Talk:Acupuncture/Archive 27

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Scientific consensus (and COI too)

If there is really sci consensus that acupuncture is bunk and that acupuncturists have COI's, why do these counterexamples exist?

251 currently-open clinical trials [1]
Used at multiple academic centers, e.g Harvard[2], Stanford [3]... plenty more
Significant proportion of doctors favor it [4][5][6]
Novella acknowledges/predicts lack of agreement (see final 3 para's) [7]
Cochrane doesn't consider practicing acupuncturists conflicted when they write about efficacy (I recognize some names; no COI declared). Nor have I found much/any evidence that other editors of tert sources perceive COI.

I notice that a lot of editors who make unsupportable claims re consensus and COI (a) fail to offer adequate sources for their assertions, (b) nonetheless staunchly express certainty, (c) are not themselves scientists or healthcare providers, and (d) seem to be repeating stuff they read on particular science blogs. Anyway these claims are unsupportable and we should respect NPOV. Note I'm talking about prevailing sci opinion, not whether or not those who think it may be effective are right: Wikipedia lags, not leads, the development of such opinion. --Middle 8 (t • c | privacy • COI) 11:16, 7 May 2015 (UTC)

An interesting question, and one which goes tot he heart of the protracted argument.

I have studied this exact question and as I understand it the answer is thus:

The trials and such exist because acupuncture has a quasi-religious following, and the followers are quite unable to entertain the possibility that they are wrong. For a less contentious example, look at homeopathy. The doctrines of homeopathy were refuted over a century ago, there is no reason to suppose ti should work and no way it can work, and yet believers are still conducting trials, ignoring negative outcomes, advocating its "integration" into reality-based medicine and in sundry other ways proselytising their creed. Science, of course, doesn't care either way: all science cares about is, are these claims true or not? The answer appears to be: no. Read the pro-acupuncture studies. Most of them start by stating that acupuncture is an ancient form of healing art. It's not ancient, as currently practiced it dates back pretty much to Mao, and to call it a healing art, or effective treatment or whatever, is to beg the question. Very few studies start out by asking whether acupuncture actually works, and those that do tend to find that it doesn't. Most will instead ask how it works, assuming in the opening premises that it could not possibly be placebo, or seek to compare effectiveness with an admittedly therapeutically null intervention.

The Cochrane issue is more contentious. I have a lot of time for Cochrane but I am aware of at least one review which is dominated by the reviewers' own work, with two of their data sets double counted amounting to well over half of all the data considered, including values which have never been duplicated and which are based on an estimated set of figures which, if you were to substitute measured values from work published contemporaneously by the same authors - also the reviewers - move from the high 80s percent to below statistical significance. There have been reviews of hoemopathic remedies with positive conclusions in Cochrane, even though this is clearly wrong. The problem is that Cochrane has not adapted to the problems identified by Ioannidis, which mean that a null treatment would be expected to generate a net positive evidence base through various biases.

The cottage industry in seeking proof for prior belief, as evidenced in your question, is what leads critics to characterise this endeavour as pseudoscience. Guy (Help!) 11:30, 7 May 2015 (UTC)

I welcome this question and thank Middle_8 for raising this in such a calm and objective fashion. It appears that Middle_8 used only US sources for their posting, which is perfectly OK, but I think this could mean the extent of such counterexamples may be considerably underestimated. Anyway, let that not be a diversion. By coincidence, I have been looking very closely at Cochrane systematic reviews of acupuncture. This has caused me to think as a scientist (biologist) (and currently neutral on whether human acupuncture works) why do so many of these systematic reviews conclude there is a positive benefit? If acupuncture really has been debunked, are all these Cochrane reviewers wrong/misguided/incompetent?

I disagree with Guy on 2 points. First, yes, there may be examples of COI or duplication of data in Cochrane, but surely you cannot be arguing this means every systematic review with a positive outcome for acupuncture can be dismissed because of these isolated incidents? Second, Guy states "Very few studies start out by asking whether acupuncture actually works". Many of the Cochrane systematic reviews do exactly this...there is no chat about meridians, qi, energy, etc, they simply ask, "does it work". Many of the trials or reviews directly compare acupuncture with various controls including sham acupuncture, placebos, pharmaceuticals, the waiting room and other therapies. Yesterday, I started working through the Cochrane systematic reviews trying to tabulate relevant details for those reviews finding a positive outcome for acupuncture. This is extremely time-consuming so I am reluctant to continue unless I know it will be accepted, however, I believe it is directly relevant to this thread of "why do counterexamples exist?" so I will post my early draft here.

Ailment	Number/type of studies reviewed	Number of patients	Strength of evidence	Compared to	Date	URL
Neck pain	10 trials	661	Moderate	Various	2010	[8]
Pain and stiffness from fibromyalgia	9 trials	396	Low to moderate	No acupuncture or standard therapy	2013	[9]
Schizophrenia	30 trials		Limited	Various	2014	[10]
Prophylaxis of tension-type headaches.	11 trials		"valuable...tool"	Various	2009	[11]
Period pain	10 trials	944	"may reduce period pain"	placebo, no treatment, conventional treatment	2012	[12]

DrChrissy ^(talk) 13:10, 7 May 2015 (UTC)

Now that M8 and the doc have been so comprehensively dismissed by Guy, can we now expect them to stop their disruption. Please. -Roxy the Viking dog™ (resonate) 13:56, 7 May 2015 (UTC)

I'm sorry Chrissy but because you commented on PMID 25932209 with "Looks great to me!", and haven't retracted it, I can't give your evaluation of sources any weight. Zad68 13:59, 7 May 2015 (UTC)

@Zad Fair enough.DrChrissy ^(talk) 14:05, 7 May 2015 (UTC)

@Zad - actually, perhaps you can show me where in the above I am making an evaluation. The words used are those given in the sources, usually the "authors conclusions".

Well what did you mean when you wrote "Looks great to me!" if you didn't intend that to be an evaluation of the source?? Zad68 14:20, 7 May 2015 (UTC)

Zad beat me to it, but I was going to say that "Looks great to me" kinda gives your feelings away. -Roxy the Viking dog™ (resonate) 14:22, 7 May 2015 (UTC)

@Zad I thought your comment was about me evaluating sources in this thread. Yes? Where have I evaluated sources in this thread?. If you have simply commented on an edit of mine in another thread, isn't that rather off-topic. Or perhaps that is what is trying to be done? Deliberate disruptiveness because you have no answer to the question Mid8 and I are asking. Let's try to comment on the edits rather than the editors, shall we?DrChrissy ^(talk) 14:33, 7 May 2015 (UTC)

So you've put up a table listing sources but have no plans to evaluate them for their quality or fitness for use here? Guy's response did comment on those aspects of sources, so that is definitely part of this conversation. Zad68 14:44, 7 May 2015 (UTC)

What a resounding pile of inconclusive results.

You've provided strong evidence for JzGuy's position, not for acupuncture.—Kww(talk) 14:41, 7 May 2015 (UTC)

Two points, DrChrissy.

First, you need to study the language of trial results used in promoting supplements, complementary and alternative medicine (SCAM). These almost invariably include only clinical trials of mainly poor methodology conducted by believers. Few, if any, provide evidence of any credible mechanism. Vanishingly few, if any at all, actually refute the null hypothesis.

Second, Middle8 has a material conflict of interest. Evidence he presents is unlikely to include anything that challenges his beliefs.

The issue with acupuncture is that it is at least minimally plausible that needling might have some effect. There is no evidence that qi or meridians exist, the claimed mechanisms advanced by TCM practitioners and other believers are generally religious and not empirically valid. It is very important to remember that a great deal of the published material is guilty of begging the question, in that it assumes a positive outcome from the trial is (a) not a false positive and (b) validates the underlying belief system, rather than the simple act of needling. The former is addressed by Ioannidis in terms of prior probability, which for most of the conditions covered is actually very low, the latter is more of a concern to us in that we have to be very clear on what the evidence actually says.

You should also think long and hard about this: when an intervention claimed by its proponents to be universal, accumulates an evidence base that varies from null to weak positive, pretty much randomly across a spectrum of conditions, then this suggests extremely strongly that the effects are non-specific (i.e. placebo) and that the major difference between the studies is not the effect of the treatment, but the quality of blinding and other mechanisms to eliminate bias.

You can also see this in analyses of acupuncture and comparable trials from China, where there are almost no negative results, ever. In SCAM studies generally, the more committed the investigator is to the intervention, the more likely the outcome is to be positive. This has been extensively investigated with respect to homeopathy, where there is a direct relationship between study quality and outcome, with the most robust studies being least likely to produce a positive outcome (Linde, 1999). I am pretty sure I have seen similar analysis for acupuncture, but don't recall the cite offhand.

What is clear is that there is no robustly demonstrable difference between real and sham acupuncture:

It doesn't seem to matter where you put the needles.
It doesn't seem to matter whether you insert the needles or not.
It doesn't even seem to matter if you put the needles into the patient or into a rubber hand.

The area of pseudomedicine, cognitive bias, placebo effects, blinding and nonspecific effects is very complex. The studies acupuncture proponents conduct are generally not terribly sophisticated, and are intended to support, rather than test, the premise. This undoubtedly exerts an effect on the outcomes. Skepticism is mandatory when reviewing these trials. And don't forget: acupuncture, and TCM generally, are quasi-religious in character, dominated by ritual and mysticism. There is deep emotional investment on the part of practitioners, many of whom have invested substantial time and resource in study of things which the reality-based community rejects outright, such as acupoints.

You can't take the statements of acupuncture proponents at face value, and you certainly can't assume that a minimally plausible mechanism of transient pain relief is likely to be the actual cause of longer term relief in symptoms whihc always turn out to be measured subjectively. Guy (Help!) 15:17, 7 May 2015 (UTC)

The way you have phrased this is more than a bit misleading. There isn't a scientific consensus that acupuncture itself is complete bunk. There's a consensus that if there's any effect at all, it's small in absolute terms and small relative to the placebo effect. I tend to side with Guy that the doubt exists because of persistent source bias, but I can't dismiss the existence of the doubt. As for the underlying TCM basis of qi, meridians, yin, and yang? Yes, those are uniformly dismissed as nonsense by reliable sources.

Again, an analogy, because it tends to make things more obvious. If there were a group of people that believed penicillin worked by scaring angry demons away, evidence that penicillin was effective would not be evidence that angry demons exist. Acupuncture is in a similar position: there is some small amount of evidence that indicates that it may have some limited effectiveness against some limited number of things. None of that is evidence in favor of TCM.—Kww(talk) 14:41, 7 May 2015 (UTC)

Good grief people! What a waste of your energy! As I stated, the table is an "early draft"! I had one thought of it existing as an appendix linked to a statement such as "Some Cochrane systematic reviews have found a positive benefit of acupuncture under some circumstances", so I/We would not be analysing the sources - Cochrane has already done that for us. Alternatively, it could on a stand-alone "list of...." page, but there could be a link to it on here.DrChrissy ^(talk) 15:01, 7 May 2015 (UTC)

Yes, good point, it would be best if a specific content change proposal were made so that we can focus the conversation on that. The OP's comment didn't actually propose a specific change and I think we're struggling with that. Zad68 15:08, 7 May 2015 (UTC)

I would even object to your summary, given your table. The summary of your table so far would be more like "Cochrane systematic reviews have been unable to reach meaningful positive conclusions due to flawed underlying studies, small trial sizes, methodological defects, and low-quality information".—Kww(talk) 15:32, 7 May 2015 (UTC)

@Guy @Kww Please note that the only sources I have been referring to specifically are Cochrane systematic reviews. I'm sure you know that WP:MEDRS states "Cochrane Library reviews are generally of high-quality and are routinely maintained even if their initial publication dates fall outside the above window." Are you arguing that all Cochrane reviews reporting positive effects of acupuncture can be dismissed as innacurate, flawed, sub-standard or whatever?DrChrissy ^(talk) 15:41, 7 May 2015 (UTC)

No, but as I listed above, all the ones you have provided so far have failed to come to strong conclusions for various reasons.—Kww(talk) 15:45, 7 May 2015 (UTC)

Well perhaps we need to contact Cochrane about this - stating that Wikipedia editors (with unknown expertise) are finding fundamental flaws in their expert, peer-reviewed, systematic reviews and these are no longer to be trusted.DrChrissy ^(talk) 15:57, 7 May 2015 (UTC)

I quoted the flaws that the study authors themselves noted, and provided links to the source of each quote. Please don't misrepresent my statements that way.—Kww(talk) 16:02, 7 May 2015 (UTC)

If only we had a source specifically analysing the accuracy of Cochrane reviews of acupuncture. What's that you say? We have?

Just because something is labelled as a systematic review does not mean it is any good. We have to be just as vigilant now as ever. Even a review with a Cochrane label does not make its true. Four out of 12 Cochrane reviews on acupuncture were wrong.
— How good are systematic reviews of acupuncture?

Note the discussion of author COIs.

The crucial bit you missed is that WP:MEDRS says that Cochrane reviews are generally of high quality, and you have interpreted that to mean that any finding of a Cochrane review is of high quality and its conclusions robust - even though the reviews themselves say the opposite.

The Cochrane Collaboration are well aware of widespread criticism of their reviews, and a vulnerability to agenda-driven reviewers. Several reviews have been replaced by newer reviews reversing or nullifying the previous findings. The review on tamiflu is deeply controversial.

The thing about science is that criticism is absolutely normal, it is what distinguishes science from quasi-religious practices like acupuncture. See if you can find any forum where acupuncturists use objective criteria to determine whether variants such as moxibustion or EAV are valid or not - it doesn't happen, doctrinal differences are exactly that: doctrinal, they cannot be objectively settled. Science, by contrast, seeks objective truth, and the attempt to look sciencey while studiously avoiding rejecting your base premise is what makes SCAM research pseudoscientific instead of scientific. Guy (Help!) 18:14, 7 May 2015 (UTC)

@Guy You stated above that 4/12 Cochrane reviews were incorrect. This means that ony 8/12 were correct. Does this make Cochrane an unreliable source?DrChrissy ^(talk) 21:16, 7 May 2015 (UTC)

@User:Kww Would you please interpret the findings of this article[13] and its suitability for inclusion in the article. My thanks in advance.DrChrissy ^(talk) 22:00, 7 May 2015 (UTC)

Why are you asking about a 2008 study when there are 7 more recent studies cited in this article on this very topic? (See WP:MEDDATE). Yobol (talk) 22:15, 7 May 2015 (UTC)

Oh right. So can I put those 7 studies in the article?DrChrissy ^(talk) 22:33, 7 May 2015 (UTC)

Um, what? Put what 7 studies in what article? Yobol (talk) 22:55, 7 May 2015 (UTC)

We are on the Acupuncture talk page. I was talking about putting the 7 articles into the Acupuncture page. You seem to be suggesting they are better articles than the single article I suggested. It might help if you identified the 7 articles you are talking about so we can all do our interpretations of their reliability.DrChrissy ^(talk) 23:06, 7 May 2015 (UTC)

Being on the Acupuncture talk page, I was talking about the 7 articles about fertility that are already used in the article (refs 121-127) (hence the "cited in this article on this very topic" phrase in my original reply). Just a suggestion, but maybe you should spend more time getting to know this article, since you have already been spending so much time on the talk page? Yobol (talk) 23:15, 7 May 2015 (UTC)

Please stick to comments on the edits, not on the editors.DrChrissy ^(talk) 23:28, 7 May 2015 (UTC)

It's hard having an informed discussion about an article when that editor does not appear to have read the relevant section of the article for which they are suggesting edits. If you choose not to read the article, that is up to you. Yobol (talk) 23:57, 7 May 2015 (UTC)

DrChrissy I directly quoted the authors' conclusions from the articles you had proposed. Please stop implying that I am interpreting the studies.—Kww(talk) 23:18, 7 May 2015 (UTC)

Your edit here[14] looks very much like an interpretation to me.DrChrissy ^(talk) 23:26, 7 May 2015 (UTC)

Given "The trials were of moderate methodological quality, but the number of participants in each trial was relatively low. There was a range of individuals studied, acupuncture techniques used and outcomes measured, so we could not combine the results of the trials to get an overall picture of the effectiveness of acupuncture. Therefore, we could only draw limited conclusions", "The small sample size, scarcity of studies for each comparison, lack of an ideal sham acupuncture weaken the level of evidence and its clinical implications.", "the information available was small scale and rated to be very low or low quality by the review authors, so not completely provable and valid", "Three of the four trials in which acupuncture was compared to physiotherapy, massage or relaxation had important methodological shortcomings", and "these findings should be interpreted with caution due to the small number of studies and study participants" I will stand by it as an accurate summarization, not interpretation. Certainly a far more accurate summary than your proposed "Some Cochrane systematic reviews have found a positive benefit of acupuncture under some circumstances".—Kww(talk) 23:44, 7 May 2015 (UTC)

@Kww I think we have got into the subtleties of semantics and nuances. I suspect this is a complete waste of effort on both our parts given that I have already indicated this is only an early draft of the table.DrChrissy ^(talk) 23:49, 7 May 2015 (UTC)

No, the distinction is not subtle. You pulled out a pile of weak reviews, proposed a misleading summary, and then attempted to claim that everyone that was pointing out that they were weak reviews was doing so out of bias. It struck me as willful misinterpretation and tendentious arguing. Nothing at all subtle about it.—Kww(talk) 00:02, 8 May 2015 (UTC)

Wow! Could you tell me what summary you are talking about?DrChrissy ^(talk) 00:14, 8 May 2015 (UTC)

Do me a favour: read upwards, where I directly replied to your inaccurate summary and then quoted it later. Actually reading other people's replies and considering them is a key discussion skill. Failing to do so makes one look like an intentionally disruptive editor.—Kww(talk) 00:21, 8 May 2015 (UTC)

I have not left a summary anywhere in this thread because I have not presented any material to summarise. I posted the table and suggested a very general, neutral sentence that it might link to. I have clearly stated the table is an early draft, so any statement linked to it would obviously also be up for discussion when the table is finished. You seem to have focussed on the table and associated comments very early in their evolution. Take a step back, relax, and wait until the table is complete. Your constructive criticism will then be very welcome.DrChrissy ^(talk) 00:43, 8 May 2015 (UTC)

Aahh ... so that misleading summary wasn't a summary? It was just a "very general, neutral sentence that it might link to"? Thank you from making your disengenuous behaviour more obvious.—Kww(talk) 00:54, 8 May 2015 (UTC)

@User:Kww I posted the "early draft" table and suggested the "statement" here on this Talk page. A function of Talk pages is to post suggested material for WP:Civil discussion - not to attack other editors. Your classification of my postings as being disengenuous is incorrect and a personal attack. Please do not do this again.— Preceding unsigned comment added by DrChrissy (talk • contribs)

As always, the best way to not be criticized is to not behave in a way worthy of criticism, not to misbehave and then wave WP:NPA at your critics.—Kww(talk) 13:39, 8 May 2015 (UTC)

@DrChrissy: If it is a waste of time, it is not because we have "got into the subtleties of semantics and nuances", it is because you do not seem to want to understand that facts. Kww and I have both explained, in detail, why your interpretation of the Cochrane studies is incorrect, and shown you that the studies themselves are quite open about their methodological limitations. I have also shown you evidence that four out of the twelve studies are wrong anyway. These are not subtleties or nuances, these are fundamental weaknesses in the evidence, noted in authoritative sources. Guy (Help!) 08:06, 8 May 2015 (UTC)

Agree with DrChrissy and Middle8. Those were very insightful statements. -A1candidate 23:45, 7 May 2015 (UTC)

Of course you agree with them, they support the POV you have consistently advanced for years. It remains the fact that they have not addressed the fundamental issue: Cochrane reviews show weak evidence from poor studies and in several cases the Cochrane reviews misrepresent the sources. The weight of evidence is entirely consistent with the idea that acupuncture is an elaborate placebo with documented risks, and entirely fails to refute the null hypothesis. Believers will not accept his this so engage in largely pseudoscientific attempts to prove their beliefs, piling up ever larger numbers of trials all of which share exactly the same flaws. Guy (Help!) 06:51, 8 May 2015 (UTC)

That is why we have to consider the clinical practice guidelines of medical organizations in addition to the Cochrane reviews, JzG. -A1candidate 08:20, 8 May 2015 (UTC)

The problem is that clinical practice guidelines lag even further behind the science. In fact, the entire field of so-called "integrative" medicine is founded on the belief that you can write clinical practice guidelines for the use of any old bullshit, without worrying at all whether it is even remotely plausible. There are clinical practice guidelines for the use of homeopathy, which is the canonical bogus pseudomedical intervention.

The current lede actually summarises the subject rather well: acupuncture is popular, but increasingly isolated in terms of genuine scientific investigation, due to the absence of a proven plasuible mechanism and the rather well documented fact that it does not seem to matter where you put the needles, what you do with them, even whether you actually insert them at all.

I have no doubt that acupuncture proponents sincerely wish and/or believe otherwise, but this has not translated into hard empirical evidence. Most of acupuncture practice is simply nonsense, based on whimsical notions of unverifiable "life force", and it is regrettable that the inevitable (per Ioannidis) existence of a weak positive evidence base is relentlessly exploited by people determined to somehow prove that the whimsy is fact. Guy (Help!) 10:04, 8 May 2015 (UTC)

I think Miller's Anesthesia and much of the scientific community disagrees with you. -A1candidate 10:17, 8 May 2015 (UTC)

As do the statements of several National Medical Organisations.DrChrissy ^(talk) 10:51, 8 May 2015 (UTC)

@A1candidate: I think you'll find that it is medical, not scientific, opinion that dissents from the findings of science. Whatever the former medical students might think, the science is pretty clear: the purported mechanisms of acupuncture are bogus, the risks are real, the benefits are elusive, and most of the research is carried out by those with a strong vested interest in acupuncture's validity. Feel free to cite a good quality source that refutes (rather than repudiating) the null hypothesis. Note that only robust fundamental science or very large and very well designed clinical trials can do this, by definition. As Cochrane notes, most of the trials are neither large nor well designed.

I refer you once again to Ioannidis and the problem of prior plausibility. Acupuncture is an implausible treatment whose outcomes are weak or equivocal and appear to apply randomly across superficially similar pathologies, Ioannidis tells us that any positive results are most likely to be false, and this is in line with the finding that you can stick the needle in a dummy rubber hand and get the same effect. Guy (Help!) 12:11, 8 May 2015 (UTC)

The mechanism includes purinergic signalling, as I've told you before. -A1candidate 12:32, 8 May 2015 (UTC)

I am well aware that you wrote that WP:COATRCAK to crowbar in speculation that this might be the mechanism. Needless to say, there is no remotely credible evidence linking this to most of the claimed effects, no evidence to account for the fact that studies show acupuncture "works" for some conditions and not for other, similar conditions, no evidence of any persistent effect form such signalling, and good evidence that it does not matter if you stick the needles in or not, including evidence that acupuncture "works" equally well if you stick the needles in a dummy rubber hand instead of the patient's hand. How does purinergic signalling affect "treatment" of stroke, leukopaenia, depression and other things acupuncture is claimed to cure:

The problem is much like that of homeopathy cultists. Dana Ullman waves a paper showing that silicates exist in solutions prepared in glass. Well, duh. That is a fact, but an irrelevant one: like doesn't cure like, and there's zero evidence of bioavailability or persistence. Ditto "purinergic signalling". Sticking a needle in someone, has a transient local effect. Who knew, apart from anybody who's ever studied the pain reflex?

Here's an interesting thing, though. If it did work by purinergic signalling that would refute the all the nonsense about qi and meridians. How much success are you having in persuading acupuncturists to drop all that nonsense, based on the newly discovered "real" mechanism? And where are the treatments making use of the same mechanism but avoiding or minimising skin penetration with all its attendant risks of infection and structural damage? Guy (Help!) 20:52, 8 May 2015 (UTC)

The answer to your last question might be found in PMID 22524543. Although Orac/Gorski insists that it has nothing to do with acupuncture, he acknowledges that the experimental design is sound. You can also try asking Edzard Ernst for his opinion about this. -A1candidate 01:04, 9 May 2015 (UTC)

Wikipedia is WP:NOTFORUM. Less own ponderings, more sources. Cheers! Jayaguru-Shishya (talk) 17:05, 11 May 2015 (UTC)

I have already talked to both Edzard and David. The short version is: you're engaging in special pleading. There is no such thing as qi, meridians do not exist, it does not matter where you put the needles or even if you insert them, therefore acupuncture, the practice, is bogus. Whether some effects can be obtained by needle insertion is a separate quesiton, and one for the reality-based medical community. Acupunture, the religious pseudomedical intervention, is a bust. There is some accidental overlap with reality, but it is just that: accidental. Discussion of such effects would belong on an article about the effects of insertion of needles, not one on acupuncture-the-pseudomedicine. Guy (Help!) 10:07, 9 May 2015 (UTC)

Could you show me the longer version of Prof. Ernst's reply, please? I am interested to know what he says. -A1candidate 12:14, 9 May 2015 (UTC)

According to Ernst it's a bust but he is but one source. Yet even he won't say it's efficacy is entirely due to placebo effect in published literature because he knows he has to make it through peer review. Why should Wikipedia treat this any differently? And why do we have so many Ernst sources on the page anyway? I was counting and most are out of date, per MEDDATE. Shouldn't these be removed and replaced with fresh findings? And per DrChrissy's original point regarding Cochrane reviews, a recent scan of pubmed literature published in 2015 on acupuncture shows positive findings in all but one publication. Why is this Wikipedia article so diametrically opposed to recent scientific findings? LesVegas (talk) 20:36, 9 May 2015 (UTC)

Perhaps because he was Europe's first professor of complementary and alternative medicine and specialised in objective analysis of research into implausible treatments. I can't provide the text of the reply as it was not email. However, the reason he says that the effects are consistent with placebo, rather than asserting as fact that they are placebo, is because he is a scientist. SCAM proponents have no qualms about stating speculation as fact (e.g. A1candidate's assertion that acupuncture "works" by purinergic signalling, something the reliable independent sources acknowledge is speculative). Science is inherently conservative, which is why SCAM treatments persist long after they are debunked. If the world paid any real attention to science, homeopathy would be illegal, as it is entirely fraudulent. Acupuncture is minimally plausible so will take even longer to die out, even with the compelling evidence that both location and actual insertion of needles are irrelevant to therapeutic effect, and the fact that effect size is determined by prior belief, all of which are precisely what would be expected form a dramatic placebo. Guy (Help!) 22:33, 9 May 2015 (UTC)

The link you provided is an outdated source. -A1candidate 22:45, 9 May 2015 (UTC)

JzG, please bear in mind that Wikipedia is WP:NOTFORUM, and unless you have some strong sources to present, please take the stories you might have had with Ernst over a cup of coffee to user Talk Pages. You are constantly defining the state of acupuncture, but I don't see any sources. Jayaguru-Shishya (talk) 17:06, 11 May 2015 (UTC)

Find me an acupuncturist who only treats the small number of conditions for which the evidence is at least moderately convincing, who does not have whimsical faux-ancient Chinese anatomical charts on the walls, who always uses good aseptic technique and who has sufficient knowledge of reality-based anatomy to avoid puncturing vital organs, and we can examine the practice in the light of that reality-based practice.

A1candidate, I think you should strike the snide insinuation that Prof. Ernst only publishes honest science because peer-reviewers won't let him get away with anything else. That really is unacceptable (you might want to read WP:BLP some time). And when you say acupuncture works by purinergic signalling, you exemplify the problem with your advocacy editing. The correct statement is that according to the best available evidence, acupuncture does not work for most things, but for the few things for which needling (which is connected to acupuncture only accidentally, since meridians, acupoints and qi are all nonsense) does seem to work, there is tentative evidence that purinergic signalling may play a role. Guy (Help!) 21:13, 15 May 2015 (UTC)

Acupuncture in western education

It ocurred to me that like the section which used to be called "Reception", we could include either within that section or standalone, something indicating that acupuncture is taught at the tertiary level in western countries. Something like -

In the UK, acupuncture is now taught at many main-stream universities, including-

University of Hertfordshire[15]

London South Bank University[16]

Middlesex University London[17]

Lincoln college[18]

University of Westminster[19]

University of Greenwich[20]

Coventry University[21]

University of Bridgeport[22]*

Keele University[23]

Manchester Metropolitan University[24]

University College Dublin[25]

Glyndwr University[26]

Of course not all of these examples would be used - but we could select some.

DrChrissy ^(talk) 17:07, 16 May 2015 (UTC)

Numbers

"Between 2000 and 2009, at least ninety-five cases of serious adverse events, including five deaths, were reported to have resulted from acupuncture.[5]" For the same sentence the numbers should be spelled out. I disagree with this edit. QuackGuru (talk) 00:49, 18 May 2015 (UTC)

Goldman-Cecil Medicine

25th edition of Goldman-Cecil Medicine has just been released. Acupuncture is mentioned numerous times:

Page 141 of Chapter 30: In Figure 30-3. acupuncture is included as a descending modulator of pain. It is listed separately from placebo.

Page 182 of Chapter 39: "Acupuncture has been shown to have various physiologic effects on the body, including stimulation of endorphins and various brain centers."

Page 2347 of Chapter 400: In Figure 400-5, acupuncture is included in the medical algorithm for treating neck pain. It is classified under "options for short-term relief".

Page 997 of Chapter 148: "HCV also can be transmitted by tattooing, piercing, or acupuncture if standard precautions are not implemented."

I propose that some of this information be included under clinical practice. -A1candidate 21:33, 15 May 2015 (UTC)

We already mention treatment of neck pain, endorphins, pain treatment, the possibility that acupuncture has effects separate from placebo, and its role in spreading hepatitis. Why do we need new sources for this? Are the current sources we have inadequate in some way?—Kww(talk) 21:45, 15 May 2015 (UTC)

Yes, they are inadequate due to the following reasons:

No mention of acupuncture as a descending modulator of pain
Duration of relief for treatment of neck pain is not mentioned
Type of hepatitis transmitted is omitted

-A1candidate 22:06, 15 May 2015 (UTC)

I agree this information is superior to what we have in the article already and would be a good replacement where we have overlap and a good addition where we don't. LesVegas (talk) 23:17, 15 May 2015 (UTC)

We already have better information in the section. QuackGuru (talk) 23:22, 15 May 2015 (UTC)

Please define exactly how it is superior so that we can consider your input. A1 made specific points regarding duration of pain relief for neck pain, descending modulation, and type of hepatitis. I would start by addressing the specifics of those, and adding how the information we have is "better". LesVegas (talk) 23:36, 15 May 2015 (UTC)

I would just note you've left out all but one of the negative or equivocal statements involving acupuncture, and the one negative statement you did include is already in the article.

Chapter 30, pg 142: "Pain is the most common indication for CAM therapies. Some of the most popular CAM modalities are acupuncture, chiropractic, and yoga, all of which have been shown to be beneficial in certain contexts. However, the effect size tends to be modest for these treatments, and there is little evidence to support one modality over another or against conventional medical treatments."
Chapter 129, pg 832: [of chronic pelvic pain] "Unproven treatments include...acupuncture"
Chapter 400, pg 2375: [of low back pain] "True acupuncture appears no better than sham acupuncture."

There are a few more. Sunrise (talk) 23:57, 15 May 2015 (UTC)

As per Kww's argument, these are already mentioned in the article and there is no need to mention it again. -A1candidate 00:02, 16 May 2015 (UTC)

I think it's pretty clear that Kww's comment is in response to your own quotes, not the quotes that hadn't been mentioned yet at that point in the discussion. Sunrise (talk) 00:16, 16 May 2015 (UTC)

And I think it's equally clear that I'm using his arguments to help you understand why I did not quote everything from the book. -A1candidate 00:21, 16 May 2015 (UTC)

I think that what I actually said will speak for itself. I didn't object to your not having quoted everything; I objected to which quotes you chose, because the effect was a misrepresentation of the book's acupuncture-related content. Sunrise (talk) 03:35, 16 May 2015 (UTC)

Miller's Anesthesia

Miller's Anesthesia. Elsevier. 2014. ISBN 0702052833.

User:Sunrise, if you have time can you take a look at Miller's Anesthesia for some quotes? QuackGuru (talk) 17:33, 16 May 2015 (UTC)

I would say that on balance Miller's is more positive than Goldman-Cecil. That said, it still contains caveats and qualifications that were omitted when it was being cited in the discussion above. For example, the "key points" summary for chapter 40, the same chapter being quoted above, only mentions acupuncture in the statement "Other complementary therapies, including acupuncture and music therapy, have become increasing popular, although less is known about their effectiveness." Most of the book is actually online (search results for acupuncture) - you can probably select which quotes you would like better than I can. :-) Sunrise (talk) 01:30, 18 May 2015 (UTC)

I added information about the contrasting acupoints. QuackGuru (talk) 02:27, 18 May 2015 (UTC)

A few sentences

I removed a couple sentences from the "Reception" section, which I also renamed "Adoption" since it primarily had to do with how many people were using acupuncture, as oppose to its reception:

The majority of patients who seek out acupuncture do so for musculoskeletal problems, including lower back pain, shoulder stiffness, and knee pain.<ref name=Ishizaki2010/> In the UK, the [[National Health Service]] (NHS) advises that acupuncture is only recommended as a treatment option for chronic lower back pain, chronic tension-type headaches and migraines.<ref name="NHS">{{cite web|url=http://www.nhs.uk/conditions/Acupuncture/Pages/Introduction.aspx|title=Acupuncture|publisher=NHSChoices|accessdate=May 2, 2015}}</ref>

This didn't seem relevant to this particular section, but I wanted to post it here in case it was useful somewhere else. Also, from what I've seen so far, it looked like acupuncture was often recommended for lower back pain, but specifically not for headaches. Given the debate I'm sure accounts differ. Seems like something worth taking a look at before restoring, if it is placed somewhere.

CorporateM (Talk) 09:18, 15 May 2015 (UTC)

I think it was me who introduced the NHS material. I did this because it shows that the National medical service of the UK publicly states that acupuncture is suitable for some conditions. They would not make such a statement without scientific backing. I have thought before that a section "Statements by National health organisations" might be useful. It could go there if this acceptable.DrChrissy ^(talk) 11:09, 15 May 2015 (UTC)

The NHS says:

Currently, the National Institute for Health and Care Excellence (NICE) only recommends considering acupuncture as a treatment option for chronic lower back pain, chronic tension-type headaches and migraines. NICE makes these recommendations on the basis of scientific evidence.

There is also some evidence that acupuncture works for a small number of other problems, including neck pain and post-chemotherapy nausea and vomiting.

Acupuncture is sometimes used for a variety of other conditions as well, but the evidence is not conclusive for many of these uses.

This will probably change with time, since there is some evidence that the effect on chemo side effects is purely that of distraction therapy, and the evidence for the other indications is weakening over time. There's no real problem quoting this overview, as long as we don't stray into cherry-picking positive statements form it as if they validate needling. Guy (Help!) 15:35, 15 May 2015 (UTC)

See WP:NOTCRYSTALBALL. -A1candidate 15:40, 15 May 2015 (UTC)

Indeed. Which is why I said I have no problem with quoting this source, as long as we don't misrepresent or overstate what it says. Guy (Help!) 16:00, 15 May 2015 (UTC)

You said: "This will probably change with time", which shows that you do not understand our policies. You can acknowledge your error or continue insisting you're correct. -A1candidate 16:08, 15 May 2015 (UTC)

What error did he make? I don't see him advocating quoting his personal opinion in the article, or refusing to use the material. He stated that he thinks it will probably change in time and stated why. Nothing in our policies prevents us from commenting about our opinions during talk-page discussions.—Kww(talk) 18:31, 15 May 2015 (UTC)

Except we are not allowed to comment on our opinions about the suitability of sources! That is staggering double standards.DrChrissy ^(talk) 18:57, 15 May 2015 (UTC)

You certainly are allowed to express opinions on sources. The current discussions surrounding your comments are based on questions and concerns about the quality of the reasoning you use in forming those opinions and your frequent characterizations of other editors as being "uncivil" or "attacking" when, in fact, they are bringing up legitimate questions about your ability to reason sufficiently well to be permitted to edit.—Kww(talk) 19:07, 15 May 2015 (UTC)

My reasoning has been this -

I have found a source which is relevant.

The source appears to be WP:MEDRS compliant

I will check with other editors to see if this source is not suitable for some other reason.

...and all this drama happens.

Where is the flaw in this reasoning? - I have been asking editors a question, not disruptively editing the article.

DrChrissy ^(talk) 19:30, 15 May 2015 (UTC)

Perhaps when you received advice on all those sources and came back and described nearly every piece of advice you had received as "Wikipedia editors are being misled ..."?—Kww(talk) 20:11, 15 May 2015 (UTC)

You are misrepresenting what I said...and I am beginning to wonder whether this is deliberate. Please be more careful. I provided diffs for comments of all the advice I received that concerned me. Your statement "...described nearly every piece of advice you had received as "Wikipedia editors are being misled" is extremely misleading. It would have been more accurate to have said "Nearly every source you provided led to the conclusion that WP editors were being misled". There is a huge difference. Please stop this extremely disruptive misrepresentation.DrChrissy ^(talk) 20:39, 15 May 2015 (UTC)

The problem is that it led you to that conclusion, but the logic was so faulty that it led to people questioning your competence and whether you were editing in good faith. Certainly you aren't denying that your competence has been questioned, and you aren't denying that people have questioned whether you are editing in good faith, are you?—Kww(talk) 20:53, 15 May 2015 (UTC)

I agree that this is what Dr Chrissy is doing in good faith. I don't think the Chinese discussion was racist. I do know there are many cmts by editors here laced with aggressive incivilities. No editor has the right to suggest another editor can't reason well and so shouldn't be editing. How incredibly un civil and inappropriate to say the least. Discussion assumes people have different views. Not agreeing or having another view or even another way of approaching discussion or content is acceptable and not only acceptable but expected given human beings are individual.(Littleolive oil (talk) 19:52, 15 May 2015 (UTC))

Blocks based on WP:Competence is required are quite common. Not surprisingly, those blocks are usually preceded by discussion about whether the editor involved is sufficiently competent to edit.—Kww(talk) 20:11, 15 May 2015 (UTC)

I agree with Littleolive; both the comments from JzG and DrChrissy were useful. Editors are not forbidden from stating their personal views on Talk and even if they were, pouncing on them is not helpful. I agree that my presumption that we were being ethnocentric (Littleolive used the term racist) appears to - at a glance - have been an ill-founded assumption. There are legitimate sources that question the credibility of chinese sources. I do think though, that we should use sources from all over the world, including China, but this would take extra work to find out which Chinese sources are considered credible, when indeed most are not. Definitely not an easy task. CorporateM (Talk) 20:37, 15 May 2015 (UTC)

Back on topic

There seems to be support to use the NHS to state its position as an important government body in the UK, similar to how we would state the FDA's position, etc. in other countries. When I went to take a look at the source it said acupuncture is used in most pain clinics and hospices in the UK. Is this a controversial claim? Is it reliable for that? I was going to add it to the Adoption section; that is the claim that it is used in most pain clinics and hospices in the UK. CorporateM (Talk) 21:13, 15 May 2015 (UTC)

It would be controversial to use it as a sign of scientific legitimacy, yes. The NHS also provides for homeopathy, and used to claim that this was based on effectiveness. While the current material from the NHS is unflattering towards homeopathy, they still provide it. It's clear that the NHS decisions are influenced by politics as much or more than they are by science.—Kww(talk) 21:26, 15 May 2015 (UTC)

There's a handy phrase to describe your evidence-free allegations of the NHS - It's called a crackpot conspiracy theory. -A1candidate 22:10, 15 May 2015 (UTC)

You can't come up with a more authoritative voice about what the NHS offers than the NHS itself: "there are several NHS homeopathic hospitals and some GP practices also offer homeopathic treatment". As I said, they are unflattering towards it, but they provide it. Are you arguing that they began to do so despite realising it was completely ineffective? That's a bit harder to research, but I'm certain I can find the original decisions relating to how they started to do so.—Kww(talk) 23:18, 15 May 2015 (UTC)

Exactly. The NHS also provides mainstream medical services and we wouldn't say these are illegitimate because they provide homeopathy as well. Basically, we quote what the NHS says and inform readers that the services are provided by the NHS to UK citizens. And we leave editorializing out because that's original research. I believe facts associated with the NHS are notable enough for the lede, as are recommendations from other notable medical bodies. LesVegas (talk) 23:31, 15 May 2015 (UTC)

As always, it would nice if you would argue with statements I had actually made. I never said that a service was illegitimate because it was provided by the NHS, or that all services provided by the NHS are illegitimate. I said that because the NHS provides homeopathy, it would be controversial to use the fact that the NHS provided a service as evidence for scientific legitimacy. Because of the existence of such a conspicuous counterexample, it's not an uncontroversial relationship.—Kww(talk) 23:50, 15 May 2015 (UTC)

@Kww - Please do find the original decisions and show us your sources. That will be a much more constructive contribution. -A1candidate 00:28, 16 May 2015 (UTC)

I'm surprised: I had thought that they were integrated later, but they were apparently a part of the NHS since its founding: http://www.britishhomeopathic.org/what-is-homeopathy/homeopathy-and-the-nhs/. I was able to find an explicit statement that being effective is not a requirement in order to get NHS funding: "There naturally will be an assumption that if the NHS is offering homeopathic treatments then they will be efficacious, whereas the overriding reason for NHS provision is that homeopathy is available to provide patient choice". That PDF is worth reading: it's the government's explanation of their belief that giving patients a choice is a higher priority than being certain that those choices are scientifically valid.—Kww(talk) 00:44, 16 May 2015 (UTC)

You found statements saying homeopathy isn't effective but that the NHS funds it anyway, but it would be OR if we applied this to acupuncture, unless they said the same about acupuncture. If they did, we can quote that. But as it stands, we should quote whatever the source says and not add anything to it. Let's not butter it up or char it either way. But it's notable and deserves to go into the article, preferably in the body and lede. LesVegas (talk) 01:03, 16 May 2015 (UTC)

Why do you feel it's important information beyond our current statement that 4,000,000 acupuncture treatments were provided in 2009? Wouldn't including it run the risk of having readers conclude that it was being recommended by an organisation that only recommended effective treatments? If we do include it, I would want to include a qualifier that the NHS explicitly supports placebo-only treatments.—Kww(talk) 01:13, 16 May 2015 (UTC)

Actually, the NHS addresses the placebo issue so any statements about the NHS what their findings on acupuncture and placebo should be direct statements from the source here, attributed and in-context. The NHS recommendation provides both a depth and a notability that our article can use. We source Quackwatch in the first paragraph of the lede. And we're still using statements from the encyclopedia of pseudoscience, as well as quotes from bloggers, but we can't use the NHS as a source anywhere? Really? LesVegas (talk) 01:59, 16 May 2015 (UTC)

The purpose of quoting them would appear to be an appeal to authority: "because the UK funds acupuncture, acupuncture must be worth funding." Even if we don't explicitly say it, that's the expected take-home message. We need to be careful in our presentation to ensure that the reader doesn't make that connection, because it's unjustified. The easiest way is to not mention it at all.—Kww(talk) 02:40, 16 May 2015 (UTC)

Kww, Wikipedia is not a SOAPBOX, nor is it CENSORED. We only report what our notable sources say, and we do not indicate to the reader how they should feel about it. We do not appeal to authority and cannot control what readers think, but simply allow sources to speak for themselves. Our job is to ensure this happens. LesVegas (talk) 02:50, 16 May 2015 (UTC)

Just to confirm, are we talking about this web-site[27]? If so, it has a subsidiary page[28] which states "There is some scientific evidence acupuncture has a beneficial effect for a number of health conditions." I can not see the harm in using these Medical organisation statements. We can simply quote them with attribution. I would be in favour of having statements from several countries in a separate, perhaps boxed-quotes, section. I think this would be of great value to the reader.DrChrissy ^(talk) 11:37, 16 May 2015 (UTC)

I am not attempting to include anything that reliable sources don't say. However, I don't understand the purpose of adding this section. The article certainly isn't lacking in information. The only explanation left is that you have a desire to indicate that an authority approves of acupuncture. If that isn't your motivation, what precisely is your motivation.—Kww(talk) 14:39, 16 May 2015 (UTC)

Is it wrong to want to include that a National authority approves of (some types) acupuncture?DrChrissy ^(talk) 14:56, 16 May 2015 (UTC)

Kww, my motives are doing what you have always suggested, citing the mainstream point of view. I hardly think the NHS is less mainstream than Quackwatch, the Encyclopedia of Pseudoscience and other sources like that which we use in the lede. My motivation is that we should use the highest quality sources possible. If we leave this out, we're not, and if anyone ever makes the argument that this article is strongly biased it's easy to win. The rest of the Wikipedia community would frown if they ever suspected we were trying to keep the most reliable of sources off the page in favor of lower quality, partisan ones. Anywho, those are my motivations, not that it matters what anyone's motives are. At the end of the day, what matters is that we have the best article with the highest quality of sources possible. And that should be everyone's motivation here. LesVegas (talk) 15:02, 16 May 2015 (UTC)

Moving forward, I support DrChrissy's idea to create a section in the article that includes government bodies and the statements they give regarding acupuncture. This can include all of the medical organizations we have and their recommendations. Once we hammer that out, we can figure out how to add it to the lede and what to take out. LesVegas (talk) 15:12, 16 May 2015 (UTC)

I have no objection to a list of countries that provide acupuncture services to their citizens, along with a citation to a reliable source supporting each entry. It's not a particularly important fact about acupuncture, so I would object to a large series of quote boxes and similar methods of providing undue emphasis on the material.—Kww(talk) 17:15, 16 May 2015 (UTC)

To include recommendations that is not scientific evidence is poor evidence. It was rejected to include this type of information in the lede and body. QuackGuru (talk) 17:20, 16 May 2015 (UTC)

Kww, but according to our article guidelines is also valid to include the fact that the NHS weighed the scientific evidence regarding acupuncture and mention what their statements and conclusions were. We need to do this especially since we use lower quality sources to characterize the scientific evidence elsewhere in the article, per Wikipedia: Balance LesVegas (talk) 18:14, 16 May 2015 (UTC)

Oh sorry, I just noticed that you only objected to box quotes and that sort of undue emphasis. I agree, no box quotes are desirable. LesVegas (talk) 18:32, 16 May 2015 (UTC)

I have no objection to stating that the NHS claims to have evaluated scientific evidence. I would object to stating that such examination actually drove the decision as a fact (or even an implication).—Kww(talk) 19:31, 18 May 2015 (UTC)

Another mechanism source

Mechanisms of Action for Acupuncture in the Oncology Setting

Seems to meet MEDRS (review article, respected journal, last five years). However, I don't have access to the full text so if someone else does and wants to add stuff from it to this article they are perfectly welcome to do so. Everymorning talk 02:22, 15 May 2015 (UTC)

"This limited review attempts to reveal some possible mechanisms of action for the effects of acupuncture for symptom relief in the oncology setting". In its "attempts to reveal", the paper engages in overt speculation, and doesn't consider the possibility of distraction, a proven reality-based effect of dramatic placebos. I think we need to wait for the findings to be replicated independently. Guy (Help!) 07:57, 15 May 2015 (UTC)

This is great and is a very reliable source and shows possible mechanisms of action our article does not include. Guy is saying for us to exclude the source entirely because these are possible mechanisms, therefore are speculation and not definite. But what is wrong with quoting the source directly? We can say "based on a review, possible mechanisms are..." Although, we would need to quote from the some place other than the abstract. Anyone with access? LesVegas (talk) 14:37, 15 May 2015 (UTC)

@LesVegas, I have access to it. This is the full conclusion (as quoted directly):

"Many acupuncture trials lack western methodologic vigor. What is known from methodologically sound research, however, suggests that acupuncture is effective due to various simultaneous local and systemic biochemical reactions and bioelectric changes. The evidence supports the use of acupuncture for the treatment of symptoms associated with cancer treatment, including pain, neuropathy, anxiety, leucopenia, gastrointestinal complaints, hyperemesis, and fatigue. Research is beginning to emerge on the mechanisms of action behind these effects."

The source clearly mentions the effects of the adenosine A1 receptor under the section "Adenosine", but denialists such as JzG will obviously continue to deny it.-A1candidate 14:48, 15 May 2015 (UTC)

A1candidate, snarky ad hominems like "but denialists such as JzG will..." just make working on this article even harder than it needs to be. I think Guy has a point that this review's conclusions are speculative, but that can be handled by qualifying the wording like "Suggested methods of action for <whatever> are not certain, but include..." and/or using in-text attribution, and also mentioning that the placebo effect is also a suggested explanation (using a good source for that). Zad68 15:03, 15 May 2015 (UTC)

Except none of the respectable sources actually mention "placebo". -A1candidate 15:07, 15 May 2015 (UTC)

Actually a large number of respectable sources do mention placebo. However, it's not easy to offend me with epithets like denialist. I am a homeopathy denialist, a psychokinesis denialist, a remote viewing denialist, an astrology denialist and of course a moon-cheese denialist. My view on acupuncture is that its history is grossly misrepresented by proponents, and irrelevant to its validity anyway; its purported mechanism (qi, meridians) is bollocks, its effect diminishes the more accurately any dummy procedure mimics the "real" thing, it does not seem to matter where you put the needles or even whether you insert them, FMRI effects are delivered just as well by needling a dummy hand as the real thing, and if there is some tiny shred of validity buried in the mountain of baloney and mystical mumbo-jumbo, it will be really interesting to see what it is. Guy (Help!) 16:08, 15 May 2015 (UTC)

Wrong again. Sham and verum acupuncture have different effects on the brain. -A1candidate 16:16, 15 May 2015 (UTC)

{{ping|A1candidate} ^{[citation needed]} — Arthur Rubin (talk) 19:45, 18 May 2015 (UTC)

Cultural heritage

Current wording Scientific investigation has not found any histological or physiological evidence for traditional Chinese concepts such as qi, meridians, and acupuncture points.[n 2][23][24] Many modern practitioners no longer support these concepts[25][26] and have abandoned the concepts of qi and meridians.[27][28] Acupuncture is currently used widely throughout China and many other countries, including the United States.[16][29] It is uncertain exactly when acupuncture originated or how it evolved, but it is generally thought to derive from ancient China.[30] In Chinese history the introduction of acupuncture is attributed to the emperor Shennong.[31] This can be expanded or the body can be expanded.

User:CorporateM, the lede can also focus a bit more on acupuncture as an ancient Chinese tradition. The Acupuncture#History section can also be expanded. QuackGuru (talk) 17:42, 12 May 2015 (UTC)

My understanding is that the practice started around 1000 or 2000 BC and was originally a very spiritual practice in China. I would just throw out a number that it's probably been scientifically evaluated as a medical practice for maybe the last 50 years and existed as a spiritual and cultural practice for a few thousand, so it seems like a substantial WP:RECENTISM issue as well as an overly US-centric view of the world. I was hoping to get to the History section eventually to expand on this topic, at which point I suspect it will become evident that there is in fact a lot of high quality academic sources about the history, culture and spirituality surrounding the practice (or a review of the source material could prove me wrong).

However, right now I'm spending so much time in discussions, I haven't had enough time to devote to actual editing. So hopefully I'll get to it eventually. Right now I'm still focused on the Regulation section, which used exclusiremain in what is a vely primary sources previously. CorporateM (Talk) 19:32, 12 May 2015 (UTC)

Here is a 2006 review that has some information about History. The short citation is <ref name=Ernst2006/>. You could probably find some books on history too. QuackGuru (talk) 19:49, 12 May 2015 (UTC)

Yup, I have an entire pile of books in my closet from bringing History of public relations up to GA and I would expect nothing less here; in that topic there was a renown historian that wrote numerous books covering different time periods. If I'm lucky, I will find something like that for this. I do not know yet how much time I will actually spend here though. For starters, the editing environment is too contentious to be enjoyable, but I do feel the current article is somewhat insulting to Chinese culture/traditions and it is unlikely anyone else will balance this. CorporateM (Talk) 20:03, 12 May 2015 (UTC)

Acupuncture as currently practiced dates back, as far as I can tell, to Mao Zedong (ancient tradition was essentially bloodletting, as far as I can tell). Its resurgence of popularity in the west can be traced back to the Nixon visit.Guy (Help!) 22:40, 12 May 2015 (UTC)

That is absolutely incorrect (the Mao and bloodletting parts, the popularity in the west from Nixon visit is debatable).Herbxue (talk) 19:11, 19 May 2015 (UTC)

@User_talk:CorporateM I can totally understand your lack of desire to remain in such a toxic editorial envionment. Please do not desert this without raising the obvious issue to other external editors/admins.DrChrissy ^(talk) 22:57, 12 May 2015 (UTC)

Sources

The current article has the following text:

Acupuncture is used at many academic medical centers, including Duke Center for Integrative Medicine, the Johns Hopkins School of Medicine, Mayo Clinic, Stanford University School of Medicine, David Geffen School of Medicine at UCLA,[304] Harvard Medical School, and Yale School of Medicine.[290] David Gorski said in 2010 that "Probably the most common form of pseudoscience to wend its way into what should be bastions of scientific medicine is acupuncture."[305]

The sources include a publication by John Hopkins, about how it is now providing acupuncture services, a blog that allows anyone to submit content and appears to have an editorial agenda to advocate against alternative medicine, and some kind of guest blog written by the same folks with a "opinion" tag on it.

The claims made in this excerpt of Wikipedia text are borderline WP:EXCEPTIONAL and should have multiple, high-quality, secondary sources. We do not accept crowd-sourced or opinion content anywhere and rarely accept blogs that aren't by journalists. I don't see this content as acceptable based on the currently used sources. CorporateM (Talk) 18:05, 18 May 2015 (UTC)

We certainly allow blogs from notable people to source statements made by those people, so long as those statements are attributed. The real question is whether David H. Gorski's opinion is sufficiently notable to include.—Kww(talk) 18:35, 18 May 2015 (UTC)

I do not think Gorski is a credible source. He suggests that genetically engineered organisms are created using age-old forced hybridization rather than new technology, and writes off any need for concern about GM safety with this argument. It appears there is a POV that surpasses his commitment to representing scientific fact, unless we are to assume he suffers from some mental ineptitude, which he clearly does not. (102:00) petrarchan47 คุ ก 02:29, 20 May 2015 (UTC)

You mean that he's an unreliable source because he understands genetics and doesn't suffer from anti-GMO hysteria? I would consider that to be a good attribute.—Kww(talk) 04:14, 20 May 2015 (UTC)

Text about ethics should be in the ethics section. Gorski is a reliable source. We had this discussion before about Gorski. QuackGuru (talk) 22:02, 20 May 2015 (UTC)

WP:NPOV

Not having edited here previously I don't know how much this has been discussed in the past and I'm sure that those on a certain side of the debate will not want to admit it. But there is at least significant parts of this article (and possibly more, not having had the chance to read it through entirely) that have an entirely blatant POV problem. The Ethics section for example is full of opinions stated as facts in Wikipedia's voice, non-impartial language and is pretty much entirely one-sided. Perhaps the one-sided part reflects the sources, but I doubt it. For instance the first paragraph is dedicated to broadcasting to the world in Wikipedia's voice that UK doctors who recommend acupuncture are failing in their duty of care towards patients. But the UK NHS doesn't seem to take this position, neither presumably do the UK medical authorities.

I'm also not sure about the the part of the following sentence highlighted in bold: "TCM theory and practice are not based upon scientific knowledge,[13] and acupuncture is described as a type of pseudoscience.[14]" Is there actually a consensus amongst sources that it is a type of pseudoscience? This is likely highly controversial so we need to reflect the sources here please, not strong editor opinions. We only have one single citation which is inadequate for a controversial issue. I do not know what the majority of sources say but I did notice when I read the UK NHS information that their evidence committee, NICE, have found accupuncture effective for some types of treatment. Thus they seem to avoid describing it as pseudoscience and say instead that "it is often seen as a form of complementary or alternative medicine (CAM), although it is used in many NHS general practices, as well as the majority of pain clinics and hospices in the UK". I've tried searching for position statements by other leading bodies but they seem to be hard to come by.

Another issue is the use of multiple citations to web sites that are as biased as possible such as Quackwatch without any opposing views which very likely exist to a relative degree of prominence.Levelledout (talk) 00:22, 19 May 2015 (UTC)

It's true that "position statements by other leading bodies ... seem to be hard to come by". That's typically the problem with things that leading scientific bodies don't take seriously. In fact, it's a great indicator that something isn't worth taking seriously. As for the NHS, they readily admit that they will fund pure placebos: their decisions as to what treatments to offer are swayed by political concerns.—Kww(talk) 18:44, 19 May 2015 (UTC)

Levelledout thank you for posting your observations. It is true that the opinions of Quackwatch, Ernst, and Novella are greatly amplified relative to the available literature on this subject. That is by choice of a dedicated group of editors who feel compelled to amplify certain voices and silence others. Quackwatch is not an appropriate source, but many editors love it. The Nature source, authored by who knows, is given absurd weight. The scientific literature is mixed and plagued by methodological problems, a subject that is treated with an appropriate, dispassionate tone in the UK NHS link you provided. Unfortunately, dispassionate does not describe the editing culture here on wikipedia. It is very dysfunctional here, so I appreciate uninvolved editors coming by to point that out.Herbxue (talk) 19:03, 19 May 2015 (UTC)

Support OP Most of the ethics section appears to read like an essay or have nothing to do with Ethics. I trimmed much of it and moved some of it like the WHO report to other sections, but QuackGuru moved it back. CorporateM (Talk) 21:53, 20 May 2015 (UTC)

It is about ethics. For example "Acupuncturists have cited the report as evidence of their approach of being therapeutic, and people have been convinced that acupuncture must work for a wide range of conditions because it was endorsed by WHO." How is that not about ethics when the report was most obviously over-optimistic overview of acupuncture? The part "Many physicians in the UK appear to recommend alternative medicine, which raises ethical issues." is about ethics too.

Posadzki, P.; Alotaibi, A.; Ernst, E. (2012). "Prevalence of use of complementary and alternative medicine (CAM) by physicians in the UK: a systematic review of surveys". Clinical Medicine. 12 (6): 505–512. doi:10.7861/clinmedicine.12-6-505. ISSN 1470-2118. PMID 23342401. Did you delete this 2012 systematic review by accident or on purpose? QuackGuru (talk) 22:29, 20 May 2015 (UTC)

So when it's convenient it's absolutely fine to present minority opinions as mainstream gospel truth then? I'm talking about the UK information which is not supported by the NHS, NICE or presumably the UK medical authorities. By the way editor opinion of the NHS is irrelevant.Levelledout (talk) 23:16, 20 May 2015 (UTC)

You are going to have to be explicit as to what you are talking about. Do you mean that we should not frame recommending placebos as an ethical issue? Or that you think that it's a minority view that acupuncture is primarily a placebo? Or what? For what it's worth, both Ernst and Vickers, responsible for the two most widely cited reviews of the effectiveness of acupuncture on pain, agree that the any actual effect of acupuncture is smaller than the placebo effects.—Kww(talk) 23:56, 20 May 2015 (UTC)

I'm saying that it would seem to be a minority view that UK doctors who practice acupuncture are failing in their duty of care towards patients or otherwise acting unethically. It shouldn't be presented as the majority view and certainly shouldn't be presented as fact.Levelledout (talk) 00:16, 21 May 2015 (UTC)

Where does it state that conclusively? All I can see directly referencing acupuncture is language like "raises ethical questions", and the only place it makes an unequivocal statement is about prescription of pure placebos being unethical. The latter is a majority view: the only question is whether acupuncture is pure placebo or whether it has some actual effect.—Kww(talk) 00:28, 21 May 2015 (UTC)

"Many physicians in the UK appear to recommend alternative medicine, which raises ethical issues. Physicians have a duty of care requiring that each patient be treated with the best treatment for a given condition and situation." Either that is implying that doctors who use acupuncture are possibly breaching their duty of care or it isn't in which case the text is redundant and irrelevant.Levelledout (talk) 00:46, 21 May 2015 (UTC)

I don't see a reason to call out the UK specifically and I especially don't see a reason to call out one individual specifically, in a way that is very hostile and reads like a major BLP problem/personal attack. However, we should certainly cover as part of the efficacy debate that many doctors that feel it is ineffective feel that those prescribing it are preventing patients from seeking legitimate forms of treatment, relying on the placebo effect or selling a sham. That is one significant viewpoint that I think can be covered in an encyclopedic manner. CorporateM (Talk) 00:53, 21 May 2015 (UTC)

So long as you bear in mind that acupuncture being primarily placebo is the mainstream scientific opinion and phrase your changes accordingly. While there are certainly political and social pressures to provide acupuncture as a treatment option, there's no scientific basis for doing so: the most favourable well-controlled studies describe an effect smaller than derived from Tylenol, which is why there are questions about whether the effect exists at all. As for being negative about Brian Berman's study? It's nearly impossible to be excessively negative about that study.—Kww(talk) 01:09, 21 May 2015 (UTC)

People that prescribe treatments which the scientific consensus holds to have little or no benefit are "possibly" breaching their duty of care. So long as the article doesn't state that they are definitely breaching their duty of care, I don't see the problem. Are you claiming that prescribing acupuncture as if it were an effective treatment is uncontroversial? That's certainly not true.—Kww(talk) 01:13, 21 May 2015 (UTC)

@Kww: With respect, I'd prefer if we stayed focused on one subject at a time. It's a very large article and it's hard to make progress when every time a very specific subject of discussion is raised, editors show a habit of re-visiting the aspect of the article in which they have a strong opinion and is most controversial. I am not a doctor and haven't read any of the sources on this topic, so I do not have anything to contribute to that discussion at this time. Anyways, I will take a look at the sources and see if we can get something more encyclopedic, if similar comments are already on the page, etc. CorporateM (Talk) 01:46, 21 May 2015 (UTC)

My comment was a direct reply to the statement it was replying to (00:46, 21 May 2015 (UTC)), CorporateM, with no topic drift whatsoever. Levelledout was complaining about the implication that UK doctors were breaching a duty of care, and I was explaining that his logic was faulty and that the sources supported the implication. I'm glad that you admit that you haven't got a background in this topic nor have you read any of the sources on the topic. Could you perhaps take the time to do the fundamental research necessary to competently comment upon acupuncture before making any more changes? After all, we are all entitled to opinions, but no one is entitled to an uninformed opinion.—Kww(talk) 04:27, 21 May 2015 (UTC)

This is an egregiously wrong characterization of the nature of Wikipedia; the absolute ideal is that our articles would be edited by non-experts with no opinion. Editors that approach an article with a pre-conceived opinion tend to argue, edit and research with an emphasis on making the article reflect their views, rather than merely following the sources. Of course we often fall short of this ideal, but it's entirely in the wrong direction to ask an editor to form an opinion before editing or to emphasize sharing their opinion. What I may have an opinion on eventually, is what general characterization is "representative of the total body of literature" - I can have opinions about what the sources say and what sources are reliable - that is the nature of our work here. And it often means adding or accepting content that we don't agree with, but is part of documenting the debate. CorporateM (Talk) 04:52, 21 May 2015 (UTC)

There is no way to understand what constitutes due or undue weight without an overview understanding of the topic, CorporateM. Otherwise, editors wind up reacting to "oooh, that quote sounds nasty" without understanding that the nasty quote may reflect scientific consensus. That's especially true of articles about pseudoscience and alternative medicine, where the largest quantity of sources range from unreliable to fraudulent.—Kww(talk) 05:05, 21 May 2015 (UTC)

Regarding the prior Ethics section, citation 285 appears to be about the use of placebos in the elderly and is already covered elsewhere in the article. Citation 284 does not appear to say anything about ethics. I will keep looking through the other sources, but it is looking like this section was fabricated as a personal essay, as expected. CorporateM (Talk) 02:28, 21 May 2015 (UTC)

Formerly citation 75 from this section is clearly identified as an op-ed. That's enough to satisfy me. I'll try to keep hammering away at the History section, as time allows. CorporateM (Talk) 02:32, 21 May 2015 (UTC)

Late edits

Greetings! It sure has been hectic here lately, hasn't it? Anyway, some of the edits caught my attention:

Here[29], QuackGuru made an edit where he - according to his ES - reverted, changed, and added material. I'd like that User:QuackGuru next time divides his edits to removals, edits, and additions separately. Especially since your Edit Summaries don't address the edit's you've made. I kept the ref improvements though.
Here[30] QuackGuru reverts a valuable edit by CorporateM. IMHO, material about efficiency does not belong to Ethics section, even if the word "ethics" is mentioned once or twice.

Cheers! Jayaguru-Shishya (talk) 15:21, 21 May 2015 (UTC)

See Talk:Acupuncture#Recent changes. You restored the original research and other problems. QuackGuru (talk) 18:15, 21 May 2015 (UTC)

Off-Wiki canvassing

I have now received several off-wiki emails from editors encouraging me to make edits that are either supportive, or critical, of acupuncture. I don't have the time/interest to respond to all of them, but I want to remind editors of Wikipedia:Canvassing, which includes a section on "Stealth canvassing". It is not appropriate to contact users covertly off-wiki in order to persuade them to join your side of the argument. Please knock it off. I presume other editors involved in the page have had similar experiences... CorporateM (Talk) 05:08, 22 May 2015 (UTC)

Cultural heritage text

Does "acupuncture is recognized by UNESCO as part of the world's intangible cultural heritage" [31] deserve mention in the lede? -A1candidate 18:18, 21 May 2015 (UTC)

The lead should summarize the body, and should reflect its weight. There is only a one-sentence mention of this in the entire article. Copying that one sentence into the lead does not reflect the weight of the body. — Jess· Δ ♥ 18:25, 21 May 2015 (UTC)

No. I can't see any reason that such a minor point deserves space in the article summary.—Kww(talk) 18:38, 21 May 2015 (UTC)

"In 2010, acupuncture was recognized by UNESCO as part of the world's intangible cultural heritage.[294]" This does not add much to the history section. So what it was recognized. QuackGuru (talk) 19:18, 21 May 2015 (UTC)

No. Acupuncture is claimed to be a medical treatment. If you want to drop that pretence and correctly characterise it as a shamanic ritual, then we can talk again. Guy (Help!) 23:07, 21 May 2015 (UTC)
- Rather than say acupuncture was recognized by UNESCO... it would be better to explain the shamanic rituals in detail. There are much better sources that go into detail about this. See Talk:Acupuncture#Sources for history. QuackGuru (talk) 06:16, 22 May 2015 (UTC)

My first inclination is that something along those lines may warrant inclusion in the Lead, which should identify why the subject is notable. However, so far, I have not found similar statements in high-quality secondary sources by academics. By time the History section is finished, we should have a better idea on whether something that is representative of the body of literature would include something along those lines. I have not seen anything about shamanism in the sources. I do note that the current Lead does not appear to have anything about History, which is generally the most important part of an encyclopedia. CorporateM (Talk) 17:47, 22 May 2015 (UTC)

Something similar can be added to the lede. I will try to add something. The placement is key. It should be in the 4th paragraph not the first paragraph. QuackGuru (talk) 21:28, 23 May 2015 (UTC)

I updated the lede and reworded the text. QuackGuru (talk) 22:04, 23 May 2015 (UTC)

RfC on COI for alt-med practitioners

See Wikipedia_talk:Conflict_of_interest#RfC_on_COI_for_alt-med_practitioners Jytdog (talk) 16:41, 10 May 2015 (UTC)

This was closed with no consensus. I archived it and it can now be found at the top of archive 20. The close is in this dif. Jytdog (talk) 11:39, 22 May 2015 (UTC)

Is that the reason that one of our acupuncturists has removed hisher name from the list of acupuncturist eds working on this page? Without discussion? -Roxy the Mainstream dog™ (resonate) 13:32, 22 May 2015 (UTC)

Unfortunately, yes. We aren't precluded from deciding that Herbxue's behaviour demonstrates a COI, though. His recent edits would be pretty weak evidence of that, but if you are aware of better, feel free to present it.—Kww(talk) 14:51, 22 May 2015 (UTC)

... and being a practitioner of a discredited therapy, which deceives its patients, isn't a COI for editing here. If you say so, then OK, but it doesn't make sense. -Roxy the Mainstream dog™ (resonate) 14:54, 22 May 2015 (UTC)

Roxy there was no discussion or convincing case for QG to put that on the acu talk page to begin with, it was harassment in my opinion. Anyway, I also made it clear on my page that I am a practitioner and I have never tried to hide the fact, not even a little bit. By the way, I never deceive anyone in my professional life and I think you should refrain from suggesting that again. You have no idea how I communicate the possible risks and benefits of acupuncture to patients, or how aggressively I refer out for patients that need to be seen by a physician. Herbxue (talk) 18:11, 22 May 2015 (UTC)

I'll take this a step further and say that Herbxue should not disclose whether they are an acupuncture practitioner or not. We operate on an anonymous editing model specifically for this reason - to avoid harassing editors based on their professional background, personal connections, etc. and to avoid personal insults like insinuating that an editor is corrupt. If there are concerns that the editor is making non-NPOV edits by using weak or cherry-picked sources to create the appearance of support for a fringe view by mainstream science, then that could be discussed based on the edits and sources without all the drama-mongering and bullying. CorporateM (Talk) 20:34, 22 May 2015 (UTC)

Actually, one of the major weaknesses of our model is that it allows conflicts of interest to persist undetected for years. I wouldn't tout that as an "advantage" at all. More like our Achilles' heel.—Kww(talk) 20:44, 22 May 2015 (UTC)

CorporateM - please have look at Herbxue's user page. everybody here, fwiw -- here is my take. since the community didn't arrive at a consensus, from my perspective it is pretty risky/risque behavior to claim that anybody has a COI because they are an alt med practitioner. I wouldn't do it. Unless, that is, a given practitioner is writing about his or her specific practice (Uncle Ben's Acupuncture on 1st Street in Springfield)... which I haven't seen happen here. Lots of people in the RfC said that WP:ADVOCACY is a major concern in these articles. If anybody wants to go after anybody over POV-pushing, I suggest you do it simply and directly as a POV-pushing case based on actual edits, and not on what anybody does in the RW. Jytdog (talk) 21:23, 22 May 2015 (UTC)

Removed my name from the top. Imagine that, judging editors by their edits.^[sarcasm] Seriously, agree with Jytdog. Additionally I'd note that Cochrane considers CAM professionals to be no more (and no less) conflicted than any medical specialist is.[32] Editors who think there should be a CAM-specific COI would strengthen their case considerably if they could find real-world precedent for it -- not just people arguing for it on blogs, but institutions actually doing it. Well? --Middle 8 (t • c | privacy • COI) 09:59, 24 May 2015 (UTC)

Recent changes

This edit added too much detail to the lede. More concise information in the lede is "It is rarely used alone but rather as an adjunct to other forms of treatment.[10]" There is a discussion about the sources. See Talk:Acupuncture#Cancer-related pain and see Talk:Acupuncture#Expansion of lead. The lede should be 4 paragraphs not 5.
This edit added this to the ethics section again but the same source is summarised in the effectiveness section.
This edit deleted this from the body again but it not speculation. The edit was previously discussed. See Talk:Acupuncture#Iceman tattoo.
This edit added information about electroacupuncture again but the article is about acupuncture not a related practice. There is a section for Acupuncture#Related practices that does have information on electroacupuncture.
This change deleted text that is not in other section.
This change combined a section that is part of the scientific view of acupuncture. It is not about a reception in general.
The lede was trimmed too much. The WP:LEDE should be four paragraphs, especially for a complex topic. See WP:LEADLENGTH. QuackGuru (talk) 06:26, 11 May 2015 (UTC)

No QuackGuru, the lede should not be four paragraphs. Jayaguru-Shishya (talk) 18:30, 11 May 2015 (UTC)

The short citations link to the long citations. See Acupuncture#cite_note-21 for example. Also see Acupuncture#cite_note-242. The short citation links to the full citation. See Acupuncture#CITEREFWiseman_.26_Ellis1996. QuackGuru (talk) 22:14, 12 May 2015 (UTC)

The edit being discusses on LesVegas' talk page was discussed in this thread. User:Jayaguru-Shishya, there is no consensus to have 5 paragraphs. QuackGuru (talk) 22:54, 12 May 2015 (UTC)

The recent change was a violation of consensus and did not improve the lede. QuackGuru (talk) 18:51, 13 May 2015 (UTC)

This change deleted a 2012 review.

This change does not appear to be sourced and I don't see a reason to add attribution to the author.

This change added no wiki tags.

Where should I begin? The text about medical organizations for human is original research and are lower-quality sources compared to other sources. This page is getting too long again. We can't include every source. The text about guidelines for the management of pain in cats and dogs is about veterinary acupuncture. The text is already in the veterinary acupuncture article. It does not belong here. The text about electroacupuncture is a related practice. It is not specifically about acupuncture. The text about the modulatory effects of acupuncture is overly technical and is incoherent to the general reader.[33] QuackGuru (talk) 07:30, 21 May 2015 (UTC)

Very well then. No editor has opposed my comments in this thread. I don't see any objections to my comments here. For the text about the organisations there is a new RfC. The text in the caption that says "Acupressure is described as "similar to acupuncture, but without needles." is misleading. Actually acupressure is not similar to acupuncture. They are different. Acupressure is a non-invasive treatment, while acupuncture is an invasive treatment. QuackGuru (talk) 21:25, 23 May 2015 (UTC)

Things have been explained and you are not explaining your reason for reverting. Please don't ask questions in a revert. QuackGuru (talk) 22:34, 23 May 2015 (UTC)

No explanation was made for restoring the original research and other problematic text. QuackGuru (talk) 23:50, 23 May 2015 (UTC)

Edits of 21:04, 23 May 2015‎

User:QuackGuru, you just carried out an enormous series of edits[34]. I reverted your series of edits[35] and asked you to explain your edits piece-by-piece on the article Talk Page. You restored your edit[36] with an Edit Summary of "This was explained per previous edit summaries. See Talk:Acupuncture#Recent_changes and see Talk:Acupuncture#Cultural_heritage_text for more details". Please see WP:BRD.

At Talk:Acupuncture#Recent_changes I see that QuackGuru answered through 21 links. When he conducted his major series of edits however, he did not point out in his Edit Summaries what he found problematic or which piece of Talk Page discussion he was referring to. Do you seriously think that one will see through all those 21 links and compare those to your series of edits right here?[[37]

User:QuackGuru, I'd like to ask you again to explain yourself at the article Talk Page explaining each edit you have/are about to make. Jayaguru-Shishya (talk) 22:58, 23 May 2015 (UTC)

Please explain why you reverted. QuackGuru (talk) 23:00, 23 May 2015 (UTC)

What issue do you have with Quack Guru's edits that you need an explanation?-Serialjoepsycho- (talk) 23:12, 23 May 2015 (UTC)

See User_talk:Jayaguru-Shishya/Archive_1#Please_stop_making_counterproductive_edits_at_the_acupuncture_page. The majority of User:Jayaguru-Shishya edits are reverts. He needs to explain why he makes so many reverts of good edits. QuackGuru (talk) 23:18, 23 May 2015 (UTC)

As explained above. Instead of carrying out a major series of edits, please make them in smaller pieces and provide decent Edit Summaries. So far, your 21 link list at the Talk Page is not really helpful. Please provide 1) the exact change you've made, and 2) the rationale for the peculiar change. Cheers! Jayaguru-Shishya (talk) 23:20, 23 May 2015 (UTC)

Isn't that part of the accusations you used to made against me, and for which you got eventually warned for WP:HOUND? Please do retract your comments, QuackGuru. Jayaguru-Shishya (talk) 23:24, 23 May 2015 (UTC)

Please provide a logical reason for your reverts over a long period of time. QuackGuru (talk) 23:23, 23 May 2015 (UTC)

Jayaguru-Shishya, You can go thru the diffs and see what changes were made. Do you have any actual issue with the content that Quack Guru has put in the article? Or is it simply that it is to long for you to read?

Quack Guru, for the peace and prosperity or *insert flashy power word here*, would you consider making smaller edits?-Serialjoepsycho- (talk) 23:27, 23 May 2015 (UTC)

Reverts should be used to remove harmful changes to an article and not as a tool to induce better edit summaries. But also, WP:CAUTIOUS explicitly states that editors should explain major changes to articles. It would be better to ask for detailed edit summaries rather than reverting and then asking for them. Additionally, although it is a pain, it would probably be best to just create a section on the talkpage to summarize any major edits in the future.TypingAway (talk) 00:30, 24 May 2015 (UTC)

QuackGuru, you have been told before that large numbers of sequential edits resulting, overall, to significant changes, impede the process of collaborative editing. This is a mature article, large scale changes are not needed. Significant changes should be discussed in advance on this talk page. The content is fine, it's the way you edit. As always. Guy (Help!) 20:51, 24 May 2015 (UTC)

Template wanted

It is certainly fair to note that contributors to this article and talk page may have a conflict of interest. It is unfair to single out one editor, Middle8, even though he does have a COI. {{Connected contributor multi}} appears to require identification of editors, which is also not what I want. Does anyone know which template to use? Guy (Help!) 11:40, 27 May 2015 (UTC)

Does the template you removed really accuse M8, or anybody who is named on it, of a COI? I don't think so. It merely highlights a potential for it. Line in the sand kinda thing. -Roxy the black and white dog™ (resonate) 12:02, 27 May 2015 (UTC)

Yes. It's actually the {{notable Wikipedian}} template. Guy (Help!) 14:49, 27 May 2015 (UTC)

History 2

I've continued slowly pecking away at the History section; I only had enough time to bleed citation 27 dry, so right now it relies heavily on a single source and isn't integrated well, but it's a work in progress. A couple things I wanted to point out:

This particular source says there has never been data that is "valid" enough to "provide clinical guidance". I'm not privy to all the medical jargon, but it sounded potentially relevant to the discussion about medical guidelines.
As I got more into Recent History, it started covering the actual scientific investigation of acupuncture more. Since this has been a major topic of debate on this page, it's worth pointing it out for further discussion. The overall reception to acupuncture appears to fluctuate wildly over time, even dating back to ancient eras, though this is still based on just a few sources.

CorporateM (Talk) 01:34, 25 May 2015 (UTC)

- I think it can be moved to the appropriate section in effectiveness. If the text is about acupoints it can be moved to Acupuncture#Qi.2C_meridians_and_acupuncture_points. If the text is moved I think it can be improved with more context. QuackGuru (talk) 02:12, 25 May 2015 (UTC)

CorporateM, it is relevant, and touches on the problems that Serialjoepsycho was touching on above: while there are some clinical guidelines that allow for sending people to acupuncturists, no one has a solid enough scientific theory behind acupuncture to generate meaningful guidelines as to what those acupuncturists should do. This would appear related to the whole sham vs. real acupuncture testing: it doesn't seem to matter much what the acupuncturist does, where he does it, or what he does it with, the result is much the same. BTW, while I still wish you would get a better grounding in the area, you've done fairly well with the history and cultural aspects. I do strongly caution that you need a better grounding before tackling effectiveness: that's where MEDRS and bias issues get complex.—Kww(talk) 04:41, 25 May 2015 (UTC)

I'm left wondering if there is not enough data to publish clinical guidelines, why clinical guidelines have indeed been published. That would lead me to think that either the source's statement is just one source's perspective, or maybe the organizations cited are not reputable? I am not knowledgeable enough to evaluate.

Regarding moving the content as suggested by @QuackGuru:, I disagree. The history of acupuncture is the subject of the source and a period of scientific investigation is part of acupuncture's history. If this content was moved, we would have no way of covering the era of rationality beginning around the 1900s. The source's can determine what information is relevant in what context for us and in this case History is the subject of the source and the source determined this information was relevant to that subject. CorporateM (Talk) 16:06, 25 May 2015 (UTC)

They have been created for two reasons: first, damage limitation; second, because acupuncture, like homeopathy, chiropractic and several other CAM interventions, has a quasi-religious following that feels a strong need to both proselytise and legitimise its practice, with political pressure taking the place of evidence as core doctrines and beliefs are refuted one by one.

This is at the root of so-called "integrative medicine", which seeks to "integrate" CAM with conventional medicine. CAM practitioners have failed to make it over the hurdle of evidence-based practice, so they use touchy-feely (and generally fallacious) arguments - and copious special pleading - to weasel their way into the clinic hoping in the process that people will forget why CAM is not already part of mainstream practice - namely, that it lacks robust evidence. Minchin's Law: by definition, alternative medicine either hasn't been proven to work, or has been proven not to work. The name for alternative medicine that has been proven to work is: medicine.

Along the way, they construct a cottage industry of "clinical trials" which ignore the theoretical improbability of the practice and usually start by stating that X is a traditional and widely used form of medicine, which is true in the same way that leeching and bloodletting were traditional and widely used, but medicine adopted the scientific method and chucked out as much of the nonsense as it could. Acupuncture is not science-based: it has no mechanism for adapting to new research or new knowledge - some practitioners may follow evidence, in as much as it supports anything they do at all, but most cleave to tradition rather than empirical science. They will claim to cure anything and everything, and will use the weak and equivocal positive findings for some conditions, as a bait-and-switch to get patients in. Acupuncture is definitely not the worst for this, by the way, but that's why there is a need for damage limitation, to ensure that people are aware of the strictly limited defensible scope of practice.

You are probably familiar with the efforts of creationists to get Biblical creationism on the school science curriculum. This is pretty much the same, and employs all the same tactics. Guy (Help!) 16:18, 25 May 2015 (UTC)

CorporateM, the source is correct: there are no scientifically sound clinical guidelines for acupuncturists. There are only clinical guidelines that permit referral to acupuncturists. That's not just a trivial semantic quibble: there are no studies that justify any particular and specific treatments by acupuncturists. As to why those other guidelines were published, that's the reason for the debate as to whether guidelines can be used as evidence of effectiveness. A medical practice guideline is not generated solely based on science, but on a combination of science, social issues, and legal issues. In an environment where insurers will pay for acupuncture and patients demand acupuncture, clinical guidelines that allow for referrals to acupuncturists in parallel with conventional treatment help prevent doctors from being sued for malpractice. So long as parallel treatment is called for, the evidence threshold shifts from "probably effective" to "probably harmless".—Kww(talk) 16:59, 25 May 2015 (UTC)

Greetings JzG and Kww. I am afraid you are running the risk of turning the discussion WP:FORUMish again. All of your sayings, however, can be given weight as long as you provide reliable sources to back up your claims. You might even bee 100% right, but what we need is reliable sources and source-based argumentation. We can't decide the article's content on editors' own opinions. Cheers! Jayaguru-Shishya (talk) 17:39, 25 May 2015 (UTC)

Your perpetual confusion of article content guidelines and talk page guidelines continues to be tiresome, Jayaguru-Shishya. Please return when you have a contribution to the discussion.—Kww(talk) 19:23, 25 May 2015 (UTC)

Incidentally, Jayaguru-Shishya, even if I thought it necessary, it would be impossible for me to source a negative. Sourcing the positive would be possible so, so, if you have any actual reason to believe that I am incorrect, feel free to find a clinical guideline from a respected medical society that refers to a particular and specific acupunctural treatment. I'd be truly interested if you can find one, and extremely curious as to what evidence they could base such a clinical guideline on.—Kww(talk) 02:01, 26 May 2015 (UTC)

I am sorry if you find my notice "tiresome", but unfortunately that's not a matter of opinion. If you think there is some "confusion" of the guidelines, please do address those points specifically. Anyway, one shouldn't underestimate the guidelines. According to WP:NOTFORUM:

In addition, bear in mind that talk pages exist for the purpose of discussing how to improve articles. Talk pages are not for general discussion about the subject of the article, nor are they a help desk for obtaining instructions or technical assistance. Material unsuitable for talk pages may be subject to removal per the talk page guidelines

WP:TPG, as linked above, is discussing the same subject:

The purpose of a Wikipedia talk page (accessible via the talk or discussion tab) is to provide space for editors to discuss changes to its associated article or project page. Article talk pages should not be used by editors as platforms for their personal views on a subject.

[...]

Please note that some of the following are of sufficient importance to be official Wikipedia policy. Violations (and especially repeated violations) may lead to the offender being blocked or banned from editing Wikipedia.

[...]

*Do not use the talk page as a forum or soapbox for discussing the topic. The talk page is for discussing how to improve the article.

So please, could you help me to understand the "confusions" I've made with respect to these guidelines, Kww? I'd be happy to revise my rationale if I've been mistaken. Cheers! Jayaguru-Shishya (talk) 17:30, 27 May 2015 (UTC)

KWW, Shishya is correct. Not a forum is a Talk page guideline and it's not entirely irrelevant. That being said, pointing it out only serves to de-rail discussion even further. My watchlist shows several dozen updates to this Talk page since I last edited, and literally all of them are discussions about editors, instead of content. We can all make an effort to keep discussions more focused I think. CorporateM (Talk) 17:43, 27 May 2015 (UTC)

CorporateM, my reply was directly on point to your question as to whether the source was reliable, and discussing the apparent contradiction between Ernst's statement that the efforts to formulate a scientific foundation for acupuncture had not generated clinical guidelines and the clinical guidelines in this article. Directly on point and directly related to improving the article. Jayaguru-Shishya seems to believe that every comment on a talk-page requires a citation, and, as you say, his constant interruption of discussions with demands for sources behind every comment serves only to disrupt conversation.—Kww(talk) 18:28, 27 May 2015 (UTC)

I am sorry, I am a bit confused right now Kww. Didn't you just explicitly say that "...it would be impossible for me to source a negative. Sourcing the positive would be possible..."? So are you now saying that you have been pertaining to some sources all the time? I am not sure if I can quite follow you.

Anyway, to keep it simple: as far as I am concerned, you've made different statements on this Talk Page. What I am concerned, is whether you have any sources to back up those statements, or are those merely your own opinions? Like CorporateM just said above, there are other things "instead of content" being discussed right now. Jayaguru-Shishya (talk) 18:55, 27 May 2015 (UTC)

This whole topic is about the White and Ernst quotation. So we have a source, and Kww explained what the source means and why it is reliable. Tgeorgescu (talk) 19:00, 27 May 2015 (UTC)

Jayaguru-Shishya, Ernst indicates that the efforts to generate clinical guidelines based on efforts to recast acupuncture in a scientific light have been fruitless. I concur with Ernst: there are no such guidelines. I explained how the guidelines in this article differ from the guidelines that Ernst is discussing. All of that is discussing the contents of sources in terms of how they relate to this article. I interpreted your intrusion as disagreeing with my analysis of the source. Since the source says that there are no guidelines, and I concur with the source, all I can see is that you have made a demand for me to prove that there are no such guidelines, i.e. "proving a negative". If you wish to refute Ernst, provide sources. If you want to say that my interpretation of the source vs. the article content is incorrect, engage that. But don't constantly come and disparage my contributions to the discussion. It's tiresome and disruptive.—Kww(talk) 19:10, 27 May 2015 (UTC)

I apologize for the confusion - I was just saying generally "not a forum" is relevant, not accusing KWW specifically of doing so. My comment was not well-written. Moving on, I think we should all keep in mind that we should be focused on content, rather than editors. Just another general statement. Lets move on. CorporateM (Talk) 19:39, 27 May 2015 (UTC)

Better sources for history

Gwei-Djen Lu; Joseph Needham (October 25, 2002). Celestial Lancets: A History and Rationale of Acupuncture and Moxa. ISBN 0700714588.

The Oxford Handbook of the History of Medicine

Tidy's Physiotherapy15: Tidy's Physiotherapy

Trick Or Treatment: The Undeniable Facts about Alternative Medicine

Planet Medicine: Origins, Revised Edition: Origins

The Whole Story: Alternative Medicine On Trial?

These sources made the final cut. After a source is added to the article it can be struck out. QuackGuru (talk) 03:46, 29 May 2015 (UTC)

Sources for history

The Oxford Handbook of the History of Medicine - This looks excellent; written by a medical history professor. Perfect. CorporateM (Talk) 21:13, 27 May 2015 (UTC)

Tidy's Physiotherapy15: Tidy's Physiotherapy - It's primary focus is not history, but it looks usable. The author is a practicing doctor, but also a teacher and the book is aimed at students to provide the same kind of general knowledge we aim to impart here. CorporateM (Talk) 21:31, 27 May 2015 (UTC)

Trick Or Treatment: The Undeniable Facts about Alternative Medicine - Well the title reads like advocacy, but the author appears credible. CorporateM (Talk) 21:37, 27 May 2015 (UTC)

I agree. Although the author himself is an expert on the topic area, it's obvious that the specific book is not meant for any serious debate on the subject. We are using other really good sources from the very author, though. Jayaguru-Shishya (talk) 12:28, 29 May 2015 (UTC)

Planet Medicine: Origins, Revised Edition: Origins - Our Wikipedia article on the author says they are an anthropologist. That sounds great for a History section source. CorporateM (Talk) 21:37, 27 May 2015 (UTC)

The Whole Story: Alternative Medicine On Trial? - Written by a journalist - not as good as a historian, but usable. CorporateM (Talk) 23:32, 27 May 2015 (UTC)

~~Yoshiaki Omura (2003). Acupuncture Medicine: Its Historical and Clinical Background. Courier Corporation. p. 13. ISBN 978-0-486-42850-5.</ref> See here~~ Appears to be written by the President of what looks like? a small/unknown non-accredited, for-profit acupuncture college. I would prefer to focus on sources written by independent historians with no vested interest (not doctors or acupuncturists, or advocates one way or another, or anyone with a vested interest/involvement.) CorporateM (Talk) 21:19, 27 May 2015 (UTC)

~~Jean-Marie Abgrall (2000). Healing Or Stealing?: Medical Charlatans in the New Age. Algora Publishing. pp. 52–. ISBN 978-1-892941-51-0.</ref>~~ At-a-glance, doesn't appear to focus much on history

~~Acupuncture may have originated from India? Glossary~~ - Anything that says "Glossary" is probably not the best source. CorporateM (Talk) 21:21, 27 May 2015 (UTC)

~~Meridians and Acupoints~~ - From what information I can find, appears to be written by two recent graduates in China. Text appears somewhat promotional. Open to other opinions. CorporateM (Talk) 21:26, 27 May 2015 (UTC)

~~The origins of everyday things~~ - cheesy infotainment. CorporateM (Talk) 21:38, 27 May 2015 (UTC)

~~Natural Remedies Dogs and Cats Wish You Knew: A Holistic Care Guide~~ - not very much here CorporateM (Talk) 21:39, 27 May 2015 (UTC)

~~Integrating Complementary Medicine Into Health Systems~~ - Not much here that would be relevant for a history section. CorporateM (Talk) 21:41, 27 May 2015 (UTC)

~~Celestial Healing: Energy, Mind and Spirit in Traditional Medicines of China ...~~ - Obvious reasons if you take a look. CorporateM (Talk) 21:44, 27 May 2015 (UTC)

~~Natural Health : Accupuncture~~ - Another obvious crock source. CorporateM (Talk) 23:29, 27 May 2015 (UTC)

~~Acupuncture For Cynics~~ - Same CorporateM (Talk) 23:29, 27 May 2015 (UTC)

Healing Or Stealing?: Medical Charlatans in the New Age - Not sure about this one. CorporateM (Talk) 23:33, 27 May 2015 (UTC)

I might search for more sources. QuackGuru (talk) 06:51, 22 May 2015 (UTC)

Thanks QuackGuru. You probably made a similar observation, but when I did some Google Books searches previously, most of what I found were written by acupuncturists or acupuncture advocates, as oppose to historians and journalists. Often I had a hard time finding more information about the author to determine which category they fell into. Books almost always have the most high-quality and in-depth histories though, so I think sorting out the 1-3 most reliable books about acupuncture's history is an endeavor worth pursuing.

I've gotten to the part of the History section where the spiritual beliefs about acupuncture (chi energy, yin yang, etc.) have started emerging. I'm not set on the best way to word it, but for now I've just made sure they are identified as "spiritual beliefs". I think this approach is respectful to Asian heritage/culture, avoids repeating other sections and makes it clear enough to any of our readers not intelligent enough to realize that "chi energies" is obviously not a scientific principle. I'm sure as the History section progresses to the scientific era, we'll be able to document shifting perceptions. CorporateM (Talk) 07:08, 22 May 2015 (UTC)

User:CorporateM, let me know if there is anything you want me to summarise for the history section. There is a lot of sources to consider. If you think a source is not reliable for inclusion you can strike it out above. If you added a source from the list above you can also strike it out. QuackGuru (talk) 17:59, 25 May 2015 (UTC)

@Quackguru: I've culled through the sources listed above - there are some pretty good sources on this list, but I was a little surprised there weren't any in-depth books where the book was both entirely focused on the history of acupuncture and where the author was a historian, not a doctor or acupuncturist. Then I found this gem on Amazon, which is written by well-known science/medical historians Joseph Needham and Lu Gwei-djen in collaboration with the Needham Research Institute, a non-profit that hosts libraries and research related to Chinese history. I think this is the best source available and the right one to get started on. I'll see if I can find a way to get ahold of it (it's expensive). CorporateM (Talk) 00:56, 28 May 2015 (UTC)

I don't think there's any actually wrong with using Healing Or Stealing?: Medical Charlatans in the New Age, but Jean-Marie Abgrall is so controversial that I think it would condemn us to even more bickering than we are currently stricken with. I'd leave it out just to preserve what little sanity we have.—Kww(talk) 00:57, 28 May 2015 (UTC)

It looks like I struck that one out merely because it wasn't very focused on history, but I do remember scratching my head at the author's strange background according to their Wikipedia page. Regarding the Needham and Gwei-djen source, I couldn't find a super-cheap used copy ($40 is the cheapest), so I submitted an inter-library loan with my local public library. They are very unreliable (since I'm not a student or faculty, I can't use the university library's inter-library loan services), so I may be MIA for several weeks/months while I wait and see if they are able to obtain a copy for me. CorporateM (Talk) 01:12, 28 May 2015 (UTC)

I started a new section for the sources that made the final cut. See Talk:Acupuncture#Better_sources_for_history. QuackGuru (talk) 03:48, 29 May 2015 (UTC)

Connected contributor Templates removed from this page

Please could somebody point me at the new WP:PAG that allows connected contributors to remove connected contributor tags without consensus? Otherwise, I will re-instate them both, unless our resident acupuncturists have suddenly stopped being acupuncturists in the last few days. -Roxy the Mainstream dog™ (resonate) 19:44, 24 May 2015 (UTC)

There is, of course, no such guidance. I have no doubt that this is interpreting the agreement that not all SCAM practitioners have a COI on SCAM articles, as meaning that NO SCAM practitioners have a COI, which is very much not the case. Guy (Help!) 20:48, 24 May 2015 (UTC)

Disclosure in the signature or homepage suffices, there's no known real-world precedent for a CAM-specific COI (Cochrane treats them all alike), and if anyone has a problem with someone's edits they can produce diffs. Roxy, how about you devote some energy to finding specific issues of concern, if indeed you can produce diffs. Or to posting something substantive on this page instead of your usual baying and hounding. Woof! --Middle 8 (t • c | privacy • COI) 21:23, 24 May 2015 (UTC)

P.S. @ Roxy the dog - in fairness, of course some of your posts here are substantive. But just look at your history here and see how many aren't (it's >75% by my rough count), and how many of those that are substantive are little more than !votes. Just saying. Derision as a rhetorical technique has its place (e.g. blogs, and this), but probably not in a large majority of article talk posts... ya know? --Middle 8 (t • c | privacy • COI) 22:18, 24 May 2015 (UTC)

Yes, those are my edits. I haven't looked at any of them. I'll have been pointing out obvious facts about Acu, you know, the sort of thing that tends to be overlooked around here. -Roxy the Mainstream dog™ (resonate) 12:55, 25 May 2015 (UTC)

You should. You might be surprised at the cumulative effect. --Middle 8 (t • c | privacy • COI) 19:02, 25 May 2015 (UTC)

Mate, I really don't think you should be speaking to this point. It took you some time to grok COI and people are still wary of you, even those of us who have revised our opinions over recent months. Guy (Help!) 21:28, 24 May 2015 (UTC)

People need to get over that by looking at my contributions. I like and respect almost everyone here but am tired of this. Turns out I grokked COI pretty well, given that I've said from the beginning that real-world precedent weighs. Where is the consensus for using the connected contributor template in these cases? Where are the institutions with a CAM-specific COI? Of course I see the argument for it, and I know some off-wiki bloggers have stated it, but there are arguments against it too -- and one can't say "oh it's obvious" without showing at least SOME real-world instances where a journal, etc., weighed the pro and con arguments and decided yes. Nu? --Middle 8 (t • c | privacy • COI) 21:43, 24 May 2015 (UTC)

@ JzG - And fair enough, I won't go (any further) mastodon over this, and truly do appreciate your word of caution. But I tire of being judged by things other than my edits, which are as good as anyone's. --Middle 8 (t • c | privacy • COI) 21:49, 24 May 2015 (UTC)

How about we ask at COI/N whether, in light of the recent RfC on COI for alt-med practitioners, the template is appropriate. Busy now but can do later, or someone can.... --Middle 8 (t • c | privacy • COI) 22:10, 24 May 2015 (UTC)

OK, I've drafted it (here) and will take it live pending feedback from Jytdog, who has interest/experience with COI issues. --Middle 8 (t • c | privacy • COI) 23:51, 24 May 2015 (UTC)

Per feedback at my sandbox (for which thanks), I'm not posting at COIN; it's liable to be taken in ways I don't intend and I don't need the hassle. Put the template back up if it makes ya'll happy; I've better things to worry about. --Middle 8 (t • c | privacy • COI) 19:02, 25 May 2015 (UTC)

So, no new WP:PAG then. I'm pretty certain of that because if anybody should know, it is M8. OK. -Roxy the Mainstream dog™ (resonate) 12:49, 25 May 2015 (UTC)

@ Roxy the well-meaning dog - I do try to stay PAG-literate, but what I was getting at is that since there's obviously uncertainty over whether acu'ists are connected contributors at all, it's dubious to flat-out assert they are, e.g. by using the template. That's all I meant: not new PAG, but how the community has most recently read (and split over) the existing COI guideline. --Middle 8 (t • c | privacy • COI) 00:18, 26 May 2015 (UTC)

Self-rv'd, restored template for myself. Obviously there's no community consensus on existence of CAM-specific COI, per recent RfC. And no known real-world precedent. And it's not being used on most other CAM pages. Given those facts, it's hard to not to see this as POINT-y at best and perhaps hounding at worst. But this needs to be left up to others. I'll recuse myself from any future !votes on this, in any venue, but reserve the right to comment. --Middle 8 (t • c | privacy • COI) 01:15, 26 May 2015 (UTC)

Thank you M8. -Roxy the black and white dog™ (resonate) 05:58, 26 May 2015 (UTC)

Given comment and action by JzG on the article and here today, I will not call for Herbexue to do the decent thing per M8's example. I note here that the connected contributor template is just that, it indicates if a contributor is connected, nothing more. While I believe that the inherant dishonesty of acu and all other alt-med cannot be separated from its practitioners, there is no evidence that our two declared acupuncturists have not been editing in good faith. -Roxy the black and white dog™ (resonate) 11:55, 27 May 2015 (UTC)

Thanks for your diplomatic statement. I will not replace the template for me because I do not believe it is appropriate. That said, I explicitly state on my user page that I am a practitioner and I make no attempts to obscure that fact in talk page discussions. Herbxue (talk) 22:30, 27 May 2015 (UTC)

Just an observation, as for the time being I have removed acu from my watchlist. I wanted to note that my bad spelling of Herbxue was an innocent one, and I have only just read the comment above. Thanks, but perhaps I could have been more diplomatic. ++shrug++ -Roxy the black and white dog™ (resonate) 19:05, 3 June 2015 (UTC)

Bee venom acupuncture

https://www.ncbi.nlm.nih.gov/pubmed/25876584 I think a brief mention of bee venom acupuncture might improve the related practices section. See Acupuncture#Related practices. QuackGuru (talk) 07:15, 11 June 2015 (UTC)

I have not heard of bee venom acupuncture, yet the abstract states that it is used widely in Oriental Medicine. Yet I have not heard of it being done in the US nor have I witnessed this anywhere in Asia. But I'm not the expert here either, so it might be something that is done and I don't actually know about it. So how about we @Herbxue: and @Middle 8: so we can get an acupuncturist's perspective about it. Is this something that is widely done in OM? LesVegas (talk) 15:12, 11 June 2015 (UTC)

Apitherapy is already covered, but we don't have a Mistlepuncture article !!! -Roxy the black and white dog™ (resonate) 16:18, 11 June 2015 (UTC)

It is not typically taught in OM schools and is not mentioned in ACAOM standards, or tested on in the board exams, and I do not know if it is becoming popular in Asia. It is a very uncommon practice.Herbxue (talk) 18:49, 11 June 2015 (UTC)

Agree; I've seen it mentioned, and people have heard of it, but it wasn't taught when I studied and it's not IME widely practiced. But surely this should be apparent from MEDRS? Like, if it were more common then it would get more than the occasional mention? (If we're going to weight the article based around the occasional adverse event, then we might as well mention at light bulb that occasionally people present to the ER with them stuck up their bums. That sort of thing probably being more frequent than someone causing serious harm with a 34-ish gauge filiform needle.) --Middle 8 (t • c | privacy • COI) 07:21, 12 June 2015 (UTC)

Irritable bowel syndrome

I don't think that [38] this source should be used to support the claim that there is "no strong evidence of benefit" for IBS, as is currently being done. The reason I think this is that this meta-analysis concluded that "Acupuncture exhibits clinically and statistically significant control of IBS symptoms." IOW, they concluded that it is effective, not that there is "no strong evidence of benefit," so I think it should be removed from that section. Everymorning talk 13:35, 31 May 2015 (UTC)

I have written-out what the sources say for now, but I do suggest that citation 218, which found in favor of acupuncture for IBS, may not be reliable. I see that it was sponsored by the "Youth Fund of National Natural Science Foundation of China" and that the authors are Chinese. I don't want to be ethnocentric in denying the reliability of all Chinese sources, but we have seen many sources question the credibility of research done in the country on this subject. Even citation 219, which has many Chinese names in its byline, says it excluded several Chinese studies that were not well-done, which I suspect may be the cause of the differences in their findings. At some point we should include Chinese studies that are found to be reliable in order to avoid being ethnocentric and to document the debate about the reliability of Chinese studies. CorporateM (Talk) 16:32, 31 May 2015 (UTC)

I also think it should be removed and the recent changes I disagree with. I could not verify the claim for the Cochrane review and the text is unnecessary since there is "no strong evidence of benefit" for IBS. Because the Cochrane review is a higher-quality source we should keep it. QuackGuru (talk) 18:53, 31 May 2015 (UTC)

Current wording: "Another meta-analysis in the The Cochrane database of systematic reviews focused on studies that used a fake acupuncture control group and excluded many Chinese-language studies the authors said were conducted with a bias. It said that the most rigorous acupuncture studies found it was equally as effective as the placebo effect of a sham acupuncture treatment."

My wording: A 2012 Cochrane review found moderate evidence that RCTs did not find any benefits of acupuncture compared to sham acupuncture for irritable bowel syndrome symptoms.~~(IBS) or health-related IBS~~ Compare the difference. QuackGuru (talk) 23:27, 31 May 2015 (UTC)

That looks better/more concise. A couple small quips/questions. Why use the term "moderate evidence"? I re-read the source and it seemed to come off quite strong/confident in its assessment. Also, is there a difference between "irritable bowel syndrome (IBS)" and "health-related IBS"? Wasn't sure why both were listed or if there was a difference. I'll also trim the other source soon if nobody opposes. I would think we would want to avoid studies that are sponsored by advocates, but wanted to give everyone an opportunity to provide input first. CorporateM (Talk) 00:19, 1 June 2015 (UTC)

Read the following text for quality of evidence: "For the sham-controlled trials, the continuous outcomes symptom severity and quality of life were rated as ’moderate’ quality using the GRADE criteria because of sparse data (i.e. less than 400 events)."[39] You could also argue it was limited rather than moderate based on the additional information from the source. I struck the unnecessary wording and added the word symptoms. This is not actually a proposal. I was just showing you a more concise way to right the text without the confusing part "fake" acupuncture control.

My proposal is to put the Cochrane review on irritable bowel syndrome where it was before minus the duplicate ref and the unreliable ref. QuackGuru (talk) 18:50, 1 June 2015 (UTC)

I disagree with creating a long list like that - almost all of our content should be in prose-style paragraphs. I also note that the study says "The risk of bias in these studies was low" and that there were 1800 participants in total. I don't think highlighting the "sparse data" of 400 (still not a bad number) is "representative of the source" which mostly gives off an air of confidence. On the other hand, I'm curious if the "Author's Conclusions" section should be summarized, as it focuses mostly on how Chinese studies have different outcomes, which is something we know is discussed in other sources and is the primary focus of much of that Conclusions section. I would defer to someone with more experience in topics like this as to whether such sections are considered credible analysis or personal opinion. Lets see if anyone else has some input. CorporateM (Talk) 19:46, 1 June 2015 (UTC)

The part "fake" acupuncture is original research. It would be a mass weight violation for the Acupuncture#Other conditions to be in prose-style paragraphs when there is no strong evidence of benefit for them. QuackGuru (talk) 20:06, 1 June 2015 (UTC)

Hi CorporateM. As far as I am concerned, World journal of gastroenterology in not an acupuncturist advocacy journal. There is currently a wider discussion about funding/sponsorship at reliable sources (medicine)#Funding. Cheers! Jayaguru-Shishya (talk) 20:14, 1 June 2015 (UTC)

The argument was in part because it was sponsored by the "Youth Fund of National Natural Science Foundation of China". QuackGuru (talk) 20:18, 1 June 2015 (UTC)

Thanks for commenting. The journal sounds fine to me at-a-glance (does anyone have access to its impact score?), but that particular study had a disclaimer that it was sponsored by the "Youth Fund of National Natural Science Foundation of China", which I do not know much about, but it sounds like an advocacy org to me.

I would say the same thing about sources like Quackwatch, which is written by advocates of another type. On corporate pages we have a similar source called CorpWatch, which sees corruption everywhere. I would think even those in the anti-acupuncture camp, should accept the logic that it is only fair to avoid advocates of both sides and focus on academic-level research.

Anyways, it is a great topic for additional debate. CorporateM (Talk) 22:34, 1 June 2015 (UTC)

In a perfect world, I would tend to agree. In the real world, the problem is that many of the medical scams just aren't covered in academic settings: no one bothers to do controlled studies of obvious nonsense. Acupuncture has just enough credibility that there are some actual studies, so we don't need to rely on Quackwatch for much. Reiki is one step down in credibility, so we rely more on antipseudoscience groups in our discussion there. By the time we get to gibberish like Emotional Freedom Techniques, we rely more heavily on antipseudoscience groups because so few academics are willing to even mention it.

If being biased in favour of reality results in being considered biased against acupuncture, that in itself says a lot. I don't think you will find widespread agreement to completely avoid QuackWatch, but you will find agreement to use it only when more academic sources are unavailable.—Kww(talk) 23:05, 1 June 2015 (UTC)

I agree with you completely @Kww:. For example, anyone that is selling a product based on "energies", Quackwatch could probably be used to state the obvious that is not explicitly stated in MEDRS sources. That being said, in many cases, I would prefer not to have an article at all, than to use cruddy sources because no good ones exist. This is why it is good to use WP:CORP (in my opinion) to avoid articles made up of re-written press release sources. Not sure if Wikiproject medicine has similar requirements, but I would guess that if there are no MEDRS-compliant sources, there may just be no good reason to have an article. CorporateM (Talk) 23:22, 1 June 2015 (UTC)

Current wording: Many US clinical trials on the use of acupuncture for irritable bowel syndrome (IBS) have found that it caused perceived symptoms to "improve remarkably", but had no additional benefit over fake acupuncture treatments administered to a control group, suggesting a placebo effect.[218][219] Many trials in China have found acupuncture to be more effective than pharmaceuticals,[220] which may be caused by an increased preference for acupuncture in the region causing a stronger placebo effect.[219][220]
Different sources verify different things. See WP:SYN. The text about China is irrelevant. I previously explained about the OR. It is still a weight violation to summarise in detail about the non-notable other conditions. I think it is better to just have the list stating, "For the following conditions, the Cochrane Collaboration or other reviews have concluded there is no strong evidence of benefit:" without the details. QuackGuru (talk) 04:29, 2 June 2015 (UTC)

A quick PubMed search reveals 31 Review articles for "Acupuncture 'irritable bowel syndrome'". I don't think the lack of detail elsewhere is good justification to avoid detail here. On the contrary, there's plenty of sources for further expansion and it's almost always a good thing to expand articles with neutral, well-sourced material. Regarding China, I don't think it's irrelevant or OR - on the contrary the sources devote a substantial amount of space to discussing it. CorporateM (Talk) 05:56, 2 June 2015 (UTC)

Yes, nonspecific chronic conditions with no known cure are usually fertile ground for peddlers of placebos. Homeopaths also like to target IBS patients, and there's an entire ecosphere of fake diseases such as "non-coeliac gluten sensitivity", "candida overgrowth" and "leaky gut syndrome". It's like tap-dancing through a minefield. There is no plausible mechanism for acupuncture in IBS. 08:34, 2 June 2015 (UTC)

User talk:QuackGuru, why did you falsely claim that you "previously explained about the OR"? I checked the URL you provided[40], and you certainly didn't give any explanation. You merely said: "The part "fake" acupuncture is original research.". Saying that you "explained" when in reality you didn't, is both misleading and disruptive.

Anyway, I think the article text is getting into right shape, and we can always back up the material with additional sources if necessary. Cheers! Jayaguru-Shishya (talk) 14:12, 2 June 2015 (UTC)

I'll strongly disagree with your implication that the article would benefit from expansion, CorporateM. It would be better to replace the entire effectiveness section with something short and sweet, along the lines of "Acupuncture is generally recognized to work primarily through the placebo effect(insert citation here). The greatest evidence of a possible actual effect comes in the region of pain control, where the two most widely cited reviews conclude that the experimental results show a small effect that appears to be an actual analgesic effect (cite Vickers and Ernst here). The authors of those two reviews do disagree over the interpretation that the other gives, with Vickers maintaining that the effects are real (another Vickers cite) while Ernst contends that future improvements in study controls are likely to demonstrate that the small positive effects were experimental errors and that acupuncture's effects are purely placebo (another Ernst citation)." There will always be new studies showing some glimmer of hope, but we aren't in the business of providing glimmers of hope, we are in the business of summarizing the current state of affairs.—Kww(talk) 14:29, 2 June 2015 (UTC)

That makes a lot more sense than the current endless wheedling. Guy (Help!) 15:35, 2 June 2015 (UTC)

@KWW:, I would like to do that eventually, but I would suggest we do it through a sub-article and using WP:SUMMARY STYLE. We are not limited by the cost of paper and we should have a space to summarize good sources. I don't think it's a good idea to slash a lot of good material and sources to be concise. However, I'm getting the sense that other conditions will likely have similar content?? with Chinese and US studies conflicting and there being a strong placebo element? If that's the case, the article would just drone on and on saying the same thing for 16 different conditions and it would improve the article greatly to summarize a sub-article instead. The end-result being a smaller, not larger article, though the amount of context and material available to the reader is greatly enhanced. I do think many readers/researchers would want to know what research has been done. I know there have been discussions on a sub-article previously, but I've sent plenty of articles to AfD successfully even after several prior AfDs failed. I think if the section was expanded into appropriate prose-style, more material was incorporated and a cogent argument was constructed, we would achieve consensus for a sub-article that would actually shrink the content more than could reasonably be done another way. CorporateM (Talk) 17:03, 2 June 2015 (UTC)

The problem we face is incessant advocacy, and the giant list of studies facilitates that. Yes, an expansion will drone on and on: it would repeat "For condition x, studies show no strong evidence of any effect greater than placebo" over and over. The laundry list is a source of the problem: studies with weakly positive results are constantly being published in the lower-quality journals, and they keep being added to the article. They would present the same problem in a sub-article: weakly positive results getting added, and weakly negative results generally being neglected (or not published in the first place, because there isn't as widespread of an incentive to publish negative results). We are best off staying strictly with a short summary that states the existing state of affairs neutrally: acupuncture has not been proven completely worthless, but any benefit is has is small and limited, with notable researchers believing that all evidence of an actual effect is the result of experimental error.—Kww(talk) 17:22, 2 June 2015 (UTC)

I don't think the need for watchlisting is a good reason not to create the article though; as a start, my guess is the four of us will watchlist it. It's important to keep in mind that from their perspective, editors like yourself are the "advocates" against it. Based on what I've read on IBS, which leans heavily towards a pure placebo effect, I think the ratio of representatives from different viewpoints in this discussion was healthy (for example). It's healthy to have some editors that support minority viewpoints and others that make sure that the majority viewpoint is still front-and-center. We should encourage such diversity in our editors and thoughtful discussion/debate amongst them. That being said, I know what you mean; the sources seem to suggest there are a lot of financial interests in keeping acupuncture alive that publish a lot of sources (books, studies, etc.) that aren't credible and there is a risk of minority viewpoints being over-represented with excessive credibility if the page isn't closely watched. An objective and fair measure on what kind of journals are acceptable would be useful.

BTW, even if you accept Wikipedia's mission being to "save" consumers from scammy practices and whatnot (that's not really our mission) we should do it with credibility, authority and utter neutrality, as oppose to attack-content and I got the sense some of our content was more of the latter. For example, I went to our article on "cleanses" because I was looking for information to encourage my wife not to use them (I presumed they were not a legitimate thing), but instead of getting credible information I could trust, I found BBC News and press releases being used as MEDRS sources. I would take weaker quality journals over the junk sources doctors use to attack alternative medicine any day and this kind of content doesn't seem much more credible than the kinds of promotion published by advocates. We can win the information war by sticking to our principles of impeccable sourcing, neutral writing, and so on.

Anyways, that's my rant based on my limited observations so far. I don't work much on medical topics due to a general lack of interest. CorporateM (Talk) 17:57, 2 June 2015 (UTC)

I think my suggested summary is a neutral representation of acupuncture's effectiveness.—Kww(talk) 18:00, 2 June 2015 (UTC)

Sorry, I was once-again going on a more general rant and only contesting the tone of some of our content and the nature of Talk page collaboration, not your depiction of acupuncture's efficacy. Presuming the sources for other conditions are similar to the 3-4 I have read on IBS, it being a pure placebo effect as you suggested seems to be the majority viewpoint and a basically good way to depict a summary. Though I wouldn't know for sure without reading much much more source material. CorporateM (Talk) 18:12, 2 June 2015 (UTC)

CorporateM, I looked into the Youth Fund of National Natural Science Foundation of China and discovered that it appears to be an independent foundation which funds any investigative work of scientists below the age of 35. Do you think it's just a grant program to help these scientists get their research performed? From what I'm seeing, it certainly looks that way since they fund a wide variety of scientific research, like this one. I cannot find any evidence that they might be a TCM advocacy group, or anything beyond a foundation for all (young) scientists in China to get their research, whatever it happens to be, off the ground. LesVegas (talk) 19:30, 2 June 2015 (UTC)

I was hoping someone would look into this more. Can you provide links where you found the information? Their name ("natural science", etc.) gave me the impression that they only sponsored pro-ATM research, but it would be great to look into a bit more. CorporateM (Talk) 19:43, 2 June 2015 (UTC)

Sure, here are a few in English, or at least partially. like this one here, and another one and here and here also. There's many, many more too because it appears to be a fairly large foundation. LesVegas (talk) 20:17, 2 June 2015 (UTC)

And it appears that they have a wikipedia page too. Not the youth fund of the Natural National Sciences Foundation, but the foundation itself does. The youth fund is some sort of grant program the foundation uses for scientists under 35. LesVegas (talk) 20:22, 2 June 2015 (UTC)

But here is more information on how to qualify for the young scientists' fund (youth fund) on this page. LesVegas (talk) 20:28, 2 June 2015 (UTC)

Hmm... so it looks like it's being sponsored by the Chinese government mostly. That's not so bad. CorporateM (Talk) 01:00, 3 June 2015 (UTC)

Repetitive text

irritable bowel syndrome,^[1]

^ Manheimer, E; Cheng, K; Wieland, L. S.; Min, L. S.; Shen, X; Berman, B. M.; Lao, L (2012). "Acupuncture for treatment of irritable bowel syndrome". The Cochrane database of systematic reviews. 5: CD005111. doi:10.1002/14651858.CD005111.pub3. PMC 3718572. PMID 22592702.

This is all that is needed. Just put it in alphabetical order like the other conditions.

The Irritable bowel syndrome section is repetitive. See Acupuncture#Irritable bowel syndrome. The other conditions section says "For the following conditions, the Cochrane Collaboration or other reviews have concluded there is no strong evidence of benefit:" We don't need to repeat for every condition in detail it is not effective. This is a clear WP:WEIGHT violation. QuackGuru (talk) 18:33, 11 June 2015 (UTC)

I agree with QuackGuru. Should we just delete the whole section, "Acupuncture#Other conditions? Terrible material for an encyclopedia. Jayaguru-Shishya (talk) 21:48, 12 June 2015 (UTC)

Why is the list of conditions for which studies have included that acupuncture is ineffective "terrible material for an encyclopedia"? QG doesn't seem to be arguing for removal of the list, but only against expanding one element into a paragraph. I do tend to agree that the expansion of IBS is unreasonable, and that our effectiveness section is oversized. Most of our effectiveness section could be replaced with "Acupuncture is generally recognized to work primarily through the placebo effect(insert citation here). The greatest evidence of a possible actual effect comes in the region of pain control, where the two most widely cited reviews conclude that the experimental results show a small effect that appears to be an actual analgesic effect (cite Vickers and Ernst here). The authors of those two reviews do disagree over the interpretation that the other gives, with Vickers maintaining that the effects are real (another Vickers cite) while Ernst contends that future improvements in study controls are likely to demonstrate that the small positive effects were experimental errors and that acupuncture's effects are purely placebo (another Ernst citation)." If we then moved the sections on "Sham acupuncture and research" and "Publication bias" to their own sections (they aren't really subsections of "effectiveness"), we would have a far more succinct article that adequately summarized the effectiveness of acupuncture.—Kww(talk) 22:35, 12 June 2015 (UTC)

I disagree with deleting Acupuncture#Other conditions section. I do agree with deleting the repetitive text. The entire section can be more concise. It would take just a few minutes to trim the entire effectiveness section. QuackGuru (talk) 04:25, 13 June 2015 (UTC)

Survey: How should we present the clinical practice guidelines for acupuncture?

How should we present the clinical practice guidelines for acupuncture? Consider the following two versions:

Current version [41]

The American College of Physicians^[1] weakly recommends the use of acupuncture only for patients that do not show improvement after being treated with other methods.

The American College of Chest Physicians^[2] only suggests the use of acupuncture for nausea relief when used in conjunction with other treatments.

The American College of Gastroenterology makes only a conditional recommendation of acupuncture due to the low level of evidence. The guideline states that acupuncture can be considered as an alternative therapy and may be associated with improved rates of gastric emptying and reduction of symptoms.^[3]

The American Academy of Otolaryngology – Head and Neck Surgery reviewed the evidence for the use of acupuncture and found that the randomized trials were methodologically flawed. The guideline concluded with a statement suggesting that "Clinicians may offer acupuncture, or refer to a clinician who can offer acupuncture, for patients with allergic rhinitis who are interested in nonpharmacologic therapy."^[4]

The British Geriatrics Society^[5] only recommends considering acupuncture as an adjunct therapy in combination with medication, not as a standalone therapy.

The American Society of Anesthesiologists found no literature meeting its highest evidence grade in support of acupuncture, and issued its guideline using information rated as grade "B2" (suggestive) and grade "C2" (equivocal) discussing acupuncture treatment. It recommends that acupuncture may be considered in the treatment of patients with nonspecific, noninflammatory low back pain only in conjunction with conventional therapy.^[6]

In 2015, the American Animal Hospital Association (AAHA) and American Association of Feline Practitioners (AAFP) issued joint guidelines for the management of pain in cats and dogs. The guidelines stated "There is a solid and still growing body of evidence for the use of acupuncture for the treatment of pain in veterinary medicine to the extent that it is now an accepted treatment modality for painful animals."^[7]

Previous version [42]

Clinical practice guidelines issued by medical societies including the American College of Physicians,^[1] American College of Chest Physicians,^[2] American College of Gastroenterology,^[8] American Academy of Otolaryngology – Head and Neck Surgery,^[9] and British Geriatrics Society^[10] have suggested the use of acupuncture for some groups of patients. According to the American Society of Anesthesiologists, acupuncture may be considered in the treatment of patients with nonspecific, noninflammatory low back pain.^[11]

In 2015, the American Animal Hospital Association (AAHA) and American Association of Feline Practitioners (AAFP) issued joint guidelines for the management of pain in cats and dogs. The guidelines stated "There is a solid and still growing body of evidence for the use of acupuncture for the treatment of pain in veterinary medicine to the extent that it is now an accepted treatment modality for painful animals."^[7]

A1candidate 23:51, 22 May 2015 (UTC)

Sources

References

^ ^a ^b Chou, R; Huffman, LH; American Pain Society; American College of Physicians (2 October 2007). "Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Annals of internal medicine. 147 (7): 492–504. doi:10.7326/0003-4819-147-7-200710020-00006. PMID 17909210.
^ ^a ^b Deng, Gary E.; Rausch, Sarah M.; Jones, Lee W.; Gulati, Amitabh; Kumar, Nagi B.; Greenlee, Heather; Pietanza, M. Catherine; Cassileth, Barrie R. (1 May 2013). "Complementary Therapies and Integrative Medicine in Lung Cancer". Chest (journal). 143 (5_suppl): e420S. doi:10.1378/chest.12-2364. In patients having nausea and vomiting from either chemotherapy or radiation therapy, acupuncture or related techniques is suggested as an adjunct treatment option
^ Camilleri, M; Parkman, HP; Shafi, MA; Abell, TL; Gerson, L; American College of Gastroenterology (January 2013). "Clinical guideline: management of gastroparesis". The American Journal of Gastroenterology. 108 (1): 18–37. PMID 23147521. Acupuncture can be considered as an alternative therapy. This has been associated with improved rates of gastric emptying and reduction of symptoms.
^ Seidman, M. D.; Gurgel, R. K.; Lin, S. Y.; Schwartz, S. R.; Baroody, F. M.; Bonner, J. R.; Dawson, D. E.; Dykewicz, M. S.; Hackell, J. M.; Han, J. K.; Ishman, S. L.; Krouse, H. J.; Malekzadeh, S.; Mims, J. W.; Omole, F. S.; Reddy, W. D.; Wallace, D. V.; Walsh, S. A.; Warren, B. E.; Wilson, M. N.; Nnacheta, L. C. (2 February 2015). "Clinical Practice Guideline: Allergic Rhinitis Executive Summary". Otolaryngology-Head and Neck Surgery. 152 (2): 197–206. doi:10.1177/0194599814562166. Clinicians may offer acupuncture, or refer to a clinician who can offer acupuncture, for patients with allergic rhinitis who are interested in nonpharmacologic therapy.
^ Abdulla, A; Adams, N; Bone, M; Elliott, AM; Gaffin, J; Jones, D; Knaggs, R; Martin, D; Sampson, L; Schofield, P; British Geriatric Society (March 2013). "Guidance on the management of pain in older people". Age and Ageing. 42 Suppl 1: i1-57. doi:10.1093/ageing/afs200. PMID 23420266. Consider the use of non-pharmacological strategies such as physiotherapy, cognitive behavioural approaches and acupuncture, in combination with medication
^ American Society of Anesthesiologists Task Force on Chronic Pain Management; American Society of Regional Anesthesia and Pain Medicine (April 2010). "Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine". Anesthesiology. 112 (4): 810–33. doi:10.1097/ALN.0b013e3181c43103. PMID 20124882.
^ ^a ^b AAHA/AAFP (2015). "2015 AAHA/AAFP pain management guidelines for dogs and cats". Journal of Feline Medicine and Surgery. 17: 251–272.
^ Camilleri, M; Parkman, HP; Shafi, MA; Abell, TL; Gerson, L; American College of Gastroenterology (January 2013). "Clinical guideline: management of gastroparesis". The American Journal of Gastroenterology. 108 (1): 18–37. PMID 23147521. Acupuncture can be considered as an alternative therapy. This has been associated with improved rates of gastric emptying and reduction of symptoms.
^ Seidman, M. D.; Gurgel, R. K.; Lin, S. Y.; Schwartz, S. R.; Baroody, F. M.; Bonner, J. R.; Dawson, D. E.; Dykewicz, M. S.; Hackell, J. M.; Han, J. K.; Ishman, S. L.; Krouse, H. J.; Malekzadeh, S.; Mims, J. W.; Omole, F. S.; Reddy, W. D.; Wallace, D. V.; Walsh, S. A.; Warren, B. E.; Wilson, M. N.; Nnacheta, L. C. (2 February 2015). "Clinical Practice Guideline: Allergic Rhinitis Executive Summary". Otolaryngology-Head and Neck Surgery. 152 (2): 197–206. doi:10.1177/0194599814562166. Clinicians may offer acupuncture, or refer to a clinician who can offer acupuncture, for patients with allergic rhinitis who are interested in nonpharmacologic therapy.
^ Abdulla, A; Adams, N; Bone, M; Elliott, AM; Gaffin, J; Jones, D; Knaggs, R; Martin, D; Sampson, L; Schofield, P; British Geriatric Society (March 2013). "Guidance on the management of pain in older people". Age and Ageing. 42 Suppl 1: i1-57. doi:10.1093/ageing/afs200. PMID 23420266. Consider the use of non-pharmacological strategies such as physiotherapy, cognitive behavioural approaches and acupuncture, in combination with medication
^ American Society of Anesthesiologists Task Force on Chronic Pain Management; American Society of Regional Anesthesia and Pain Medicine (April 2010). "Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine". Anesthesiology. 112 (4): 810–33. doi:10.1097/ALN.0b013e3181c43103. PMID 20124882.

The relevant practice guidelines are

—Kww(talk) 00:37, 23 May 2015 (UTC)

You seem to have left out PMID 25701863 added by DrChrissy.
And why did you not mention PMID 23420266 at all?

-A1candidate 00:48, 23 May 2015 (UTC)

Added the geriatric guideline that I had inadvertantly omitted. At first blush, the veterinary reference doesn't appear to have been misrepresented, so I left it alone. If I've missed some way in that the strength of the recommendation has been misportrayed, let me know.—Kww(talk) 00:55, 23 May 2015 (UTC)

None of the references were misrepresented. At least not in the previous version. -A1candidate 01:04, 23 May 2015 (UTC)

Previous version is far more concise and readable. It is obviously not perfect and may require some slight modifications to better reflect the guidelines, but it is certainly better than the current version as it summarizes the practice guidelines of medical organizations and gives appropriate emphasis on the clinical recommendations and consensus statements of medical organizations. On the other hand, the current version distorts the statements found in the original guidelines and places undue weight on the fact that these recommendations are far from strong. It should be reverted back to the previous version before the entire section becomes impossible to understand. -A1candidate 23:51, 22 May 2015 (UTC)
Current version. The previous version was grossly misleading, as it implied that these societies were actually recommending acupuncture. More careful review of the guidelines themselves make it clear that most of them were providing extremely weak recommendations under extremely limited circumstances and that none of them were recommending acupuncture as the primary course of treatment. Even the word "suggest" is too strong: these guidelines provide extremely tepid support for the use of acupuncture. Every qualifier that I added accurately reflects the source guidelines themselves. By the way, a "religion" and "sociology" RFC? In what way is this anything other than a medical and scientific issue?—Kww(talk) 00:00, 23 May 2015 (UTC)
Can you add the citations into the collapsed sections above? CorporateM (Talk) 00:29, 23 May 2015 (UTC)
- The refs are now included. -A1candidate 00:34, 23 May 2015 (UTC)

Thanks. I started looking through a few of them and noticed that the journals being cited are published by the organizations themselves. Is there any debate/disagreement as to whether these are primary sources? CorporateM (Talk) 01:07, 23 May 2015 (UTC)

Not that I'm aware of. There's been some debate as to whether clinical guidelines are worth including at all, but a clinical guideline inherently is a direct statement by the organisation itself, so a primary source, correctly attributed to the source organisation, is probably the best way to go.—Kww(talk) 01:10, 23 May 2015 (UTC)

(ec, responding to Kww) (edit: in response to CorporateM's question as well) I wouldn't make that a general principle, though. It's very different from e.g. a company's press release - in some circumstances, sources like these can represent a statement of the general expert opinion on a subject, so (without saying anything about the current situation) I think it's potentially reasonable to dispute that. In some cases such statements may be more than "typical" primary sources, which is at least partially why clinical guidelines are included in WP:MEDRS as acceptable sources (when "from nationally or internationally recognised expert bodies"). It's the same reason that, for example, the IPCC is a strong source for statements of fact about climate change - it's agreed that it's best to treat it as if it's secondary or tertiary. There's a high standard to meet for that, but the discussion would have to analyze who the authors are. Sunrise (talk) 01:36, 23 May 2015 (UTC)

No. At least from the perspective of WP:MEDRS, I believe they are generally considered to be secondary sources (similar to review articles) since their recommendations are based on primary studies. PubMed also categorizes them as "Review", so there's no way Kww and others can argue that this isn't the case. -A1candidate 01:13, 23 May 2015 (UTC)

Comment: It's hard for me to say without a stronger familiarity with our standards in medical topics/sourcing, but my instinct is to suggest deleting the entire bit. Looks like primary sources pieced together into an advocacy piece intended to make it look like a lot of organizations either oppose or support acupuncture depending on the version. I would need strong secondary sources to know if these organizations have an agenda, if their clinical advice is considered credible, and so on. Given that the scope of this article is very large, I would expect better sourcing to be available. That being said, I might defer to the better judgement of an impartial editor more experienced in this subject area and would consider that if the sources are acceptable, something in-between the two versions is probably the most obvious approach. I can put something together for discussion if the sources are deemed acceptable. CorporateM (Talk) 02:19, 23 May 2015 (UTC)

CorporateM please actually read MEDRS, particularly the definitions section where secondary sources are defined. Clinical guidelines issued by major medical bodies are gold standard MEDRS sources. Jytdog (talk) 10:54, 23 May 2015 (UTC)

@Jytdog: First of all, please stop emailing me with all these loaded comments about how I'm "destroying my credibility" with you, unless I essentially agree with you. I have already previously asked editors to stop doing this here in case you didn't see it. This is extremely inappropriate bullying, covert manipulation and bordering on harassment. I insist you knock it off. Any further private communications will merely be copy/pasted publicly, where all discussion should take place.

In other news, Jytdog does appear to be correct. MEDRS says "medical guidelines or position statements published by major health organizations" are secondary sources. Correcting me the usual way would have worked just fine. I'm busy this weekend and my interest in the medical aspect is limited, so I don't know if I will have the time/interest to sufficiently investigate the source material in order to cast a vote. However, given Jytdog's conduct, this raises significant questions about the integrity of this discussion if other editors are engaging in similar off-wiki lobbying, bullying and collusion. CorporateM (Talk) 15:55, 23 May 2015 (UTC)

I replied on your Talk page. Your comment was both untrue and inappropriate for an article Talk page. Jytdog (talk) 16:15, 23 May 2015 (UTC)

Current version: I think that the sources are ok (stated with attribution). Further, one should not cherry-pick quotes from them, but render their whole evaluation of acupuncture and the doubts they have about the evidence for it. Tgeorgescu (talk) 02:22, 23 May 2015 (UTC)

Comment Between the two the current version is more informative and less promotional. But this RFC seems a little malformed.-Serialjoepsycho- (talk) 04:18, 23 May 2015 (UTC)

While I'd say the current version is better, I question if the subsection Clinical practice guidelines in the section Clinical practice has the effect of unduly legitimizing and promoting the field of acupuncture.-Serialjoepsycho- (talk) 00:34, 24 May 2015 (UTC)

Current version or delete. The current text is better written and closer to what the sources said. The previous text was a huge SYN violation. Removing the SYN tag without fixing the problem is not how to improve our articles.[43] We do have solid evidence in the effectiveness section. The recommendations are weak evidence. We have better sources on the topic. QuackGuru (talk) 05:27, 23 May 2015 (UTC)

current version it is more accurate--Ozzie10aaaa (talk) 08:50, 23 May 2015 (UTC)

current version - With regard to the ASA, the source actually says, after reviewing the evidence and finding it poor (as described in the "Current version"): "ASA and ASRA members agree and consultants are equivocal with regard to whether acupuncture should be used for nonspecific, noninflammatory low back pain. Recommendations for acupuncture. Acupuncture may be considered as an adjuvant to conventional therapy (e.g ., drugs, physical therapy, and exercise) in the treatment of nonspecific, noninflammatory low back pain." the so-called "previous version" (which lasted for about a half hour) was created by this edit by the OP which rendered that as "acupuncture may be considered in the treatment of patients with nonspecific, noninflammatory low back pain". After some back and forth the current version was arrived at. The killer thing to me, is that even the OP backed off the "previous version" in this diff and this dif (in another piece of this section) as part of that back and forth. On the basis of those diffs it appears that the OP himself does not support the version linked to as "previous". Jytdog (talk) 10:53, 23 May 2015 (UTC) (add note that ASA reviews the evidence - edit shown with underline Jytdog (talk) 12:17, 23 May 2015 (UTC))
- I backed off in an attempt to compromise. I support most, if not all, of my own edits. -A1candidate 11:11, 23 May 2015 (UTC)

your own edits that I linked to, were made as part of the WP:CONSENSUS making process that led to the current version. This RfC is repudiation of that and is a waste of time in my eyes. Even you, via your subsequent edits, do not support the "previous version.' And I will add, since you chose to argue with me, that your edit creating the "previous version" is so far away from the source that it was either incompetent or tendentious; there is no chance that the "previous version" will be accepted in this RfC. Please withdraw this RfC. Jytdog (talk) 12:16, 23 May 2015 (UTC)

Current version The previous version hides all the nuance in the position statements and gives a stronger endorsement than they actually provide. The previous version is also technically an original synthesis, Second Quantization (talk) 11:15, 23 May 2015 (UTC)
Current version. As a disclaimer, I am not fully familiar with Wikipedia's standards for medical sources (though I have recently read the MEDRS thing). Also, my wife is someone who has acupuncture treatment (for symptomatic relief only) and appears to benefit from it, and I myself use acupressure techniques for controlling occasional headache and for relaxation - but as a statistically meaningless sample of only two, I have no way of knowing whether we receive physical medical benefit, placebo benefit, or psychological benefit. With that in mind, I think Wikipedia treads dangerous ground if it tries to summarize clinical practice guidelines into generalities, risking venturing into the realms of synthesis, and I think the 'previous version' does do that (and I think it presents a more positive whole than the parts themselves warrant). If any clinical practice guidelines are to be presented at all, I think they should be as close as practical to actual quotations from the various bodies themselves. And so I very much favour the 'current version' if there has to be a version at all. Mr Potto (talk) 15:52, 23 May 2015 (UTC)

Both, conditionally. The previous version fits best for the lede, while the current version fits best in the body. However, the previous version needs slight modification in order to convey to the reader that each organization has conditional and not blanket recommendations which they recommend acupuncture for, while the current version, placed in the body, needs to remove OR and weasel words such as "only" as in The American College of Chest Physicians only suggests acupuncture for nausea because this source, like several others in the current version, have not done exhaustive research into other conditions which acupuncture is appropriate for or not. Implying they have done so is deceptive and their use here misleads the reader. LesVegas (talk) 16:45, 23 May 2015 (UTC)

Previous < Current < Merge <= Alternative: If the current stays then this section should either be made into a table, a bulleted list, or turned into prose, and more clinical recommendations from non-American sources should be present. Primarily though I ~~agree with QuackGuru~~ think that this information should be incorporated into relevant sections (i.e. CHEST's nausea recommendations moved into the section on nausea) rather than bundled together in its own section. I would only want this section to remain if sources that analyzed and summarized clinical recommendations and provided general descriptions of clinical recommendations could be found and used. Such a section might compare the clinical recommendations of organizations in places like China to those in the West, or describe trends in how acupuncture is recommended (usually as a complement rather than stand-alone treatment).TypingAway (talk) 00:02, 24 May 2015 (UTC)

None of the above. We should describe such guidelines with great care and be careful to avoid making any implication of legitimacy beyond what the guidelines support, which is, in most cases, functionally equivalent to don't replace real treatment, but it probably won't do any harm and it'll keep the patient happy. Guy (Help!) 21:27, 24 May 2015 (UTC)

I was careful to do just that, Guy. Can you point out a place where I failed?—Kww(talk) 21:30, 24 May 2015 (UTC)

I have nothing against your edits, my problem is with trying to cast this section in stone via an rfc that offers only two options. I don't think that's necessary. It's A1candidate's attempt to crowbar his preferred version into the article, and frankly we don't need that. I am not persuaded that the section belongs at all, since it is an open invitation to quote mine. Guy (Help!) 09:07, 25 May 2015 (UTC)

Current version, but with an introductory line: The previous version is, in my opinion, seriously misleading; it certainly isn't a shortened version of the much more factual current version. But I do think that simply listing the recommendations of six medical groups, without any introductory/summary sentence, isn't helpful to readers. I suggest something like: "Six medical organizations recommend acupuncture be considered only in specific, limited situations." I don't think it's necessary to be explicit, in such an introductory sentence, that the evidence for effectiveness is questionable, since that becomes obvious upon reading the detail. And I don't think there is a danger of misleading people by selectively quoting only the introductory sentence, particularly if the wording is "be considered" rather than "be used". -- John Broughton (♫♫) 17:55, 26 May 2015 (UTC)
None at all or, second alternative, Current version. Saw this on Jimbo's talk page. The previous version is clearly POV and overstates the case for acupuncture. The current version is slightly better, but given that lives can hang in the balance, my preference is that there be nothing in this article that a patient can interpret as encouragement to use this fringe bit of quackery. Coretheapple (talk) 18:39, 26 May 2015 (UTC)

Neither Given these two choices, from the view of a non-medical expert and non-CAM expert, neither seem to convey information in a neutral, satisfying manner. The Previous version is more concise and readable, but sounds vague and oversimplified: "have suggested the use of acupuncture for some groups of patients" seems like possibly broad support, but for what patients and why? The Current version is more informative but barely readable, with seven groups and seven positions to keep track of: not summary style. My first impression from reading the Current is that in general they mostly don't dismiss reiki, but don't find it does a whole lot either. With both versions, because a group of organizations is included without explanatory context, I also wonder, why these particular orgs, are they of similar stature, are they all the orgs for which reiki could apply or are there other groups not represented, it seems arbitrary. These are my immediate impressions in reader POV. The ideal presentation would be a better-written summary, not a point form data dump. A less elegant, probably less contentious, effective approach would be to assemble it all in a simple table: Organization, Position, Target Patient, something like that, and summarize for what and to whom, eg:

ACP > weak recommendation > where other approaches are ineffective
ACCP > only for nausea relief, in conjunction with other treatments > -
ACG > conditional recommendation as alternative therapy (due to low level of evidence) > -
AAOHNS > an option for those interested in nonpharmacologic therapy > for allergic rhinitis

And so on. At least things are summarized and relatively easy for a general reader to assimilate. --Tsavage (talk) 21:11, 27 May 2015 (UTC)

Current version Like John Broughton I reckon that an introductory sentence would be an improvement. As for the concise older version I agree with the majority that it is hopelessly slanted. Editing its POV shortcomings to produce more of a sound-bite slickness for readers who can't read would be possible, but unencyclopedic and poorly cited. Anyone who doesn't like the idea of eternally wading through all (heaven have mercy!) SIX recommendations plus proper citations can skip the section after the introductory sentence if he prefers. Not an unreasonable burden on the reader IMO. JonRichfield (talk) 09:53, 3 June 2015 (UTC)
The current version is a fairer summary of what the guidelines say. Something to keep in mind throughout this discussion, that I am sure was kept in mind by the authors of those guidelines: placebos do work. Maproom (talk) 06:35, 8 June 2015 (UTC)
Previous version Bearing in mind that acupuncture is not a subject that overly interests me I found the previous version fine to read but the current version labourious. I would caution against providing a long slightly repetitive list that is a chore to read for the average person when it could be easily summarised. I also don't believe that we need to hear each position in detail when each organisation takes a relatively similar attitude.Levelledout (talk) 00:58, 10 June 2015 (UTC)
Previous version Returning to the discussion with a fresh pair of eyes. Just by having a few seconds of look to the current version, it's apparent that the prose and readability have suffered drastically when compared to the previous version. We have to set the bar higher, and the whole article suffers now from the current poorly written section. I'd say let's restore the previous version, although not perfect, and edit further from that one. What I am slightly concerned though, is that the previous version might somewhat exaggerate the recommendations for acupuncture, and we need to express it more clearly that the recommendations are not always unconditional. Jayaguru-Shishya (talk) 07:14, 10 June 2015 (UTC)

Discussion

The recommendations from the organisations are lower-quality sources compared to other sources currently in the effectiveness section. QuackGuru (talk) 07:19, 23 May 2015 (UTC)

with regard to evidence yes things like Cochrane reviews are better, but clinical guidelines are also gold standard MEDRS sources. Jytdog (talk) 11:05, 23 May 2015 (UTC)

User:Jytdog, the information is essentially redundant. There is a huge effectiveness section with numerous high-quality sources. Please read this comment. "Given that the scope of this article is very large, I would expect better sourcing to be available". User:CorporateM, you are right. We have much better sources available. QuackGuru (talk) 19:56, 23 May 2015 (UTC)

Quackguru you do like to stir the pot! :) You know as well I do that reviews of the evidence in the biomedical literature, and clinical guidelines provided by major medical bodies/statements by major scientific bodies, are the bedrock of MEDRS. In most cases they line up with each other. In places where they diverge, we've determined elsewhere they should get equal weight. Jytdog (talk) 20:06, 23 May 2015 (UTC)

The issue is that it is redundant and this article is getting too long to include this. QuackGuru (talk) 20:12, 23 May 2015 (UTC)

The one concern I have is that this list has an inherent cherry-picking problem. By searching for "acupuncture" in clinical guidelines, someone came up with these six. Other clinical guidelines make no allowances for it at all. If these are truly the only six guidelines that countenance acupuncture out of thousands that don't, having the list without some qualification is a problem, "gold standard" or no. Is there any reasonable way to present the rough volume of clinical guidelines that countenance the use of acupuncture vs. those that do not?—Kww(talk) 17:49, 23 May 2015 (UTC)

If you have a source that discusses the relative absence of acupuncture from the majority of clinical guidelines then you could include that, but be careful of doing original research. Herbxue (talk) 19:34, 23 May 2015 (UTC)

If the issue is that the article is getting too long, WP:LENGTH would suggest we create sub-articles, so that everything that can be reliably sourced can be included, while leaving a concise summary on the main page. For example, in addition to the page we have on Regulation of acupuncture, I could certainly see something like History of acupuncture eventually, as well as Efficacy of acupuncture. I share similar concerns as @KWW:; how does one pick which organizations to include? One sensible way to do it might be to base it on a list of the most authoritative "major health organizations" according to a reliable source - then look for which orgs on that list have published clinical guidance. This way a source, not Wikipedia's editors, are deciding which org's clinical guidelines to include. CorporateM (Talk) 21:44, 23 May 2015 (UTC)

There was a previous discussion for Effectiveness of acupuncture. Editors did not want a new article. Editors wanted to trim the section instead. Now we got more bloat. QuackGuru (talk) 21:58, 23 May 2015 (UTC)

Reading [44] I don't really see the recommendation that the doctors become acupuncturists or just randomly start jamming needles into their patient. This subsection Clinical practice guidelines doesn't actually seem to have anything to do with The actual clinical practices of acupuncturist. The APC is recommending acupuncture pretty much when everything reasonable has failed.-Serialjoepsycho- (talk) 22:18, 23 May 2015 (UTC)
- Current wording "The American College of Physicians weakly recommends the use of acupuncture only for patients that do not show improvement after being treated with other methods.[62]"[45] Thoughts? QuackGuru (talk) 22:26, 23 May 2015 (UTC)
  - It's not the wording but the sectioning I think that brings an issue. It may have the effect of adding undue legitimization to acupuncture. While these are clinical practice guidelines they don't seem to be clinical practice guidelines of acupuncture. Seems more the clinical practice guidelines of referral to acupuncturist.-Serialjoepsycho- (talk) 22:32, 23 May 2015 (UTC)
    - I would have serious issues with presenting the clinical guidelines of acupunctural societies in this article. What would they base those guidelines on? The referral guidelines are iffy enough to include.—Kww(talk) 22:35, 23 May 2015 (UTC)
      - I'm not interested in putting the clinical guidelines to Acupuncture in. I'm pointing out that might be apropriate in this section. These referral guidelines seem as if they might add undue legitimization to the practice of acupuncture. It may be better to put these elsewhere or simply remove them altogether.-Serialjoepsycho- (talk) 22:51, 23 May 2015 (UTC)
  - I used that wording as a neutral presentation of the guideline contents. While I sympathise with "when everything reasonable has failed", this section isn't the place to characterise acupuncture as unreasonable.—Kww(talk) 22:35, 23 May 2015 (UTC)
    - I refer you to my last comment above. -Serialjoepsycho- (talk) 23:15, 23 May 2015 (UTC)

User:TypingAway, I think the lower-quality evidence from the organisations should be deleted because we have similar information in the effectiveness section that uses higher-quality sources. QuackGuru (talk) 00:09, 24 May 2015 (UTC)
- I see, sorry to have mischaracterized your argument then. I have changed my post accordingly.TypingAway (talk) 00:14, 24 May 2015 (UTC)

Perhaps it good be changed from a subsection to a standalone section. Perhaps a new title, that indicates in someway that these are not the clinical guidelines for acupuncturist's, could be chosen.-Serialjoepsycho- (talk) 00:39, 24 May 2015 (UTC)
- I moved it and renamed it to address the concerns. QuackGuru (talk) 01:00, 24 May 2015 (UTC)
Note that the section has been renamed as well as moved to a different section: Acupuncture#Medical_organization_guidelines -Serialjoepsycho- (talk) 03:45, 25 May 2015 (UTC)
Current version The longer more detail version is better. Still, it may be too long and undue. Content like this is not easily shortened but if it is undue, then it could be forked to another article. An article on "clinical practice guidelines for xxx" would be unprecedented but for controversial topics like this maybe it would be useful. Blue Rasberry (talk) 12:37, 26 May 2015 (UTC)

I am curious, on most Wikipedia medical articles how are clinical practice guidelines presented? It seems like there may be a good model to follow which we can adopt here. LesVegas (talk) 16:54, 10 June 2015 (UTC)

Comment' A table listing institutions and their positions.“WarKosign ” 05:12, 13 June 2015 (UTC)

Publication bias

@Gandydancer: expressed concern here about how the WHO report is positioned in the "Publication bias" section. After some prodding, I've taken a closer look at it. A few notes:

Looking at the "Reputation and Impact" section of the About Us page for The Lancet here, the journal appears to be reliable and the source does support the hypercritical tone it is used for. That being said I don't think "critics assailed it" is an encyclopedic tone or that the sentence is terribly well-written.

The source that follows that (despite a hyper-editorialized title for the book) appears to be written by general science writers and appears to be reliable in the general sense, though not for medical claims. At first blush, I would say it is probably reliable for its first use, but not for analyzing clinical studies as was done upon its second use, which would need MEDRS sources.

The third source also looks fine - nothing raises an alarm bell and it is accurately represented.

On my Talk page I said the section title appears to be very POV-laden, putting it under "Publication bias"; I now have more context from the sources and see that it's not as outrageous as I thought, but still wonder if this section is necessary and can't be consolidated into a more general section on the debate. We currently have 16+ sections devoted to the same debate about efficacy.

Regarding the general depiction of the WHO report, the current sources look reliable to me and the content does appear to be representative of those sources. The only argument I see against the hyper-critical depiction is if there are other sources of similar reliability that provide other viewpoints and are currently missing. This argument requires someone to come forward and provide such sources that they argue were not included and should be; so I'd like to invite that here for further vetting/discussion. CorporateM (Talk) 21:21, 5 June 2015 (UTC)

I don't think we have an emphasis problem: this isn't the first time that a medical arm of a primarily political body has made statements that are rejected by groups with a more scientific perspective. The conclusions of the WHO report certainly don't hold up in comparison to more recent reviews of the evidence.—Kww(talk) 02:30, 6 June 2015 (UTC)

I would lean towards agreeing, based on the sources that are currently used. Article content that is hyper-critical or hyper-positive, rather than balanced, always raises red-flags, because in most cases this is an indication of POV pushing. But if that really is representative of the sources, we write very negative, or very positive, content, if that's what the sources say. That being said, I only looked at the article's current sources and do not know what else may be out there. CorporateM (Talk) 17:09, 6 June 2015 (UTC)

So you are implying that WHO is merely a political body with little scientific perspective? No Kww, I'm afraid you are wrong here. Perhaps you'd like to revise your comment? Cheers! Jayaguru-Shishya (talk) 19:00, 9 June 2015 (UTC)

I agree. The WHO is both a political and scientific body, and the scientific aspect of it is rather strong. The WHO is in the same class as the NIH and NHS, and there has been resistance by editors here to suppress statements by all of these organizations. If there are reviews that reject their statements, as Kww said, we can certainly cite those as well. What we shouldn't do is cite only one side of the science especially if it means censoring statements by the WHO, NIH, and NHS. LesVegas (talk) 19:23, 9 June 2015 (UTC)

For the most part, the criticisms in the current article appear to be representative of the reliable sources provided as citations. There is no obligation to provide "the other side" if sources lean heavily in one direction, but if there are other strong sources of equal reliability that present a more diverse range of perspectives, what we need are those sources to be offered and discussed here. CorporateM (Talk) 19:33, 9 June 2015 (UTC)

The problem with the WHO is that there have been several publications on their website by true believers that are not actually WHO endorsements but are presented as such by believers (e.g. homeopathy). There are also documents describing the practice which are misrepresented as validating the practice (e.g. chiropractic). The political aspect is visible at the fringes and abused by charlatans to capitalise on the WHO's reputation in immunisation and other areas where content is genuinely WHO sourced. Guy (Help!) 10:07, 10 June 2015 (UTC)

Is that the case with this document? Is this an example of a document presented by a believer and not an actual WHO endorsement? TylerDurden8823 (talk) 23:02, 10 June 2015 (UTC)

TylerDurden, here is an example. And Guy is correct, but I should point out that WHO has many types of sources. For instance, this one is a review of evidence and is also a statement by the WHO and would be a good quality source, whereas a source like this would be a true believer making a statement that ends up on WHO's website, and is one we shouldn't ever use or try attributing to the WHO. LesVegas (talk) 23:45, 10 June 2015 (UTC)

And to answer you more specifically, TylerDurden, no, it's not the case with the document in question. The document in question is a review of the evidence and was conducted by the WHO and can therefore be attributed to the WHO. The one issue I have with it is that it's old (2002). However, it is the last such review that the WHO has done and, therefore, represents their current viewpoint until they conduct another review. We do have newer evidence on some of these topics, however. I think what I would be supportive of is stating that the WHO has reviewed evidence and currently recommends acupuncture for these conditions and then give a list. But I would not be supportive of using the WHO as a source for, say, allergies or nausea or any other specific condition because we have newer sources for that. LesVegas (talk) 23:53, 10 June 2015 (UTC)

I didn't think of that before, but I think @Doc James: told me that ten years is usually considered roughly the limit for representing "current scientific consensus"? (doc correct me if I'm wrong). If that is correct, the 13-year-old WHO report would be very old indeed. I've recently been reading a book about computer technology that was published in 2012 and found that it was already really out-dated. Surely the medical field moves slower, but the attitude towards acupuncture has fluctuated radically over time throughout history, often in a much shorter time-frame than 13 years. CorporateM (Talk) 05:09, 11 June 2015 (UTC)

It is, however, a fringe position, LesVegas, stating as fact positions that are generally unsupported by medical literature. It even misrepresented the contents of 27 of the 35 studies it claimed to be based on.[46]—Kww(talk) 05:21, 11 June 2015 (UTC)

This is actually included in WP:MEDRS, which says to look for reviews in the last 5 years. An older review that contradicts newer ones would clearly be deprecated here. Guy (Help!) 12:13, 11 June 2015 (UTC)

Guy, I am aware that MEDRS states to look for reviews in the last 5 years, which is why I personally would not support using the WHO reviews as medical claims here. However, I do support it as a claim for the WHO's statement, since this is their most recent statement on the matter. To that end, MEDRS says, Statements and information from reputable major medical and scientific bodies may be valuable encyclopedic sources. These bodies include the U.S. National Academies (including the Institute of Medicine and the National Academy of Sciences), the British National Health Service, the U.S. National Institutes of Health and Centers for Disease Control and Prevention, and the World Health Organization. So that's how it should be included. All this reminds me that we had a discussion on creating a section on medical organizations some time ago, in regards to the NHS. Perhaps this is the best way to include the material. We just go down the list of medical orgs like the NIH, the NHS, the WHO and cite their statements. In the case of the WHO, we should include the fact that their most recent statement was in 2002 on the matter. Agreed? LesVegas (talk) 14:30, 11 June 2015 (UTC)

I disagree, since that would be a fallacious appeal to authority. Guy (Help!) 17:39, 13 June 2015 (UTC)

No, Jayaguru-Shishya, I didn't say anything that any reasonable person could have misinterpreted that way. Please stop misrepresenting my comments and contributions: it's disruptive to conversations and debates, as well as making it impossible to make progress on articles.—Kww(talk) 05:21, 11 June 2015 (UTC)

This argument is used often, that something is "reliable for the point-of-view of the author"; I think this is a poor argument. All sources are reliable for the POV of the author, including op-eds, primary sources, corporate websites, and press releases, but there are reasons we don't use them. I don't see it as mandatory to include WHO's perspective, or any other specific organization for that matter, if they haven't published something more recent. However, there are things like the German acupuncture trials (also too old) that are significant enough to be a part of the debate's history and should be included in a historical context. It is tough to delete sourced content, but the policy is pretty clear in calling for its deletion. That being said, I see no reason it can't be restored in a History section later on, if those corresponding sources suggest it was that much of a landmark aspect of the debate. CorporateM (Talk) 16:37, 11 June 2015 (UTC)

This is about publication bias not history. QuackGuru (talk) 18:22, 11 June 2015 (UTC)

Sourced text was deleted. The argument was more than 5 years old per discussion on MEDRS requirements. Per WP:MEDDATE, we don't have newer sources on this specific material. QuackGuru (talk) 18:22, 11 June 2015 (UTC)

Deletion of sourced text from the lede that clearly summarised the body

This sentence was deleted "Cochrane reviews found acupuncture is not effective for a wide range of conditions."[47] The lede should summarise the body. I don't see a logical reason to delete the sentence sourced to a very high-quality overview of Cochrane reviews. QuackGuru (talk) 04:15, 15 June 2015 (UTC)

The summary of the body has been restored. Good. QuackGuru (talk) 05:09, 15 June 2015 (UTC)

[1] Manheimer, E; Cheng, K; Wieland, L. S.; Min, L. S.; Shen, X; Berman, B. M.; Lao, L (2012). "Acupuncture for treatment of irritable bowel syndrome". The Cochrane database of systematic reviews. 5: CD005111. doi:10.1002/14651858.CD005111.pub3. PMC 3718572. PMID 22592702.

[APS-2] Chou, R; Huffman, LH; American Pain Society; American College of Physicians (2 October 2007). "Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline". Annals of internal medicine. 147 (7): 492–504. doi:10.7326/0003-4819-147-7-200710020-00006. PMID 17909210.

[chest-3] Deng, Gary E.; Rausch, Sarah M.; Jones, Lee W.; Gulati, Amitabh; Kumar, Nagi B.; Greenlee, Heather; Pietanza, M. Catherine; Cassileth, Barrie R. (1 May 2013). "Complementary Therapies and Integrative Medicine in Lung Cancer". Chest (journal). 143 (5_suppl): e420S. doi:10.1378/chest.12-2364. In patients having nausea and vomiting from either chemotherapy or radiation therapy, acupuncture or related techniques is suggested as an adjunct treatment option

[4] Camilleri, M; Parkman, HP; Shafi, MA; Abell, TL; Gerson, L; American College of Gastroenterology (January 2013). "Clinical guideline: management of gastroparesis". The American Journal of Gastroenterology. 108 (1): 18–37. PMID 23147521. Acupuncture can be considered as an alternative therapy. This has been associated with improved rates of gastric emptying and reduction of symptoms.

[5] Seidman, M. D.; Gurgel, R. K.; Lin, S. Y.; Schwartz, S. R.; Baroody, F. M.; Bonner, J. R.; Dawson, D. E.; Dykewicz, M. S.; Hackell, J. M.; Han, J. K.; Ishman, S. L.; Krouse, H. J.; Malekzadeh, S.; Mims, J. W.; Omole, F. S.; Reddy, W. D.; Wallace, D. V.; Walsh, S. A.; Warren, B. E.; Wilson, M. N.; Nnacheta, L. C. (2 February 2015). "Clinical Practice Guideline: Allergic Rhinitis Executive Summary". Otolaryngology-Head and Neck Surgery. 152 (2): 197–206. doi:10.1177/0194599814562166. Clinicians may offer acupuncture, or refer to a clinician who can offer acupuncture, for patients with allergic rhinitis who are interested in nonpharmacologic therapy.

[6] Abdulla, A; Adams, N; Bone, M; Elliott, AM; Gaffin, J; Jones, D; Knaggs, R; Martin, D; Sampson, L; Schofield, P; British Geriatric Society (March 2013). "Guidance on the management of pain in older people". Age and Ageing. 42 Suppl 1: i1-57. doi:10.1093/ageing/afs200. PMID 23420266. Consider the use of non-pharmacological strategies such as physiotherapy, cognitive behavioural approaches and acupuncture, in combination with medication

[7] American Society of Anesthesiologists Task Force on Chronic Pain Management; American Society of Regional Anesthesia and Pain Medicine (April 2010). "Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine". Anesthesiology. 112 (4): 810–33. doi:10.1097/ALN.0b013e3181c43103. PMID 20124882.

[AAHA-8] AAHA/AAFP (2015). "2015 AAHA/AAFP pain management guidelines for dogs and cats". Journal of Feline Medicine and Surgery. 17: 251–272.

[9] Camilleri, M; Parkman, HP; Shafi, MA; Abell, TL; Gerson, L; American College of Gastroenterology (January 2013). "Clinical guideline: management of gastroparesis". The American Journal of Gastroenterology. 108 (1): 18–37. PMID 23147521. Acupuncture can be considered as an alternative therapy. This has been associated with improved rates of gastric emptying and reduction of symptoms.

[10] Seidman, M. D.; Gurgel, R. K.; Lin, S. Y.; Schwartz, S. R.; Baroody, F. M.; Bonner, J. R.; Dawson, D. E.; Dykewicz, M. S.; Hackell, J. M.; Han, J. K.; Ishman, S. L.; Krouse, H. J.; Malekzadeh, S.; Mims, J. W.; Omole, F. S.; Reddy, W. D.; Wallace, D. V.; Walsh, S. A.; Warren, B. E.; Wilson, M. N.; Nnacheta, L. C. (2 February 2015). "Clinical Practice Guideline: Allergic Rhinitis Executive Summary". Otolaryngology-Head and Neck Surgery. 152 (2): 197–206. doi:10.1177/0194599814562166. Clinicians may offer acupuncture, or refer to a clinician who can offer acupuncture, for patients with allergic rhinitis who are interested in nonpharmacologic therapy.

[11] Abdulla, A; Adams, N; Bone, M; Elliott, AM; Gaffin, J; Jones, D; Knaggs, R; Martin, D; Sampson, L; Schofield, P; British Geriatric Society (March 2013). "Guidance on the management of pain in older people". Age and Ageing. 42 Suppl 1: i1-57. doi:10.1093/ageing/afs200. PMID 23420266. Consider the use of non-pharmacological strategies such as physiotherapy, cognitive behavioural approaches and acupuncture, in combination with medication

[12] American Society of Anesthesiologists Task Force on Chronic Pain Management; American Society of Regional Anesthesia and Pain Medicine (April 2010). "Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine". Anesthesiology. 112 (4): 810–33. doi:10.1097/ALN.0b013e3181c43103. PMID 20124882.

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