what was best for their patient at all times and always used science then why do USA hospitals have such poor food? Food is one of the basics of health. Doctor to what is traditional and safe from laws suits and peer attack.

"I have never read a science article that was written with a view point that was from outside of science. Why should Chinese medicine have to be view from sciences point of view to be valid?"

Because science is just a word for "looking for truth while taking care to make as few mistakes as possible". Science is not just one of many viewpoints, it's the systematic method for searching for the truth. Working within a group and ignoring what other people think is a pretty safe way to draw wrong conclusions. That is what you are trying to do.

"Why do you believe that water is made of subatomic particles? Is it because you know this to be true or because someone showed them to you or because some of the smartest people in the world told you it is true or do you believe in them without ever seeing the truth yourself because you were told by your father when you were 10?"

I know it because I used electrolysis to split water in its parts and the hydrogen volume was exactly twice the oxygen volume, because I know how to compute the orbitals of hydrogen, because I saw the hydrogen spectrum which agrees exactly with the computation, because I understand why the chemistry of oxygen and hydrogen is as it is, because I understand hydrogen bonds and the effects they have, because I understand why ice is lighter than water and builds crystals in the form it does, etc. You see, science is not just words - it has a lot of background.

Pseudoscience, on the other hand, is just a mockup consisting of empty words. You folk talk about "meridians" but you never saw one under the microscope or can explain how it works or what it consists of. And you can't show empirically that needling a meridian is better than needling anything else. To the contrary, it has been shown many times now that the point where you needle is not important. You had lots of time, and there were lots of studies, but they failed.

Sorry, but all your arguments are just smokescreens and red herrings. --Hob Gadling 13:47, 17 October 2005 (UTC)

• • • While all these useless discussions continue about whether or not acupuncture works, whether or not all acupuncturists are evil and should be lynched/hanged etc. the rest of the world has been busy. A preliminary study conducted by researchers in China has found that one possible physiological explanation of the meridian is the perivascular space. Journal of Alternative and Complementary Medicine, Volume 9, Number 6, 2003. pp851-859. Certainly not conclusive, but it's a start in the right direction. Definitely more productive than preaching from a soapbox, without researching the facts first. Come on people, show some intelligence.Piekarnia 08:43, 12 January 2006 (UTC)

Actually, I can explain what a meridian is and show directly how it works. I'm not an acupuncturist, but use of meridians is a demonstrable technique that I've learned in the context of martial arts. Not to mince words, I can knock someone on their butt thereby, very convincing! I have demonstrated it to the satisfaction of several sceptical scientists, to the point that I now lecture annually on the ethics of tradiutional Chinese medicine to fourth year Western medical students (externs) at a local Medical School. You just haven't had a competent practitioner demonstrate the system to you. If you'll look at our pseudoscience article, you'll see that one of the definitions of such is pretending to scientific validity. Chinese medicine (except for some modern New Age charlatans) doesn't do that. Science can measure the effects of TCM, but TCM was not formulated on scientific principles. Scientific principles didn't exist systematically in any culture anywhere in the world when TCM was being developed. --Fire Star 22:50, 17 October 2005 (UTC)

(I don't know if you are identical to the anonymous user above. I'll assume that you are not, since your points are a lot more sensible.) So you can "knock someone on their butt" by kicking (or whatever) in his acupunture points. Did you try if it works just as well with a point 10cm beside it? (I don't mean: once. I mean: double blind. Tell newbie fighters that the acupuncture points are here, tell others that they are there. Let someone check if there is a difference between the two groups. This has probably never been done, and it will probably never be done, but I hoope this makes it a bit clearer that your "I have demonstrated" argument does not hold water for anyone who knows what sources of error lurk in the human mind.) That's one of the problems with quackeries like acupuncture: they just look at some data, they just want to confirm and are not interested in refutation. I guess "a competent practitioner demonstrating the system" will not be able to convince me. But you may be right that acupuncture does not claim to be science. --Hob Gadling 09:34, 8 December 2005 (UTC)

It seems clear from the sampling of results cited in the article that the studies cited in the article have neither proved nor disproved the efficacy of accupuncture. I'm not sure where the conclusion that accupuncture doesn't work comes from, it is not supported by the evidence that has been provided. Perhaps this article should be renamed - the quality to date of acupuncture experiments. Most MDs are not primarily scientists, their interest is in helping people. I think the same can be said of most acupuncturists. If in the worst case scenario, acupuncture is no better than the placebo effect, it would still be better (in many instances) than the best treatment available from an MD. At least there aren't significant side effects. --By L.M. PhD. [12/18/2005]

I think that rather than renaming the article we should look carefully at the issue of what an article should be. We should not be criticizing what we do not understand. If the critique of a therapy goes beyond something like "generally regarded as effective and safe" or "generally viewed as outmoded and potentially harmful," then the critique should go into a separate article. The article on accupuncture should not suggest that people prefer this treatment modality, nor should it argue that they avoid this treatment modality. What it should do is to summarize the main points, especially the main theoretical points from which other points can be derived, that are present in standard medical texts on accupuncture used in China, Taiwan, etc. P0M 20:10, 19 December 2005 (UTC)

Request for specific info

While there is a lot about wether acupuncture works or not, there is not much on what it's actually (supposed) to do. I'd like to see more on what specifically it's (supposed to be) good for. I myself have no idea after reading this article. It is said to do things to my Chi, but what would that actually do for me? I'd like to know what ailments acupuncturists claim to be able to treat and what not. For example, I don't think acupuncture (if it works at all) could ever treat a cavity in my teeth. I can however imagine it could work for teeth that are oversensitive to heat or cold. A clear sign of quackery is that one particular cure or method can treat anything from cancer to acne and hemerroids, like the good old snakeoil. Since according to the practioners acupuncture is not quackery, there must be things that acupuncture can and can not do. I'd like to see some specifics of that included in the article. Who can help? And how about a bit more info on the origins, such as some of the theory behind it from The Canon of the Yellow Emperor, the basis of most TCM practices.

Good idea. There should be some info about the scope of acupuncture in the article.

This is very much needed. There is a lot in this article about wether it works or not, but that is very much related to what acupuncture is (supposed to be) usefull for. Insulin works, but only if you're a diabetic. It doesn't do much good for you if used to treat, say, a stomach ulcer. Penicillin works too, but not against viral infections, only bacterial. So what is the indication for the use of acupuncture? There must be some acupuncturists who know what they're doing. But then again, maybe not.

It's easy to say what insulin and penicillin are good for because (a) they have been tested in scientific studies for various ailments, and (b) we understand a good deal about how they work. With acupuncture, the scientific status of both the clinical studies and the theories is highly questionable, which makes it very difficult to identify a consensus. If rigorous science is not backing up experience and ideas, how do you decide who to listen to? Art Carlson 12:19, 2005 Jan 18 (UTC)

Many good articles regarding acupuncture efficacy are listed on the World Health Organization's site: http://www.who.int/medicines/library/trm/acupuncture/acupuncture_trials.pdf is one. http://whqlibdoc.who.int/publications/2003/9241545437.pdf is another. In this second link Chapter 3 is particularly useful.

Various

Just wanted to clarify. The edit by 209.178.189.56 on Dec. 18 was me -- I guess I wasn't logged in. -- [User:Bcrowell]

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Supporters of acupuncture claim that it works on animals, which are not influenced by placebos. Could somebody mention this? -- Error

• ah, but the result is interpreted by humans, with all the associated problems such as confirmation bias.

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This page required major editing, apparently was written by someone with an ax to grind against acupuncture, but little depth of knowledge. It was riddled with errors and omissions, starting with the first sentence referring to acupuncture as a "surgical" procedure. Also, it made no reference to any literature within the past decade (such as the NIH consensus statement). I retained the NCAHF excerpts in the interest of healthy skepticism. Yes, most research on the physiology of acupuncture has been performed on animals. I admit to bias, being a practitioner and student of the medical art of acupuncture for 18 years; also I am an MIT graduate and am no more fond of exaggerated claims or fuzzy thinking by my colleagues re acupuncture than is the NCAHF.[user:barrylevine]

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When I asked my father, a respected doctor with 25+ years experience, about his opinion on acupuncture, he said 'of course it works, and it isn't just opiates either'. He is a firm believer in the energy field, and claims to sense it himself, actually. In fact, hundreds of doctors apparently sense this energy field, along with vortices which correspond curiously with the chakras... To deny the possibility of such an energy field is only closed-mindedness... It sickens me how much the religion of science has taken hold of social opinion. Any real scientist recognises science for what it is--a tool, rather than a dogma. People who go about calling others 'psuedoscientists' are actually, ironically, the epitome of psuedoscientists themselves, in having directly conflicted with the essential nature of science as both a tool and an artform which includes no absolute certainty, but only theory. It is more aligned with Tao than with dogma, it seems. Khranus

• Let your father show James Randi or CSICOP that he can sense that energy field, take a million dollars and probably a Nobel Prize to boot. I'm afraid he wouldn't recognize energy if he got hit on the head by it. Science has investigated (using science as a tool) the energy field, found absolutely nothing and moved on to more useful things. And 'only theory'? You should look up what 'theory' means in a scientific context before using it like you do.

• Ironically? Only theory? You seem to not understand the meaning of theory and irony... [3]

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This thing is like the art of drawing blood. Some doctors could poke holes in their patient's arm for hours until a more experienced nurse takes over. The difference is that the bruises on the arm is a visual indication that if the poke is successful or not. Acupuncture does not show immediate feedback. A researcher may be spending years poking at the wrong spots and draw a wrong conclusion about the effectiveness of acupuncture. It is like proving no one could fly by asking a child to build an airplane. 12.234.73.11 08:26, 20 Oct 2003 (UTC)

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http://jama.ama-assn.org/cgi/content/abstract/293/17/2118

This article is typical of acupuncture research. At first read you would think that acupuncture is worthless but lets look a bit closer.

First assumption in this research is that a migraine is a condition treated by acupuncture. This is not true. If you look through 2000 years of acupuncture literature you will not see the word or the translation of the word migraine. Acupuncture would have many diagnosis for all these patient not one and thus many ways of treating the patients. A TCM acupuncturist would also be looking at diet, stress, sleep, and other forms of treatment like herbs after doing an hour long interview to learn the true cause of the problem. As my teachers always say, “bad diagnosis, bad treatment!”

German acupuncture. We tend to think of Germany as being leaders in alternative medicine but they have no real acupuncturists. (Not to say that some don't go to good schools outside of Germany.) In Germany you must be an allopathic doctor or a naturopathic doctor to practice acupuncture.

I was told that all I had to do was pass their naturopathic test to do Chinese medicine in Germany. The test is all allopathic medical questions to make sure that naturopaths now how to spot patients that need a referal to an MD.

Both allopathic doctor and naturopathic doctor then take a few weekends of courses to be able to practice acupuncture, not that the law requires this. They do not need to take any other tests to prove that they know what they are doing. Would you get surgery from an allopathic doctor that was really an acupuncturist with a few weekends of training in surgery? Would you expect him to prove that surgery works by doing “real” surgery and fake surgery or no surgery? In contrast my training at Bastyr University took 4 years including summers of 20+ credit a quarter of classes. In some places in the USA MD's can also get away with this incompetence of little training. Learn the quality of your acupuncturist. Believe science when it is done well but also learn to see poor science for what it is!

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[This is for humor and for us to be glad that we are not doing this online encyclopedia like the H2G2 of BBC is doing, for example allowing such an article on acupuncture to appear in its collection and still present.]

Acupuncture (from H2G2 of the BBC) Created: 10th May 1999 http://www.bbc.co.uk/dna/h2g2/U37243

A pseudo medical procedure whereby ill people stab themselves repeatedly with a large number of long thin metal needles, or worse, ay someone else to stab them. Originally a Chinese invention, believe it or not this has spread around the world with incredible popularity. Ill people not only pay money to be tortured in this way, they are quite prepared to make apointments weeks in advance and look forward to the procedure with something approximating eagerness. Adherents of acupuncture can be easily recognised by their startling resemblance to a stainless steel porcupine.(NB it is vitally imortant to remember when greeting patients of acupuncture NOT to grip them in a big friendly hug- for obvious reasons).

Pachomius2000 07:40, 18 February 2006 (UTC)Pachomius2000

re External links sec'n

PubMed

The following link

• PubMed - US National Library of Medicine search engine with hundreds of scientific article on acupuncture is imperfect in that the site offers no URL that produces the effect of keying in the word "acupuncture". That is certainly no excuse for removing it, but if one of our programming or searching gurus could come up with a means of single click access, it would be a significant improvement. --Jerzy 17:58, 2004 Feb 19 (UTC)

Okidoki. -- Kimiko 19:17, 19 Feb 2004 (UTC)

Su Jok

On the other hand, the Su Jok link & graph added by IP 202.63.171.4 leading to e.g. a first sentence

Su Jok TM acupuncture stands as one of the aspects of the ONNURI TM medicine founded by Professor PARK JAE WOO, a scholar from South Korea are an adv, and i have removed them. --Jerzy 17:58, 2004 Feb 19 (UTC)

Photo

I could put my photo (currently linked) here, but with the drawing and the infobox, it seems like a bit much. Thoughts? heidimo 02:09, 4 May 2004 (UTC)

Something weird

I've edited out a pretty blatant and rather clumsy POV paragraph and somehow the Wikipedia managed to remove any access to the previous version which included it dated 4 July, 2004. I've had some problems before with the Wikipedia not registering edits, but this is the first time that this has happened. Unfortunately, I don't remember the name of the contributor whom I reverted. If it does somehow return to us, and if such a thing belongs anywhere, it should be cleaned up and posted at Qi. Fire Star 04:48, 5 Jul 2004 (UTC)

• Well, today it has reappeared, very good. I thought for a minute that I had magically developed sysop powers! I can see that the bit does have some relevance to the article - it is an attack on acupuncture's underlying theory - but is so insulting that it can't stand as it was written. Scepticism about qi is quite real and noteworthy, but it shouldn't be given the dismissive finality of the bit that I edited out. Fire Star 14:55, 5 Jul 2004 (UTC)

This article is bad. Is this neutral: "For the skeptic, this is proof enough...". How about something more in the line of: those who are familiar with the effect of placebo (and when it's more likely to be found) and the difficulties doing a double blind study of something like ac. most often come to the conclusion that ac. is a pseudoscience.

English is not my first language but could someone not currently taking homeophatic medicine, dancing in circles hoping for rain, change this please.

Best regards / closet scientist practising ac. on a daily basis for personal gains

Dear 195.198.190.70, I agree, and have edited the offending section. Fire Star 22:47, 28 Jul 2004 (UTC)

Criticisms

Okay, I have been reading this article, and it is in no way, shape or form a NPOV article. I am quite sceptical about acupuncture, and nothing about my reasons for scepticism is reflected in the article. I will do some research to find some sources but I want to question several things:

• The Otzi story: the only reference I could find says that the tattoos are on the actual painful joints, not the acupuncture spots! References please! I will remove it from the introduction, and either remove it or put it in a less prominent place with some disclaimers.
• The NIH declaration: this has been heavily criticised. I will add some of the criticisms of this declararation to the article
• The line Acupuncture has eluded scientific explanation to some degree. seems to me far too weak. It has eluded scientific explanation to any degree, and many believe there is nothing there to explain! The only evidence are statistical studies.

Anybody got any problems with this? --Frank.visser 15:13, 3 Aug 2004 (UTC)

The line Acupuncture has eluded scientific explanation to some degree. seems to me far too weak.
From what I've read, acupuncture is at least sometwhat effective (i.e., better than a placebo), and the mechanism is well understood scientifically: it's the principle of counter-irritation, which is that one source of irritation distracts the patient from another. The stuff about qi energy is of course nonsense, and I believe there is also evidence against the traditional beliefs about where to apply the needles for various complaints. One criticism I've seen of acupuncture is that the use of needles is an unnecessarily invasive technique; the same thing could be accomplished with any other type of irritation, e.g., rubbing with sandpaper. What I really hate about the article as it stands is that it is clearly written from the point of view of true believers in acupuncture, and it blithely mixes real science with pseudoscientific nonsense.

Support. From my firsthand experience with accupuncture, the counter irritation really works quite well, but I've found that it works equally well using fingernails or other noninvasive techniques, as the German study in the article has shown. Still, it does not invalidate accupuncture as a valid treatment. --Autrijus 05:01, 2004 Aug 18 (UTC)

• It's the old 'if you hit someone on the thumb with a hammer, he'll forget about his headache for a while'. No chi, no meridians, no energy. Works just fine!

The "Protoscience" tag

User:Tim Starling has reverted 65.30.121.64's change of adding "protoscience" tag, citing that it is "not new, not under development". However, scientific study of accupuncture and qi theory is active in Chinese, Taiwan and especially Japan academic fields (cf. Academia Sinica researcher Wang Wei Gong's journal articles and projects in http://www.phys.sinica.edu.tw/~publication/html/ongoing_projects28.htm and his book, 'the symphony of qi' ISBN 986-7975-50-2). Also, it may be considered "new", as in "newly subjected to scientific investigation". Based on above reasons, I think it warrants the protoscience tag. I'll wait for reasonable consensus before adding the tag back. Autrijus 04:50, 2004 Aug 18 (UTC)

Accupuncture as praticed in not a protoscience. Praticioners a pretty much able to dd what they like and do not have to show scientific evidence for any of thier practices in order to be able to do themgeni14:17, 18 Aug 2004 (UTC)

Considering "Category:Protoscience", I think your description also fits the popular practice of Alchemy, Biorhythm, Chiropractic medicine, Cryptzoology, Gaia philosophy, Meme and Parapsycology. IMHO, the fact that most practicioners don't cite relevant research should not count against a developing protoscience. Autrijus 14:26, 2004 Aug 19 (UTC)

Alchemy partly lead to chemistry and towards the end it was becoming vagly scientific. Biorhythm shouldn't be there. There are a few prationers of Chiropractic medicine who do praticve it acording to scientific principles (becoming more common in europe). Can a catogry be listed on vfd?Geni 10:12, 19 Aug 2004 (UTC)

Two Taipei CAM clinics I've been to (漢醫苑 and 古道堂) are operated by CAM researchers actively publishing papers, especially on pulse-measuring machines and counter-irritation treatments (eg. http://jbsc.nhri.org.tw/abs_search2.php?reg_no=1135&abs_no=1135 is authored by 漢醫苑's Y.C. Kuo, in collaboration with Dr .Wang). Since it is required in Taiwan for CAM doctors to also have degrees in western medicine, I think the situation is comparable to the European situation you described on Chiropractic medicines. Would you agree? Autrijus 14:26, 2004 Aug 19 (UTC)

Your link is broken. there are many areas of alt med that try and get them sleves a vinear of respetibilty by having thier own journals. Got anything beyond low level pain relife published in mainstream journals (pref in english)?Geni 21:10, 19 Aug 2004 (UTC)

If there are any scientific theories (scientific method, falsificationism) or positive results of clinical trials (double-blind, placebo-controlled randomized controlled trials) related to acupuncture or the existence of qi, it would be certainly important to quote in the article, next to references to studies by National Council Against Health Fraud and University of Heidelberg. The host jbsc.nhri.org.tw doesn?t seem do exist, though. Rafał Pocztarski 22:22, 19 Aug 2004 (UTC)

Yikes. That page is still in Google cache, though. Here are some quick links I've found from a bit of googling in IEEE med and bio journals:

* [Pressure wave propagation in arteries] -- the basis of Wang's meridian and qi theory; for some of Wang's other papers, see http://www.ee.ntu.edu.tw/www/publications/backup/wk-wang and the sinica page above.

* [Electrical properties of meridians]

* [The science of acupuncture-theory and practice]

* [Applying quantum interference to EDST medicine testing]

* [Clinical applications of the EDST]

--Autrijus 03:59, 2004 Aug 20 (UTC)

You should probably add references to those papers to the article if you find them appropriate and on-topic, however judging from their abstracts they focus on trying to explain phenomena which don?t seem to have been demonstrated in any double-blind clinical trial, using hypotheses and devices often considered pseudoscientific at best and fraudulent at worst, so don?t be surprised if you later have to argue with anyone who questions their assumptions, relation to scientific method, or relevance—e.g. before referencing a paper on “applying quantum interference to EDST (electrodermal screening test) medicine testing” you should read on “electrodermal screening” in Quack “Electrodiagnostic” Devices article on Quackwatch by Stephen Barrett, M.D., a vice-president of the National Council Against Health Fraud, for that article and the references therein contain very important examples of the arguments you will subsequently have to refute. Rafał Pocztarski 14:30, 20 Aug 2004 (UTC)

Yeah, I'm aware that EDST medicine is highly controvertial, and the experiments in Wang's pressure wave propagation theory are mostly only known in China, Japan and Taiwan. As I'm not a researcher in this field, I'll contend myself in adding the first two references to the article. Autrijus 17:04, 2004 Aug 20 (UTC)

I do appreciate the constructive discussion here. :-) Since a consensus is not reached, I'll refrain from adding the protoscience tag on this article, although I'd like to point out the inconsistency withthe article Protoscience, which lists acupuncture among lucid dreaming as protosciences before this discussion begins. Also, other articles currently listed in the protoscience category does not seem to be subjected to a consistent standard. Autrijus 17:04, 2004 Aug 20 (UTC)

I wouldn?t exactly call acupuncture new, nor does it follow scientific method, so I am not sure why do you call it protoscience. You have posted links to papers which cost $35.00 each to read. It would probably make more sense to reference only publicly available texts so the External links section would contain only things which can actually be directly linked to.

From the abstract it is not clear what the “model with radial dilatation for simulating the behavior of a real artery” has to do with acupuncture:

Abstract: The authors solve the equation of pressure wave propagation in an artery with radial dilatation to give an analytic solution of wave propagation in an elastic vessel for more generalized conditions. This will serve as a complementary solution to work that is based on the assumption that the radial dilatation of the arterial wall is small. The authors' solution is important for physiological studies because it simulates the behavior of a real artery. To confirm the authors' analytic solution, experiments were performed in tubes with different elastic constants

Also, while the second paper might not have any reference to “electrodermal screening” in the title itself, it has several such references in the abstract alone:

[...] The EDST is also based on ancient practices and is safer and more holistic, versatile, and cost effective. The device is elegantly simple and not extremely expensive. Hopefully, it will help free medical progress from its dependence on ever more expensive and specialized medical instrumentation. This alone would have a profound effect on health care cost and accessibility. The quality of health care will also improve with integration of the EDST into modern medical practice. Because the EDST makes use of the body's meridian system, it can map and help analyze the body's own signals, making it particularly useful in early diagnosis. With its solid theoretical foundation in modern physics and quantum mechanics, it is perhaps the most "modern" medical methodology available today.

You have to realise that you do not help acupuncture at all by connecting it to quackery.[4] [5] [6] [7] If you are arguing against acupuncture then providing those links might be a good idea, though. Rafał Pocztarski 00:13, 21 Aug 2004 (UTC)

• Uhm, acupuncture IS quackery.......

Just for the record, the abstract of the second paper on “the science of acupuncture” starts with:

Acupuncture has been used for thousands of years and is effective in a wide range of situations. It has not been integrated into modern health care primarily because of lingering suspicions that it is not scientific. A bioenergetic model has been developed to explain nearly all aspects of acupuncture and meridian theory, but there remains a definite prejudice against human energetic theories in the medical-scientific community, which must be overcome before integration can take place.

Rafał Pocztarski 00:19, 21 Aug 2004 (UTC)

The latest meta-analysis for the Cochrane library finds evidence for a small but significant effect on PONV by stimulation of the P6 acupuncture point: as this is the most recent study currently available (march 2004), i thought it was relevant. I have quoted all the authors conclusions as I am always suspicious about precis about what author's actually said. Meta-analyses are generally agreed to be of more worth than individual studies like the Heidelberg study (which has been criticised: more details later).

BScotland.

One line destoryes the credibiblty of the meta analysis "none of which reported adequate allocation concealment". Not one experiment was even single blinded. As for meta analysis being better than single studies where did you get that idea?Geni 11:49, 19 Sep 2004 (UTC)

Sheesh.I didnt say it was the case, i said it was generally agreed to be the case, which is ..er...generally accepted. Of course one good study is worth more than a meta-analysis of twenty (or whatever) bad studies. I mean, duh. However, the Cochrane has a generally good reputation, and I thought that the results of their meta-analysis should be included. I also included another conclusion from another study that points out that whereas most studies point to a beneficial aspect to acupuncture, few of these studies are of an acceptable standard, and that more research is clearly necessary. BScotland.

Spamming

An anonymous user at 62.49.59.192 keeps adding [8] [9] this link:

• A Very Informative Site about Acupuncture

and now with a new domain:

• A very informative site about Acupuncture

to the External links section. Incidentally, 62.49.59.192 is an IP address of tai-chi-chuan.demon.co.uk, no less... This “very informative site about acupuncture” is in fact an advertisement of “The College of Chinese Medicine, Three Year Part Time Weekend Professional Training Course in Acupuncture Chinese Herbal Medicine and Traditional Chinese Diagnosis.” The first time it got posted, I changed [10] that link to the real website title, wondering whether that advertisement should stay at all. (At that time I didn’t know that it was added from an IP in the same domain.) Later, someone else has removed it, and now someone from the IP of that website has added another “very informative site about Acupuncture” link, which I am now removing. Please stop adding links to your website. If you want traffic for your training course, consider buying AdWords on Google. Wikipedia is not a place for spamming. Rafał Pocztarski 03:55, 23 Nov 2004 (UTC)

colorpuncture

Does anyone know anything about colorpuncture [[11]],[[12]]?

I don't know anything about colorpuncture but French auricular acupuncture uses color filters in their treatments.

Controversy

The Acupuncture article is top-heavy with at least mildly PoV commentary and long quotes about effectiveness or ineffectiveness. Its inclusion in such volume in a general article on the subject is PoV: it is not absurd to claim that responsible consumers of med care can reasonably risk making decisions about seeking out acupuncture without consulting their physicians, but it is entirely reasonable to argue that no one without training in physiology and experimental design should do so. I will split everything after somewhere in the middle of "Purported benefits" out to a Controversies on effectiveness of acupuncture or Claims of effectiveness of acupuncture article, and substitute a 'graph pointing at the new article, unless someone better qualified does so soon. That will provide a less PoV relationship between the general interest topic and the specialized one. --Jerzy(t) 19:55, 2004 Dec 21 (UTC)

Dated NCAHF Statement

The National Council Against Health Fraud statement cited in the article stated that acupuncture had not been proven in scientific research in the last 20 years. However, that statement was released in 1991. As the PubMed link will show you, there have been a number of more recent studies and meta-analyses of acupuncture.

Unsigned outline that was originally put at the top of this page

Here's my attempt to untie the knots of a debatable alternative health topic:

A proposed outline to help organize all that's written before

1) Overview of acupuncture as one element of Traditional Chinese Medicine (TCM)

a) Alternative medicine caveat, 'bioenergy field' observations are an issue, etc.

b) Brief history of highlights in TCM over last 1,000 years (extends back 5,000)

c) Growth and spread of availability, acceptance within medical community, NIH

d) Insurance plan provisions for acupuncture treatments and diagnoses treated.

e) Do not ever avoid or put off seeing a regular doctor for medical complaints.

2) Theory and Practicse of Traditional Chinese Medicine

a) Yin Yang, 5 Phase association and Elements, Organs, Meridians, Acupoints etc.

b) Nature of healthy harmonious function versus disease/pathological function

c) Modalities of treatement: needles, moxa, massage, exercize, diet, meditation, herbs, lifestyle

d) Updated theories and models explaining how TCM treatment may provide effective benefits

e) The as of yet unexplained and yet to be substantiated aspects, i.e. claims only supported by tradition.

f) References for more information, studies, and study guides.

3) A visit to the TCM practioner

a) Referal from doctor for conditions and treatments with ICD9 codes (yes, insurance pays some.)

b) Assessment and diagnosis, appearance, tongue, pulse, sound, smell, palpitation; informing practioner of drugs taken, diseases, STDs, etc. Use of accessories, electronics.

c) Treatment plan: acute versus chronic treatment plans, cooperation with other plans, modalities

d) Not intended to supplant/replace needed surgery, drugs, and contemporary medical treatement.

e) Assessing the practitioner

i) Level of education and supervised hours clinical training

ii) Level of cooperation with medical clinics, hospitals, etc.

iii) Scope of practise and specializations

iv) BBB rating, issues with state licensing body, etc.

v) Quality of referrals from other practioners, patients

4) Table with Pro & Con arguments concerning validity of Traditional Chinese Medicine Acupuncture

a) Replicable studies, tested hypotheses and outcomes, NIH articles

b) Links to university articles/studies concerning medical value of acupuncture

c) Summary arguments and conclusions pro and con

d) Editorial observations and comment

5) Lists of accredited colleges

a) US, CA, UK, Europe

b) China, Japan, Pacific Rim

c) Elsewhere

6) Lists of reference books and other resources

a) overview texts, introductions, basics

b) reference material covering material appearing on board exams.

c) internet sites with reasonable quality information

d) books covering intesting developments

e) electronics and other devices used in current treatments

COMMENT: I do not believe we should ever be seeing referrals here to specific practioners/clinics. Colleges with accreditation may be listed especially if they are host to teacher/researchers publishing peer reviewed articles of scientific value. It should be reasonable to link to peer reviewed journals, studies, etc. and where permitted by the author/publisher. These might provide a sound starting point for serious debates.

At this point, I have to admit newcomer Unipedia seems to have a better written article than this current one: http://www.unipedia.info/Acupuncture.html

I don't understand. The article referenced above appears to be a straight copy of the Wikipedia article. P0M 03:25, 26 Mar 2005 (UTC)

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I have moved this new outline because discussion pages are, by convention, added to at the end of the page. Once somebody had gone into something else at the bottom of this page, most interested parties would not even have seen it since serial readers will automatically jump to the "new stuff." P0M 00:58, 26 Mar 2005 (UTC)

Neutrality

I have a fairly good background in this subject for someone who is has not been trained in traditonal Chinese medicine. The problems that I see, actually, are with the POV of the people whose critiques of accupuncture are referenced in this article. Interested readers should study The Theoretical Foundations of Chinese Medicine, Manfred Porkert, 1974. (MIT Press?) to get a more adequate basis for understanding these issues. Complaining that Chinese texts on accupuncture do not conform to Western terminology and do not use Western concepts is a little like criticizing Ravi Shankar for not playing Indian music in the equal tempered scale that is the standard of most (but not all) Western music.

Before one can tell whether an Indian musician is playing "out of key," one would have to know the rules for the tuning that s/he is supposed to be using.

With regard to Chinese medicine and its theory, one should first understand what the practitioners are actually claiming as their rationales, and then one can evaluate their medical practice on two different bases: (1) whether their rationales are logically coherent, internally consistent, and whether they are responsibly evaluating the efficacy of the various treatments that are available to them. (2) The efficacy of their treatments as compared to other available treatments.

The fact that some treatments used in Western medicine are not very effective is not an argument against the legitimacy of Western medicine. It simply reflects the fact that some diseases are more difficult to treat than others, and that Western medicine may not have discovered a really satisfactory treatment yet. The fact that some treatments work better with some patients than with others is, likewise, not an argument against Western medicine but only an objective recognition that matching treatment to patient may require time and effort. The same standards should apply to Chinese medicine. This article should aid the general reader to understand the theory and practice of Chinese medicine. Questions of what Western medicine thinks about Chines medicine should be secondary.

Bad medicine happens when theory takes precedence over objective evidence that some treatment is useless or even counterproductive. P0M 03:16, 26 Mar 2005 (UTC)

Acupuncture

"This article should aid the general reader to understand the theory and practice of Chinese medicine. Questions of what Western medicine thinks about Chinese medicine should be secondary."

As a trained licensed practitioner of Acupuncture I feel compelled to agree with the comment I have quoted - but would consider it futile to put much effort into a debate about the efficacy of Chinese medicine. The practice of medicine is more political than most would imagine and less scientific than many would like to claim. I succeed with clients on a daily basis. I treat many issues that have not been successfully treated in other ways. I refer people to Western trained doctors, I have MD's as clients. I think it worthy to note that nearly 1 in 4 persons worldwide rely upon a form of TRADITIONAL medicine (read- 'alternative medicine based on theories several hundred years in use') as their primary care modality.

Many people here just love to bash Chinese medicine because they don't understand it. They claim it is just voodoo science, they say the Chinese herbs are poisons etc. But they fail to read the newspaper on how many over-the-counter medications were pulled off the market recently by the FDA. The American pharmeceutical companies have been feeding people with poisons too, but these bashers just ignore to see that those so called scientific studies are just as useless as voodoo in some cases. At least, the Chinese herbs have been in use for thousands of years whether they are poison or not. To me, it is just a kettle calling the pot black. There are many scientific researches being done on the Chinese medicine to figure out how it worked for thousand of years. When something is not proven true scientifically yet, it does not imply it is false by default. It is just basic logic. I guess when our ancestors killed pain with willow barks, they didn't understand how it worked either, but it does not mean it is not effictive unless it is made into Aspirin pills. Kowloonese 07:37, Apr 22, 2005 (UTC)

I think I just heard somebody on NPR a couple of days ago who said that aspirin would have trouble getting approved by the FDA today because it has side effects. My point is that with some medications we probably do not have double-blind tests to prove their effectiveness because they have been used effectively for so long that people do not test them unless it begins to look like they may cause previously unexpected problems. With aspirin we learned via individual physicians noticing that their patients had problems and then the information got collected and evaluated. (Now we recommend that younger patients not be given aspirin for flu-like symptoms.) P0M 14:52, 22 Apr 2005 (UTC)

I don't care whether medicine is "Chinese" or "Western", but I do care whether it really works. The only way to be sure it works is with randomized-controlled trials. With RCTs you don't have to know how something works to find out whether it works. Unfortunately, in many cases RCTs are not yet available and you have to go with what you've got until they are. In the "West" there is a system in place, albeit imperfect, to verify that medications on the market are reasonably effective and harmless. What is the corresponding system for traditional medicine? Art Carlson 11:33, 2005 Apr 22 (UTC)

That's a good question. There are studies being done on some treatments. There is another problem in that even with the best modern medications we are learning that people with different genetic constitutions may react very differently to different medications. There is now one preferred treatment for some heart conditions for black people because what has been working well for other groups has not had good outcomes for them. Carry that idea to acupuncture, where you are presumably balancing a system in somewhat the same way that a mechanic balances a new tire on your car. Whether the treatment works may well depend on the skill of the practitioner.

In Chinese herbal medicine, the formula is supposed to be adjusted according to the yin-yang balance of each particular patient. The formula is often a cocktail of many herbs to achieve a certain balance. In western medicine, they only test one drug in one treatment and since interaction among drugs are not tested, they just avoid cocktails all together. Only in the past decade, they started to develop "cocktail" prescription for AIDS patients. Chinese doctors have been using "cocktail" for thousands of years. Testing cocktails is not easy because of so many interacting factors especially the composition should be adjusted per patient. Kowloonese 19:18, Apr 22, 2005 (UTC)

(1) Take an herbal medicine, say cinchona tree bark for malaria, and analyze what chemicals it contains. Test the components one by one, and you will find that only one of them, quinine, makes a difference. The same with the aspirin in willow bark. For most herbal medicines that have been proven effective, it has been found that one particular indegredient is active. That is one rational for testing pharmaceuticals individually. (2) Another practical reason is that it is unmanageable to test all combinations. Many binary combinations have been tested, but it is difficult enough to test the thousands of medicines individually much less the millions of binary combinations. No system of medicine that uses "cocktails" can possibly have made tests of any significant fraction of the combinations it uses. (3) The only way that using "cocktails" can work consistently (unless you believe in magic) is by having a valid theory of operation. The drug combinations used to treat AIDS are the result of an understanding developed over decades of research costing billions of dollars. If practitioners of TCM actually have such a theory, it would be possible to prove the validity of their choice of cocktails (though not of their way of thinking about it) by letting them diagnose and prescribe but substituting a placebo for half of their remedies. This has never been done successfully. Art Carlson 20:07, 2005 Apr 22 (UTC)

I agree with you it is almost impossible to test Chinese herbal medicine because it is always a cocktail. But can you prove it is ineffective when it is not tested. Chinese doctor have been curing people with these cocktails. In TCM, the doctor knows the curing properties and side effects of each herb, they use a few herbs to target the symptoms and use other herbs to counteract the side effects. Yes, TCM have theories, though the theories were formed by trial and error and obversations over generations. Each practitioner designs the cocktail based on his diagnosis, it is more like the art of cooking, different cooks have different receipes. Do you need to analyse a meal scientifically to prove that it is delicious? Most of these formula have not gone through double blind tests, some are being researched by modern scientists. Kowloonese 20:58, Apr 22, 2005 (UTC)

I don't expect TCM to muster the quantity and quality of evidence supporting conventional medicine, but is there any reliable evidence that a Chinese cocktail works better than any single ingredient or better than a conventional alternative? Art Carlson 05:26, 2005 Apr 23 (UTC)

The answer is yes according to the Chinese herbal doctors. In TCM, there is something called yao4yin3zi0 (藥引子) which literally means "medicine triggers" (or catalyst) without them the recepe does not work. If single ingredient would work, they would not have searched and found the catalyst. Kowloonese 11:30, 24 March 2006 (UTC)

What would you make of "conventional" alternatives that were originally part of the Chinese pharmacopeia?

No problem. My point is that there is evidence-based medicine (which doesn't care where an idea came from, only whether it works) and everything else. Medicine as practiced in the West has a large overlap with evidence-based medicine, while TCM has a small overlap. Some elements of TCM have presumably been verified and taken up by conventional medicine. I would be very interested to hear some examples. Do you know any? Art Carlson 10:12, 2005 Apr 24 (UTC)

It might be unethical for a Chinese doctor to use a single ingredient when he believed that a combination of ingredients would provide a better treatment, but for a test of medicines using subjects who gave informed consent, then it should be o.k. to give single-herb or even single component test doses to people. To me it would make better sense to establish the pharmacological efficacy of individual components first in double-blind comparisons, and then to test the efficacy of components.

As for "which drug is better," how do you mathematically calculate a score that includes things like rapidity of reduction of white cell count, patient discomfort from headaches and other side effects, etc., etc. It seems to me that just within Western medicine there are alternative medicines that all have their share of advantages and disadvantages. There are probably a dozen approved OTC medications for my sore throat, for instance. Are we sure that some people favor one cure and other people favor another cure for purely subjective reasons? P0M 03:38, 24 Apr 2005 (UTC)

Something really useful, I think, would be to get instantaneous feedback as the needles are being manipulated, with periodic follow-ups -- just to see whether anything is really changing. That would be a start. You wouldn't know, in some cases, whether the change was useful, but at least you would distinguish between treatments that don't do anything at all other than cause a slight amount of pain and treatments that, e.g., drop the pulse rate of the patient from 180/minute to 90/minute within half an hour. P0M 14:52, 22 Apr 2005 (UTC)

Any proof pf breakable needles?

The article says: "acupuncture needles are very thin and can break." I can see where hypodermic needles might break, because they are made to be rigid. But the ordinary acupuncture needle is made of spring steel, and, moreover, it is designed for one-time use. I spend lots of time in my pasture trying to get ordinary iron wires to break (being too lazy to walk back to the house for a pair of nippers), and getting any kind of wire to break requires bending it back and forth at a sharp angle very many times. The same thing applies to guitar strings, which are steel wires of the same type as the acupuncture needles. They break, but only when tuned very tight and then played very enthusiastically for some time. If I were chained to a desk and forced to make an acupuncture needle break I think I would try to drive the needle as rapidly as possible through flesh into some nice flat bone and hope that the needle would shatter. But it would only shatter if at some point the metal had been crystallized. So I would only try each needle once and hope that my captors would mess up and give me a lot of needles that hadn't received good quality control. Of course, if I were permitted to cheat I would heat treat it so that it became very rigid and brittle.

Some acupuncture needles are special-purpose and not made of spring steel. Is that the kind of needles that are known to break? Am I missing something? I just can't see spring steel breaking under any normal circumstance. P0M 04:37, 24 Apr 2005 (UTC)

I am a acupuncturist. The needles do not break anymore. I have tied them in knots and they do not break. The needles are a lot like stiff cat whiskers in flexibility and size. Back when needles were reused and the steel was of lesser quality they broke after much use and autoclaving. Some places still use reusable needles in this world and they are still subject to this problem thus we are trained never to insert the needles all the way in. The needles tend to break at the handle and thus can still be pulled out in most cases.

There was a study published in Japan in 2003 that detailed a woman who suffered damage to her peroneal nerve after the tip of an acupuncture needle broke off during her treatment. Unfortunately the acupuncturist was unwilling to cooperate with the study, and so details regarding reusable/disposable needles and exactly how it happened are unclear. See Journal of Bone and Joint Surgery, volume 85-A, number 5, May 2003, pp916-918 for full article.Piekarnia 08:52, 12 January 2006 (UTC)

New Research links

I'm fairly surprised to see that the impression given by the BBC article (to which I'd linked: http://news.bbc.co.uk/1/hi/health/4493011.stm ) could be as far from the truth as the abstract ([13]) appears to prove it to be. Is the abstract misleading when out of context perhaps? Can somebody with full access to the journal's database please check and compare with the BBC news article to see if their story is completely wrong? If it is I'd like to ask the BBC for an explanation.

--wayland 11:58, 3 May 2005 (UTC)

I don't understand. What do you think is so misleading about the BBC precis? I have read the whole article in the journal (which is now linked) and it seemed reasonable. The key point which anti-acupuncturists would want to concentrate on is that NONE of the three 'treatments' reduced pain, although none of them were expected to either.

• Well, right at the beginning, the BBC news article states: "Scientists say they have proof that acupuncture works in its own right." So the reader is thinking "proof that acupuncture works...okay, I'll read on..."

Then, further on, the article states: "The researchers used positron emission tomography (PET) scans to see what was happening in the brains of people having acupuncture treatment for arthritis pain." So the reader is thinking "The treatment was for pain and they have proof that it works, so therefore that should mean the pain was reduced..."

Further on, the article states: that both the trick needle treatment and the real acupuncture activated an area of the brain associated with the production of natural opiates - substances that act in a non-specific way to relieve pain and that in real acupuncture, in addition, another region of the brain, the insular, was excited by the treatment. "This was a pathway known to be associated with acupuncture treatment and thought to be involved in pain modulation."

So the general impression given is that the acupuncture reduced pain and that two areas of the brain believed to be associated with pain reduction were observed to be activated. The article fails to mention that the three interventions " did not modify the patient's pain." (which is clearly stated in the abstract of the original published paper).

The false impression was also strongly given in the BBC radio news and television news both of which were broadcast that day.

>>>>>>>Fair enough, although I don't agree. The BBC key para, it seems to me is that 'When the researchers analysed the patients' PET scan results they found marked differences between the three interventions. '. I read the article and did not infer that the acupuncture treatment reduced pain. The journal article of course does not claim that acupuncture reduced pain, and of course pointed out the obvious that it was not expected to either (one session of acupuncture hardly ever has any effect).BScotland

>>>>Incidentally someone might want to mention this piece of research: http://tiny url.com/bkc3a (I added that space between tiny and url because wikipedia told be that tinyurl was a blacklisted website and asked me to remove the link 203.4.250.227 13:29, 7 March 2006 (UTC)JeremyG)

Chakras, the tobiscope et al

I'm sorry to bring this up here, but I thought this might be of interest. An anonymous user has edited the Chakra article mentioning a "tobiscope", a device supposedly invented in 1965 by Russian scientists to measure... something (meridians, life forces, ki?). This person claims that (1) chakras coincide with acupuncture points and meridians, and (2) both can be detected using this apparatus (and similar ones). Does anybody here know about this tobiscope? What about other devices? The article on chakras was well-balanced so far, and I don't want to cause an edit war there; Acupuncture seems like the place to ask about advice on such claims. Thanks! --Pablo D. Flores 03:20, 20 May 2005 (UTC)

It's a good question. People all over the world learn things from their bodies, and, if people are being reasonably objective, they should come to some of the same observations. That being said, I don't see chakras marked on my acupuncture charts. That doesn't mean that Chinese people don't know about them or at least have similar ideas. Your anonymous user may be getting confused in the different universes of discourse involved in Chinese thought. The Chinese have long talked about the dan4 tian2, for instance, and that corresponds to one of the chakras if I recall correctly. The idea that there is something special from a spiritual/psychic standpoint about the area below the navel has some confirmation in Western thought too. For reasons too complicated to go into here I got into a discussion with a man and his wife about quelling violent outbursts from youths under extreme accumulated stress (bad family/social conditions for years, for instance). The young lady said that she worked as a sort of matron in a live-in facility for youths that had been removed from their previous social/family environment to give them a chance to regain some degree of equilibrium. She said that their explicit instructions were that in case a young person became violent they were to attempt to restrain them with one hand and apply firm pressure to the abdominal area with the other hand. At that point her husband, who was pretty deeply involved in yoga, said that the method made good sense to him since it was using a chakra.

As for the tobiscope, if what I've found by Googling the term is correct, it is just an electrical device used to measure resistance. I've experimented with the mesurement of resistance on the human body, and it quickly becomes clear that it is tricky. You can get an inexpensive multimeter from any place that supplies people who repair radios, etc., who experiment with electronics, etc. They are not very expensive, being, essentially, a coil of wire that forms an electromagnet balanced against a spring so that the more current flows through the harder the needle is pulled against the spring.

What you will quickly discover is that if you want to be objective you have to fabricate a device that will use spring pressure to put a measured pressure on the electrical probe that you move along the surface of the body to measure its resistance at different points. If you just use an ordinary probe, which is really nothing more than a wire that is thick enough that you won't prick yourself with it and strong enough that you won't easily bend it, you will discover that the resistance you measure will depend inversely on the amount of pressure you apply to the probe. (That's why you sometimes can get a car to start by taking loose the connections to the battery, cleaning everything up, and then tightening the connection.) In simple language, electricity gets through more easily as you press harder and make a better contact. Of course, if you break the skin and get contact between your apparatus and your blood you will get a very low resistance measure indeed.

All of that detail is important because people trying to prove the electrical conductivity of the accupuncture points is low have been observed to move the probe lightly over the skin until they get to the point where they know an accupuncture point is supposed to be, and then they will press harder on the probe, the light will come on or the needle will swing, and they will claim that they've proved something.

I never had the time and money (grad students frequently have little of either) to make a very good probe, but just using a regular probe and moving it around while trying to maintain an equal pressure I could never find any obvious differences of resistance except right over the veins that stand up on the backs of my hand. The reason is pretty clear, the electricity goes through a thin layer of skin and then finds a good electrical conductor in the form of the blood and from there it goes through the blood system to the second probe (which is usually a fairly tight band of conductive stuff around one of your ankles).

There is some religious Daoist stuff, and/or stuff involved with qi4 gong1, that talks about the dan4 tian2 (cinnabar field) and other tian2, but those materials have probably been influenced by Indian ideas for nearly 2000 years, so even if they claim "we knew this all along" and point to native elements of thought, there still could be some influence in the terms of how early texts are interpreted. (The Dao4 De2 Jing1 has an esoteric interpretation that makes it into a religious Daoist "hygiene" text. That's an example of how one school of thought can creatively reinterpret the works of another field of thought.)

Short version: Unless the person can come up with some very good citations, the assertions should not be accepted. IMHO they don't fall into the area of "things everybody knows and is too lazy to look up the citations to." (My usual fault.) P0M 06:29, 20 May 2005 (UTC)

Thanks a lot for the detailed explanations. I'm a skeptic myself (I don't believe in ki/qi or special energetic points in the body), but I recognize there's a difference between the ancient traditions of China and India, on one hand, and fringe New Age material. I came to Chakra following a request to make the article NPOV, and together with a few others we did some work and the article was left OK, informative and not controversial. Then this guy came along with his tobiscope... He doesn't get the Wikipedia mindset at all and I was getting really angry, so at Talk:Chakra I promised to leave the page alone until June (probably someone will fix the tobiscope thing by then). Thanks again. --Pablo D. Flores 10:37, 20 May 2005 (UTC)

Ötzi's acupuncture tattoos attribution

http://dsc.discovery.com/convergence/iceman/evidence/tattoos.html

Unfortunately the above URL only gives a report of a claim. I've think I've read that some people who have studied the tattoos say they are not close enough to actual acupuncture points to be convincing. I'd like to see photos.

As far as other cultures knowing something about acupuncture, I remember that my grandmother, who was born a decade or so after the end of the Civil War, told me that one of her uncles (or maybe it was brothers) was adept at treating headaches by massaging certain areas on the head. In retrospect, it sounds like the man must have been massaging acupuncture points. My mother and her brothers had a fair amount of orientalia. There was a ma jiang set in my grandmother's house, among other things, so it is possible that there was also more transmission of medical practice info at that time than we might assume today.

It is possible that people discover these things independently. My high school biology teacher taught us a point on the body that will inhibit a sneeze (useful information for footpads). It works, but it is not on my acupuncture charts. P0M 23:34, 20 Jun 2005 (UTC)

Perhaps then we should make it a bit more clear in the article that it is a supposition. Interestingly, the point system that I have learned studying with the Wu teachers doesn't correspond exactly to the published acupuncture charts I've seen. They do correspond, but I'd say only by about 70-80%. Fire Star 01:59, 21 Jun 2005 (UTC)

there ares so many different acupuncture charts that you have a hard time finding a point that isn't on a chart somewhere.Geni 02:04, 21 Jun 2005 (UTC)

Especially since the meridian lines that are all over the charts (or any line, for that matter) are collections of an infinite number of points! ;-) Fire Star 16:20, 21 Jun 2005 (UTC)

I might add the Smithsonian Natural History Museum has an Otzi exhibit and makes the acupuncture claim there as well. -S

I did a quick spin around Google and found:

http://www.acupuncturetoday.com/archives2000/jun/06iceage.html

which (assuming they are being responsible) shows that there are some points that are dead on, some that are near misses, and some that are more remote. It isn't clear how many more tattoes there might be on the body.P0M 22:41, 21 Jun 2005 (UTC)

Why acupuncture cannot be proven to be effective

As an acupuncturist in North America, I can see first hand the beneficial effects of acupuncture on my patients who come to me primarily because they find that Western medicine cannot help them or that the side effects of medication/surgery outweigh the benefits.

On the question of the efficacy of acupuncture, with the thousands of years experience notwithstanding, the so-called "studies" done today in North America are mostly ill designed and under funded. The question always comes down to money - who gains and who loses from a properly done study that would actually show the benefits of acupuncture. To be more precise, those who gain are the practitioners of CAM and the general public, while those who lose are the pharmeceutical companies. Doctors have nothing to lose because all they need is 300 hours to become an acupuncturist (which is not enough time to learn all the points, but that is another story). The business of producing drugs depends on keeping patients, not necessarily healing them. Studies that are funded by those companies present with outcomes that show their product in a positive light, or they are done again and again until the desired result is acheived.

Consider if acupuncture were proven to be effective in curing many diseases more effectively and with less side effects than pharmeceuticals - insurance companies would need to start covering acupuncture, and the reliance on drugs would be greatly diminished. An entire industry would start losing money. This cannot be allowed to happen.

If we were really concerend about health, we would integrate both Western medicine and CAM for the most comprehensive treatment. They are two extremes that can be seen from the micro and macro levels - that is, that drugs work on the cellular level while acupuncture works on the "wholistic" level.

The article on acupuncture in this encyclopedia presents the practice of acupuncture for the layman in terms that are easily understandable; however, it first takes the point of view that acupuncture does not work and then cites sources presenting both sides of the argument, having first already taken a side. It is unfitting for such an encyclopedia that presents drugs from a neutral perspective.

Please sign your postings. I learned to do so after aggressively attacking something that it later turned out I had written myself. ;-)

You are quite right about beginning an article with a POV judgment on the value of whatever is being discussed. The correct way to handle things, assuming that we are going to cover the subject at all, is to describe the subject in terms of its own theory, its own ideas on how it is supposed to work. Once readers have been given an unbiased view of the subject they can be referred to secondary articles that deal with criticisms, alternative takes on the question, etc.

For instance, it would be correct to say that Newtonian physics has been proven false. But it would not be helpful to readers who want to understand what Newton succeeded in figuring out about the Universe to tell them that they should ignore Newtonian physics and direct their attention immediately to Quantum physics and Relativity. The appropriate thing to do is to explain how Newton conceptualized the Universe, how he created a model of the Universe that explained most things so well that we still use it today for almost all purposes, and then go on to inform the reader that the theory broke down under certain exptreme conditions of size and speed, and that those failures led to both reconceptualizations of the subject matter and to new formulas that express reliably the new discoveries made in the course of working out all of the consequences of Newtonian Physics.

The problem for the general reader in trying to understand accupuncture is that the conceptual system by which the entire Universe is undersood is incompatible with the Western view at the same fundamental level at which Newtonian physics is founded. The Western reader wants to talk about matter and energy, unconsciously having in mind the very sophisticated Newtonian concepts, when the Chinese theoretician wants to talk about qi theory.

Neither the Newtonian nor the Qi theory can be assumed to be true. Both are models for understanding processes that go on in the Universe. Ask somebody who has a well founded understanding of both systems how to translate an observation made in terms of one theory into the terms of the other theory and the right answer will be, "You can't get there from here."

Both theories talk about the same Universe and, more-or-less, the same entities. To put that observation in simpler language, both a Western doctor and a traditional Chinese doctor can look at the same patient. What is available to each of them is presumably the same. I.e., the patient doesn't change colors or anything depending on which doctor is looking at him or her. But the two doctors are looking at the patient through two different sets of colored glasses, metaphorically speaking. The Chinese doctor says something is going on with the patient's triple burner and the Western doctor asks where in hell the patient's triple burner is, trying to find a proper anatomical term for it. But the Chinese doctor is dealing with systems of function, not with physically discrete organs.

The productive way to handle the fact that the Chinese doctor and the Western doctor are using different models to understand their patients and their problems is to keep firmly in mind that the patient comes first and the rational systems come afterwards and are used to codify insights, to put insights into what is going on with the individual patient into terms that another "speaker" of the same conceptual system can understand. So if something is going on with a patient and a Western doctor happens to notice it, that information may not be readily codified in terms of the Chinese doctor's model. I have no idea of how Chinese medicine understands stomach ulcers, but let's say that some Chinese doctor has been treating ulcers by accupuncture points that have nothing to do, ostensibly, with the stomach. The points are on the patient's ears, feet, and other places totally "remote" from the patient's stomach. The Western doctors have been telling patients to drink milk, stay away from pepper, etc., etc. for generations. Some patient tells them that milk does nothing for his ulcer but yogurt is almost a miracle cure. The doctors all scoff at this idea and ask him which little witch lady in which health food store he got that idea from. Then somebody notices that ulcer patients have unusual bacterial colonization of the stomach. The other doctors find polite synonyms for quack and idiot. The doctor drinks a culture of the bacteria, immediately comes down with an intense stomach ulcer problem, and then cures himself with a good dose of antibiotics (and hopefully saves himself a long recovery period by taking homemade yogurt). Now the Western doctor tells the Chinese doctor that ulcer patients have microbes in their guts that are physically attacking the stomach lining. Maybe that gives the Chinese doctor the idea that ways useful to treating infected wounds might be applicable to treating ulcers -- even though his theory might not have predicted that connection. And maybe it turns out that the ways that the Chinese doctor has been treating ulcer patients do indeed not having anything to do, directly, with the stomach, i.e., if you put all sorts of instrumentation to work look at the patient's stomach while he was being treated for ulcers, the stomach might not show any changes at all. But the Chinese doctor may have been doing things that do make changes that the Western doctor could observe in the "discrete" organs that the Western doctor identifies with the immune system. So the Western doctor learns that rather than using drugs to perk up the immune system, drugs that have side effects that nobody should ever want, perhaps, he can stimulate accupuncture points and get the same beneficial results with virtually no undesirable side effects.

Maybe the new contributor can help us see how to boil the stuff in Manfred Porkert's book down to encyclopedia size. He's the only one I know of who has tried to put the Chinese conceptual system, as it pertains to medicine, into English. It's a good book, i.e., responsible and thoroughly grounded in the Chinese systems, but it's several hundred pages and pretty rough going for the non-medical and non-Chinese philosophy crowd. P0M 18:54, 4 December 2005 (UTC)

New Material in Risks

I just added some minor new material to the risks section, but did not add sources. Both of my sources are already listed in 'external links.' FYI if anyone was curious. --User:Jeffmedkeff | Talk 00:59, 2 December 2005 (UTC)

Pseudoscience

Why is there no pseudoscience tag on this page?! It's core belief is in Meridian and Qi (Chi) which has no basis in Science, cant be verified yet is passed off in Acupuncture as a practical reality, that is psuedoscience. Qi can be more closely aligned to an element of Chinese myth or religion, something cant be considered science if it is based on such a principle, this is pseudoscience for the same reason Feng Shui is. - UnlimitedAccess 18:45, 2 January 2006 (UTC)

It isn't pseudoscience because its underlying theory doesn't pretend to scientific validity. It underlying theory predates the scientific method by 2,000 years, at least, so it cannot pretend to be a scientific approach even if it wanted to. Science may certainly describe traditional Chinese medicine and the culture it grew from, from many different angles (archaeology, anthropology, linguistics, chemistry, biology, etc.), but as a subject to be studied, not a scientific theory. Theories may indeed be drawn about it, but those theories would be outside of TCM. The pretension to scientific validity is a necessary part of the definition of the term pseudoscience for use at Wikipedia. Some prefer protoscience for this sort of thing. There are many acupuncturists etc., especially in the West, who pretend to be scientific (especially the many medical doctors who now perform acupuncture in their clinics), but for us to paint the entire theory by the recent actions of some of its adherents in the article is proscribed by our original research policy. --Fire Star 19:23, 2 January 2006 (UTC)

Good point, Fire Star. I think "prescientific" is a better term for TCM theory, and prescientific or not, it's also clinically useful! And even elegent, depending on the eye of the beholder. The NIH consensus statement itself notes that TCM theories "are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture." How much clearer can it be? The validity of acupuncture manifests in, and must be measured by, clinical efficacy. This is true irrespective of the culturally-conditioned ideas (which are, in effect, ancient and pragmatic mnemonic devices) that predict such efficacy. TCM theory is therefore an alternative, but still useful, lens through which to view the human organism. -Backin72 (n.b.) 01:15, 15 February 2006 (UTC)

Should acupuncture be called an art? Each practitioner's mastering of the skill is different. Some masters achieve great result with their patient. Some get no result at all. Like a Western doctor drawing blood, some get it right the first time, but some give the patient bruises all over the arm. When blood does not come out, can one jump to conclusion that blood is not there? Blood vessles are visible so practice would improve the skill. It would be hard to master the same with acupuncture. Kowloonese 02:21, 15 February 2006 (UTC)

I wouldn't call acupuncture only an art, but I agree there is definitely an element of art to it. A lot of doctors say that biomedicine is both art and science. One could say something similar about TCM. It's not a science in the Western sense, but the theory is certainly systematic and internally consistent. I think it's fine for the article to call it a therapeutic technique or healing modality, and maybe say that as with other healing modalities, there is an art to doing it effectively. -Backin72 (n.b.) 03:28, 15 February 2006 (UTC)

Let's clean up the page

This article on acupuncture is truly quite appalling. There are several barriers that I see in cleaning this up:

1. There are a large number of people who insist on talking about all the hype and propaganda about the validity of acupuncture rather than sticking to the facts. This is not a new system of medicine, but it is new as far as western medicine is concerned. The research is still being done, therefore quoting statistics from the late 80's aint gonna cut it if there is more recent research from this century that proves otherwise. People more interested in fuelling the political debate rather than positively contributing to publishing knowledge of the topic on this wiki should do so in an informed and reasonable way in a separate article rather than taking up space in the main page. Perhaps the title of that page could be "The debate about the validity of acupuncture" or something similar.
2. The page NEEDS to be seriously reworked. The headings listed above seem to be quite good for a start. If no one can suggest anything better, perhaps it might be worthwhile to make a start on those headings. Unless someone can come up with some good reasons otherwise within the next week or two, I'll make a start.
3. There is an absolute truckload of scientific studies done into acupuncture, and I don't think we really need to have a synopsis of all of them on this page. We need to work out a way to either a) get rid of them b) put them in an entirely separate article possibly titled "research related to acupuncture" Piekarnia 09:50, 12 January 2006 (UTC)

Interesting debate

I found the debate here most interesting. I have learnt quite a lot. Someone reported that it works on animals too. 1)Does it work on plants too? Has anyone tried it on plants? 2)Since the porcupine has in-built needles all over its body, is it the most healthiest animal? 3)Also , how do you define cure? If patient say he is cured, is he cured? If doctor say patient is cured, is he cured?

(1)Because plant rights advocates reject moxibustion, results are few and far between.

(2)Only those that engage in frequent venery seem to be more healthy than others.

(3)See refutations of your covert point by the well-known specialist, 方琵.

Cochrane Collaboration

Hi Backin72

Thanks for your work on the article. I would like you to consider putting back some of the material you removed. I didn't cherry pick, and it was a list of criticisms. If you google acupunture on cochrane you will see what I mean. I also reported accurately that Cochrane had some support for P6 in the wrist. Looking forward to some good collaboration on this one. Mccready 23:23, 16 February 2006 (UTC)

Hi Mccready, yes, I think it's fine to list some of Cochrane's conclusions as long as it's a balanced list and includes some of the stuff for which they thought acupuncture was valid (unless P6 was the only one!). There are a lot of hits on Cochrane for acupuncture and I'm not sure how to sort through it all efficiently. Cochrane does seem to be a pretty good EBM site and not biased against CAM in the way NCAHF/Quackwatch/Barrett are. I appreciate the spirit of collaboration too; it's a real strength of this site. Best regards, --Backin72 (n.b.) 06:59, 17 February 2006 (UTC)

Hi McCready, I see that you simply reverted, but did you understand and address the concerns I expressed just above? Thanks; more on your other edits later; have a great weekend. -[[[User:Backin72|Backin72]] (n.b.)

Hi Backin72 and Mccready

I have read some Cochrane articles. No, I am not a scientist, but I think I am intelligent enough to know that the Cochrane folks could be more straightforward with their reviews of studies. I mean, they must state if in terms of morally possible certainty, a study has already proven or not, beyond reasonable doubt, that a cure has been effected by acupuncture. You see, according to what I learned in law 101, if we insist on absolute certainty then nothing can be certain because in human affairs that is impossible; but in terms of moral certitude, then it is possible to arrive at such a certainty, namely, that which excludes all reasonable doubts. Maybe I am mistaken, that Cochrane also seeks moral certitude, not absolute certitude or scientific certitude when science is open-ended (what is scientifically certain today can be not and will not be so in the future, as science expands and grows more elaborate in its grasp of life and the universe). For example in one article I read, in the conclusion the authors of the review article say about the worth of the study they reviewed, worth=silver (meaning not gold); I might be more exact but they did use the word silver, and the mood is one of ridicule -- considering that these are supposedly academically scientific people. What about with drugs and medical procedures of conventional scientific medicine, do they also require that every drug and every medical procedure should be 100% certain to be successful? I don't think so, as a matter of fact, I know it is not so. They always tell you what probability of success you can expect from a drug or a treatment. My father was operated on for a heart bypass, and the surgeon who did the operation told my father before the operaton that he had an 80% probability of successful surgery -- but he did not tell him that his life would be as good or better than before the bypass (now he is not as good as before, whereas a neighbor who resisted bypass but insisted on medication and at most an angioplasty is better all around than my father). I can continue on and on, but I am addressing myself to Backin72 and Mccready: if you both are into acupuncture and into scientific examinations of acupuncture, why not invest some time and labor to pick out those cases where acupuncture is really successful, and reasonable critics are satisfied, but with moral certainty; not with absolute certitude which I think is not applied either to conventional scientific medicine. Pachomius2000 06:19, 24 February 2006 (UTC)Pachomius2000

Hi Pachomius In order to try to discuss Cochrane I'd need to know what article you find problematic. In terms of medical treatment its worth understanding that different humans respond in different ways so 100% certainty is highly unlikely. It's worth spending time understanding the concepts at [Bandolier at Oxford University]. Mccready 07:16, 24 February 2006 (UTC)

Hi Pachomius - Remember, scientists are people too, and they will have different subjective standards (and sometimes double-standards) for what constitutes "proof". Even if acupuncture ONLY treated pain (a mere "subjective symptom", as some say), it would still be highly valuable. For evidence of acupuncture (actually a related technique, moxibustion) treating a condition other than pain, see this study for treatment of breech presentation of the fetus [14].

For Cochrane's analysis of that and other studies, see this [15]. Basically, Cochrane is saying that in this case there aren't yet enough randomized controlled trials to support the technique unequivocally, but there is preliminary evidence. That seems to be a perfectly reasonable conclusion (as long as Cochrane's editors understand that procedures cannot be double-blinded in the same way pills can, and apply the same exacting standards to biomedical interventions: I have no reason to doubt their integrity on the latter point, but am not sure they have sufficiently considered the former).

What I object to is the use of double-standards: as the NIH concensus statement notes,

Assessing the usefulness of a medical intervention in practice differs from assessing formal efficacy. In conventional practice, clinicians make decisions based on the characteristics of the patient, clinical experience, potential for harm, and information from colleagues and the medical literature. In addition, when more than one treatment is possible, the clinician may make the choice taking into account the patient's preferences. While it is often thought that there is substantial research evidence to support conventional medical practices, this is frequently not the case. This does not mean that these treatments are ineffective. The data in support of acupuncture are as strong as those for many accepted Western medical therapies.

Thus, it needs to be kept in mind that in biomedicine, a number of practices are routinely used that don't rise to Cochrane's standards of proof either. Critics who highlight the lack of proof for some therapies in alternative medicine, while ignoring the similar lack of proof for some therapies in biomedicine, are biased and/or disingenuous. I think the article, as it stands, implicitly makes this clear enough, but keep in mind that many critics of acupuncture ignore this point. I hope this discussion addresses some of your concerns. -Backin72 (n.b.) 21:52, 24 February 2006 (UTC)

Pachomius here -- but first: I really don't know how this discussion works in respect of contributing here; so just anyone in charge, please put my contribution in the proper place and also proper layout.

Backin72 says "What I object to is the use of double-standards: as the NIH concensus statement notes..."

Addressing Backin72: Do you know of any Cochrane reviews about any treatments in conventional scientific medicine that obtained the same less than 100% positive rating or grading from Conchrane, as acupuncture in respect of the same medical complaint, say, low back pain or some other medical complaints; but critics of acupuncture do not object to their employment whereas they do with acupuncture? And how can this inconsistency of double-standards be pointed out convincingly to such critics? Pachomius2000 04:09, 4 March 2006 (UTC)Pachomius2000

fda

An FDA Guide to Choosing Medical Treatments by Isadora B. Stehlin FDA Consumer June 1995 http://www.fda.gov/oashi/aids/fdaguide.html said re acupuncture "at this time their safety and effectiveness are still unproven." so until another updated FDA source is provided I'll remove the claim from the article Mccready 01:40, 21 February 2006 (UTC)

Actually, in 1996 the FDA did change acupuncture needles from Type 3 devices (experimental) to Type 2 (safe and effective when used according to certain standards, i.e. sterilized, etc.). Google for "fda acupuncture safe effective" and you'll find it. I'll fix it later. -Backin72 (n.b.) 21:55, 24 February 2006 (UTC)

victorian board

I haven't been able to substantiate the claim that the Australian Victorian system has been used elsewhere. In fact the system is a mess as any examination of the law or their website will show. After six years they are still working on a FAQ for the general public, their findings that some practioners were lying in the statment of claim as to English competency have not been properly pursued, the board is aware (see decisions) that practioners are achieving registration by fraud but ..... Mccready 02:21, 21 February 2006 (UTC)

NIH Consensus Statement

McCready, I took out your edit that the Consensus Statement is "outdated". Just because 1997 was nine years ago doesn't make it outdated. For it to be outdated there would have to have been some fundamentally new information. Studies since 1997 have shed new light on acupuncture's physiological effects, supported its use in some areas (e.g. osteoarthritic pain) and not supported its use in others (cocaine addicion). I don't see in any way that in sum, the studies since 1997 change the overall conclusions of the Consensus Statement. In the absence of credible arguments or evidence for a contrary claim, my revert should stand. - Backin72 (n.b.) 22:04, 24 February 2006 (UTC)

Fair enough Bakcin72, good call. Could you let me know any study to Cochrane stds on osteoarthritis. Cochrane, from my research, doesn't support it. Mccready 06:25, 25 February 2006 (UTC)

This one is pretty good; don't know if Cochrane has reviewed it or not - Berman et. al. Ann Intern Med. 2004 Dec 21;141(12):901-10 -Backin72 (n.b.) 25 February 2006 (UTC)

Example of Acupuncture Practice

Why is it necessary to say anything in the example of practice section about Cochrane, or anything else? This is why I took out all of the statements about efficacy, pro or con. As far as I can tell, this section is meant more to describe what a visit to an acupuncturist is like. The article is clear enough elsewhere on claimed and proven efficacy, standards of proof, study design etc. -Backin72 (n.b.) 25 February 2006 (UTC)

Hi Backin72, I think it useful for each section to be balanced and as comprehensive/encyclopediac as possible. If a section, standing alone, can be read as one sided then we have failed WP duty. Why not draw the readers' attention to all areas of controversy so that the reader can form their judgement? Mccready 04:58, 26 February 2006 (UTC)

Yes, that is a good principle to keep in mind. I would say that we need to balance it with another principle, namely: avoiding redundancy across sections, on the assumption that the reader is intelligent enough to read the whole article. However, on this edit, since the section in question does mention the treatment of a specific condition, I can see the value of mentioning observations of efficacy. I'll leave the EBM cite in there and restore the stuff I deleted about clinical observation of tenderness to palpation and so on. Actually, I just noticed that Cochrane's conclusions were more nuanced than the one-line summary you inserted, so I'll clarify that as well. Thanks! I'm enjoying the collaboration here, and I think the article is improving quite a bit as a result. -[[[User:Backin72|Backin72]] (n.b.) 04:30, 27 February 2006 (UTC)

Berman et al

thanks Backin72 for the link to [berman] I couldn't get the full text so almost impossible to judge its worth. I noticed that the editors said there was 25% drop out rate and results should therefore be treated with caution. Sample sizes after the drop out were small. Given that, and given the meta-analysis of Cochrane do you think we're on solid ground to conclude there is insufficient evidence that acupuncture has therapeutic value for osteoarthritis? I also found a good warning on [RCTs]. On your earlier comments re cochrane, I did understand your point, and try as i might I could only find one instance (P6 in wrist) where it might be of value. Mccready 06:01, 26 February 2006 (UTC)

Hi Mccready; Cochrane's treatment of acupuncture for osteoarthritis is in progress, so Berman et. al. will be incorporated there. Yes, drop-out rate is a confounding factor (how small is a "small" sample size, btw? relative to what?), so I'm not sure whether this study would rise to their "gold standard". On your question as to whether or not we can "conclude there is insufficient evidence that acupuncture has therapeutic value for osteoarthritis", that of course depends on what standards one chooses. One of the things I like about Cochrane is that they offer more nuanced conclusions than simply saying whether evidence is "sufficient or insufficient". I think that approach more closely corresponds to scientific and clinical reality (as opposed to, say, political reality). Knowledge is not the same as certainty, and the search for the latter can actually impede the acquisition of the former.

For example, regarding Cochrane's conclusions on idiopathic headache, your edit originally stated that "the Cochrane Collaboration found there is insufficient evidence that acupuncture is beneficial for treating idiopathic headache." However, that is in fact a rather gross oversimplification, if not outright distortion, of what they actually stated in their conclusion: Overall, the existing evidence supports the value of acupuncture for the treatment of idiopathic headaches. However, the quality and amount of evidence are not fully convincing. There is an urgent need for well-planned, large-scale studies to assess the effectiveness and cost-effectiveness of acupuncture under real-life conditions." I presume you simply erred in haste here, and have amended the article accordingly; I will also do so if and where the article's other citations of Cochrane so warrant. I think that approach is consistent with the spirit of your suggestion above to err on the side of being comprehensive, and letting readers decide. I'm really glad you brought Cochrane in, btw; fantastic resource.

Finally, thanks for the article caveating the design of RCT's. A good explanation of the virtually insurmountable with applying EBM's "gold standards" of double-blinding to surgical procedures (and by extension any procedure, such as acupuncture, that isn't readily amenable to placebo controls) is given here:

Evidence-based medicine is defined by Sackett et al. as the integration of the best available research evidence with clinical expertise and patient values. The best research evidence is clinically relevant research---both basic science and patient centered clinical research. In the ideal situation, the best clinical evidence is arrived at by a randomized, prospective, double-blind study. With diverse surgical procedures, including spinal fusion research, these designs are difficult at best and the ideal of EBM is virtually too problematic to achieve, given the unethical nature of employing a sham surgical procedure. Purely scientific evidence does not exist in spine fusion research. The best that can be achieved is a prospective randomized clinical trial. Patient acceptance of randomization in virtually any type of surgical procedure has proven problematic, albeit less so in socialized countries where patients may have less choice. Therefore, clinical decisions must be based, as Sackett states, on the best evidence available including the clinical experience of the surgeon. With this limitation in mind, it is also crucial to appreciate that the absence of ideal EBM evidence is not equivalent to the absence of truth, the absence of benefit or the absence of positive clinical effect.

cheers,-Backin72 (n.b.) 07:38, 27 February 2006 (UTC)

EMB and FDA

Thanks again Backin72 yes I edited a bit quickly, trying to get the "cochrane doubts list" under one rubric. I'm not sure sufficient effort has gone into blinding in acupuncture research. Single blind with assessment not being made by practioner is simple and even blinding the practioner inserting needles to patient identity is feasible. In other words the EMB problem is not as tough in acupuncture as it is in fusion treatment of lower back pain.

On your FDA edit, I'm concerned that as it stands it implies FDA approval of acupuncture when in fact they were looking at whether inserting needles per se was dangerous. Would you like to consider a rewording? Kevin Mccready 08:46, 27 February 2006 (UTC)

I think we should report exactly what the FDA said/did and what it meant. What they did was reclassify acupuncture needles from Class III to Class II medical devices, which means exactly what the article says (cf. refs; like the NIH consensus statement, this caused a lot of consternation in some quarters [16], but nonetheless that's what they said). I do think it's appropriate to add a statement re the reclassification thing; it should probably also be mentioned under "Potential Risks". -Backin72 (n.b.) 04:46, 28 February 2006 (UTC)

sounds good, will you go ahead and do it? Mccready 05:46, 28 February 2006 (UTC)

I sure will - within a day. Cheers! -Backin72 (n.b.) 06:30, 28 February 2006 (UTC)

further note on ebm

According to the Centre for Evidence-Based Medicine, "Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." Do we really want to accept the Sackett forumulation about patient values? Sure there's a role for patient values in treatment, but not in EMB. Mccready 08:49, 27 February 2006 (UTC)

Interesting question. Patient values clearly matter in care. If EBM excludes them, does that mean that EBM alone is insufficient as a basis for providing care? -Backin72 (n.b.) 01:43, 28 February 2006 (UTC)

Further thoughts: it may be that Sackett's inclusion of patient values in the definition of EBM is intended, in effect, to create a form "EBM" that one could say IS completely sufficient for patient care. But Cochrane's meta-analyses of RCT's say nothing about patient values, so all that's going on when a doctor claims to practice "Sackett EBM" is that s/he's lending the imprimatur of empirical validation to non-empirically-validated clinical decisions that doctors make all the time, based on anecdote, experience, intuition and so on.

I would prefer to just call a spade a spade and have docs be clear about what aspects of their practice are informed by EBM and what aren't. Some stuff docs do may never be able to be based on strict EBM, and that's OK, and in some situations even desirable. Things like bedside manner, trust and so on are important factors in the patient's healing response, even if they do fall (in whole or part) outside EBM, and even if they are regarded as "mere placebo effects". I seek out docs with whom I have good chemistry and whom I trust, intellectually and emotionally. When I'm sick, I want everything working in my favor, placebo as well as EBM! :-) - Backin72 (n.b.) 07:41, 1 March 2006 (UTC)

reversions March 1 2006

Mccready, no offense, but your last batch of edits are without merit.

• Bandolier is 1998, which is way out of date for obvious enough reasons: since then there have been 23 RCT's on acupuncture and headache. Cochrane (2006) supersedes.
• On Empire, it's insane for the article to start listing the views of every insurance company on acupuncture. It would be pages long if we did so. There are some in the US that cover it for anything, and some that cover it for nothing. The reasons for such coverage vary.
• On the Huang Di Nei Jing, give me a break, the entire second section of that text (Ling Shu) is about acupuncture. Googling or checking any basic introduction to acupuncture and TCM shows this.

Sorry if I seem testy here, but I'm getting a little tired (cf. your distortion of what Cochrane said about headache) of editors shooting first and asking questions later. Thanks. -Backin72 (n.b.) 22:56, 1 March 2006 (UTC)

History section

The history section has a few minor problems. I'd fix them but I don't know enough about the subject to correctly edit. The section seems a mixture of facts about its history, some conjecture and edits to discredit acup. Could someone knowledgeable editor help me resolve these issues:

1. What does (Ma-wang-tui graves 68 BC)' mean?
2. Later in Chinese history, 365 points along the meridians were spoken of, not because they were anatomically identified, but because there are 365 days in a year. Could we get a cite for works that talk about 365 points? Is it an old idea that is no longer accepted? Is the points=days thing accepted or one user's POV?
3. Some hieroglyphics... Which hieroglyphics? Where were they found? What are they called?
4. Bian stones...not directly related to acupuncture Is it accepted that they aren't related to acupuncture or is this, again, one editor's POV? If they aren't related to acupuncture, they shouldn't be in the article

Regards,Ashmoo 04:38, 3 March 2006 (UTC)

Hi Ashmoo: (1) Ma-Wang-Tui refers to ancient medical texts; see Unschuld's Medicine In China. (2) I deleted this; it's not a central theory in acupuncture. (3) No idea. (4) I fixed this; there is some debate. BTW good idea to add the new section on accreditation and controls. regards, -Backin72 (n.b.) 07:55, 5 March 2006 (UTC)

Backin72 reverts

Hi Backin72, it's not like you to revert in this manner so I'm a bit surprised. My edits were factual on the health insurance company. I also have found no mention of zhenjiu (針灸) in Huangdi Neijing (皇帝內徑) - if I am wrong please let me know. On the bian stones, these are not acupunture despite acupuncturists attempt to claim the lineage - they are for blood letting. I've foreborne to revert until we discuss here. Thanks and looking forward to your cooperation. If I've attributed edits to you which you didn't do, please forgive me, I don't have time to track each edit at the moment. Kevin Mccready 06:57, 3 March 2006 (UTC)

Backin72, you have not assumed good faith. In fact I have discovered a problem in windows search which was why HuangDiNeiJing came up with a negative result. I have rechecked and yes you are right. As to the health insurance question, the fact that such a large organisation follows what they believe is good science is in fact a significant criticsm of acupunture which belong in the criticsm section. On the issue of "out of date". If we agreed that the NIH guidelines had not been updated and belonged, then likewise the bandolier. Lots of RCT don't make a summer (see the bias section of Bandolier). Mccready 11:10, 4 March 2006 (UTC)

Hi Kevin. On the Huang Di Nei Jing, I did assume good faith on your part in that I figured you'd made a well-intentioned error; nor have I ever doubted that your motivations are to improve the article. My objection was simply that this is a very basic issue that could easily have been double-checked elsewhere. And I must admit I was a little irritated at the time because similar things had happened a couple of times before, not just with Cochrane/headache, but also with an earlier deletion you made citing tattoos on the "Tyrolian Iceman" Ötzi (01:48, 21 February 2006); you said a source was needed, but of the two included only one was a dead link and the other was fine. Easily fixed, but I'm busy too, and I'd rather not have to feel like I need to double-check your edits for accuracy. So all I would ask is that you try to refrain from editing in haste and relying on others to clean up. This is a minor complaint relative to all the good stuff you've added, and I hope I've expressed it in the friendly spirit I intend.

On Bandolier, their goals are considerably different than those of the NIH Consensus Statement, so it's not just about the date of publication. Amusingly though, as it turns out, Bandolier later trashes Cochrane's treatment of idiopathic headache (2002, undated), and predictably completely overlook the problems with double-blinding (e.g., there is disagreement over the validity of sham acupuncture). This shows that both the criteria for EBM and its application (cf discussion above) are more subjective than its proponents would like to think. Anyway I think it's fine to have the more recent Bandolier things I found in the article; I'll put them in later.

On Empire, I don't think it or any specific insurance plan belongs there. Just how many insurance companies would you propose listing in the article? Empire's one of many. Is it appropriate to list them all? What criteria should we use for which ones to list? What criteria are the insurance companies using for their coverage, and do they make this clear? I think it's fine to mention insurance, and that coverage varies, but listing a bunch of individual insurance plans is not appropriate for an encyclopedic article. Plus I think there are more credible scientific critics than bottom-line driven businesses.

Someone else brought up Bian stones. Yes, they're for bloodletting, but that's actually still used in certain situations today in acupuncture (e.g. traumatic injury or fever), and some scholars believe bloodletting presages certain acupuncture techniques [17]. I added that. I also deleted the 365 thing as it's not a central part of acupuncture theory (see Unschuld on Ma Wang Tui etc). regards, -Backin72 (n.b.) 08:47, 5 March 2006 (UTC)

Backin72, I've never edited Otzi, but having checked it out and the simple error is that of correlation ([pirates have disappeared while global warming has increased says the Flying Spaghetti Monster]). Anyone tatooed like him will have a tatoo on or near an acupuncture point. The Bandolier stuff was good and confirms my discovery that there is variability in quality across Cochrane groups - all the more benefit in having many sources of analysis evaluated. Your second Bandolier article was dated 1998-9 from memory. Do you have any sources on the problems sham acupuncture as a blind. In that case, how can you test the claims? What is a testable hypothesis for an acupuncture treatment? On empire I think but am happy to listen to alteratives that it definitely belongs. It is a large firm covering millions of people and says it bases its opinions on acupuncture on science. Naturally if other equally large companies have a view then that should be considered for the article, including their reasons for forming that view (I'd assume that the commercial motivation would be strong in either case). I think we should replace the 365 - it's an undeniable part of the history. The source you gave for bian stones didn't seem strong and I don't have access to the book. Mccready 12:04, 7 March 2006 (UTC)

Hi Kevin, I think it was you who deleted Otzi (see history), but no matter. I don't know whether or not it's BS, but the issue isn't having a tattoo near just any acupuncture point, but rather ones specific for conditions Otzi was suspected to have. It's past my bedtime and no time to add Bandolier now, but I'll try to tomorrow, or please feel free to stick it in. On issues with sham acupuncture, see NIH Consensus Statement:

"A commonly used control group is sham acupuncture, using techniques that are not intended to stimulate known acupuncture points. However, there is disagreement on correct needle placement. Also, particularly in the studies on pain, sham acupuncture often seems to have either intermediate effects between the placebo and 'real' acupuncture points or effects similar to those of the 'real' acupuncture points. Placement of a needle in any position elicits a biological response that complicates the interpretation of studies involving sham acupuncture. Thus, there is substantial controversy over the use of sham acupuncture in control groups. This may be less of a problem in studies not involving pain."

What does one test? Same sort of hypothesis as one tests in any procedure where a sham isn't accessible, right? As in most surgical procedures. Compare the intervention with some other intervention, preferably one that does have a placebo baseline.

On Empire, I continue to have serious reservations about the article listing specific insurance companies, because there are so many, and their reasons for coverage vary widely. They may say "science", but what does that really mean? Does another company's covering it for anything the patient wants really mean anything? Also, isn't it POV to list Empire's coverabe under "Criticisms" when the stuff it does cover could just as easily be considered an endorsement of acupuncture's efficacy? I'd rather see Empire in a different section if at all. One 365, have you got a reference giving its importance in historical context? I'll check Unschuld for that; he's one of the top guys in the field. There is scholarly debate on Bian stones; they are mentioned in the Chinese-published standard English-language text on which Americn national certification is a based, so I think that should count. Will get to this and other stuff later; it's nearly 3 AM over here! Ciao, -Backin72 (n.b.) 07:44, 8 March 2006 (UTC)

Please excuse my lack of medical knowledge, but I'm sure there are a couple of people out there with the same questions. What is wrong with the following double-blind protocols. Either teach a non-practitioner to properly insert the needles, but not which points relate to which diseases, then tell him to insert the needles in points which are right for some patients and wrong for others. Or, just tell the practitioner that the patient has a different disease to the one which they actually have? 203.4.250.227 13:29, 7 March 2006 (UTC)JeremyG

Jeremy, the double-blinding problem is not as severe, but in the same ballpark, as the problem with double-blinding a surgical procedure. Technique matters and you can't so readily blind the person giving the treatment if that person is sufficiently trained so as to have good technique. A surgeon would usually know whether or not he's taking out an appendix, right? Sure any dummy can shove needles into a spot, but then you're studying something different than TCM acupuncture in which technique is said (and in clinical practice, often observed) to matter. But of course you can blind the evaluator, etc. -Backin72 (n.b.) 07:44, 8 March 2006 (UTC)

Simple Error? What ever the truth about Otzi and his tattoos, the article in the medical journal the Lancet, one can not dismiss the hypothesis as being the result of a simple error (ie. the tattoos are 'grouped' rather than spread out randomly etc). The article also suggests that Otzi is not the only example.

[| 'The Lancet 1999;' A medical report from the stone age? 354:1023-1025; DOI:10.1016/S0140-6736(98)12242-0]

One of the problems with acupuncture seems to lie in the observation that it is often effective as a palliative treatment for self limiting conditions. As such it doesn't lend its self to trials originally developed for testing would be cures. Using a western example: diazepam does not cure dislocated joints, but a large dose of said drug, can so relax muscles -that were tense from the pain- that the joint will then sometime slip back of its own accord.

The body is a complex negative feed back system and so it is possible that acupuncture provides an opportunity for the body to re-balance (regain full homeostasis) by temporally blocking an over active response in part of the feed back system. We will have to await more studies, as recently done using a fMRI scanner. Although made in conjunction with the Open University and the results this study were broadcast on UK BBC television, no paper has yet been published[[18]].

As for testable hypothesis, I take it you mean is it possible to design a trail or study that can answer the question once and for all. If so, then part of the answer to that problem is in comments above, plus the limitations of resources available (doing a study costs a lot of money; not even drugs get 'thoroughly' tested but just enough to get them over the hurdles of the regulators.) So, I think it is possible to prise out the truth - we just don't know how yet, and those that think they do are quite likely deluded (well 50% must be wrong!).

The British medical journal has recently accepted an article for publication on the effectiveness of acupuncture for low back pain. and here the researchers had to make do with what opportunities the real world provided -rather than the ideal. How good the trial design was I don't know as I am fed up at the moment with reading papers, but some have already commented on it, so you can read theirs and the whole pre-pub article in PDF form.[BMJ.com]

As for double bind trials: it might not matter were the needle is inserted or whether the patient gets no treatment at all, the recover time can be the same (as makes no difference) for self limiting conditions -even with western treatment. What is important here is whether the acupuncture treatment relived the patients symptoms more so than the placebo effect. (then there is the question of the treatment effect plus the placebo effect of having the treatment, but lets keep things simple). There is no objective way yet, of measuring perceived (subjectively experienced) relief brought on by treatment, although scanning looks promising. With rats it would be easier; as one could time how long they could tolerate keeping their paws on a hot plate. This is a procedure that is sometimes used for testing the effect of drugs.--Aspro 16:28, 7 March 2006 (UTC)

But the page states that there is NO way of performing double-blind trials, not that there is no way to test them in 'self limiting conditions' 203.23.158.24 00:46, 8 March 2006 (UTC) JeremyG

Please see my comments above on this. Also I added a link to NIH Consensus on sham, mentioned above to Mccready. -Backin72 (n.b.) 07:44, 8 March 2006 (UTC)

Placebo effect

Hi, here's an article (sorry don't have the full text or a link, just an abstract) comparing a sham acupuncture needle has more of an effect than a sham pill

Kaptchuk TJ. Stason WB. Davis RB. Legedza AR. Schnyer RN. Kerr CE. Stone DA. Nam BH. Kirsch I. Goldman RH.

Institution Osher Institute, Harvard Medical School, Boston, MA, 02215 USA. ted_kaptchuk@hms.harvard.edu

Title Sham device v inert pill: randomised controlled trial of two placebo treatments.

Source BMJ. 332(7538):391-7, 2006 Feb 18.

Abstract OBJECTIVE: To investigate whether a sham device (a validated sham acupuncture needle) has a greater placebo effect than an inert pill in patients with persistent arm pain. DESIGN: A single blind randomised controlled trial created from the two week placebo run-in periods for two nested trials that compared acupuncture and amitriptyline with their respective placebo controls. Comparison of participants who remained on placebo continued beyond the run-in period to the end of the study. SETTING: Academic medical centre. PARTICIPANTS: 270 adults with arm pain due to repetitive use that had lasted at least three months despite treatment and who scored > or =3 on a 10 point pain scale. INTERVENTIONS: Acupuncture with sham device twice a week for six weeks or placebo pill once a day for eight weeks. MAIN OUTCOME MEASURES: Arm pain measured on a 10 point pain scale. Secondary outcomes were symptoms measured by the Levine symptom severity scale, function measured by Pransky's upper extremity function scale, and grip strength. RESULTS: Pain decreased during the two week placebo run-in period in both the sham device and placebo pill groups, but changes were not different between the groups (-0.14, 95% confidence interval -0.52 to 0.25, P = 0.49). Changes in severity scores for arm symptoms and grip strength were similar between groups, but arm function improved more in the placebo pill group (2.0, 0.06 to 3.92, P = 0.04). Longitudinal regression analyses that followed participants throughout the treatment period showed significantly greater downward slopes per week on the 10 point arm pain scale in the sham device group than in the placebo pill group (-0.33 (-0.40 to -0.26) v -0.15 (-0.21 to -0.09), P = 0.0001) and on the symptom severity scale (-0.07 (-0.09 to -0.05) v -0.05 (-0.06 to -0.03), P = 0.02). Differences were not significant, however, on the function scale or for grip strength. Reported adverse effects were different in the two groups. CONCLUSIONS: The sham device had greater effects than the placebo pill on self reported pain and severity of symptoms over the entire course of treatment but not during the two week placebo run in. Placebo effects seem to be malleable and depend on the behaviours embedded in medical rituals.

Publication Type Journal Article. Randomized Controlled Trial.

Conclusion is that there may be a difference, but it is not scientifically significant. Mar 13 2006

If taking a phony aspirin pill produces some benefit in the reduction of, e.g., headache pain, then taking an aspirin pill also produces some benefit in the reduction of pain due to whatever factors are active in the case of the inert pill. We do not know exactly how the placebo effect works. There are also therapies that involve the deliberate mobilization of the bodies own resources without the trickery or manipulation involved in the use of placebos. One of the differences between placebo pills and placebo needles is the specificity of the mental stimulus provided. If a phony aspirin pill is administered, the psychological message implied is, "feel less pain." Expectation of the relief of pain may facilitate the relaxation of muscles constricting the blood vessels or otherwise causing head pain, but it also may facilitate the release of endorphins out of the same sense of relief because "someting is being done." Theories abound, but nobody really knows why the use of needles, heat, and accupressure are efficacious, but each of these methodologies can cause the mind of a conscious patient to focus very sharply on one point in the body. To an extent, the more powerful the stimulus, i.e., the greater the pain or the greater the felt pressure, the more strongly one's attention may be focused on these points. But the applicaiton of a phony needle, especially to a naive subject, may be equally productive in causing intense attention to be directed to those points.P0M 01:07, 17 March 2006 (UTC)

With regard to the abstract above, I don't have the full text either, but it does state that there were significant differences between the sham needle and placebo pill groups on certain measures during the study's full course (i.e., greater than a 2-week period). Those observations, and the conclusions given by the authors in the abstract, are not the same as the editor's comment: "Conclusion is that there may be a difference, but it is not scientifically significant". Patrick, I agree the issues are complicated and not fully understood. I also think the article (as of this moment, with the references to double-blinding issues and NIH on sham) summarizes and caveats the issues adequately. Thanks. -Backin72 (n.b.) 08:05, 17 March 2006 (UTC)

It occurred to me earlier today that if we really want to know whether something like aspirin works the best way to find out would be to administer it without the experimental subjects being aware of it. It's easy to vary the input into an intravenous drip without alerting a patient. But it would be much more difficult to stimulate acupuncture points without letting the patient know what is going on. Maybe low voltage, low amperage currents to be delibered to probes attached at various points on patients' bodies without letting them be aware that they were being zapped. That might be a plan in the case of hospital patients suffering conditions that force them to remain bedridden and relatively immobile anyway. Maybe with miniaturized controls other patients could serve as test subjects without their having to be immobilized.P0M 02:12, 20 March 2006 (UTC)

I just noticed your reply here; sorry for delay. Yes, I agree, that would be an interesting experiment. Quite creative. -Backin72 (n.b.) 23:22, 25 March 2006 (UTC)

Science section

Backin72, you can't prove a negative - article already too long - my rewrite of the intro in science section should meet your concerns - pls disucss otherwise. readers can look up refs (that's what they are for. On stroke the issue here is not safety. I'm happy to delete ideopathic headache ref becuase it doesn't fit intro and I've moved p6 to make it clear Mccready 08:51, 21 March 2006 (UTC)

Hi Kevin. Yes, readers can look up references, but (without accusing you of bad faith) I still think your summaries oversimplify and err on the negative side. Cochrane is more nuanced than that; they don't set a threshold and just ignore possibly interesting trends under it. So I will fix that somehow without being too wordy. Simply removing their summary on headache is hardly a solution either; it's pure POV to list only negative conclusions for acupuncture under "science" (as if by implication the preceding section is unscientific). I think the whole section needs to be merged with indications and research under an EBM subsection, and lists summarized more carefully.

If article length is a concern, then Empire is surely on the chopping block; I doubt there is any other respected encyclopedia whose entry on acupuncture mentions the plans of specific insurance companies. Linking to something like that is fine, however. thanks, Backin72 (n.b.) 01:16, 22 March 2006 (UTC)

Hi Backin72 and other editors Yes I'm open to some sort of merge and acknowledge that removing headache could be POV. Though you will be aware of criticisms of bias creeping into cochrane reviews. As for "interesting trends", how do we measure them, and where would we put them? Lots of stats can be manipulated to give trends. What we want to tease out is real effects and causation. The implications though of the Indications and research are that all the things listed can somehow be helped by acupuncture - I get the feeling you would ack that all these have not been demonstrated susceptible to acu. Yes the implication is that the preceding section is unscientific. I think this needs to be handled. Further work we could agree on would be to move the licensing stuff in modern medicine to the licensing section, clean up history section, rationalise NIH consensus which is repeated everywhere (perhaps shorter quotes and refs would be appropriate), use of sources should be to make the point then ref (in order to cut length), risks are risks potential is tautological. Apart from the last point, I'll try to avoid editing until you respond, but please go ahead if you think I'll accept. Cheers. Kevin Mccready 07:22, 23 March 2006 (UTC)

Hi Kevin. Generally agree that the article still needs work. It's improved a lot, in no small part thanks to our collaborating, but still has a way to go! -- e.g. the links section is a mess.

On what we call "scientific": I am not comfortable with the equation "verified by EBM standards" = "scientifically proven", or "not EBM-gold-standard" = "not scientific(ally relevant)". As we know, not all scientists, let alone clinicians, agree that EBM criteria are the appropriate ones to use to tease out real effects and causation in every case. That objection obviously includes modalities like acupuncture that are based on procedures (cf. blinding issues) and, often, individualized treatment (other controls). It's a scientifically plausible objection, FWIW, and not "merely" a clash of paradigms based on competing religious vs. naturalistic worldviews or some such thing. If one is going to study something, one can't just look "where the light is good" (like the drunk guy in search of his car keys) and imagine that is sufficient. Nor does this objection reflect some sort of extreme minority view among scientists. It's part of a legitimate debate about how data are interpreted. So, let's not spin all that is non-EBM as inherently non-scientific.

On the overall presentation: obviously, we're not after "objective truth" here but rather verifiability and NPOV. Therefore, in terms of claims for indications or efficacy, I think it's better to be clear on who says what and why, rather than (implicitly or explicitly) presume EBM or anything else to be the objective-truth standard. Does that make sense? And that's more or less what the article does as it stands now, IMO. I think that at this point it mostly needs pruning and editing so that claims, objections, lists, etc., aren't subtly spun one way or another. What do you think?

In terms of specific edits, please go ahead, but with regard to NIH citations I'd appreciate discussing changes first as I feel most of those reflect important issues (blinding, safety, many biomedical techniques not EBM-gold-standard either). I'd like to prune redundancy but keep that stuff. I'm entering a busy stretch and will be somewhat hit-and-miss for the next two weeks, so if I'm absent just go for it and I'll have a look later. Cheers, Backin72 (n.b.) 09:22, 25 March 2006 (UTC)

Like democracy, EMB, is imperfect but is the best system we have. It also includes (and this is not yet reflected in WP article, the Number Needed To Treat concept. We must also consider the weight given to minority views - you are probably aware of this in WP guidelines. The question remains, how many large RCTs are necessary to conclude with reasonable firmness that acupuncture is not useful for certain conditions? To my mind we are reaching that point in a great many areas, though I agree that the equations you are concerned about at the beginning of your post are inadequate and inaccurate. Mccready 13:06, 25 March 2006 (UTC)

I wouldn't agree with the EBM-democracy analogy. (On reflection, I'd probably agree with the proposition that science is like democracy [in the sense of being flawed, but the best thing we've got], but I think EBM is sort of like America's Electoral College: not the best means to the end, slanted and prone to conceal meaningful information!) Your question regarding RCT's and efficacy is meaningful primarily to those who accept the applicability of EBM's parameters. If one rejects them, the question is irrelevant. If (as I do) one accepts them provisionally, as part of the picture, one might say "it depends". If one accepts them fully? -- I suppose one might say "six" if one is a Bandolierian, or "eight" if one is a Cochraneian. You aren't suggesting that our job as Wikipedians is to settle on some integer as an answer and edit accordingly, are you? Our task is instead to present adequately the POV(s) of those who do believe it is an important question to ask and answer, along with other relevant POV's. Also, majority vs. minority is a function of which community one is talking about. For example, see poll. - best, Backin72 (n.b.) 00:58, 26 March 2006 (UTC)

If we are going to use the term science we must understand that it can be no more than a set of probability statements and therefore, yes, you need to put numbers on it. It's 99.9999999% likely the sun will rise tomorrow. It's 80% likely (to pluck a figure at random for the purposes of demonstration) that acu is no more than placebo. It's 95% likely that homeopathy is no more than placebo. It's 99% likely that astrology is crap. As to how you can accept emb for some purposes and not for others .... :-) Mccready 03:51, 26 March 2006 (UTC)

You're putting the prediction-cart in front of the observation-horse. Science predicts only after observing systematically. It is EBM's criteria for the latter process that is questioned by critics. EBM does tend to "look where the light is better" in its systematic reviews of RCT's (double-blinding problem) and thereby favors pills over procedures. (Good graphic of EBM's hierachy here in context of TCM discussion.)

From what I've read, both Bandolier's and Cochrane's reviews tend to exclude non-double-blinded RCT's for acupuncture without comment, but they aren't so blithe when concerning surgical procedures. Here, the problem doesn't seem to lie so much in EBM's principles per se but rather in how the EBM reviewers have been approaching the subject.

There are some who argue that CAM can never be evidence-based [19]; I'm not sure I'd go that far, depending on how EBM's decision analysis is applied. EBM does (in theory) include "lower-tier" material in its decision analysis [20], and that point is worth mentioning along with findings regarding the "top tier" (i.e., systematic reviews of RCT's).

Thus far, as well, no EBM reviewer distinguishes among acupuncture treatment styles; other problems have been noted [21]. -[[[User:Backin72|Backin72]] (n.b.)

HELP

I have still not gotten my answer for the (Question not answered) thing! Please answer...I am very curious!

Imagine you asked a similar question about how Asperin worked back in the 5th century BC. You won't get an answer until a couple thousands years later. Back then the willow bark would have been called pseudoscience because no body could explain how it worked. Many discoveries were by accident and people made up a model to explain them. Most of the time, the model was inaccurate and only explained some cases but not all cases. I remember sometimes ago, "scientists" believed atoms look like swiss cheese, but the model changed overtime. Back then, they called that science though we would call it cheesy science now. :-) Nowadays, scientists believes atoms are made up of subatomic particles, waves etc., who can be sure the current model would be the same 200 years from now? I'll bet my lunch it will change, though you won't want to eat my lunch 200 years from now. There was a guy called Li Shizhen (李時珍) who chewed all kind of herbs and see if he would die from it. He survived and wrote a book about the medicinal properties of all kind of herbs based on his body's reaction to them. Many Chinese herbal doctors still base their prescriptions on this guy's book. Is that book 100% accurate? Probably not. One person's reaction can never be reliable. Is it totally worthless? Not so either. Asperin was discovered in similar way too. Many well known Chinese medicinal receipes had gone through clinical tests. The Chinese University of Hong Kong had done many scientific researches with Chinese medicines. I don't know how acupuncture was invented. However, I guess someone was kneading his own body and found that certain points had different sensation when pressed. When he squeezed those points very hard, his body had some reactions. If surface pressure caused a reaction, then what would happen if you poke it with a needle? Millions of trial and errors later, someone documented and classified the effect of each response. Someone drew a conclusion and formed a model trying to explain what was going on. The model is as good as the swiss cheese atoms model. It works in some cases, but not in others. In current state, acupuncture is an art, it is not science until some scientists found a good model to explain what is going on.

If you are interested in acupunture, sequeeze around your own body. Take note of all the places that give you a special sensation when squeezed. Then buy a book on acupuncture and read about what the Chinese found out about those spots through experiments in the past thousand years. You don't have to believe those emperical results because they are only as good as what conclusion is drawn from them, but you will be amazed that those acupressure points are not random locations, they were found based on your body reactions to pressure. There are several famous acupressure points: try sequeezing the flesh between your thumb and index finger, there is a spot near where the two bones join which give you a numbing feeling when squeezed. How about rubbing your temples, the base of your skull etc.? There are many spots on your body that are different from the rest. Experiment with them and report the result here. Kowloonese 08:31, 24 March 2006 (UTC)

Sorry, I agree this is an interesting subject, but what does it have to do with how we edit the article? It still has to present all relevant POV's in a balanced way, whatever anyone feels from the exercise you suggest. -[[[User:Backin72|Backin72]] (n.b.) 08:57, 25 March 2006 (UTC)

Bakcin72's reorg

In the science section you've gone beyond what we've agreed here Backin72.

• your opening statement implies acupuncture works - the jury is still out on this - the P6 stuff is the best you have and even the conclusion "seems" is controversial
• i don't agree there is a better framework than emb.
• I don't agree the NIH consensus statement should be top of the science section (and it is far too long - better to make the point then leave the link)
• I don't agree that a study on endorphins belong at the top either and the site you give for this is appalling as I hope you will acknowledge.
• the NCAHF points to a Wp source which doesn't site source of crits
• I'm not happy if you say that emb is unscientific
• I'm not happy with non-peer reviewed televsion programs being put in

I've removed insurance stuff as you requested. I've removed the list of tradtional indicators because of the implication that acu is effective in relation to them - a point you didn't demur on.

next time, and I will try to do the same, can you please put drafts on the talk page if you are considering such wholesale contentious changes. thanks Mccready

Hi Kevin. If you look carefully you'll see that virtually all I did was rearrange content. That was my only goal for the edit; there is of course plenty yet to be done. I didn't add or delete material except for a couple redundant things on licensure and an intro statement on research that was as innocuous as I could come up with.

Show me where I said or implied in the article that EBM is unscientific.

I'm restoring the traditional indications. Please re-read the policy on NPOV and understand that it's not our job as a Wiki editors to decide whether acupuncture "works". An article on acupuncture that doesn't include the POV of what acupuncturists say about it would be laughably POV. Clinical experience of practitioners is highly prized in classical TCM as a standard of "truth", which isn't entirely irreconciliable with EBM, but still reflects a different hierarchy [22]. -Backin72 (n.b.) ] 19:08, 27 March 2006 (UTC)

P.S. You disregarded my request above: "In terms of specific edits, please go ahead, but with regard to NIH citations I'd appreciate discussing changes first as I feel most of those reflect important issues (blinding, safety, many biomedical techniques not EBM-gold-standard either)." Rving it all for now pending further discussion. - Backin72 (n.b.) 20:17, 27 March 2006 (UTC)

Backin72, the article is too long. The US NIH stuff has been superceded. It repeats stuff already in the risk section. The smoking stuff is already in too. You have eliminated the electro stufff. The comparison with other forms of medicine is irrelevant IMO. The statment's uyse of MAY, REASONABLE SINGLE CASE, PROBABLY and PROMISING have now been superceded by scientific research, just as they urged, and should go in the history section if anywhere. The post op nausea appears twice in the NIH stuff too. The bias of the NIH statement must be clear to you. They pre-empted scientific findings - not a good look. I've edited accordingly and urge you again to try to cut down the WHO puff. They themselves said it was a PROVISIONAL list. Again it belongs to the history section if anywhere. If you want to put a statement that clinical experience is valued above scientific research you'll need to provide a source. Mccready 00:55, 28 March 2006 (UTC)

I'll reply more later. But one question. We discussed NIH being superseded earlier, and at that time you agreed that it was not. What has changed since then? Presumably a bunch of new RCT's have been published in the intervening month, right? That must be it. Obviously, it's not possible that you, let alone the NIH panel vs. Cochrane's reviewers, are interpreting the same data differently. Because that would be unscientific, or biased, or something less than rational. Right? Looking forward to your rational reply to this. -[[[User:Backin72|Backin72]] (n.b.) 04:16, 28 March 2006 (UTC)

yes my view has changed because i've reconsidered the evidence like a good scientist should. Mccready 06:55, 28 March 2006 (UTC)

And you are entitled to your view personally, but in your capacity as a Wikipedian you don't get to discount the NIH consensus statement or say it is outdated without sourcing that claim. Let me be clear: you, Kevin, are not a reliable source for making recommendations about efficacy based on meta-analyses of RCT's. The NCCAM (among other groups) is, and abides by the consensus statement. For that reason I'm reverting, and you can put your opinion about it back in when you find a source for it.

I don't think you fully understand the nature of scientific debate and the fact that legitimate and defensible differences exist over the interpretation of data. You seem to think that science is about certainty rather than knowledge. Perhaps my view of you is mistaken, but in any case: The NCCAM's view on acupuncture research differs from that of Cochrane et. al., but is clearly a relevant one in the biomedical community if the poll of doctors I cited above is any indication. Therefore, it can be included along with other POV's. You may realize that it is nothing new that clinicians and scientists sometimes diverge on matters of clinical efficacy. The reader can conclude for himself (as you have, with access to evidence) whether NCCAM's view is bad science or a difference of opinion in interpreting the data. You will notice that I've explained some reasons for those differences already, and will add some of the above-sourced stuff to the article. Thanks. -Backin72 (n.b.) 07:35, 28 March 2006 (UTC)

Kevin, I would also ask that when editing you keep in mind Wikipedia's NPOV policy on fairness and sympathetic tone. It is not necessary or appropriate to undercut other POV's by criticizing as you go along, as your edit (and others in the past) did. I value your contributions and in no way question your good faith. Just a constructive criticism, and of course I'm open to such as well. Update: On NCCAM, I put in a reference for their continuted endorsement of the Consensus Statement, which is plainly evident on their acupuncture page which does cite stuff from 2004 and therefore has been updated. In accordance with guidelines on tone, I also added a qualifying statement there about putative putdatedness, so all you have to do is find a verifiable and reliable source for that claim. -Backin72 (n.b.) 18:06, 28 March 2006 (UTC)

More on science and EBM

Since we may have an edit war brewing over this NIH/EBM business, I think we should try to isolate which issue(s) are contentious. The discussion will benefit from third parties as well.

I understand that some editors, like Kevin, feel that acupuncture is pseudoscientific and/or that scientific consensus is that it is not more than a placebo. These are issues that potentially affect the very structure of the article itself owing to NPOV guidelines regarding pseudoscience and undue weight.

On pseudoscience, it is important to distinguish between acupuncture theory and practice. Ironically, even though TCM theory is arguably pseudoscientific, its predictions still guide modern research and have predicted positive results in RCT's [23], [24]. The value of TCM theory in a vacuum (with its bodily humors and medieval sounding-stuff) is quite a different matter from TCM's value (even if informed by that theory) in practice. In other words, modern, scientifically-literate TCM clinicians believe that there is some valuable information encoded in the culturally-determined models used by the old doctors. (Where do you think the researchers got the idea to use P6 for nausea?) As one EBM advocate points out, evidence is more important than power (i.e., the political legitimacy of a modality of healing).

The question of evidence naturally arises, and leads to the issue of majority POV and undue weight. Scientific consensus is indeed that EBM is the "gold standard", but it is wrong to infer from EBM's lack of support for acupuncture that the scientific consensus is that acupuncture is a placebo. I can't cite any definitive source for the scientific consensus on acupuncture's efficacy (and challenge others to find something explicit), but to my view what actually follows from EBM is that acupuncture's efficacy is for the most part unproven. EBM's support (or lack thereof) for acupuncture is a function of at least two things: (1) the criteria for top-tier evidence, and (2) the application of the decision tree for lower-tier evidence (cf. evidence is more important than power above). There is substantive debate over the former (double-blinding issue), and the application of the latter is a matter for the individual clinician and therefore (as Kevin seems loathe to consider) is something that depends on the individual doctor and patient. Thus, when Cochrane summarizes its top-tier evidence, they are careful to say whether there is pretty much no evidence (e.g. for smoking), or that evidence is mixed but inconclusive (low back pain), etc. They are also careful to note varying results among RCT's. This is so that doctors can make their own calls, rather than just blindly follow some one-size-fits-all EBM "bottom line".

The issue of individual judgement among clinicians may be a factor in the finding that a polled majority of doctors state that acupuncture is (in general) at least somewhat effective [25]. This is a significant divergence from what Kevin presumes (reasoning only from top-tier EBM data and ignoring the rest) must be a skeptical scientific consensus on acupuncture. I suspect that Kevin's view is really a straw man. Let's remember that we haven't really established what is the consensus of scientists on acupuncture: Kevin is assuming that absence of evidence = evidence of absence = most scientists think it's bogus, but we don't know that's true. However, if we were to assume that it were true, then we'd have an interesting situation wherein the majority POV would be a function of the community polled, and surely the weight of doctors' views on such a matter has some bearing. Of course, if you poll doctors a majority will say they believe in a Judeo-Christian God too, but it would be difficult to argue that their belief in acupuncture reflects Judeo-Christian cultural conditioning.  :-) And of course clinical decision-making is a somewhat different matter than belief in a deity.

Anyway, enough said, but I hope I've added something to the debate here. Bottom line, there is no obvious majority POV on acupuncture's efficacy among scientists, and among doctors, the evidence presented so far sways towards favoring efficacy. The inferences in terms of our edits (sympathetic tone, weight, NIH) should be clear enough. -Backin72 (n.b.) 09:11, 28 March 2006 (UTC)

Whatever the defects and problems in "Western" medicine (and there are PLENTY), the nonsense of Acupuncture gains no iota of validity from that. It is basically akin to witchcraft and astrology. I once got up from an acupuncture table (I am openminded to try something before dismissing it completely) to discover that the practitioner had left a needle in my foot. 66.108.4.183 12:21, 16 August 2006 (UTC)

A needle left in your foot? Wow. I heard a surgeon left a scalpel inside someone's abdomen once. I'll have to make a mental note to avoid surgery too, at all costs. ;-) Your view of the science behind acu differs from the sources in the article, which is worth a careful read. thx, Backin72 (n.b.) 18:52, 29 August 2006 (UTC)

mccready reasons for revert

Dear Backin72 Yes you are wrong about my understanding of science. I do not assume lack of evidence means it’s not effective. I simply ask that the alternative with lots of weasel words not take its place. And yes the issue is what is the majority science view. Clearly, very limited possible exceptions aside, scientists in large majority say acu is has no more demonstrated effect than placebo.

You have got to be kidding to link this NCCAM stuff and call it science. I find the implication that acu might be useful for fibromyalgia disgusting. This is a simple con with no reliable evidence to support it (happy to eat my words if I’m wrong). The getout weasel word “MAY” for this condition and the others is intellectually pathetic, particularly given the amount of data now in. You cannot seriously use this source to paint a legitimate scientific dispute.

In Australia you would be prosecuted and found guilty for false and misleading advertising for stuff like this. Our legislation specifically says even to imply efficacy will get you into trouble – happy to provide further evidence if you wish. The other logical flaw in using the quote is that it is self referencing back to the prevaricating NIH consensus statement. Just as an exercise for yourself you may like to count the number of weasel words in the statement. Once again let me tell you why it is outdated – research work since its publication answers questions it posed. You have failed to address the points in my earlier post in relation to this ie all the weasel words.

Your link to a study of 39 people for pain and oral surgery was, quite frankly, pathetic. This is the sort of stuff which was used in my stats classes to illustrate how people misused stats. You just cannot draw conclusions from numbers like this. That is why LARGE trials are needed. I leave you to draw your own conclusions about a P value of 0.001 in the moxibustion paper!!

I’m not loathe to consider doctor patient relations Backin72. But the type of doctor that tells a patient the doctor knows best from his/her own experience and therefore scientific findings can be ignored would rightly get struck off the register. The fact that some doctors believe mumbo jumbo from pharmaceutical companies, conventional medicine or anywhere else does not count a fig in whether or not the mumbo jumbo is scientific.

A disagree fundamentally with your conclusions that there is no majority scientific view on acu. And by your logic on EBM, anyone making any unfalsifiable claim could push it arguing there is no proof against it because it fits in the framework as level three or four or whatever. Science and EMB is perverted by such arguments. As I’ve said before the request to prove a negative is clearly absurd.

As to your insistence on the WHO provisional list. Please explain. The implication remains that it MIGHT be useful and once again this is offensive to reason. The statement, like the NIH, is almost 30 years old and it outdated by NEW evidence. Your insistence as an acupuncturist in keeping it in, despite the evidence is POV. Your insistence on removing the statement that the NIH stuff has been superceded by scientific work looks like POV too. Would you prefer to reword the sentence?

Once again you have reverted the statement. “Science does not support the use of electrical acupuncture.” I’m happy to reword or even remove if you can prove otherwise.

Your reverts appear to have taken no notice of my point that the article says TWICE that acu has no demonstrated effect on smoking cessation. Surely once is enough. Mccready 02:01, 29 March 2006 (UTC)

Hi Kevin:

>Yes you are wrong about my understanding of science. I do not assume lack of evidence means it’s not effective. I simply ask that the alternative with lots of weasel words not take its place.

I'm not using weasel words as an editor, but citing a fact about an opinion. If that opinion uses weasel words (and scientists use "may" all the time; cf. climate change debates etc.), then that is fine per Wikipedia as long as it is a verifiable and reliable source for a relevant POV. Nor am I saying that the POV expressed by NCCAM (which as I've shown is echoed by a majority of of American docs, per poll) must replace another POV. I'm just saying let's include them both. Read NPOV guidelines. NPOV is not the same as "scientific POV".

That above pretty much sums up all that follows. Please consider it carefully.

> And yes the issue is what is the majority science view. Clearly, very limited possible exceptions aside, scientists in large majority say acu is has no more demonstrated effect than placebo.

If that's so clear then you should be able to find a reliable and verifiable source stating such, and even then that would be no excuse not to include other relevant POV's.

>You have got to be kidding to link this NCCAM stuff and call it science. I find the implication that acu might be useful for fibromyalgia disgusting. This is a simple con with no reliable evidence to support it (happy to eat my words if I’m wrong). The getout weasel word “MAY” for this condition and the others is intellectually pathetic, particularly given the amount of data now in. You cannot seriously use this source to paint a legitimate scientific dispute.

Others reserve the right to interpret extant data differently. You are free to disagree. You are not free, as a Wikipedian, to delete that POV because you disagree with it.

>In Australia you would be prosecuted and found guilty for false and misleading advertising for stuff like this. Our legislation specifically says even to imply efficacy will get you into trouble – happy to provide further evidence if you wish.

Fine, but I'd like to remind you that this is Wikipedia, not Australia.

>The other logical flaw in using the quote is that it is self referencing back to the prevaricating NIH consensus statement. Just as an exercise for yourself you may like to count the number of weasel words in the statement. Once again let me tell you why it is outdated – research work since its publication answers questions it posed. You have failed to address the points in my earlier post in relation to this ie all the weasel words.

I addressed it above. Some people's POV's include what you might call "weasel words". Editors are supposed to avoid using weasel words themselves, but facts about opinions are not constrained by this guideline. See any number of articles citing people who say "may" about something.

>Your link to a study of 39 people for pain and oral surgery was, quite frankly, pathetic. This is the sort of stuff which was used in my stats classes to illustrate how people misused stats. You just cannot draw conclusions from numbers like this. That is why LARGE trials are needed. I leave you to draw your own conclusions about a P value of 0.001 in the moxibustion paper!!

As I said, others reserve the right to interpret extant data differently. Not all doctors follow EBM, and even with regard to those who do, you have not addressed my point above about EBM's decision tree and its inclusion of data below the "top tier".

>I’m not loathe to consider doctor patient relations Backin72. But the type of doctor that tells a patient the doctor knows best from his/her own experience and therefore scientific findings can be ignored would rightly get struck off the register. The fact that some doctors believe mumbo jumbo from pharmaceutical companies, conventional medicine or anywhere else does not count a fig in whether or not the mumbo jumbo is scientific.

First, recommending acupuncture in the absence of top-tier EBM data is not necessarily unscientific if the doctor feels that lower-tier data support doing so. Second, again: NPOV is not the same as "scientific POV"

>A disagree fundamentally with your conclusions that there is no majority scientific view on acu.

I understand that. If you're right, surely you can source your claim. As I said, it sounds like you're just inferring that it reflects scientific consensus.

>And by your logic on EBM, anyone making any unfalsifiable claim could push it arguing there is no proof against it because it fits in the framework as level three or four or whatever. Science and EMB is perverted by such arguments. As I’ve said before the request to prove a negative is clearly absurd.

For purposes of the article the issue isn't your or my analysis of what is logical or scientific. The issue is representing different POV's fairly. If NCCAM is really a tiny minority POV, why do ca. 60% of American doctors in the poll I cited say acupuncture is at least "somewhat effective"? You need to source your claim.

>As to your insistence on the WHO provisional list. Please explain. The implication remains that it MIGHT be useful and once again this is offensive to reason. The statement, like the NIH, is almost 30 years old and it outdated by NEW evidence. Your insistence as an acupuncturist in keeping it in, despite the evidence is POV. Your insistence on removing the statement that the NIH stuff has been superceded by scientific work looks like POV too. Would you prefer to reword the sentence?

On NIH, please note: I already proposed a reword along with an opportunity for you to source your "outdated" claim. Rather than provide such a source you reverted.

On WHO, of course I have POV, as do you and most editors, but our job is to ensure NPOV in the article. Unless you can show that your POV really is a large majority and everything else a much smaller minority -- and that 60% of doctors statistic shows you almost certainly cannot -- then we have to give reasonable space to other POV's even if you say they aren't scientific.

In fact, the WHO list still guides instruction and practice today, as any TCM textbook or curriculum (at least in the US) would show. Recall the "traditional" in TCM and that it relies on clinical experience, including that recorded in the old texts. Loathesome as it may seem to you, it is part of the TCM paradigm in which clinical experience is valued more than RCT's (I'll add that source to the article, but have cited it above, and here it is again.) So the point of my citing WHO was just to represent the POV of TCM practitioners regarding what acupuncture treats, and that does need to be represented somehow in the article no matter how much you dislike it. I'm happy to cite something more up-to-date, e.g. Wiseman and Ellis's translation of a Chinese TCM textbook. Again, some people rely on different evidence than RCT's (or additional evidence), a/o interpret evidence differently. Clinical experience and RCT's sometimes diverge. The article can note this point and its implications fairly and sympathetically along with the obvious objection about placebo.

>Once again you have reverted the statement. “Science does not support the use of electrical acupuncture.” I’m happy to reword or even remove if you can prove otherwise.

Friend Kevin, you are really out on a limb here. Surely you realise that it is not my burden of proof to justify removing an unreferenced assertion. I deleted the sentence (as I said when I did so) because it is unreferenced, and it was left over from Empire. YOU are the one who needs to source it.

Your reverts appear to have taken no notice of my point that the article says TWICE that acu has no demonstrated effect on smoking cessation. Surely once is enough.

No problem with that at all. That's easy to fix and I will if/when I revert. But this point is hardly the crux of this debate.

Overall, you are pretty plainly disregarding the need to source your claims, mistaking NPOV for scientific POV, and disregarding fairness and tone. Any response before I revert and we call in third-party moderation? -Backin72 (n.b.) 04:33, 29 March 2006 (UTC)

burden of proof

Backin72, I accept I need to provide source for electoacu. I do not accept I need to provide source that 30 year old material has been superceded by modern research. I do not accept that a survey of doctors represents scientific opinion (in any case survey questions, as you know, can be framed to get the result desired). Your source on EBM/TCM states "acupuncture treatment is typically highly-individualized and based on philosophical constructs, and subjective and intuitive impressions." This is not science. As for accepting the traditions of TCM based on this kind of logic, that is akin to accepting voodoo practices in medicine. Even the source your quote states "Convincing published data for acupuncture efficacy are minimal or lacking for most conditions, especially under the standards for EBM." It is up to you, not me, to prove your claim that scientists generally support efficacy of acu.

I do not accept that it is legitimate scientifically in any way shape or form to rely on the P values in the studies you cite or the number in a trial (39). You cannot fudge the issue by trying to say it is a legitimate dispute between scientists examining the data - that is like saying creationism is a legitimate science. It is not. We are talking Stats 101 here.

• Mccready 06:47, 29 March 2006 (UTC)

Backin72, you said "I'm happy to cite something more up-to-date, e.g. Wiseman and Ellis's translation of a Chinese TCM textbook." yes please in which case we agree to delete WHO stuff unless you want to link it in history section. Mccready 06:55, 29 March 2006 (UTC)

Hi Kevin,

I'm not arguing that scientists generally support efficacy. I am arguing that you go too far if you imply that the consensis is it DOESN'T work, as opposed to that consensus is that efficacy is unproven but still an open question. If the consensus were that it doesn't work, why all the research?

The article needs to take into account and adequately cover at least three relevant POV's: (1) Classical TCM. (2) Modern clinical practice of doctors. (3) Scientific consensus.

(1) I didn't say you had to prove that WHO's claims are superseded by RCT's. I said that those claims represent the clinical experience of TCM practitioners, and thus are part of the TCM paradigm which (as I referenced) values such experience more highly than RCT's. Let me be clear: that who list being superseded by RCT's IS IRRELEVANT within the classical TCM paradigm, because TCM DOESN'T VALUE RCT's as highly as clinical experience. I know very well that the quote above re TCM isn't science. It's still part of acupuncture, even if it is pseudoscience. The article can be explicit about that, but it has to be included somehow (I'm fine with replacing it w/ a similar list from Wiseman later, but till then I want to leave it as an e.g. of what TCM says since by TCM's own evidential criteria it's not outdated). You are want to exclude because it doesn't fit scientific POV, but Wikipedia explicitly is about NPOV and not a scientific POV.

(2) On American MD's and NCCAM, again you confuse NPOV and scientific POV. I didn't say that the doctor survey represented a scientific view. It does shows a majority view within the community of Dr's and is thus relevant to the article, as is the NCCAM view which parallels it. If doctors don't always practice medicine per EBM gold standards, fine, say so, but you can't pretend it doesn't exist. Nor can you say that their reliance on non-gold-standard EBM evidence is unscientific or even un-EBM. You don't have to believe me on that (I'll put this in the article as well):

EBM as often presented by CAM advocates is a caricature unrecognizable from EBM as usually understood. CAM advocates seems to suggest that the only thing that matters in EBM is scientific evidence, that the only scientific evidence that counts is large randomized trials and that the results of these trials should be followed blindly with no place for clinical judgment and assessment of individual patient needs. Accordingly, a typical argument is that EBM constitutes a 'contrasting rhetoric' to the clinical art, intuition and the idiosyncratic nature of the consultation [1]. It is difficult to credit that anyone who has made an attempt to learn about EBM could believe such a claim. For example, the first paper found by the search "What is evidence based medicine?" on the worldwide web is an editorial by Sackett et al [2]. The very first sentence states that EBM is "about integrating individual clinical expertise and the best external evidence." Later in the article, Sackett claims that "clinicians who fear top down cookbook [medicine] will find the advocates of evidence based medicine joining them at the barricades". Similarly, the claim that EBM pushes doctors to use only those treatments "research has proven [to] work" [1] bears no relation to anything found in the EBM literature. Quite the opposite, by incorporating decision analysis (see page 138 of Sackett et al's introductory book [3]), EBM provides an explicit framework for incorporation of therapies where evidence is incomplete.[26]

(3) On scientific consensus, please pay attention: I am not claiming that scientists generally support the efficacy of acu. You are claiming that they believe it is not more than placebo -- that they think it doesn't work. That is different from saying that its efficacy is unproven and still being studied. There is a difference between not believing it is raining outside and believing it is not raining outside. This may seem semantic but it is a highly relevant distinction, and impacts the weight given to other POV's. If the consensus were indeed that acupuncture was just a placebo, then it would be getting about as much research these days as phlogiston does. Instead it is vigorously researched. Does that suggest a consensus that it's no more than a placebo? No, it says scientists are curious about it.

Regarding NCCAM's citation and statistics, you are still confused about NPOV vs. scientific POV, and you also seem to believe that you are the arbiter of what acceptable scientific POV's are. NCCAM and many doctors see the data (and analysis thereof) differently than you or Cochrane. As an editor you may cite criticisms of other POV's but you may not omit them, especially when they are held by large numbers of people, as they indisputably are in this case.

This is going to go to third-party moderation without a doubt, which will be good, because it will clarify some important issues for Wikipedia: (a) how to correctly identify and describe a scientific consensus POV, and (b) how to reconcile treatment of scientific consensus with other POV's that are held by a majority outside science but by a minority within it. IMO, (a) needs to be done with care to avoid your error of conflating absence of evidence with evidence of absence, and (b) needs to be handled by giving greater weight and more respectful treatment of non-scientific-consensus than you seem willing to. So, Rving, and we'll take it from there. -Backin72 (n.b.) 07:50, 29 March 2006 (UTC) (+ some edits -Backin72 (n.b.) 21:08, 29 March 2006 (UTC))

BTW, Kevin, note that your objection about the NIH consensus statement being outdated/superseded is at the end of that section, and awaits a citation. If it's as egregious a problem as you say I'm sure you can find a good one. Scientists spoke out very convincingly and vocally on the "Intelligent Design" issue. If they also disagree with NCCAM's position, surely they will have made their voices heard somehow. If scientific consensus is anywhere near as unified and strongly-opposed to NCCAM as it is to ID, then it will be VERY obvious. And it's not. Some scientists disagree with NCCAM, maybe even most, but that needs to be sourced rather than inferred. To my view, NCCAM's position is on the optimistic end of "the jury is out" and within the mainstream. In any case, cf. 60% of docs, it's a significant enough POV to merit more than cursory coverage. -Backin72 (n.b. 23:09, 29 March 2006 (UTC)

Reorganization to address differing paradigms

I just did a reorg that's intended as a step toward adequately covering the spheres I mentioned above: (1) Classical TCM. (2) Modern clinical practice of doctors (and other practioners?). (3) Scientific consensus. The article has to be clear on the difference between principle and practice, which is a bit challenging because doctors may practice with an eye both toward EBM and TCM/CAM criteria.

One purpose of this reorg is to address the concerns Kevin mentioned above re inclusion of the WHO list of traditional indications. It should go under its own umbrella rather than the article taking a stance on its "working" because -- this needs to be understood -- different paradigms rely on different evidence sets and ways of evaluating them. I tried to be as clear as possible that the list is TCM-based and not science-based. I experimented with several reorgs to day and finally placed it under the theory section and renamed it "TCM Perspective on Treatment of Biomedical Disease".

On the science section, I think the article should avoid the POV that the NIH statement isn't "scientific", because that's a bit like saying who is really a Christian. Better again to cite facts about opinions along with data (and summaries thereof). On that basis, readers can decide for themselves whether NIH is "prevaricating" as some believe, or whether Bandolier shows bias against acupuncture by selectively glossing the double-blind issue etc. -Backin72 (n.b.) 22:29, 29 March 2006 (UTC)

P.S. That said, I still intend to replace WHO with a list derived from a standard TCM textbook like Bensky & O'Connor or the Cheng Xinnong text. I am cool with pruning this section and other stuff as long as it's done evenly and not at the expense of any POV. Some of the theory can perhaps be pruned a/o merged with TCM; I'll have a closer look at the latter. 36K isn't over the top but of course we should shoot for the guidline of 32. Also, Kevin, I think your earlier point about FDA belonging under risks is correct and I moved it. -Backin72 (n.b.) 06:49, 30 March 2006 (UTC)

Added "matter of active scientific research and debate" to lead section so readers understand it's taken seriously in scientific community as a subject for research, unlike astrology or something. -Backin72 (n.b.) 22:56, 31 March 2006 (UTC)

On the WHO list, I'd hoped to find a list that was more up-to-date in terms of reflecting clinical practice in the West. What I'm finding so far is that if such a source exists, it probably isn't going to be in translations of introductory TCM texts from China. Both Cheng Xinnong and O'Connor & Bensky, the two standard teaching texts in the US, include lists of conditions that don't differ appreciably from the WHO list: that is, they include stuff like infectious disease and pediatric conditions, which in Western settings aren't treated nearly as often as chronic and acute pain in adults.

However, the ubiquity of the WHO list (or stuff very much like it) in Asian texts argues for its inclusion in the article as a reflection of the POV of TCM clinical experience (cf. Npov#Anglo-American_focus). We can add a note about Western applications as well.

And the article does need to be pruned, and I think this is best done collaboratively. But that shouldn't be at the expense of any POV currently included, because (as I've argued above) no one has been able to substantiate a single POV as the majority one (cf. WP:NPOV#Undue weight). thx, Backin72 (n.b.) 04:35, 12 April 2006 (UTC)

Another possibility is splitting the article. That could be done without creating a POV fork. There is some stuff that could be trimmed, but it might be hard to get it to 32K. Since Wikipedia isn't paper, we're not obliged to eliminate material that seems valuable. -Backin72 (n.b.) 02:01, 13 April 2006 (UTC)

Journal of the American Medical Assocation Study: May 2005

I think this article should describe the recent findings of a the JAMA double blind study involving sham accupuncture. As reported in the following Scientific American article: [27] The JAMA issue May 4, 2005

"Klaus Linde and his colleagues at the University of Technology in Munich compared the experiences of 302 people suffering from migraines who received either acupuncture, sham acupuncture (needles inserted at nonacupuncture points) or no acupuncture. During the study, the patients kept headache diaries. Subjects were "blind" to which experimental group they were in; the evaluators also did not know whose diary they were reading. Professional acupuncturists administered the treatments. The results were dramatic: "The proportion of responders (reduction in headache days by at least 50%) was 51% in the acupuncture group, 53% in the sham acupuncture group, and 15% in the waiting list group." The authors concluded that this effect "may be due to nonspecific physiological effects of needling, to a powerful placebo effect, or to a combination of both."

I think this is research speaks for itself. I am new to Wikipedia so I did not feel right diving in to make the addition myself.

Patniemeyer 19:40, 31 March 2006 (UTC) Pat Niemeyer

Hi Pat, good study; there is a citation to a Cochrane mata-analysis that looked at 26 RCT's on headache and it may or may not have included this one. No objection in principle but in the interest of keeping article size down we should make sure that links to individual studies are notable. Sham has been looked at in other studies with varying results. thanks, -Backin72 (n.b.) 22:54, 31 March 2006 (UTC)

I am not sure what could be more definitive than a double blind study sponsored by JAMA. I think the current article, in attempting to represent many sources is muddled and leads to the conclusion that there is no scientific concensus on the topic. I think that is misleading.

I will wait until I have time to make a thoughtful review of the entire article and make an attempt at a fair revision. -Pat Niemeyer (signature added by other user)

Hi Pat - before editing, please also read the Talk page where we've covered similar ground, along with Wikipedia's NPOV policies, and keep in mind that

• JAMA didn't sponsor the study, they published it
• The article's study design seemed good, but the authors didn't list the specific methods used for sham points; those were in another paper that as I recall isn't an English-language source, which makes it difficult for commentators to address the issue
• Dozens, perhaps hundreds, of randomized controlled studies exist for acupuncture
• Scientists generally agree that no single RCT is definitive; results need to be replicable and multiple RCT's need to be meta-analyzed. Google for "Evidence-based medicine" aka EBM
• The results of the study speak to the points studied and techniques used in that study, and generalizing them to all of acupuncture is unwarranted
• If any single majority view on acupuncture existed (scientific consensus, or otherwise) that consensus should be easily citable in a commonly accepted reference text. The burdon of proof is on the person asserting that a view is a majority view, so you if you believe consesus exists you need to show this, not simply infer it from what you think is sufficient evidence
• If there does exist scientific consensus, why do they keep investigating basic questions about acupuncture?
• Even if a majority scientific view could be proven to exist, NPOV is not the same as scientific POV, and requires the treatment of all significant views on a topic. See the cited poll in the article on American MD's, and the stuff about TCM being a different paradigm.

edit: obviously, it's cool to put stuff like this in the article, esp. if we're not worried about space and it's eventually going to be split, but please be careful of overgeneralizing from its results to some sort of general "consensus" unless you can demonstrate that such exists among a majority of scientists. Also, you might want to check and see if Cochrane already covered it in their meta-analysis. What criteria do you think that this article, or a daughter article, should use in choosing which individual studies to discuss? thx, Backin72 (n.b.) 19:01, 20 April 2006 (UTC)

Pruning

hi Backin72 thanks for your message. what do you mean by no POV viewpoint in the ascendency? please go ahead and begin pruning - let's do it bit by bit so we can check on progress. Mccready 09:17, 14 April 2006 (UTC)

HI Kevin - no POV in the ascendency = NPOV approach when no majority view. As mentioned above, some splitting a/o consolidating possible; theory could be moved to TCM article. thx, Backin72 (n.b.) 18:20, 14 April 2006 (UTC)

Hi all Might I suggest that we create a new page titled "Science and TCM" (or similar) to relocate all the information from this page and the chinese medicine page regarding scientific evidence, NIH, NCCAM, "questions of efficacy" etc. These sections take a lot of space on both pages and have similar content, a lot of which is repeated. I think a paragraph summarising the main issues (plus a link of course) would suffice to highlight the contention that exists and direct interested readers. I think it is inappropriate to dedicate such a large amount of space on these pages to contentious argument. So many studies I have read on acupuncture and chinese herbal medicine (and I'm talking over 1,000 articles) have concluded that more research needs to be conducted into the area - regardless of positive or negative research findings. Study into TCM is still a work in progress and it seems futile to continue with the "he said" "she said" stuff on the main page because it's not representative in terms of describing what acupuncture is, the flow of the article is disrupted and contains little bits from here and there. Every month new studies emerge that contradict previous ones, and I think that a separate page would allow a better focus and more attention to be paid to this particular "subset" in the TCM/acupuncture story. It is a big subset afterall, and is only going to continue to grow. I would have created the new page today already, but with all the b@?tch-slapping on this page, I'm afraid of getting dragged into this crazy debate, or worse still, a thoughtless revert imposed upon my changes. If there are any objections to this suggestion of creating a "Science and TCM" page, please state them clearly and sanely in response to this post.Piekarnia 02:57, 19 April 2006 (UTC)

Hi Piekarnia. It seems to me that creating such a page would arguably be an example of a POV Fork.

Also, until or if such a page is created, I think that the stuff you just deleted should stay. The last paragraph from the NIH Consensus Statement, about TCM theory's value lying in its clinical efficacy rather than its correspondence with biomedical theory, is intelligent and nuanced stuff, neither skeptical nor "believing". Shouldn't Wikipedia present a range of POV's? I agree that some of this stuff can be folded into the TCM article, and linked accordingly, but I'd be happier if it could stay until we have a chance to integrate the two. I haven't had much time to edit lately, but apart from the fact that the article is (at 37K) too long, there is nothing urgent here; the TCM, EBM and "pragmatic clinical" (NCCAM; also majority of American MD's, cf poll) POV's are all adequately represented and well-balanced with respect to one another (none of them being demonstrably majority POV's). thx, Backin72 (n.b.) 05:05, 19 April 2006 (UTC)

Hi Bakcin72. Sorry to step on your toes. The reason I removed the content is that I felt it was already covered in other areas, and at the very least had no place under the heading of "Traditional Theory". The two paragraphs are not representative of Traditional Theory, but rather of contemporary interpretation - science/pseudoscience whatever. Perhaps it should be in a different category. We are meant to be discussing Acupuncture and TCM, not dedicating every section to a different fragment of the science vs tcm argument. See also the final paragraph in the "example of acupuncture treatment" section - it doesn't fit. I feel that including the scientific justification or argument is important, but it should be dedicated to a separate section - without comments all the way through. The subject headings and content itself doesn't lend itself well to having scientific discourse littered throughout. If you refer to the article on POV and criticism, they say that criticism shouldn't be put into a separate section - unless it affects the flow and readability. I strongly feel that due to the nature of the subject, a separate section is warranted in order to maintain readability. But if you truly believe that the scientific discourse belongs in each subsection, I'm not going to start a revert war.

Also, I don't believe that the separation of the two sections is contrary to Wikipedia guidelines. I refer you to the final paragraph in the first section on POV Fork:

In line with Wikipedia's semi-policy of assuming good faith, the creator of the new article is probably sincerely convinced that there is so much information about a certain aspect of a subject that it justifies a separate article. There is no consensus whether a "Criticism of .... " article is always a POV fork. At least the "Criticism of ... " article should contain rebuttals if available. And the original article should contain a summary of the "Criticism of ... " article. See also Wikipedia:Criticism

Further in the same article under the subject heading "Article spinouts"

Even if the subject of the new article is controversial, this does not automatically make the new article a POV fork. Provided that all POVs are represented fairly in the new article, it is perfectly legitimate to isolate a controversial aspect as much as possible to its own article, in order to keep editing of the main article fairly harmonious.

A separate science page SHOULD NOT constitute a criticism page because there would be data presented from both sides. Properly conducted scientific investigation will only strengthen the basis of TCM and acupuncture, it will tell us where the strengths and weaknesses truly lie - which doesn't necessarily constitute a negative opinion. Unfortunately, if the general practice of TCM involves "individualising" treatments according to symptom differentiation and/or accompanying factors, the ol' double blind RCT is not going to be able to take that into consideration and serve as an accurate testing protocol. We need to have research comparing real TCM treatments with other therapies (pragmatic trials) and we need research that is representative of the therapy. If people are reporting that they are getting success from a particular modality of treatment, but the studies are saying otherwise - perhaps we should be doing the studies differently before we call healed patients "loco" and dismiss their experiences. As a TCM practitioner, I am appalled at how ridiculous studies can be - they do not represent anywhere near what would happen in clinic, yet we are trying to use them to argue for our point of view, and the critics are trying to use them against us by saying they're poorly designed. I agree! Most of them are crap, but I think so for different reasons. Yes, there are aspects of the subject of science and TCM that are definitely POV, but surely they should be more completely represented in a separate, unbiased section. At the moment, both sides are needing to sell themselves short in terms of telling their story in order to conserve space on the page. Piekarnia 06:35, 19 April 2006 (UTC)

Whilst we're talking about pruning the page, are there any plans to include more complete information about acupuncture, such as the different "flavours" of acupuncture = five element acupuncture, japanese acupuncture, microsystems other than auriculotherapy (which has its own page I believe)? What about discussion about the different types of needles used, and a reference to the ling shu? It is the earliest text on acupuncture, and quite comprehensive. What about the classification of points == jing-well points, he-sea points, luo and yuan points etc. Musculotendino meridians, eight extra meridians, luo channels etc. This page could contain so much more useful information about what acupuncture is and its theory, rather than contesting and justifying whether or not it can be explained by science.Piekarnia 06:58, 19 April 2006 (UTC)

This is a good discussion to be having. Aren't there some acupuncturists who accept that EMB is the way to go? In which case the prominence in the article given to traditional pre-science stuff needs to be balanced. At the same time we may need to say that different practitioners and styles don't agree on where the points are and what they may do (if my understanding is correct). The long list from 1979 WHO needs to be pruned down and perhaps even moved to the history section because some items on the list are no longer accepted by a significant number of practitioners as being amenable to acupuncture (again I could be wrong abou this). If there is consensus I would like to try to edit down the NIH stuff with links to the NIH site. Mccready 07:31, 19 April 2006 (UTC)

Good stuff to consider. Piekarnia, you are right that there is MUCH more that could be put in (I say this as a fellow TCM practitioner, btw). China has a "three roads" policy (cf article). Maybe we should emulate that, and do as you suggest. As Kaptchuk pointed out, TCM is founded on basic axioms from which everything unfolds, whereas biomedicine is ever-changing and based on the scientific method. They are arguably different entities, not just different POV's on the same entity. So there could be articles on TCM, traditional acuppuncture (possibly branching into different articles on different styles) and science and acupuncture. (I also agree that in the interest of fairness and tone, every paragraph about TCM theory or practice need not be followed by a "but science says this is BS" type statement.)

Kevin, the problem with "undue weight" is that there isn't good evidence as to the proportions of people holding different views (or doing different things), and the question also arises, among whom? Scientists? Doctors in the West? Doctors worldwide? We shouldn't feel constrained to keep this stuff, including different scientific views on acu, to just 32 K. I'd rather have more information than less, since this isn't a paper encyclopedia. On different point locations, AFAIK for body points they are very consistent with rare exceptions; there is some debate over auricular points. Can you reference that? thx, -Backin72 (n.b.) 21:06, 19 April 2006 (UTC)

P.S. Forgot to add: as I mentioned above, the WHO list includes basically the same stuff as current, standard English-language teaching texts. This is basically the TCM piece of Chinese medical education (which can be anywhere from 10-50% of a Chinese doc's training depending on the school). This is important enough to merit inclusion, even if most Western graduates don't devote much of their practice to treating, e.g., infectious disease. However, "TCM-ized" acupuncture (TCM in the sense of the PRC's official version of it) isn't the only acupuncture taught or practiced in the West, although it's the most prevalent one (and the basis for most of the national board certification exams) in the US. There is Japanese, French, Worsleyan 5-Element, emerging American styles, etc. Those should be mentioned too. I think we should focus on spinning off a new article or two before deleting stuff from this one.

As for science and undue weight, again, NCCAM is a significant player representing a POV that should be covered (cf. 60-75% of American MD's). thx, Backin72 (n.b.) 22:47, 19 April 2006 (UTC)

Pruning NIH; more on NIH consensus (NCCAM) and EBM

Kevin, if the above wasn't clear, there ISN'T consensus on pruning NIH, so I'm reverting and am going to keep doing so unless or until you adequately address my reasons (stated above several times) for leaving it in. Please quit taking out stuff that doesn't jibe with your POV. You need to cite assertions that it's outdated or biased. Even that doesn't justify removing it. And if we're gonna split the article anyway, there is no need to prune. Thanks, Backin72 (n.b.) 05:15, 20 April 2006 (UTC)

P.S. I've left that tagged statement on "outdated" in there for well over a week. As you know, uncited statements can be removed at any time, but I've heard that a week is customary for tagged things. I'll leave it awhile longer so you can dig something up, if you like. -Backin72 (n.b.) 05:21, 20 April 2006 (UTC)

Due to an edit conflict my ealier post didn't make it. Here is is again:

Keep cool Backin72 and assume good faith. Looks like we don't agree on leaving it all in. To help us along could you ennumerate why the bits I removed should stay? In particular, you need to say why the comparison with other forms of medicine should remain. At the moment it reads like an advertisement for acupuncture, which is not the point of the article. The bias is a simple statement of fact and doesn't need a source, but I'll rephrase it and hope you agree. On outdated, I've also said before that plenty of stuff has been done in the quarter of a century since the biased statement was published - and that stuff, we both agree, has improved our knowledge to a point well beyond what was available in 1977. Once again, its heavily qualified use of what we also both acknowledge as weasel words, make it a problematic, not necessarily authoritive source, from one particular agency in one particular country. It would be similar perhaps to inserting critical material from [28]. I've therefore moved it to the history section, which I hope is OK? I don't agree the article should be split at this stage when there is still discussion about pruning. Mccready 06:47, 20 April 2006 (UTC)

I do assume good faith, Kevin, but I've stopped assuming that you understand that NPOV isn't the same as scientific POV, or that you are careful in your edits.

• First of all, NCCAM is 1997, not 1977. Oops. They stand by what the 1997 report said, and that alone suffices whether or not you think it's outdated. Putting it under history is absurd, and saying it's not scientific is just your POV (TCM is obviously not the same as science, but NCCAM's panel was mostly composed of PhD's). Your qualification "although much research has since been published" still has some POV, suggesting their position is unreasonable. Why not just find a source who says so? If you can't, then it shouldn't be in the article.
• Second, their purported bias is obviously an opinion, not a fact.
• Third, weasel words are something we want to avoid as editors, but if a source uses them that does not mean that the source isn't reliable (by any Wikipedia standard that I'm aware of; please correct me if I'm wrong). Life is full of uncertainties and probabilities and possibilities, you know? So is clinical practice.
• Fourth, you say it sounds like an "advertisement" for acupuncture on the basis that it gives qualified endorsement of acupuncture for certain conditions; this is circular logic based on your reading of the studies as showing lack of efficacy (as opposed to Cochrane, which more often than not says that studies are insufficient to show efficacy, which isn't the same thing; NCCAM interprets the studies still more liberally, and it's not our place as Wikipedians to exclude a significant POV we don't agree with).
• Fifth, you wish to delete material on its safety relative to Western therapies when in fact safety is an essential factor, along with efficacy, in clinical decision-making.

Please feel free to include the critical material you refer to. I see no justification for your deletions, and am rving. Why err on the side of shutting down other POV's? Clarify the ones you think are important, and try writing for the enemy once in awhile. - Backin72 (n.b.) 07:47, 20 April 2006 (UTC)

Thanks Backin72, sorry about the error 1977/1977 and I do in fact understand NPOV and science. Yes, given my error it is not appropriate yet in the history section. Regarding your safety arguments, wouldn't it be better then to put it in the safet section? I would like you to consider how, as editors we can include the fact that the statement, to the extent it prejudges research, is IMHO biased. Unless your argument, if I understand you correctly, is that they, not accepting science, somehow imagine some other type of research. Are you also suggesting they reject EMB? In either case, the case for bias is made out in logic. Regarding your fourth point there is no circular logic - as I've said before you cannot prove a negative. Rhetorically for the moment, how many studies and how much money spent would it take for you to allow the conclusion that enough is enough? What we are seeing here, not necesssarily from you, is a religious belief (ie science doesn't matter, we have a diferent framework, my personal experience says etc etc). If that is the case we need to work that into the article. Thanks for the go ahead on the NSW material, I think it will make a useful addition for why regulation takes place. Many practitioners believe that regulation = approval. It does not and we need to cover this also. Mccready 08:50, 20 April 2006 (UTC)

Hi Kevin, good call on moving the appropriate comments to the safety section. On NCCAM's putative bias, I don't think they prejudge research. I think their view is that given that acupuncture is relatively safe, it doesn't hurt to try it in some cases where the data is suggestive, and by doing this we will accumulate clinical observations that will be helpful. Such qualified endorsement may sound to you like an advertisement, but in Wikipedia terms it has to be allowed as a difference of opinion. All I can say, as before, it please feel free to flesh out other POV's/criticisms for which you have reliable sources, but you don't get to infer "bias" as "fact" within NPOV.

Your rhetorical question on "when enough is enough" is a leading question. My response is that it will answer itself when scientific consensus is reached. This isn't like flat-earthism; there is active research on acupuncture worldwide. If consensus existed that it was ineffective, shouldn't you have been able to find it by now? One might be tempted to ask: at what point do we say enough is enough, and stop trying to exclude significant POV's because they don't correspond to an imaginary, unproven majority view?

Finally, I think the article is pretty clear on the differences between classical TCM and science/EBM. edit: meant to add -- in what ways do you think it's not? I did try in recent edits to make clear that classical TCM isn't based on the scientific method, etc. thx, Backin72 (n.b.) 22:17, 20 April 2006 (UTC)

P.S. On proving a negative, note that there is a difference between the meta-analyses of RCT's for smoking (essentially no evidence of efficacy) and headachce (mixed). Giving unproven-by-top-tier-criteria stuff a try isn't antithetical to EBM, at least according to this source (already in the article at end of EBM section). Consider NCCAM (NIH Consensus recommendations) in that light. If something is very unlikely to cause harm (certainly true of acu in trained hands: my malpractice insurance is really cheap relative to what MD's pay), it's not unethical (or unscientific) to try it in practice, especially if doing so is suggested by clinical experience, consistent with patient values and has the potential to generate information that can guide further research. That's how good stuff is sometimes discovered, or re-discovered. thx, Backin72 (n.b.) 07:07, 22 April 2006 (UTC)

New South Wales report; AMA and NIH

Hi Kevin, I just read the New South Wales report you mentioned[29]. It's a good example of a well-considered regulatory proposal, and notably has useful summaries of regulation of acu worldwide.

Above you said "Many practitioners believe that regulation = approval. It does not and we need to cover this also." I don't read regulation as endorsement, but as ensuring both freedom of consumer choice and safety. These issues arise with any modality or practice that has the potential to harm. In any case we should stick close to sources and use fair tone.

The safety issues raised that were acu-specific had to do with unsterilized needles, linguistic competency of practitioners, and patients' potentially not seeing warranted biomedical intervention. (Issues of toxicity were mentioned with regard to herbal TCM.) These are issues frequently raised in regulating acu and CAM; they are covered somewhat in the Safety & Risks section (to which the Legal and Political Status section should refer). Were those the things you wanted to add? thx, Backin72 (n.b.) 19:13, 21 April 2006 (UTC)

hi Backin72, yes they were the issues. I moved the NIH stuff to safety. On the bias question we'll have to agree to disagree. They did, after all, say the research would prove them right or words to that effect. I'm not going to have time to work on acu much for a little while, but pls feel free to put the NSW stuff in. Mccready 12:23, 22 April 2006 (UTC)

Hi Kevin; thx for adding AMA. On NIH, perhaps you hadn't noticed that I'd already moved the safety-specific stuff to that section? The rest was about research, efficacy and suggestions for clinical use, and is better left under the Research section. It is too POV to edit the article such that positive statements by scientists are left out of the Science section and thereby subtly spun as unscientific. (I don't know whether that was your intention or not; just commenting on the way it reads.) edit: On bias, I don't think that any of the quoted commentators (Bandolier, NIH Consensus Comittee, AMA) are without some degree of bias, though none of it appears extreme; readers can infer a/o sources can be cited on this issue. (If no one finds a source, I'll remove tagged statement on NIH being outdated in a few days). Have a good weekend, and thanks, -Backin72 (n.b.) 01:14, 23 April 2006 (UTC)

About the AMA reference, don't mean to be picky, but it's a pretty dodgy reference. It's a report that was commissioned a number of years ago that contains two references to acupuncture: 1) a digest article from AMA from 1992 2) an article written by our friend S Barrett (recognised biased writer). There are no primary sources stated, no direct references to any trials. Are these the only two things they read before writing the report? Other material available from the AMA website shows that the opinion stated in the 1997 article is outdated. In fact, in a 50 page report on pain management from 2005 [30], they discuss the role of acupuncture and quote real research. They state that many benefits are based on empirical observations with only a few studies done to back up. On their site they quote NIH 1997 and their link to acupuncture tells a very different story [31] to the one currently listed on wiki. Can we please remove the statement and replace it with something more current and representative? Cheers Piekarnia 05:58, 26 April 2006 (UTC)

Agree that the AMA report is pretty underwhelming; they have some boilerplate citations and don't even purport to analyze RCT's. But AMA is a relevant POV, and I'd tend to err on the side of inclusion. Googling, I couldn't find anything better from them. thx,Backin72 (n.b.) 06:08, 27 April 2006 (UTC)

Not sure if everyone is aware, but the page on Medical acupuncture discusses some of the issues that we're talking about here. Perhaps some of the scientific discourse would fit on that page? The page is lacking somewhat in references and some of it is relevant to what we're discussing here.Piekarnia 06:07, 26 April 2006 (UTC)

Hi Piekarnia. "Medical acupuncture" is basically Joseph Helms' synthesis of various schools. I think it should probably be treated in the same way as Japanese, Korean, Worsley, TCM, etc. -- either merged or having its own page, but being clear on what it is and isn't (it is valuable, but it's not more "scientific" or "rigorous" just because docs are doing it). I like your original idea of having a "science and acu" page that covers emerging scientific research in more detail, and would naturally be updated more frequently than a TCM page. I think we also should try and distinguish between China's "offical" TCM and the larger body of material that's sometimes called "traditional Oriental medicine". Lot of work to do. Wish I had more time, but I'm happy to help incrementally. best, Backin72 (n.b.) 06:04, 27 April 2006 (UTC)

AMA Statement

I disagree with the views expressed above re the AMA statement. The medem.com site is not the AMA, though it is true that acupuncture received a signficant boost in the west as a result of chinese businessmen fleeing communist china during and after the cultural revolution - some of them had been trained in Mao barefootdoctorism (the doctor you get when you don't get a doctor because the communists were exterminating the intelligentsia).

The AMA pain link stated:

"efficacy of acupuncture may have more to do with the therapeutic relationship between the patient and the acupuncturist than the direct physiological effects."

I think you may have misread other parts as support for acupuncture. My own view is that the human mind is one of the most powerful but least understood parts of the health equation. I look forward to a day when we can harness the placebo effect reliably and repeatedly - unfortunately western medicine moved away from this, for example when it pooh-poohed hypnosis or meditation and turned instead to a one size fits all type of medicine that failed to account for individual differences. This is not to say that EMB should be abandoned - it's just that your EMB must take individuals into account. So I'd be reluctant to alter the science section as suggested. There is still no scientific proof that acupuncture is anything more than placebo for any condition whatsover. Even the metastudy on P6 for nausea is hotly contested. Mccready 11:27, 26 April 2006 (UTC)

You forgot to quote from the same sentence:

"Anecdotal evidence suggests acupuncture can produce some significant physiological changes, some of which have a pain-mitigating effect"

Later in the article they mention the use of acupuncture as a non-pharmacological intervention for pain management in conditions such as myofascial pain and fibromyalgia. Whilst I'm not saying that we should quote this article, and I am very aware that there are no "blanket" statements that acupuncture is the holy grail, what I was trying to highlight was two main points.

1. Firstly, the sentence that is quoted from the AMA is from 1997 (the best part of a decade ago). The actual article that it comes from was a very general article that discussed everything from homeopathy, herbal medicine, acupuncture etc - so it more accurately describes their view of complimentary medicine in general rather than acupuncture. The article itself is very poorly referenced, they have not actually referenced any primary sources - rather they get their information on the effectiveness of acupuncture from secondary sources. One of these sources was S Barrett, who is a known biased writer on the topic. The other was a digest article from a 1992 issue and can hardly be considered a "solid" reference. So my first argument is that it's a poor quality piece of writing and it shouldn't be used. I'm not sure if you have a university degree, but this quality of report writing is unacceptable for a university student to produce and it's definitely unacceptable for a body such as the AMA to be producing. Why are we quoting it? Was it the first thing that you found that had a negative skew toward acupuncture? It seems to me that you enjoy fishing for negative viewpoints instead of trying to find actual viewpoints here.

2. Secondly, I find that there is a great difference between the two statements

"There is little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies."

"Anecdotal evidence suggests acupuncture can produce some significant physiological changes, some of which have a pain-mitigating effect, still, the efficacy of acupuncture may have more to do with the therapeutic relationship between the patient and the acupuncturist than the direct physiological effects"

and I am certainly not delusional about their views on acupuncture with regard to their pain article. I do however see a large difference between the two statements and I think there is a better sentence that we could quote the AMA on.

Yes, the medem.com site is not the AMA, but it does represent two things. Firstly, and less importantly, it represents a wider medical community opinion. Secondly, and more importantly, organisations like the AMA must be quite prudent in websites that they link to, and should not link to websites like that if they do not support the views presented there. Whilst it is obviously not their website, it does show that they appreciate the information held there moreso than they do the quackwatch site for example - which is not linked to.

You've really gotta cut us some slack here, Kevin, it's quite tiring having to deal with your constant provocation here. I stated that the article that you quoted was of poor quality and suggested that it doesn't represent their current point of view. I suggested that we find a better quality article written by the AMA and referenced an example of something they have produced that is properly researched. You jump from that statement to questioning my insight - pointing out that their pain article wasn't an advertisement for acupuncture. I was actually aware of this, and did read the article myself. Did you? (Did you find the reference to fibromyalgia on page 25 disgusting?). I'm really quite insulted by this entire process, here we are trying to have intelligent discourse on this topic and you continually manipulate our words, refuse to see the difference between NPOV and scientific POV and constantly indulge your own POV. What right do you have to come onto this forum and continually bash your own point of view around, and insult others for not having NPOV? You are the only person on this discussion page who clearly has no idea what NPOV means. I would really like to know what your actual problem is.

I'm going to concentrate more on getting some content done for the other topics listed earlier that aren't covered on the page. Should I post them here first? Put them straight on - or hold off until the page has been "revamped"?Piekarnia 00:02, 27 April 2006 (UTC)

My two cents is that you should go for it. We all get a little hot under the collar sometimes, but overall I think the article has improved significantly due to Kevin's presence here (esp. bringing in EBM). Valid criticism does everyone a favor. If we keep erring on the side of inclusion, fair tone and balance, the article will imo keep getting better (and naturally spin off other articles). best, [[[User:Backin72|Backin72]] (n.b.) 06:42, 27 April 2006 (UTC)

Thanks Backin72, I think that Piekarnia has misunderstood my position. I suspect that we all actually agree. ie the mind is a powerful thing. The psychological point is well made and one I agree with - I didn't forget to quote it because it was clear in what I said. I will repeat though that what we are talking about could be due to psychology/placebo/power of human mind in and of itself, not due to acu. Mccready 08:43, 27 April 2006 (UTC)

I think acu, like anything that makes a person feel good, does harness placebo aka the self-healing mechanism. I think that some acupoints (e.g. the best-known, most-used ones like LI 4 and St 36) will be found to do that more effectively than others. I also think that some acupoints will be found to have specific effects (on nociception regionally, neuroendocrine activity, etc.). But that will require careful study design that takes into account its traditional use rather than "looking where the light is better". cheers, Backin72 (n.b.) 05:06, 2 May 2006 (UTC)

Ok, so I have just added some brief theory about point categories. This is pure acupuncture theory, so anyone who wishes to improve its accuracy or add to what I have written (according to TCM framework) is welcome to do so.Piekarnia 10:36, 30 April 2006 (UTC)

Lead section

I removed the statement about cochrane collaboration from the lead section. Wiki guidelines state that the use of specialised terminology should be avoided in lead sections, that we should ease our readers into the topic without dropping them into the middle straight off. Knowing about the cochrane collaboration is not an essential component to one's knowledge of acupuncture: simply stating that there is scientific debate is an adequate introduction. The general reader is "eased into" the topic (see Wikipedia:Lead Section), interested readers can easily find the scientific debate section. I also expanded the information on the cochrane stuff so that it made more sense, previously the reference to P6 did not state what it was tested for. The adverse opinion to the cochrane findings is not made by cochrane themselves, now this is clear to the reader. Cochrane have stated their P6 findings, there is no need to state that it is not valid according to their system just because another group said so. It is good to quote SRAM, but their findings do not change the Cochrane findings. If Cochrane do change their stance, then it will be appropriate to quote that "None of the findings of acupuncture have been proved....etc". But not before.Piekarnia 12:02, 30 April 2006 (UTC)

Hmmmm. "None" goes too far, but "most" may have been OK. Even so, it does need to be made clear that debate extends into the EBM realm as well (P6, headache). And you make a valid point about the technical nature of the definition of EBM and its scientific standards. (1) The reader may not know what EBM is, or what its standards for efficacy are. (2) Scientific standards include not only efficacy, which is debated, but also safety, which is generally accepted (or at the very least much more widely accepted than efficacy is). (3) Finally, EBM also includes non-scientific standards, such as clinical experience, so a doc doing EBM could therefore do acu without transgressing EBM standards. Would the reader understand these issues from the single statement about EBM in the lead? Doubtful, so it becomes a POV statement, an oversimplification of a nuanced issue that needs to be "eased into". Will have to sleep on this, but I think I agree with your point here. thx, Backin72 (n.b.) 05:06, 2 May 2006 (UTC)

The other thing I forgot to mention is that wiki guidelines also state that longer articles can afford to have longer lead sections. So whilst removing the detail about EBM may suffice for the meantime, I think it's worthwhile considering fleshing the lead section somewhat so that we can summarise a little more of the article's contents, perhaps rephrasing the EBM sentence to be more of a layman's version and less technical whilst still representing the issue and providing adequate introduction. We should probably also put in a sentence or two to summarise the other sections as well to provide a more complete overview of the article. Your thoughts, Backin72? Piekarnia 06:21, 2 May 2006 (UTC)

Excellent idea, Piekarnia -- go for it & I'll ponder too (short on time just now). cheers, Backin72 (n.b.) 17:51, 2 May 2006 (UTC)

Kevin (User:Mccready) suggests that A in the lead section should be substituted with B:

• A) The mechanism of acupuncture and its effectiveness are a matter of active scientific research and debate.

• B) Whether acupuncture is truly efficacious or a placebo is subject to scientific research.

I suggest C:

• C) "The nature of acupuncture's effects, and the degree to which it is truly efficacious or a placebo, are a matter of active scientific research and debate."

This, however, definitely doesn't belong in the lead section:

None of the claims for acupuncture have been proved to the scientific standards of evidence-based medicine (cf. Cochrane Collaboration).

Please see my comments just above (currently the second entry in this section, beginning with "Hmmmm...") for why. The sentence is misleading for several reasons. Even EBM types, when discussing top-tier evidence for efficacy, disagree on headache and nausea. You're trying to advance one view based on your intrepretation of studies. As with your ideas about the existence of a purported majority consensus view that acu is no more than a placebo, Kevin, I think you're venturing into original research here. thx, -Backin72 (n.b.) 23:39, 3 May 2006 (UTC)

Thanks for discussing Backin72 and Piekarnia. Pls see WP:LEAD - anything that's in the article is ideally summarised in the lead. I disagree with you Backin72 about EMB. You seek to pick the lowest stds (anecdote/individual clinical experience) and I pick the highest in EMB (replicable proof). That's why the phrase scientific standards is there and the reference to proof - it modifies the EMB statement. So the statement "None of the claims for acupuncture have been proved to the scientific standards of evidence-based medicine (cf. Cochrane Collaboration)." is true. You seem to acknowledge that your strongest point (sorry for the pun)is P6 for nausea - but we both know that is hotly debated. Therefore it is not a settled question to the standard of scientific proof. Your wording in (c) also assumes, albiet only in the first phrase, that there is an effect beyond a placebo - yet there is no good, or strict or scientific evidence of this. The word "active" is also tautological in this context. If it is a matter of research then it is ongoing. I also reject the use of the word evidence applied to anecdote/an individual's clinical experience. Indeed "anecdotal evidence" is an oxymoron. Let me now turn to your other arguments. 1) the reader may not know what EMB is - that's why there is a hyperlink. 2) scientific stds here applies to the efficacy of acupuncture - not to safety. It's sophistic to try to argue otherwise. 3) I've addressed the EMB differences already. Disagree that a true statement that a reader MAY not understand becomes POV - sorry Backin72, that's just illogical. If memory serves me correctly Backin72 is was you who put the cochrane stuff into the lead - if so, I'm surprised you've taken it out. Mccready 17:07, 5 May 2006 (UTC)

The issue seems simple enough. The lead section should adequately summarize the article. The article covers several POV's on scientific research and efficacy, and we've already agreed, it seems, that in the interest of NPOV most of it should stay. Is your version, which basically summarizing Bandolier's take on EBM, a fair and accurate summary of what the article says on these matters? Pretty clearly not. Your version appears to confuse scientific POV with NPOV again, and even then, it ignores the differences between Bandolier and Cochrane (on both P6 and headache), and the differences among NIH and the above-mentioned EBM groups in what to recommend clinically.

My version does not assume effects beyond placebo. It simply says that the nature of those effects is a matter of research. "A matter of active scientific research and debate" is meant, as I mentioned when I made the edit, to clarify that these questions are engaged by people in the mainstream, unlike e.g. flat-earthism. Your rejection of the idea of "clinical evidence" is one POV, but not the only one; even EBM factors in clinical experience, which some would call a kind of evidence. It's fine to mention EBM, but there should be some context, and safety should be mentioned as well. Please see my reply below to Piekarnia for suggestions on how to proceed. (BTW, it was you who placed Cochrane in the lead originally. It's better to just say EBM, with explanation.) thx, Backin72 (n.b.) 7:11, 6 May 2006 (UTC)