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Summary text

Wondering why "TCM is largely pseudoscience, with no valid mechanism of action for the majority of its treatments." was removed? Was based on a 2007 Nature article Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:15, 30 April 2014 (UTC)

That looks to be as reliable a source as we can get. I don't see any engagement here from people who are disputing it so I will restore ----Snowded 16:24, 30 April 2014 (UTC)

If you don't see any engagement its because I didn't link to the discussion regarding it at Traditional Chinese Medicine, my apologies. There has been much discussion regarding this issue and it has been sent for third party review because there is not consensus to include this source as a conclusion in the lede. It does not summarize the body, and represents an opinion. I do not object to the opinion being expressed, but it must include who is expressing it. (If we, as WP, don't have consensus regarding this then it can't be presented as an accepted conclusion). Herbxue (talk) 17:12, 30 April 2014 (UTC)

This has been discussed at the TCM talk page. See: Talk:Traditional Chinese medicine#Labels: Pseudoscience, proto-science, pre-science, Talk:Traditional Chinese medicine#Pseudoscience, Talk:Traditional Chinese medicine#Protoscience, and Talk:Traditional Chinese medicine#Inappropriate conclusion in lede of article. There is a current discussion at Misplaced Pages:Dispute resolution noticeboard#Traditional Chinese medicine. The text in the lede is a summary of the body at this article and at TCM. QuackGuru (talk) 17:22, 30 April 2014 (UTC)

Continued below: Talk:Acupuncture#More_re_TCM_.26_pseudoscience_wording --Middle 8 (leave me alone • talk to me • COI?) 02:52, 13 May 2014 (UTC)

Summary of TCM

I think a WP:SUMMARY of TCM is appropriate because Acupuncture is a key component of traditional Chinese medicine (TCM) which aims to treat a range of conditions. No evidence to the contrary has been provided. QuackGuru (talk) 04:28, 4 May 2014 (UTC)

Of course not. Acupuncture is a key component of TCM, and therefore we included it in the TCM article. But TCM herbology is not a part of acupuncture, and that's why it doesn't belong here. --Mallexikon (talk) 08:43, 4 May 2014 (UTC)

@QuackGuru, you are misreading WP:SUMMARY. It recommends a summary on the parent article, not in the child article. It's intended for sections such as Traditional_Chinese_medicine#Acupuncture_and_moxibustion. --Enric Naval (talk) 09:37, 4 May 2014 (UTC)

The text summarised in the lede should be discussed in the body. QuackGuru (talk) 17:40, 4 May 2014 (UTC)

Yes maybe one paragraph / 4 sentences. I agree that the previous summary was a little too large. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:51, 4 May 2014 (UTC)

Acupuncture is a key component of traditional Chinese medicine (TCM) which aims to treat a range of conditions. Successful TCM results have been scarce: artemisinin, for example, which is an effective treatment for malaria, was fished out of a herb traditionally used to treat fever. Although advocates have argued that research had missed some key features of TCM, such as the subtle interrelationships between ingredients, it is largely pseudoscience, with no valid mechanism of action for the majority of its treatments.

Here is the current text in the body. I kept it brief. QuackGuru (talk) 21:58, 4 May 2014 (UTC)

No. This is ridiculous. Artemisin has nothing to do with acupuncture. Chinese herbology is a child article of TCM, i.e. its a sibling article of acupuncture. We don't include summaries of sibling articles at WP. --Mallexikon (talk) 01:53, 5 May 2014 (UTC)

This is not ridiculous. This is fun to edit. I deleted the Artemisin bit. QuackGuru (talk) 03:40, 5 May 2014 (UTC)

Should only really be about how acupuncture is used within TCM. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:28, 5 May 2014 (UTC)

Acupuncturists often sell TCM products. QuackGuru (talk) 03:41, 5 May 2014 (UTC)

Sure but this article is about acupuncture rather than acupuncturists. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:11, 6 May 2014 (UTC)

Consensus was never reached for the changes

There never was WP:CON for this change at TCM or this page. None of the edits improved the article. This source was previously rejected from TCM. QuackGuru (talk) 02:17, 6 May 2014 (UTC)

Yes, there was consensus for Richard Keatinge's proposal at Talk:Traditional Chinese medicine#Labels: pseudoscience, protoscience. As far as I can see, these edits improve the article very much. And, yes, someone wrongfully deleted the source you're talking about. It is, however, reliable. If you don't think so, please provide evidence for your allegation. --Mallexikon (talk) 03:58, 6 May 2014 (UTC)

A personal website is not RS material.

Things were already hammered out with the uninvolved editor User:Dominus Vobisdu and other editors. See Misplaced Pages:Dispute_resolution_noticeboard#Traditional_Chinese_medicine.

User:Jim1138 explained there does not seem to have consensus for change and now you are making non-consensus changes to this article after they were rejected from TCM. QuackGuru (talk) 04:11, 6 May 2014 (UTC)

Are you referring to this "uninvolved" editor who has been edit-warring since last year? -A1candidate (talk) 04:20, 6 May 2014 (UTC)

"Personal website"?? This is the source. It's an article from Steven Novella in Science-based Medicine, an online skeptic journal. Your opposition to this source is ridiculous (especially given the fact that it was you who insisted on keeping a quote from Quackwatch in the TCM article) and reeks of WP:Tendentious editing. Now come up with some real arguments or move on, please. --Mallexikon (talk) 04:50, 6 May 2014 (UTC)

You haven't shown how this personal website is reliable. What you added was also WP:OR. I don't see any improvements so far. QuackGuru (talk) 04:56, 6 May 2014 (UTC)

What part of "online skeptic journal" (their editors can be found here) did you not understand? --Mallexikon (talk) 05:15, 6 May 2014 (UTC)

The fact that it's described as an "online" publication should be clear to all. Is there even a proper peer-review process for such a poorly-designed blog? From what this blog says, anyone can submit an article regardless of their credentials. Is it a suitable source for Misplaced Pages? No. -A1candidate (talk) 11:37, 6 May 2014 (UTC)

As blogs go, that one is actually very good, but not good enough. The problem is that the author and the chief editor are the same person, Novella. That doesn't mean it is wrong, (it isn't) it. Just means the sourcing isn't sufficient. The correct response isn't edit warring a summary deletion, it is either finding a better source or tagging with {{medrs}} to draw such better sourcing.LeadSongDog come howl! 13:33, 7 May 2014 (UTC)

Better sourcing was previously found. I think we can go back to this version and see what can be improved before all the controversial edits begun. For example, this edit that was a an obvious violation of WP:ASSERT did not improve the lede and never had consensus at TCM. This edit at TCM was also against consensus. He continues to edit war against consensus at TCM. He is also violating assert at TCM. He added this source to acupuncture against consensus and he personally thinks it is speculating that TCM is probably just pseudoscience. It looks like he is editing according to his belief and not according to reliable sources. QuackGuru (talk) 17:55, 7 May 2014 (UTC)

Looks like evidence that you're edit-warring, QG. And since you continually add material here and elsewhere without consensus, your WP:KETTLE isn't very persuasive. --Middle 8 (leave me alone • talk to me • COI?) 04:58, 8 May 2014 (UTC)

This edit improved the lede by using language according to the source. But the source itself is a study. It is not a general overview of TCM. It should not get the weight of an overview.

I don't think it would be a good idea to go back to this version. It failed MEDRS. Editors should follow MEDRS and not their personal beliefs. --Middle 8 (leave me alone • talk to me • COI?) 05:21, 8 May 2014 (UTC)

You should know by now editors you should follow WP:ASSERT and not when any editor has a personal disagreement with the Nature source. QuackGuru (talk) 19:10, 9 May 2014 (UTC)

You keep citing WP:ASSERT but reading it again, it totally supports my position and not yours. If we cannot agree on what is fact vs. what is opinion, we certainly do not have consensus to assert fact in the article.Herbxue (talk) 16:44, 12 May 2014 (UTC)

MEDRS and ASF violations are continuing to happen at ACU and TCM

See here and here. I do think it is wise to go back to an earlier version. QuackGuru (talk) 02:38, 9 May 2014 (UTC)

So…. the first edit is fine and well sourced and the second one makes the mistake of using a primary source to make an edit that requires a systematic review. Absolutely no relation between the two edits you call "violations" - just revert the second one with a thoughtful and considerate explanation. Are you capable of thought and consideration? No, you want to push POV by suggesting we need to revert to an earlier version of the article. Are you PPdd?Herbxue (talk) 05:30, 9 May 2014 (UTC)

(e/c) Two purported instances are not "mass" violations; I've changed the section header to less contentious wording, especially since the second is from a new editor who should be welcomed and not subjected to negative hyperbole (cf. WP:BITE; and note, I'm sure you didn't realize the editor was a newbie when you titled the section).

The first one is fine per WP:SPS, given Novella's background (plus, there's editorial oversight, FWIW). Agree that the second source is inadequate since it's not a review, but we can use reviews cited in archived talk regarding biomedical correlates of acupoints. Since the second can simply be removed, there's no need to go back to an earlier version. For the sake of decorum and not being BITE-y I'm not going to remove it right away, and suggest leaving it be for a few hours at least; rather, I left a note and a welcome on the new editor's page, encouraging him to have a look at the sources in the talk archive above. --Middle 8 (leave me alone • talk to me • COI?) 05:39, 9 May 2014 (UTC)

There is strong opposition to including the first here.

And there was no CON at TCM either.

User:JzG previously deleted it along with others at TCM.

User:Alexbrn wrote don't need to attribute statements that aren't seriously contested, it endangers our neutrality. See WP:ASF.

So why are the ASF violations continuing here when no serious dispute has been presented? QuackGuru (talk) 17:21, 9 May 2014 (UTC)

No serious dispute? Are you kidding me? Its all we have been talking about for the last 2 weeks! As far as I can tell there is consensus for attributing the pseudoscience as a quote so that the opinion is included but that we maintain encyclopedic tone. Are you just choosing to ignore all other editors on these pages?Herbxue (talk) 17:26, 9 May 2014 (UTC)

You still have not provided a serious dispute. The serious dispute must be among reliable sources. Because you personally object to it is irrelevant. We edit according to the source not you personal belief that you think it is not pseudoscience. See Misplaced Pages:Dispute resolution noticeboard#Traditional Chinese medicine. QuackGuru (talk) 17:37, 9 May 2014 (UTC)

Remember WP:CONSENSUS, QG? The dispute is this: editors are deciding how to use RS's. Nobody disputes that the Nature ediorial is an RS, but there is obviously disagreement over how to use it. That includes the matter of using attribution (per WP:ASSERT), as you well know. (One reason many editors find you hard to work with is that things like what I just wrote need to be explained to you.) --Middle 8 (leave me alone • talk to me • COI?) 18:51, 9 May 2014 (UTC)

You are ignoring the obvious fact that on Misplaced Pages we ASSERT the text when there is serious dispute. Editors already explained this at Misplaced Pages:Dispute resolution noticeboard#Traditional Chinese medicine. QuackGuru (talk) 18:56, 9 May 2014 (UTC)

Not ignoring anything obvious, just expressing a different view than you on what is fact and what is opinion, and the Nature editorial is vague and too far toward the latter. Here is a bit more along those lines from DRN, and here's my followup to your reply at DRN. Let's not fork discussion; please reply here or there. Thx --Middle 8 (leave me alone • talk to me • COI?) 23:00, 9 May 2014 (UTC)

• I agree that the first is acceptable though EBCAM is pushing a heavy barrow up a steep hill (read: advancing an agenda). QuackGuru: if you can find a source more skeptical than Steve Novella you're doing pretty well. The second is not, for several reasons not least of which is the fact that location of needling has been extensively tested and found to make no difference at all, so a single paper in a journal publishing outside its area of expertise cannot possibly be used as a source to assert the opposite. Guy (Help!) 17:44, 9 May 2014 (UTC)

I have updated the article. I don't think it added much to the section. QuackGuru (talk) 18:32, 9 May 2014 (UTC)

No consensus for non-atribution wording. Reverted due to lack of consensus. Please don't do that again, cf. WP:OWN. --Middle 8 (leave me alone • talk to me • COI?) 21:56, 11 May 2014 (UTC)

Please don't do that again? I'm not Bob. User:Bobrayner removed the vague attribution from the text. It seems you do not have CON for your edit and you have not shown a serious dispute. Please provide a serious dipsute otherwise you should stop adding in-text attribution. QuackGuru (talk) 01:55, 12 May 2014 (UTC)

Sorry, I stand corrected re: Bob's edit, not yours. See below: Talk:Acupuncture#More_re_TCM_.26_pseudoscience_wording --Middle 8 (leave me alone • talk to me • COI?) 11:52, 12 May 2014 (UTC)

The article has not been found to resolve the NPOV issues with any consensus. Propose a draft here to your revisions and we can all pitch in and make improve the article. Regards. DVMt (talk) 21:19, 9 May 2014 (UTC)

Strong Bias towards Skeptic Researchers

Example at the Efficacy section:

Although minimally invasive, the puncturing of the skin with acupuncture needles poses problems when designing trials that adequately control for placebo effects. Publication bias is listed as a concern in the reviews of randomized controlled trials of acupuncture. SKEPTIC POV

Since most trials found "sham" acupuncture may be as efficacious as "real" acupuncture, the validity of traditional acupuncture theories including acupuncture point locations has been questioned. Some research results are encouraging but others suggest acupuncture's effects are mainly due to placebo.SKEPTIC POV

It remains unclear whether acupuncture reduces pain independent of a psychological impact of the needling ritual.

The results of trials researching the efficacy of acupuncture are variable and inconsistent for any condition.SKEPTIC POV

An overview of high-quality Cochrane reviews suggested that acupuncture is effective for some but not all kinds of pain. An overview of systematic reviews found that numerous reviews have shown little convincing evidence that acupuncture is an effective treatment for reducing pain.SKEPTIC POV

Acupuncture is generally safe when administered using Clean Needle Technique (CNT) but there is a low risk of adverse effects, which can be serious including death in rare cases.SKEPTIC POV

5 instances of the skeptic POV dominating the tone, weight 3 references to Ernst, 2 to Colqhoun. These 2 represent the fringe, or outlier POV. If they represented the mainstream, medical POV, then these guys http://www.medicalacupuncture.org wouldn't be around. Where does dry needling, or medical acupuncture fit it? DVMt (talk) 22:21, 9 May 2014 (UTC)

Ah? Who cares were or not these guys are around "http://www.medicalacupuncture.org/" Whether or not evidence supports acupuncture has nothing to do with whether or not some physicians do acupuncture. Lots of MDs promote stupid stuff and have non evidence based practice.

We should be using the original Cochrane reviews IMO rather than this paper Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:39, 9 May 2014 (UTC)

Um, no, that's "strong bias towards reality-based researchers". This is medicine and science we're talking about, any claim has to be proven by its proponents and the more extraordinary it is, the stronger the burden of proof. In medicine, appeal to tradition is tantamount to an admission that it's twaddle. Before the 20th Century we knew next to nothing about human physiology, biochemistry or the mechanism of disease. A system based on the idea that an empirically unverifiable life force flows in empirically unverifiable meridians and is subject to imbalances that can be corrected by inserting needles - oh and by the way ancient texts show this was fleams not needles - could only be anywhere close to right by the most amazing happenstance. In reality, of course, we now know that it doesn't matter where you stick the needle, or even whether you stick it in. That's what we find if instead of asking "how do we show that acupuncture works?", we ask "does acupuncture work?".

Existence of some kind of trade body does not validate the practice. There are medical homeopaths. That does not make homeopathy any more valid. Guy (Help!) 23:05, 9 May 2014 (UTC)

We're not talking about homeopathy which, according to my knowledge has no evidence of effectiveness. Also, we're skipping my main point: overuse of skeptic POV at the efficacy section. We're also dismissing an entire system of healing based on our own Western values as opposed to what the Chinese actually think and do. This is called cultural relativism. Regardless of the mechanism, why are we using 5 skeptic papers to dismiss the increasing body of literature that suggests effectiveness for specific conditions, such as this new systematic review which states "there is high-level evidence to support the use of acupuncture for treating major depressive disorder in pregnancy." http://www.ncbi.nlm.nih.gov/pubmed/24761171. The article, like many other CAM articles over-represents Ernst et al. while watering down (or deleting) sources that suggest otherwise. DVMt (talk) 17:39, 10 May 2014 (UTC)

That is a fringe journal written by the trade. Med Acupunct. 2013 Jun;25(3):164-172 is not an independent source on the subject matter. See WP:FRINGE. Cheers. QuackGuru (talk) 17:45, 10 May 2014 (UTC)

Are you asserting a fact, or your personal belief system? Providing a source would be helpful. There is another systematic review that concludes "Our results are consistent with acupuncture significantly lowers blood pressure in patients taking antihypertensive medications. We did not find that acupuncture without antihypertensive medications significantly improves blood pressure in those hypertensive patients." ( http://www.ncbi.nlm.nih.gov/pubmed/24723957). This and other CAM articles at WP, that have a growing evidence-base, seems to be whitewashing or watering down sources that suggest effectiveness or that contradict the Ernst, whom you acknowledge you're in contact with (https://en.wikipedia.org/search/?title=Talk%3AChiropractic&diff=606080466&oldid=606052541). How are do you explain the fact that it appears that you're acting as a meat puppet for EE? He's directly and personally feeding you with his critical articles offline. Something is definitely awry here. DVMt (talk) 18:05, 10 May 2014 (UTC)

Does Med. Acupunct. have legit peer-review? AIM, it turns out, doesn't, disappointingly: see WT:MEDRS archived discussion. We have to use good journals, no question. If EBCAM has real peer review, great, let's use it. I'm just real cautious after the AIM experience (good on jps to catch that). --Middle 8 (leave me alone • talk to me • COI?) 19:36, 10 May 2014 (UTC)

(e/c) Some thoughts, and forgive me for talking a bit about the subject rather than the article:

Just my thoughts FWIW. --Middle 8 (leave me alone • talk to me • COI?) 18:57, 10 May 2014 (UTC)

I will tell you why the skeptical viewpoint is favored by default in science: Mertonian norms. Tgeorgescu (talk) 01:15, 16 May 2014 (UTC)

The skeptical viewpoint shouldn't be confused with dogmatic or cynical viewpoint. Misplaced Pages is littered with dogmatic skeptics and cynics which is why these holistic/CAM/traditional/alt-med pages never get past the fundamental issue: what SPECIFIC aspect of practice is considered FRINGE and what specific area of practice is considered MAINSTREAM? The whole thing is bogus nor pseudoscience. That term is loosely thrown and broad here and it does wikipedia a great disservice. It leaves the narrative polarized as though there is no middle ground. Dominance is given to skeptic researchers whose weight is thrown around in a false context. Physiotherapists are lobbying hard in the US to get 'dry needling' rights which is to stick needles in the human body for therapeutic benefit. We need to separate fact from fiction, Western vs. Eastern approaches and present all the reviews as they are, without attempts to delete reviews that are supportive of acupuncture for 'x' diagnosis. Perhaps we should get an ArbCom to review this and chiropractic since the same principles and players are at play. DVMt (talk) 03:08, 16 May 2014 (UTC)

To begin to work towards neutrality on this article, the introductory paragraphs should be as neutral as possible. I have attempted to make edits in this spirit and have been reverted by multiple by tag-team editors gaming the system, attempting to have me stumble into a three reverts first. I don't see how we can have a true encyclopedia-worthy article with edits such as these. I, therefore propose the following: a completely neutral, matter of fact description of what acupuncture is in the introductory paragraph. Then, creating a criticism section down the article where those who feel passionately that acupuncture is pseudoscientific can have their voices heard. Once we create that section, then perhaps we can positively work towards neutrality in the rest of the article and hope to have the neutral POV tag removed. Ricflairsbutt (talk) 22:18, 24 May 2014 (UTC)

You may want to read Mertonian norms: skepticism is by default the scientific position, adopted professionally by all scientists worth their salt. So, accusing us of skeptic bias means accusing us of being biased in favor of science, which is pretty germane to a pseudoscience label applied to acupuncture. Tgeorgescu (talk) 00:03, 25 May 2014 (UTC)

The official Misplaced Pages stance: WP:LUNATICS. Tgeorgescu (talk) 00:05, 25 May 2014 (UTC)

More re TCM & pseudoscience wording

The disputed wording is this (in the lead, and similar wording in the body):

TCM is "fraught with pseudoscience", with no valid mechanism of action for the majority of its treatments. (source: Nature editorial

The "fraught" part can be improved upon and the "no valid mechanism" part isn't supported by context.

We all agree, I think, that TCM is based on pseudo- and pre-scientific ideas (meridians etc.). Guy put it well at DRN (diff). When Nature says TCM is fraught with pseudoscience, that's what they're talking about. More on that below.

Nature's comment about "no valid mechanism", however, is presented as one possible answer to a question about drug discovery:

"So if traditional Chinese medicine is so great, why hasn't the qualitative study of its outcomes opened the door to a flood of cures? The most obvious answer is that it actually has little to offer: it is largely just pseudoscience, with no rational mechanism of action for most of its therapies. Advocates respond by claiming that researchers are missing aspects of the art, notably the interactions between different ingredients in traditional therapies."

This is a fair assessment of two sides of an argument: the "it doesn't work because it's BS" side, and the "to find out if it works we have to test it in the way it's traditionally used, i.e. as mixtures of herbs". It's a good source for both sides of the argument, but it would be grossly misrepresenting the source to say it asserts either side, and worse still to depict either side as fact. Additionally, in any case, the context of the editorial -- that it's one side of an argument about drug discovery -- needs to be clear.

Back to "fraught": The editorial goes on to discuss some ways that scientists are trying to test test for interactions between ingredients, and says:

"Constructive approaches to divining the potential usefulness of traditional therapies are to be welcomed. But it seems problematic to apply a brand new technique, largely untested in the clinic, to test the veracity of traditional Chinese medicine, when the field is so fraught with pseudoscience."

In other words, they're skeptical that TCM herbs will prove useful and are expressing reservations about testing them. That's the context in which they say the field is "fraught with pseudoscience". But using that wording is too vague outside of its context (i.e., an editorial about how to proceed with research).

What we need to do is be clear and precise about the pseudoscience in TCM. As editors familiar with the field we are entitled to make this translation, e.g. "TCM is to a large degree based on pseudoscientific and prescientific explanations". That's an example of wording we could use, IMO, stated as fact, and we can fill in additional sources later to supplement or supersede the Nature one. What do you all think? --Middle 8 (leave me alone • talk to me • COI?) 11:46, 12 May 2014 (UTC)

Sources on acupuncture with positive results

Greetings! Here are couple of sources dealing with the positive research outcomes with acupuncture that I'd like to suggest to be taken into account in the article:

1. The effectiveness of acupuncture research across components of the trauma spectrum response (tsr): a systematic review of reviews: "Thirty-one studies were included in this review. The majority of included trials comparing true acupuncture and sham acupuncture showed a trend in favor of acupuncture. The combined response rate in the acupuncture group was significantly higher compared with sham acupuncture either at the early follow-up period (risk ratio : 1.19, 95% confidence interval : 1.08, 1.30) or late follow-up period (RR: 1.22, 95% CI: 1.04, 1.43). Combined data also showed acupuncture was superior to medication therapy for headache intensity (weighted mean difference: -8.54 mm, 95% CI: -15.52, -1.57), headache frequency (standard mean difference: -0.70, 95% CI: -1.38, -0.02), physical function (weighted mean difference: 4.16, 95% CI: 1.33, 6.98), and response rate (RR: 1.49, 95% CI: 1.02, 2.17). ... Needling acupuncture is superior to sham acupuncture and medication therapy in improving headache intensity, frequency, and response rate." (Sun, Y., Gan, T. J. (2008). Acupuncture for the Management of Chronic Headache: A Systematic Review. Anesth. Analg. 107: 2038-2047)
2. A randomised controlled trial of acupuncture care for persistent low back pain: cost effectiveness analysis: " A short course of traditional acupuncture for persistent non-specific low back pain in primary care confers a modest health benefit for minor extra cost to the NHS compared with usual care. Acupuncture care for low back pain seems to be cost effective in the longer term." (Ratcliffe J, Thomas KJ, MacPherson H, Brazier J. A randomised controlled trial of acupuncture care for persistent low back pain: cost-effectiveness analysis. BMJ 2006;333:626)

I suggest that these findings will be included into the article in order to have a more balanced view on the subject.

Ps. This also intersects with the Acupuncture and moxibustion as well, so if you haven't, please take a look at that as well! ;) Jayaguru-Shishya (talk) 18:18, 12 May 2014 (UTC)

Agree, these are excellent MEDRS's. There's also this (h/t Puhlaa): Evidence Map for Acupuncture, a medical guideline from the US Dept. of Veterans Affairs Health Services Research and Development Service. --Middle 8 (leave me alone • talk to me • COI?) 02:51, 13 May 2014 (UTC)

] (leave me alone • talk to me • COI?), that's just great! It should be definately included in the article. Jayaguru-Shishya (talk) 15:26, 13 May 2014 (UTC)

Disagreed. We have newer sources for Acupuncture#Cost-effectiveness.

The other source is already in the article. Lee, Courtney; Crawford, Cindy; Wallerstedt, Dawn; York, Alexandra; Duncan, Alaine; Smith, Jennifer; Sprengel, Meredith; Welton, Richard; Jonas, Wayne (2012). "The effectiveness of acupuncture research across components of the trauma spectrum response (tsr): A systematic review of reviews". Systematic Reviews. 1: 46. doi:10.1186/2046-4053-1-46. PMC 3534620. PMID 23067573. {{cite journal}}: Unknown parameter |displayauthors= ignored (|display-authors= suggested) (help)CS1 maint: unflagged free DOI (link)

The Evidence Map for Acupuncture cited reviews which we currently use in the article. If there are any missing reviews we should use the reviews directly. QuackGuru (talk) 03:02, 13 May 2014 (UTC)

I agree that we should cite individual reviews, but reviews of reviews -- or medical guidelines, like the VA Evidence Map -- are also considered good MEDRS's. --Middle 8 (leave me alone • talk to me • COI?) 18:25, 15 May 2014 (UTC)

I think you have misunderstood something regarding the publication date of an article. There are currently two articles listed in Acupuncture#Cost-effectiveness, one from 2011 and the other from 2013. The one that I mentioned is from 2012. All of these articles are published by a different set of authors in rather a short period of time, and you can't make a conclusion that those authors who have conducted the latest research would be somehow automatically "the most right". It's typical for human sciences to obtain a large variety of different test results, and that's the reason why a lot of repetition is needed. The latest one available, however, does not signify that it would be somehow more reliable or a better one even. Therefore, it is still very well-grounded to include those two pieces of research in the article. Jayaguru-Shishya (talk) 15:26, 13 May 2014 (UTC)

However, the usual problem applies: what are the chances of someone studying acupuncture in this way, who is not already convinced of its efficacy and seeking to confirm it? Where will negative results get published? How many journals are looking to carry negative results for things that have no plausible mechanism of action anyway? For subjective symptoms, placebo effects, expectation effects, regression to the mean and so on are particularly strong, so do we see much weaker results of objectively measurable outcomes (yes we do) and what does this indicate about whether the intervention actually works (it weakens the conclusions of studies on subjective outcomes). You have to be really careful with reviews like the VA one. They are very often motivated by political pressure for a treatment that has failed to gain acceptance through the orthodox route of unambiguous good quality evidence. It has taken a long time to show that meridians and acupoints are almost certainly irrelevant, and most of the studies involved in these reviews will not have been able to properly blind for whether the needle is inserted or not. Guy (Help!) 09:38, 13 May 2014 (UTC)

@Guy - Given the numerous results showing little evidence for efficacy, somebody has to be publishing them, and it's not just Cochrane. You're certainly right about caveats such as blinding and expectation effects, but it's up to reviewers to account for these, right? On the VA source, IIRC it doesn't deviate hugely from other reviews, and one wouldn't expect unanimity. Author bias is possible, but that's speculative; I don't remember any red flags. Seems like yet another meta-analysis. I think it's reasonable to say that if we're going to exclude positively slanted things just because they're positive, then we're not fairly representing the current state of the literature (and I say this as someone who believes that WP:NOTTRUTH and WP:FLAT shouldn't be taken too far). For example, we saw within the last year both "pro (Wang et. al.) " and "con" (Colquhoun and Novella) editorials in a mainstream journal. (The latter rang truer, but the former didn't really contest a lot of its conclusions.)

As far as why study it at all, one answer I've seen is that it's highly safe and makes people feel better, so the large placebo effect is actually a plus when added to whatever its nonspecific effects may turn out to be. Yes, that would be really perverse logic if used when evaluating a new drug, but the double standard is apparently justified by acu's known lack of side effects and drug interactions. An example of this view is the editorial introduction to the "pro" and "con" editorials above, and I've heard some doctors, whose patients try it and like it, say similar things. Perverse but pragmatic. --Middle 8 (leave me alone • talk to me • COI?) 20:01, 15 May 2014 (UTC)

Publication bias? Yes, that might be true, or then it might be not. We are not here to conduct critical evaluation on such things though in Misplaced Pages. There are analytical tools however to evaluate possible publication bias, such as the funnel plot etc. It's a very interesting issue still; in an ideal case the scientific community will try to falsify the test results. For example, if opponents of some theory would like to falsify the former results, they would naturally have the incentive to re-run the test setting and publish any negative / statistically insignificant results acquired. When it comes to meta-analyses, of course, it is good for oneself to be aware what studies have been included in the meta-analysis, what have been left out, and why possibly? Anyway, that's a whole different field of research (and a lot of work and data collection!) and we are not here to do that in Misplaced Pages. Interesting subject though. Jayaguru-Shishya (talk) 15:26, 13 May 2014 (UTC)

Publication bias is not an issue with complementary medicine journals, this also occurs in conventional medicine. Also the suggestion that negative reviews would be buried is pure speculation but there is evidence of this with pharmaceutical companies duping the public . The reality is, acupuncture, like chiropractic, is gaining increasingly researched with better designs and there seems to be a pattern emerging and that acupuncture is useful adjunct with specific diagnoses. This does not validate TCM theory, but it does suggest that needles inserted at various points seems to have a beneficial effect. DVMt (talk) 00:09, 14 May 2014 (UTC)

Guy, not only do I agree with the previous 2 comments, I would also point out that actual scientists, people who do science and whose reputations depend on a truthful explanation of science, would never be so cavalier as to assert that ANYTHING has been absolutely firmly established, ESPECIALLY the absence of phenomena based on an absence of evidence. Even Ernst, who is truly on a mission but nevertheless is a true believer in science, does not make the kind of absolute, religious fundamentalist type conclusions you make about the current scientific lack of evidence for some of the effects of acupuncture and TCM. Your appeal to attack any positive reviews for publication bias is absurd considering there is literally no profit-motive (patents) in the acupuncture profession the way there is in the pharmaceutical industry or even in the realm of surgery. Even with the current natural medicine loving culture we have in the states right now, schools of acupuncture are under pressure to reduce tuition and program length due to debt-to-income ratios. Almost nobody gets wealthy doing acupuncture, so who is driving the publication bias you complain about? Are you at the Vioxx page decrying publication bias? How bout Chantix? Cuz those are truly dangerous areas where money talks louder than science. Acupuncture is simply not such an area. Herbxue (talk) 07:32, 14 May 2014 (UTC)

Ah, a nice dose of common sense! Agreed with the comment above. Some editors are trying to substitute their own personal belief system and white-wash the whole profession or modality as pseudoscientific. With almost 21000 hits at Pubmed (http://www.ncbi.nlm.nih.gov/pubmed/?term=acupuncture) is it still really fair to say there is no scientific aspect about the study of using needles to promote positive physiological change? — Preceding unsigned comment added by DVMt (talk • contribs) 01:02, 16 May 2014 (UTC)

Proper scientists who do real scientists certainly do say that things have been firmly established. The problem here is that there are two parallel threads of research: one conducted by believers, looking to find evidence of the conditions for which acupuncture might work, and the other conducted by non-believers, looking to test the basis of the claims made for and about acupuncture. If you are determined to seek a mechanism by which it works, then you have to allow the possibility that the mechanism is placebo effects, expectation effects and the like: most publications on the mechanisms of acupuncture quietly ignore this rather important question. When you consider that the supposed meridians and acupoints are different between Chinese and Japanese acupuncture, you can't really carry on ignoring this. To quote one source:

Research on the nature of acupuncture points and meridians is often difficult to evaluate because of the diverse nature of the claims made, incomplete data provided in published studies and the variety of parameters involved in the assessment of these claims. Many of the studies purporting to have identified acupuncture points or meridians come from China; the role of publication bias in Chinese literature needs to be considered in light of the fact that no trial published in China from 1966 through 1995 found a test treatment to be ineffective. Obvious contradictions exist between current acupuncture practice and the historical record, as well as on the “correct” number of points and meridians reported by current practitioners of acupuncture. From an empirical standpoint—discrete structures such as acupuncture points and/or meridians would revolutionize the study of anatomy and physiology—no such revolution has occurred. Whatever the clinical efficacy of needling, there is, as yet, no convincing evidence to show that acupuncture points or meridians exist as discrete entities.

That seems pretty neutral to me, albeit not to the taste of acupuncturists. It's also in line with the absence of any credible evidence of anatomy associated with the purported meridians and acupoints.

We should not feel threatened by this sort of thing. There's no reason to believe that ancient wisdom is anything other than wrong in medical matters, the cases of historical remedies, diagnoses and treatments that turn out to be both valid and only recently unambiguously shown to be so, are few and far between. We worked out salycilic acid and quinine quite early in the development of modern medicine. In practice, it does not seem to matter where you stick the needles and it does not seem to matter if you actually insert them. Neither of these is at all surprising given the source of both ideas. I think the question of the non-existence of meridians and acupoints is settled, with only the believers continuing to plough that furrow. I don't think this is a particularly controversial view, other than with believers. Guy (Help!) 18:35, 16 May 2014 (UTC)

Who here is discussing about meridians and acupoints? We're talking primarily about systematic reviews of effectiveness. You're conflating theory and practice. You can get good results with a wrong theory. DVMt (talk) 19:29, 16 May 2014 (UTC)

Cultural Bias

I propose modifying the article to rid it of cultural bias. By definitively characterizing acupuncture as pseudoscience while using only select Western studies to back up these claims, it becomes quite problematic. If modern, scientific studies are required for the article, perhaps studies mostly conducted in modern-day China, opposed to US/Europe would be a better solution. Ricflairsbutt (talk) 19:41, 24 May 2014 (UTC)

Please read WP:MEDRS. This is how we determine our refs. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:21, 24 May 2014 (UTC)

My point is that using only modern, western scientific journals to cite claims made in an article on an ancient Eastern healing modality is biased, both selective bias as well as cultural bias. If a credible US publication made one claim and a credible Chinese publication made another, to avoid cultural bias we would have to use the information from the Chinese publication. And, don' t forget, the WHO has considerable data on acupuncture which should be given more weight than US publications.Ricflairsbutt (talk) 21:10, 24 May 2014 (UTC)

It was previously discussed by User:JzG and others. The lede has a "strong bias towards reality-based researchers". See Talk:Acupuncture#Strong Bias towards Skeptic Researchers. QuackGuru (talk) 00:45, 25 May 2014 (UTC)

Reality based researchers? Can you please engage in a discussion without using weasel words? Klocek (talk) 01:41, 25 May 2014 (UTC)

The OP's suggestion sounds like it would actually increase the chance of bias, not reduce it. Zad68 03:16, 25 May 2014 (UTC)

If OP could be met with anything other than total dismissal, that would be great. Herbxue (talk) 03:24, 25 May 2014 (UTC)

Chairman Mao had a dog in this fight: . this explains the Chinese bias. According to WP:LUNATICS, Misplaced Pages does not give on medical issues equal footage to science and ideology. Tgeorgescu (talk) 12:12, 25 May 2014 (UTC)

And Adolf Hitler helped develop commercial sulfa antibiotics. Your point doesn't have anything to do with the OP's argument, which, as I understand it is that there are high quality studies in acupuncture performed in China and that certain claims can't be made when they're in conflict with data from Chinese studies, which should be given stronger weight. Personally, as a person of mixed Asian decent, this article struck me as xenocentric and even a tad bit racist. While I'm sure Misplaced Pages doesn't exist to coddle everyone's feelings at the expense of quality, I think what has been suggested here is quite reasonable. Studies from today's Chinese researchers would probably be set up and conducted with superior understanding. If you have ever had acupuncture done on you, you understand what I'm saying. One acupuncturist might have excellent technique in needle insertion and stimulation, whereas another is painful and gives you horrible results. Acupuncture is an art-form, and since it originates in China, it stands to reason they would recognize this better. Chinese studies would be more likely to have renowned acupuncturists doing the needling, opposed to Western studies, which might not even use trained acupuncturists at all. Klocek (talk) 12:52, 25 May 2014 (UTC)

We base our content on high quality secondary sources published in well respected journals. If there is continued removal of the current high quality sources than a ban or block may be needed. Chinese researchers are more than welcome to publish secondary sources in respected journals. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:59, 25 May 2014 (UTC)

Woah there, put your gun back into your holster, nobody's saying we should remove high quality sources. The whole point is that certain claims might be disputed when you have two HQ reliable sources with two different conclusions. If that's the case, then can these claims even be made, when one high quality reliable source doesn't support it and happens to be more high quality (conducted in China) than the other, possibly culturally biased source?Klocek (talk) 13:34, 25 May 2014 (UTC)

I agree with you Ricflairsbutt and Klocek, there is currently a strong bias in the article, and I hope it can be fixed in the future. I don't see any reason why modern-day Chinese articles would be any worse than Western articles. If somebody wants to conduct statistical studies about possible publication bias (China vs. West), university is the right place that and we will be waiting enthusiastically the fruits of such researches here in Misplaced Pages. However, Misplaced Pages is not the right forum to speculate possible publication bias. So far, I think Chinese articles published in respected journals (Chinese or Western) are just equally good with all the other articles. Personally, I can't any Chinese though ;) Jayaguru-Shishya (talk) 17:36, 25 May 2014 (UTC)

A pseudo-systematic review funded by the trade?

• Vickers, AJ; et al. (2012). "Acupuncture for chronic pain: individual patient data meta-analysis". JAMA Internal Medicine. 12 (Suppl 1): O9. doi:10.1001/archinternmed.2012.3654. PMC 3373337. PMID 22965186.

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

Is this source reliable or is this publication bias? See diff. QuackGuru (talk) 00:47, 25 May 2014 (UTC)

Reliable source. You seem to be attempting original research. Herbxue (talk) 05:09, 25 May 2014 (UTC)

This is a secondary source published in a good journal that is pubmed indexed thus see no problems with it use.Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:35, 25 May 2014 (UTC)

I agree with Doc James. -- Brangifer (talk) 17:43, 25 May 2014 (UTC)

I agree with Herbxue, Doc James and Brangifer. Jayaguru-Shishya (talk) 17:50, 25 May 2014 (UTC)

Pseudoscience

The article calls acupuncture a pseudoscience, but nowhere in wikipedia's guidelines does this seem to be allowed. Misplaced Pages:Fringe_theories There is no scientific consensus that acupuncture is pseudoscience, therefore, it is classified as a questionable science. Klocek (talk) 12:05, 25 May 2014 (UTC)

The same way, why call astrology a pseudoscience when there are people aiming to transform astrology into hard, empirical science? Tgeorgescu (talk) 12:21, 25 May 2014 (UTC)

If there are high quality reliable sources that say it is a pseudoscience so should we. Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:39, 25 May 2014 (UTC)

DocJames, Have you read ? It addresses your point. Just because some high quality reliable resources say it's a pseudoscience, doesn't mean the article can claim it. There is no scientific consensus. Hell, even in the article we have conflicting research and meta-analyses. Acupuncture, therefore falls into wikipedia's classification of questionable science, not pseudoscience. Klocek (talk) 13:11, 25 May 2014 (UTC)

If there are conflicted sources than we say "X state it is pseudoscience, Y describes it as..." Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:13, 25 May 2014 (UTC)

But that's not what the guidelines on Fringe Theories say to do. It says Misplaced Pages's definition of questionable science, opposed to pseudoscience, is that there are conflicted sources. Therefore, to follow Misplaced Pages's guidelines, it would need to read "Acupuncture is a questionable science, with X saying this, Y saying this".Klocek (talk) 13:21, 25 May 2014 (UTC)

We follow the sources, and they say pseudoscience. -- Brangifer (talk) 17:19, 25 May 2014 (UTC)

I understand that one source says pseudoscience, but Misplaced Pages's guidelines state that the very definition of questionable science is that there isn't scientific consensus and therefore, we cannot broadly and definitively characterize something as pseudoscience. Further, one cannot make a broad claim of consensus with one editorial backing it up.Klocek (talk) 18:04, 25 May 2014 (UTC)

Opening paragraph

In an effort to resolve the neutral POV tag, I had made several high quality, well-referenced changes to illustrate other POV's. These high quality edits were reverted wholesale, without any discussion by what appears to be a team of editors. I would like to open discussion to resolving this issue. Klocek (talk) 17:07, 25 May 2014 (UTC)

Thanks for not continuing an edit war. That never works. I have left some instructions about edit warring and BRD on your talk page.

Discussion of each change is the way to go. You're editing the WP:LEAD, and the lead should always follow changes to the body. Changes to the body will need to be accepted first, and sometimes that will entail minor tweaks of the lead, but not always. That's why changing the lead is often very controversial, so it's really a bad place to start, especially when you're deleting long-standing content which is based on properly sourced content in the body of the article.

Much of your editing looks like special pleading and whitewashing, so be careful. Start here by suggesting an edit, including its source. Then we can work on it. A consensus version has the advantage of being accepted by more editors, who will also protect it. -- Brangifer (talk) 17:17, 25 May 2014 (UTC)

I couldn't find anything wrong with the sources you used and indeed, they seem to be of a high quality. I can't see any reason why the edits you made couldn't be remained at the article, but I agree with BullRangifer: maybe you could start from the body of the article first? As long as the source doesn't fail, it is more than welcome to be used in the article. Jayaguru-Shishya (talk) 17:23, 25 May 2014 (UTC)

Thanks for your suggestion and for confirming the sources I used. I'll take your advice and add to the body first. Klocek (talk) 17:59, 25 May 2014 (UTC)

I agree that some of your sources might be okay, but when you make so many edits, which also include deleting properly sourced content you don't like, then it's much easier to start all over and take it a bit at a time, using discussion to guide us. -- Brangifer (talk) 17:41, 25 May 2014 (UTC)

The "properly sourced" content I think you're referring to is one editorial from Nature magazine which is supposed to support the claim that "acupuncture is largely considered to be pseudoscience. One editorial cannot support such a broad consensus, especially when, even in this very article, there are contradictory claims. That is why I deleted it. Furthermore, here are the Misplaced Pages guidelines regarding the use of the term pseudoscience:

"Pseudoscience: Proposals which, while purporting to be scientific, are obviously bogus may be so labeled and categorized as such without more justification. For example, since the universal scientific view is that perpetual motion is impossible, any purported perpetual motion mechanism (such as Stanley Meyer's water fuel cell) may be treated as pseudoscience. Proposals which are generally considered pseudoscience by the scientific community, such as astrology, may properly contain that information and may be categorized as pseudoscience."

"Questionable science: Hypotheses which have a substantial following but which critics describe as pseudoscience, may contain information to that effect; however it should not be described as unambiguously pseudoscientific while a reasonable amount of academic debate still exists on this point."

Given these guidelines, the term shouldn't be used. Clearly, with many high quality studies, meta analyses and scientific support of acupuncture's efficacy, it should undoubtedly be termed "questionable science" instead of pseudoscience. Anyway, that's the reason for my removing that statement and source. Klocek (talk) 17:57, 25 May 2014 (UTC)

Issues include: 1) use of non pubmed indexed sources 2) use of the journal medical hypotheses that is not a reliable source 3) one of the publications was retracted 4) issues with caps 5) issues with the refs being poorly formatted so that other editors have trouble following them up

Klocek you are at 5 reverts and have a warning on your talk page. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:49, 25 May 2014 (UTC)

no, I'm at 2 reverts for the content under discussion, and so are you. Klocek (talk) 18:53, 25 May 2014 (UTC)

1. Cite error: The named reference swallow was invoked but never defined (see the help page).
2. Cite error: The named reference pmid17265547 was invoked but never defined (see the help page).
3. Cite error: The named reference pmid16783282 was invoked but never defined (see the help page).
4. ^ Cite error: The named reference Colquhoun2013 was invoked but never defined (see the help page).
5. Cite error: The named reference Moffet 2009 was invoked but never defined (see the help page).
6. Cite error: The named reference Ernst2006 was invoked but never defined (see the help page).
7. Cite error: The named reference Madsen2009 was invoked but never defined (see the help page).
8. Cite error: The named reference pmid21359919 was invoked but never defined (see the help page).
9. ^ Cite error: The named reference Ernst 2011 was invoked but never defined (see the help page).
10. Cite error: The named reference Xu S was invoked but never defined (see the help page).

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