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Plos One

I thought there was consensus that Plos One is not per se a reliable source, is never a WP:MEDRS, and should only be used if all the authors are experts in appropriate fields. I could be wrong, though. — Arthur Rubin (talk) 20:20, 8 November 2014 (UTC)

Unlike the reference in the section above, I don't think it has negative reliability, just little positive reliability. — Arthur Rubin (talk) 20:22, 8 November 2014 (UTC)

I don't remember any specific discussion whether Plos One is reliable. This source (PMID 24349293) was recently added. QuackGuru (talk) 20:30, 8 November 2014 (UTC)

Think the OP would be better off asking this on the Talk:PLOS ONE. I can't recall any mention on WP or anywhere else, that questions PLOS's reliability. The section about is titled low Low Impact factor but this has nothing to do with WP:MEDRS. PLOS is peer reviewed. However, it does publish a great amount stuff (compared to other journals) that is very little studied. So it is expected that it will have a low impact factor when compared to journals that cherry pick the flavor of the month academic papers. So one must not judge by that metric - alone.--Aspro (talk) 18:45, 9 November 2014 (UTC)

Whether PLOS ONE is a reliable source is completely irrelevant to the article PLOS ONE, so there should be no discussion at Talk:PLOS ONE. WP:RSN may be the appropriate board for discussion, unless there is a specific board for WP:MEDRS questions. In addition, absent evidence to the contrary, the "peer review" in WP:MEDRS should be "traditional" (pre-publication, and probably anonymous) peer review, not the post-publication peer review described for this journal. — Arthur Rubin (talk) 10:38, 11 November 2014 (UTC)

There is no specific discussion of PLOS ONE at WP:RSN; there is a clear consensus that at least two publishers of open-access journals do not have adequate review to be considered reliable, but that is specific to those publishers. PLOS ONE has a different "peer review" model, and, if WP:MEDRS is changed to include non-traditional peer review, it might qualify. — Arthur Rubin (talk) 10:46, 11 November 2014 (UTC)

PLoS Medicine is specifically listed as a "high-quality journal" in WP:MEDRS (although, oddly enough, not specifically stated to be "reliable"); if that represents consensus, I'm tempted to withdraw this comment, until consensus can be confirmed at WT:MEDRS. — Arthur Rubin (talk) 10:52, 11 November 2014 (UTC)

The point about first questioning this at Talk:PLOS ONE is that along the same lines as "given enough eyeballs, all bugs are shallow". It is the first logical step before escalating. Second: PLOS (as far as I can see) does employ "traditional peer review". So, therefore, et cetera, et cetera, WP:MEDRS does not need updating. The difference to other journals perhaps, is that PLOS rely on post publication discussions to decide the importance, rather than leaving it to the foibles of their own editorial team. Did you base your question on the ramblings of a malfarius yellow journalist critic or internet blogger? Guard against letting the tail wag the dog.--Aspro (talk) 14:08, 12 November 2014 (UTC)

Plos One favors quantity (and free access) over quality. It is how itself defines its business model. That should be a red flag. Tgeorgescu (talk) 11:05, 11 November 2014 (UTC)

Your quote:Plos One favors quantity (and free access) over quality. By what evidence do you suggest this? This is like a logical fallacy. A supermarket may have thousands on lines on their shelves but does this mean quantity of their fair are of a lesser quality from the corner shop that 'specializes' on just a few basic items? So much for you red flag!--Aspro (talk) 14:11, 12 November 2014 (UTC)

From the horse's mouth: http://blogs.plos.org/everyone/2012/12/13/plos-one-launches-a-new-peer-review-form/ Tgeorgescu (talk) 00:16, 13 November 2014 (UTC)

I'm curious, if Plos One is unreliable as some suggest, what about Plos Medicine? Same open access, same registration fees, peer review, etc. Is Plos anything unreliable? LesVegas (talk) 00:35, 14 November 2014 (UTC)

I don't know about that, but Plos One stated that its own peer review process is shallow. Tgeorgescu (talk) 02:21, 14 November 2014 (UTC)

I read your link and didn't see Plos One directly state what you claimed, but rather describe the fact that their review process doesn't include the step where literature that does not make a significant advance is editorially rejected. To me, this doesn't create shallow content, and in fact, is a solid check on the centralization of scientific research. Excellent research comes out of this publication. In fact, several nobel laureates have research published in it. But listen, I get it. I understand the need for quality publications in the article here. If I had it my way, we would get rid of any research that does not meet STRICTA/CONSORT reporting standards. But MEDRS says nothing about reporting quality, so I can't justifiably hold that rubric to this article. Likewise, Plos One meets all the requirements Medrs suggests. It's peer reviewed and while their process is different than some other journals, they do have a process. I don't see any reason this journal should be excluded. And earlier, you said there was consensus about it. But clearly, since I'm protesting along with a few others, there isn't consensus. LesVegas (talk) 20:04, 14 November 2014 (UTC)

It's highly respected in many fields and has a solid impact factor of around 3.1, which I think would easily put it in the top 25% of journals. TimidGuy (talk) 11:51, 11 November 2014 (UTC)

Note. MEDRS requires using independent sources. Cheong KB, Zhang JP, Huang Y, and Zhang ZJ are alternative medicine advocates (PMID 24349293). See Misplaced Pages:Identifying reliable sources (medicine)#Use independent sources. QuackGuru (talk) 20:41, 11 November 2014 (UTC)

They may be advocates, I don't know for certain, you would probably be more of an expert there than I would. But if independence is of strict concern, then you would have to remove anything by Ernst since he's an avowed opponent of alternative medicine. When it comes to something like acupuncture, there's always going to be parties that aren't completely neutral or may have stated their opinion at one time or another. My philosophy is pretty libertarian and I'd like the article to encompass everything, not in favor of one side or the other, and have as much rich data as possible. Placement and weight can be debated, but inclusion/exclusion not so much, at least not if we are to follow policies here. LesVegas (talk) 01:14, 12 November 2014 (UTC)

"Many medical claims lack reliable research about the efficacy and safety of proposed treatments or about the legitimacy of statements made by proponents." Statements made by proponents are not independent. See Misplaced Pages:Identifying reliable sources (medicine)#Use independent sources. QuackGuru (talk) 02:10, 12 November 2014 (UTC)

Sure, we could argue about that forever. Fact is researchers always have opinions, deep down, whether they admit to these or not. What matters is, are they following the scientific method? Are the sources reputable, peer-reviewed, secondary, etc? Yes, yes, and yes. But at the end of the day, we have to remember MEDRS is not the law of the land but is just a guideline. NPOV is law of the land, and here is what it has to say:

"Neutral point of view should be achieved by balancing the bias in sources based on the weight of the opinion in reliable sources and not by excluding sources that do not conform to the writer's point of view." LesVegas (talk) 00:14, 14 November 2014 (UTC)

I don't completely agree with anyone else here.
Discussion of whether PLOS ONE is reliable should not be at Talk:PLOS ONE, per WP:TPG. Discussion or whether PLOS ONE is really peer-reviewed might be there, but it would not necessarily relate to our use of "peer-reviewed".
I agree that, even in WP:MEDRS, we may use clearly biased articles if published in (traditional) peer-reviewed journals, as the review is supposed to remove bias affecting the meaning of the article. However, PLOS ONE is not "peer-reviewed" in the that sense, for two reasons: the the "peers" are self-selected, and the reviewers are not supposed to judge whether the result is "interesting", which is how extreme bias is removed in traditional review. The review occurring after publication is irrelevant.
On the other hand, QG is wrong as to the meaning of "independent". If the journal were peer-reviewed, then the articles would be considered "independent" even if written by proponents, because the editors or reviewers would be independent. On the other hand, if not, then QG would be correct in regard WP:MEDRS guidelines. (I thought that WP:SPS had restrictions on using experts' self-published comments on their own work. Apparently, I was mistaken.) — Arthur Rubin (talk) 03:49, 17 November 2014 (UTC)

Arthur, thank you for your interesting points. I do agree that self-selection of peers might be problematic, but since I'm not an expert on scientific journals (and probably most of us here are not) I do think this topic would probably be better discussed somewhere else. I also agree with you that Plos:One talk is not the place to do this, though. But since Plos One articles are cited widely across Misplaced Pages, perhaps a policy or guideline talk page would be better? MEDRS talk maybe? It would be nice if MEDRS was more specific about peer-review. As it stands, there is no truly clear criteria for what is acceptable peer review and what is not. If you take this up there, please let me know, as I would love to be part of that discussion. I have particularly strong opinions on editors squashing research because the results aren't "interesting," and would love to be part of any discussion that brings this up specifically. LesVegas (talk) 17:39, 17 November 2014 (UTC)

I don't know if that's the basis. I've rarely seen papers which are so biased as to be misleading actually published, and I assume that the reason a reviewer would state for rejection is that the authors' statements of their own views is not "interesting", as the claim that they are "inaccurate" would be false. I know that, in the few instances that I was selected as a peer-reviewer, I would have rejected such a paper, even if it was not in the publication guidelines. Other more current peer-reviewers would have to comment as to the reason the reviewer would give, but "so biased as to be misleading" is not commented on by any of the published Plos One reviewing guidelines. Probably WP:RSN would be the appropriate place for initial discussion, as there doesn't seem to be a WP:MEDRSN; although WT:MEDRS might also be appropriate for the general question of the definition of "peer-review" for the purpose of WP:MEDRS. My wife's injury last Saturday is more severe than I had previously thought, so I may not have time to bring this up. — Arthur Rubin (talk) 23:27, 18 November 2014 (UTC)

As someone who has a passing familiarity with PLOS - PLOS One is peer-reviewed only for "technical" issues, so they ensure that e.g. the reported results support the conclusion, but they do not evaluate e.g. whether the conclusions are scientifically important. (The post-publication discussion isn't a peer review.) It has some good papers, especially because a few well-known scientists publish exclusively in PLOS One based on principle, but overall article quality can vary a lot. The other PLOS journals, like PLOS Medicine, employ traditional peer review. Sunrise (talk) 06:56, 20 November 2014 (UTC)

All of which sounds reasonable enough for a WP:RS. All across the project we use sources that fall well short of that bar or employ no use of peer-review (nor are expected to by our policies). Even bearing in mind the specific concerns of WP:MEDRS, it's not specifically required (though, don't get me wrong, I still found those details very informative with regard to PLOS One). So long as we are ascribing proper weight to any content derived from any PLOS One references, relative to how those perspectives fit in the overall scientific consensus, I think our readers should be allowed to determine themselves from context (and their own opinions on the sources, if they have any) just how they view each individual claim; we're meant to stay away from judging claims in that sense per WP:NPOV, a principle we are tacitly violating if we omit references from a notable journal based on our own assessments of the strength of that evidence. MEDRS is meant to inform upon a nuanced interpretation of WP:V and WP:RS to keep out fringe material that truly warps the presentation of the field of mainstream scientific perspectives on the subject -- not references from a major journal that just happens to have a slightly less rigorous peer-review policy than some other sources that appear in a given article. Likewise, addressing an issue raised farther above, impact factors are not in and of themselves an argument, in terms of policy, for the inadmissibility of a given source; though a high impact factor argues well for a source, the inverse is not necessarily true. Snow talk 02:48, 12 January 2015 (UTC)

Old reference

Hello all! I added a review article from 2011 which compared acupuncture meridians and fascial networks. I rearranged the citation below it for now, which is Ernst 2008. However, it says, "no research has established any consistent anatomical structure or function for either acupuncture points or meridians" which is outdated now, particularly since a 2011 review did just that. But before deleting the old 2008 information, I figured I would bring it to the talk page first. Any objections? LesVegas (talk) 18:07, 11 December 2014 (UTC)

Yes. 2008 is not old compared to 2011. QuackGuru (talk) 18:17, 11 December 2014 (UTC)

4 years is awhile in any emerging science, but yes, I understand that in comparison it's not too bad. However, 2008 is beyond the parameters of the 5 year window which MEDRS recommends, and we have agreed that citations which get outdated based on newer research ought to be removed. That 2008 citation is now nearly 7 years old, which doesn't make it un-usable on that count alone, but since it is clearly in conflict with the more recent research I can't see that it passes the reliability test any longer. MEDRS seems pretty clear that we should remove citations like this. Is there anything else I am missing?LesVegas (talk) 18:57, 11 December 2014 (UTC)

Your using a poor source to argue against a more reliable source. The refs are 3 years apart. QuackGuru (talk) 19:26, 11 December 2014 (UTC)

The journal has a decent impact factor, it's respected in its field, peer-reviewed and the 2008 citation isn't a journal at al, but a book making a dated claim instead. I don't see where you can possibly argue that one source is poor and the other is reliable. According to MEDRS, part of reliability is whether something is dated or not. A book, making a bold claim that is now inconsistent with more modern research, is not reliable any longer. At one time, perhaps, but not in December 2014. LesVegas (talk) 19:41, 11 December 2014 (UTC)

Remember, you wanted the fringe journal in the article. What you wrote was inconsistent with the source. Now the text says "They found that the anatomical basis for the notion of acupuncture points and meridians in TCM has not been determined." QuackGuru (talk) 19:47, 11 December 2014 (UTC)

An impact factor of 2.175 is significant. It is higher than many anatomy and physiology journals. -A1candidate (talk) 20:06, 11 December 2014 (UTC)

The source does not contradict the 2008 source. The text was misleading. I went ahead and fixed it. QuackGuru (talk) 20:14, 11 December 2014 (UTC)

"In this paper, a convergence of evidence from various fields related to fascial anatomy and physiology were reviewed and considered with respect to the possibility that the fascia might be the physical substrate referred to as the meridian system in TCM." I fixed the orginal research. I also fix the misleading text by adding a quote instead: They found that "the basis of the nature and material of acupuncture points and meridians has not been resolved." QuackGuru (talk) 20:14, 11 December 2014 (UTC)

Which the text does not 'conclude. The first line quotes that "it has not been resolved" clearly referencing all the old data, such as the very 2008 source we are talking about. Then they go on to show correlations between meridians and fascia. If Galileo says "The debate about a geocentric universe hasn't been resolved," and then goes on to show his strong argument that Earth revolves around the sun, you can't then say "But Galileo found that the basis for a heliocentric universe hasn't been resolved," as though this were his conclusion. You are clearly taking this out of context. LesVegas (talk) 20:21, 11 December 2014 (UTC)

I quoted the source correctly. I did not quote the first line from the abstract. QuackGuru (talk) 20:26, 11 December 2014 (UTC)

No, that is essentially what the first line of the abstract says. Do you think you're quoting from somewhere else, or are you just not hearing me? LesVegas (talk) 20:33, 11 December 2014 (UTC)

Further, exactly how is the statement, "They found that the human fascial system could be the anatomical basis of acupuncture points and meridians in TCM" original research, when the friggin title of the article is "Review of Evidence Suggesting That the Fascia Network Could Be the Anatomical Basis for Acupoints and Meridians in the Human Body" and the conclusion finds just that, that there is a correlation and fascia may very well be the material basis? LesVegas (talk) 20:38, 11 December 2014 (UTC)

You could not verify the text but I did. See "..., the basis of the nature and material of acupuncture points and meridians has not been resolved." This is not from the abstract. The source said it "...considered with respect to the possibility that the fascia might be the physical substrate referred to as the meridian system in TCM." QuackGuru (talk) 20:46, 11 December 2014 (UTC)

QuackGuru, it is the first line from the abstract! It is again quoted in the introduction in this context, "Although scientific interest in the validity of meridians and acupoints has been growing in the last decade, the basis of the nature and material of acupuncture points and meridians has not been resolved." Please note it is in the abstract and introduction and note the context with which it is used. My point is that you are quoting it as a conclusion.Are you still not hearing me? The title of the article is "Review of Evidence Suggesting That the Fascia Network Could Be the Anatomical Basis for Acupoints and Meridians in the Human Body." The article then quotes, "The VCH and living body imaging studies together indicate that the anatomy of the fascial network in the human body is consistent with the traditional view of the meridian network pattern." LesVegas (talk) 21:07, 11 December 2014 (UTC)

https://www.ncbi.nlm.nih.gov/pubmed/21584283 The abstract does not have that quote. That quote is from the full text and they stated it is not resolved. As for the other text, your quoting part of the context. Read what they wrote at the beginning of the same paragraph what they said under 3. Discussion: "...considered with respect to the possibility..." QuackGuru (talk) 21:17, 11 December 2014 (UTC)

Here is the abstract, in full:

Abstract

The anatomical basis for the concept of meridians in traditional Chinese medicine (TCM) has not been resolved. This paper reviews the evidence supporting a relationship between acupuncture points/meridians and fascia. The reviewed evidence supports the view that the human body's fascia network may be the physical substrate represented by the meridians of TCM. Specifically, this hypothesis is supported by anatomical observations of body scan data demonstrating that the fascia network resembles the theoretical meridian system in salient ways, as well as physiological, histological, and clinical observations. This view represents a theoretical basis and means for applying modern biomedical research to examining TCM principles and therapies, and it favors a holistic approach to diagnosis and treatment.

LesVegas (talk) 21:25, 11 December 2014 (UTC)

The other text, in full is here:

In this paper, a convergence of evidence from various fields related to fascial anatomy and physiology were reviewed and considered with respect to the possibility that the fascia might be the physical substrate referred to as the meridian system in TCM. The anatomy of the fascial network in the human body, as demonstrated through VCH and living body imaging studies, is consistent with the traditional view of the meridian network pattern, and the efficacy of acupuncture has been shown to rely on interactions with the fascia. Additionally, it appears that the fasciae mediate an active mechanical transference role as they provide dynamic connections between and among the muscles and bones. Moreover, the phenomenon of neurogenic inflammation triggered by stimulation of nociceptive receptors in fascial tissues is consistent with the notion that disruption of fascial physiology can have notable consequences on human health. Indeed, it is our view that neurogenic inflammation in fasciae may constitute a form of disruption of meridian energy flow in TCM.

What is out-of-context here? Please show me. LesVegas (talk) 21:29, 11 December 2014 (UTC)

Wow, let us everyone cool down guys. There is no original research, and we can replace the outdated 2008 source with a more recent 2011 one. I just restored a more stable version of the article, but I couldn't help wondering if we needed to go even further back to a better version? After all, many of the recent edits are rather questionable, and don't really justify altering the improvements made earlier. Cheers! Jayaguru-Shishya (talk) 21:55, 11 December 2014 (UTC)

LesVegas was kind enough to alert me on my talk page that I had removed the Bai, et al content. I wasn't aware this had been discussed in this thread, so I'll explain why I removed it. Here is what I removed:

• Despite scientific debate in the validity of meridians and acupoints has been increasing, the premise for the idea of acupuncture points and meridians in TCM has not been determined. A 2011 review, representing a theoretical basis, noted that the human fascial network is consistent with the ancient view of the meridian network pattern, and may be the anatomical basis for acupoints and meridians within the human body. Further, it noted that the efficacy of acupuncture has been observed to depend on interactions with the fascia. It noted that reconstructions of the fascial connective tissues in the body show line-like structures, similar to those of acupoints and meridians/collaterals.Additionally, these fascial strings form a network of lines that are close to the virtual meridians in anatomical location.

My edit summary should be self-explanatory: "rmv content from one source which is not a true "review" of the literature. It's one primary source and speculation, and it violates MEDRS rather grossly.".

What likely fooled people is that the title uses the word "review", but it's not a literature review at all. It's a primary source opinion piece, filled with speculation and "if"-type qualifiers. It's also a lot of content using just one source, a source which doesn't begin to meet our MEDRS standards. If anyone still questions the wisdom of my removal, let's discuss it here, and please ping me. Thanks. -- Brangifer (talk) 04:04, 18 December 2014 (UTC)

1. ^ Bai, Yu; Wang, Jun; Wu, Jin-peng; Dai, Jing-xing; Sha, Ou; Tai Wai Yew, David; Yuan, Lin; Liang, Qiu-ni (2011). "Review of Evidence Suggesting That the Fascia Network Could Be the Anatomical Basis for Acupoints and Meridians in the Human Body". Evidence-Based Complementary and Alternative Medicine. 2011: 1–6. doi:10.1155/2011/260510. ISSN 1741-427X. PMC 3092510. PMID 21584283.{{cite journal}}: CS1 maint: unflagged free DOI (link)

Hi BullRangifer, thanks very much for your thoughtful comments. I noticed the speculation and if type qualifiers as well, and when I originally posted it, like this it was consistent with the "discussion" section at the end of the piece. While they did state that the human fascial network "is consistent" with the ancient view of the meridian system, they certainly do use a lot of "may's" and "could be's". But in my original edit, I wanted it to be very consistent with the spirit of the source. That edit took on several incarnations which I did not approve of and made it known. I'm not sure if those indicators were still present, and probably were not, by the time you altered it, so your revert was probably well justified on those grounds (I dunno, I'll have to go back and check.) Now, one area where I'm afraid that I must disagree is that it is a primary source. In the section on "characteristics of secondary sources" it meets these as it's built from several primary sources, it provides commentary, analysis, interpretation, etc on them, etc. While it's not a systematic review, it is a review, and certainly not primary. MEDRS would classify it as a narrative review, or a literature review, opposed to the systematic reviews we usually see used. But MEDRS does allow for these types of reviews to be used. Actually, MEDRS does even allow for primary studies to be used, but only until secondary sources come about later, if I'm reading it correctly. Anyway, if I'm incorrect in any of this, by all means let me know. LesVegas (talk) 00:30, 19 December 2014 (UTC)

Hello, since the source was a review and there were no further objections here on talk, I have added it back in. Peace! LesVegas (talk) 21:17, 3 January 2015 (UTC)

This change was original research. The source is only speculating. The source said "This view represents a theoretical basis". The source also said "Specifically, if true, then contributions of the fascia...". The word "if" is not a fact. QuackGuru (talk) 00:44, 4 January 2015 (UTC)

Dear QuackGuru, we certainly do not ban the word "if". :-) Anyway, as you said: "This view represents a theoretical basis". That means it represents a theoretical basis. Jayaguru-Shishya (talk) 01:02, 4 January 2015 (UTC)

I agree with Jayaguru's point, and QuackGuru, I addressed this earlier with one of the copy-and-paste statements above. Some of the supporting text is here: The anatomy of the fascial network in the human body, as demonstrated through VCH and living body imaging studies, is consistent with the traditional view of the meridian network pattern, and the efficacy of acupuncture has been shown to rely on interactions with the fascia. Additionally, it appears that the fasciae mediate an active mechanical transference role as they provide dynamic connections between and among the muscles and bones. Moreover, the phenomenon of neurogenic inflammation triggered by stimulation of nociceptive receptors in fascial tissues is consistent with the notion that disruption of fascial physiology can have notable consequences on human health. Indeed, it is our view that neurogenic inflammation in fasciae may constitute a form of disruption of meridian energy flow in TCM and also Based on supportive evidence in the literature, the present paper provides support for a fascia network hypothesis of meridians—that is, the view that the fascia network may be the anatomical basis for acupoints and meridians in the human body. The edit says "may be" which is reflective of the source. LesVegas (talk) 01:13, 4 January 2015 (UTC)

TCM is largely pseudoscience according to the source presented

Getting back to the NPOV version. Misleading text was restored. This edit replaced sourced text with OR. QuackGuru (talk) 22:11, 11 December 2014 (UTC)

It was summarized, but now I quoted it nearly verbatim because you continue to object and call any degree of summarization OR. LesVegas (talk) 23:58, 11 December 2014 (UTC)

The text you added was about the imaging. It was not the evidence. QuackGuru (talk) 00:46, 13 December 2014 (UTC)

This is getting out of hand at this point. QuackGuru (talk) 23:49, 11 December 2014 (UTC)

What has gotten out of hand is outrageously ridiculous POV edits like this everywhere in the article. We don't engage in disputes using Misplaced Pages's voice. It violates at least three policies in NPOV, and I quoted all of these in the edit summary. Nowhere in the article should statements like this exist, least not in the lede. LesVegas (talk) 23:58, 11 December 2014 (UTC)

Lets get back on track to the last NPOV version here where the text was neutrally written and used a quote form the source. QuackGuru (talk) 00:07, 12 December 2014 (UTC)

Oppose - This is about acupuncture itself, not about TCM. -A1candidate (talk) 00:09, 12 December 2014 (UTC)

On the contrary. Are you saying support when you can't provide a rationale explanation? For example, the sentence is about TCM not acupuncture. QuackGuru (talk) 00:13, 12 December 2014 (UTC)

There is nothing irrational about making sure that acupuncture, not TCM, is discussed in the lede of acupuncture. -A1candidate (talk) 00:15, 12 December 2014 (UTC)

Let me remind you that acupuncture is often accompanied by using TCM. According to your edit summary you thought the sentence was about acupuncture. QuackGuru (talk) 00:22, 12 December 2014 (UTC)

That will only merit a discussion in the lede if acupuncture had no valid mechanism of action, but it does have. -A1candidate (talk) 00:26, 12 December 2014 (UTC)

The sentence was about TCM not acupuncture. QuackGuru (talk) 00:31, 12 December 2014 (UTC)

Acupuncture has a valid mechanism of action. It's misleading to imply otherwise. -A1candidate (talk) 00:35, 12 December 2014 (UTC)

Do you understand the sentence you deleted is specifically about TCM? QuackGuru (talk) 00:38, 12 December 2014 (UTC)

Yes, it's a misleading statement and it doesn't belong there. -A1candidate (talk) 00:40, 12 December 2014 (UTC)

It is misleading, it is written in Misplaced Pages's voice, and is not attributed to the author. Further, it is misleading since it takes sides. Misplaced Pages doesn't engage in disputes, it describes them only. The statement that TCM is pseudoscience is disputed in many places. That one statement violates multiple aspects of NPOV. Just as a refresher, here's just one of the violations from the NPOV policy page:

1) Avoid stating seriously contested assertions as facts. If different reliable sources make conflicting assertions about a matter, treat these assertions as opinions rather than facts, and do not present them as direct statements.

2) An article should not give undue weight to any aspects of the subject but should strive to treat each aspect with a weight appropriate to the weight of that aspect in the body of reliable sources on the subject.

3) Misplaced Pages describes disputes. Misplaced Pages does not engage in disputes. A neutral characterization of disputes requires presenting viewpoints with a consistently impartial tone; otherwise articles end up as partisan commentaries even while presenting all relevant points of view. Even where a topic is presented in terms of facts rather than opinions, inappropriate tone can be introduced through the way in which facts are selected, presented, or organized. Neutral articles are written with a tone that provides an unbiased, accurate, and proportionate representation of all positions included in the article.

4) The tone of Misplaced Pages articles should be impartial, neither endorsing nor rejecting a particular point of view. Try not to quote directly from participants engaged in a heated dispute; instead, summarize and present the arguments in an impartial tone.

5) Biased statements of opinion can be presented only with attribution. For instance, "John Doe is the best baseball player" expresses an opinion and cannot be asserted in Misplaced Pages as if it were a fact.

And further, as A1Candidate said, it's irrelevant because it deals with TCM and this page is acupuncture. While the two are related, broader topics shouldn't be in the lede, least not when they violate multiple NPOV policies. LesVegas (talk) 01:18, 12 December 2014 (UTC)

The article is about acupuncture, not traditional Chinese medicine. Insertions about TCM should be placed to traditional Chinese medicine, and insertions about acupuncture should be kept here at acupuncture. Jayaguru-Shishya (talk) 19:55, 12 December 2014 (UTC)

Acupuncture is often used with TCM. It is largely and no serious dispute exists. QuackGuru (talk) 00:46, 13 December 2014 (UTC)

Copyvio? QuackGuru (talk) 00:46, 13 December 2014 (UTC)

Quackguru, first of all, it is not pertinent to talk about TCM in an acupuncture lede. It is too broad of a subject. Even still, that statement does not belong in the TCM article. It violates all 5 of the aspects of NPOV I mentioned above. It is a clear violation of NPOV. We do not state seriously contested assertions as facts in Misplaced Pages's voice, period. We do not take one side on an issue. To say TCM is pseudoscience just because some POV editor here dug up a citation saying those words, is wrong on many counts. BLP issues aside, we cannot say "Bill Cosby is the most prolific rapist of all time" citing Howard Stern's radio broadcast, using Misplaced Pages's voice. We cannot say "Bill Clinton is a criminal" and cite Rush Limbaugh. There's many, many problems with that.

As for this copyvio accusation, let me remind you you accused me of taking something out-of-context. You also said you weren't quoting directly from the abstract. So that's when I posted the context and posted the abstract, to show everyone else the truth. Now you want to accuse me of a copyvio?? Why do you always insist on turning everything into a battleground? LesVegas (talk) 04:11, 13 December 2014 (UTC)

So this statment belongs to traditional Chinese medicine, not acupuncture. Jayaguru-Shishya (talk) 21:17, 14 December 2014 (UTC)

No, LesVegas, TCM is obvious pseudoscience. The violation of policy would be to portray TCM as having any merit.—Kww(talk) 04:36, 13 December 2014 (UTC)

Some forms of TCM have a valid mechanism, such as acupuncture. -A1candidate (talk) 08:48, 13 December 2014 (UTC)

This question have popped up every now and then. I agree with Kww to the extent that we should have extreme caution with any claims of medical efficiency of TCM. However, TCM predates what we call as "science" by thousands of years, so personally I find it pretty hard to see how it could possibly be "pseudoscience". Anyway, this is getting a bit off-topic now since this is Talk:Acupuncture, not Talk:TCM. Cheers. Jayaguru-Shishya (talk) 21:17, 14 December 2014 (UTC)

Really? And what would that be? Yes, the body can sense and react to getting poked by a needle. There is nothing unusual about that. It's the speculative connection between a needle and nonexistent acupoints and meridians, and then claims of healing, that's where the problem lies. For it to then be useful, one needs consistency, predictability, reliability, reproducibility, and objectively verifiable results which are clear to everyone, including nonbelievers. Acupuncture fails miserably on all counts. -- Brangifer (talk) 08:56, 13 December 2014 (UTC)

It's not speculative. Read the article carefully. -A1candidate (talk) 09:06, 13 December 2014 (UTC)

You are confusing two things, A1candidate. Do some of the things that TCM advocates work? Certainly. Does TCM provide any sound explanation for this? No, because TCM is a pseudoscience based on false principles. Not all conclusions derived from false principles are necessarily false: even a stopped clock is right twice a day.—Kww(talk) 15:46, 13 December 2014 (UTC)

You've acknowledged that some forms of TCM (such as acupuncture) works. We should provide the scientific explanation instead of debunking TCM. -A1candidate (talk) 16:18, 13 December 2014 (UTC)

That would appear to be an intentional misreading, so I will say it in a less polite form, A1candidate: each and every explanation provided by TCM is false. It is pseudoscientific to its core, and any effort to portray it as having merit goes against the policies set down by the pseudoscience arbitration decisions. Do not continue to attempt to portray TCM as having validity: it has none. That's a completely different thing from saying that each and every item used in TCM is harmful or fruitless: if someone believed that penicillin works by scaring demons away, he's completely wrong, but that doesn't keep the penicillin from working.—Kww(talk) 16:26, 13 December 2014 (UTC)

TCM may or may not have validity, but acupuncture certainly has. -A1candidate (talk) 16:30, 13 December 2014 (UTC)

I am not sure if I understood this correctly, but whenever we are dealing with claims on medical efficiency, we strictly follow MEDRS. So if there is a reliable MEDRS compliant source that has to offer some positive results, then we can use it. We can't, however, categorially exclude any such sources. And this works in both directions. Probably most of the MEDRS compliant sources report that TCM isn't effective, so if we just follow MEDRS, it will represent the reality as it is.

"...if someone believed that penicillin works by scaring demons away, he's completely wrong, but that doesn't keep the penicillin from working." Heh, well put... but it doesn't prevent us from reporting that penicillin per se does posses beneficial medical properties. If there is a peculiar tradition that indeed believes that penicillin scares demons away, we can report that as the very belief of that tradition, but we have to strictly separate that from the facts concerning the medical efficiency. Jayaguru-Shishya (talk) 21:17, 14 December 2014 (UTC)

I'll grant that it has enough appearance of validity that people study it, but that doesn't mean that your any of your comments related to the TCM discussion have much merit. The sentence you insist on removing is about the TCM foundation of acupuncture. Acupuncture has its foundation in TCM: that's indisputable. Even if it happens to work in some limited fashion for some limited set of cases, there's no scientific consensus that it does, and no scientific consensus as to what the mechanism would be. You keep arguing "endorphins", but that's a hypothetical explanation supported by an extremely small group of studies.—Kww(talk) 16:44, 13 December 2014 (UTC)

Claiming that TCM is pseudoscience, therefore acupuncture is also pseudoscience because it is based on TCM, is a violation of WP:ORIGINALSYN. Please read WP:OR carefully. -A1candidate (talk) 16:55, 13 December 2014 (UTC)

If the article would say that "Acupuncture has its roots in traditional chinese medicine", going on about TCM would be reasonable. At the moment, the article just suddenly jumps into TCM, even the article indeed is about acupuncutre. Jayaguru-Shishya (talk) 21:17, 14 December 2014 (UTC)

If the article would say that "Acupuncture has its roots in traditional Chinese medicine", going on about TCM would be reasonable. At the moment, the article just suddenly jumps into TCM, even the article is indeed about acupuncture. The question about "being a pseudoscience", though, is highly controversial for obvious reasons. Jayaguru-Shishya (talk) 21:17, 14 December 2014 (UTC)

Oh, I have, A1candidate. I'm not in violation in any way, nor is accurately pointing out acupuncture's foundation a violation. You, on the other hand, are apparently attempting to disrupt this article in an effort to promote acupuncture.—Kww(talk) 17:15, 13 December 2014 (UTC)

The source is about TCM, not acupuncture. -A1candidate (talk) 17:17, 13 December 2014 (UTC)

And the sentence you are continuously deleting discusses TCM. If your contention is that we cannot mention the origins of acupuncture in an article about acupuncture, that's clearly a non-starter of an argument.—Kww(talk) 17:32, 13 December 2014 (UTC)

It may be okay to discuss related issues in the main body, but not in the lede. -A1candidate (talk) 17:38, 13 December 2014 (UTC)

A1candidate has got it right here: the source doesn't even discuss acupuncture. It might indeed be that acupuncture has its roots in TCM, and I find it perfectly reasonable to mention that in the article. The article is about acupuncture though, so I find it a bit absurd that we insert claims about TCM using sources about TCM. It's like adding to chemistry out of the blue that "Alchemy is pseudoscience". Jayaguru-Shishya (talk) 21:17, 14 December 2014 (UTC)

That certainly appears to be an arbitrary fiat without a foundation in policy or logic.—Kww(talk) 17:49, 13 December 2014 (UTC)

Misplaced Pages is an encyclopedia, not a place to debunk pseudoscience. We consider the needs of the reader first and foremost. -A1candidate (talk) 17:54, 13 December 2014 (UTC)

That's certainly true. Why wouldn't the reader of an article on acupuncture need to know about its foundations?—Kww(talk) 18:34, 13 December 2014 (UTC)

Because we place more emphasis on actual scientific mechanisms and lmost established ess on mythological interpretations. To quote AndyTheGrump at the Aryuveda article: "The (pseudoscience) label cannot be misapplied retroactively. It is impossible to be practice pseudoscience in a pre-scientific era, and accordingly one cannot describe an entire subject spanning well over two thousand years as such. Pseudoscience can only exist once there is a real science for it to imitate.". -A1candidate (talk) 18:40, 13 December 2014 (UTC)

Treating people with Ayurveda in the 21st century is pseudoscience, because there is science-based medicine, which has removed the need for such bogus, superstitious treatments. Besides, there are purported scientific mechanisms for acupuncture, there is no scientific consensus that acupuncture would be based upon some scientific mechanism, nor which scientific mechanism would that be. Tgeorgescu (talk) 22:23, 13 December 2014 (UTC)

If it doesn't imitate science, it won't matter which century you're referring to. -A1candidate (talk) 23:54, 13 December 2014 (UTC)

Wasn't this discussed just recently at Talk:Ayurveda? Correct me if I'm wrong, but wasn't the outcome that Ayurveda is not pseudoscience (for the very obvious reason that it pre-dates what we call "science"). Jayaguru-Shishya (talk) 21:17, 14 December 2014 (UTC)

Pretending to effectively treat people is a medical claim, and in the 21st century medicine is a science, so all medical treatments based upon ancient superstition are pseudoscience, unless they are scientifically shown to be effective. Tgeorgescu (talk) 00:43, 14 December 2014 (UTC)

In the 21st century Ayurveda is bereaving people of evidence-based treatment, so it is an alternative which is opposed to science. When there was no such thing as modern science, obviously there was no such thing as "alternative opposed to modern science". Tgeorgescu (talk) 00:49, 14 December 2014 (UTC)

The term "pseudoscience" has a definition of its own, and I don't think this is one of them. I understand where you are getting at Tgeorgescu, but we shouldn't use the term "pseudoscience" loosely. We are discussing the medical efficiency of Acupuncture / TCM largely in the articles, and the reality makes justice here; both acupuncture and TCM have at most cases provided to be ineffective, and that't what we report in both articles. If there are, however, MEDRS compliant studies that suggest positive results on the efficiency, sure we can report them. If you are afraid that the article will get biased in favour of acupuncture / TCM, you can rest easy: the very reality and MEDRS ensure us that no such bias will be born. Should there be an unreliable source in the article(s)? Remove it. For these two reasons the article will be just fine. Jayaguru-Shishya (talk) 21:17, 14 December 2014 (UTC)

If there were a consensus that acupuncture was effective, that would be one thing. There's consensus that there's enough reason to investigate effectiveness, but no consensus that it is effective or via what mechanism that it would be effective if it is.—Kww(talk) 00:59, 14 December 2014 (UTC)

There is consensus that it is effective for some conditions (albeit a very limited number) and there is consensus that it involves stimulating the nerves and the release of neurotransmitters. -A1candidate (talk) 09:38, 14 December 2014 (UTC)

More like there are some studies that showed some signs of effectiveness. There's not a general consensus that it is effective.—Kww(talk) 15:24, 14 December 2014 (UTC)

It is effective for some conditions -A1candidate (talk) 15:42, 14 December 2014 (UTC)

A meta-review concluded that the analgesic effect of acupuncture seemed to lack clinical relevance and could not be clearly distinguished from bias says it all: there's no consensus that it is completely ineffective, but no consensus that it is effective, either.—Kww(talk) 15:46, 14 December 2014 (UTC)

That review is from January 2009. We need to use reviews published within the last five years. -A1candidate (talk) 16:41, 14 December 2014 (UTC)

You have a source that speaks to some massive sea-change in terms of studies? The situation remains much the same: glimmers of hope, signs of effectiveness, but no consensus that it actually is effective or how it would be effective.—Kww(talk) 17:13, 14 December 2014 (UTC)

The old review you cited included 13 trials with 3025 patients, while a newer review includes 29 trials with 17922 patients and concludes that "Acupuncture is effective for the treatment of chronic pain". --A1candidate (talk) 17:57, 14 December 2014 (UTC)

We can follow MEDRS. It'll be just fine. Jayaguru-Shishya (talk) 21:17, 14 December 2014 (UTC)

One study does not create a general consensus. I'll stand by my assessement of these sources: there are studies that indicate effectiveness, there's a consensus among the medical community that there's enough evidence of effectiveness to warrant further study, but there is not, at this point, a general consensus as to it being effective, how it would be effective, or what it would be effective for.—Kww(talk) 13:45, 15 December 2014 (UTC)

A sytematic review is not just "one study" but takes into account many dozens. The consensus is that is is effective for treating chronic pain. You can verify that in most medical textbooks and reference works. -A1candidate (talk) 14:09, 15 December 2014 (UTC)

I know precisely what a systematic review is. It doesn't create a general consensus.—Kww(talk) 14:33, 15 December 2014 (UTC)

The consensus is in medical textbooks -A1candidate (talk) 15:07, 15 December 2014 (UTC)

Kww, what I see are essentially two major issues with this sentence being in the lede.

Issue #1 As A1Candidate says, this article is not about TCM, it is about acupuncture. Some people mistakenly believe the two are somewhat interchangeable, that acupuncture is always part of TCM, but it's not. Acupuncture predates TCM, which is a style based on several different classical lines of thought, mixed in with some Western medicine concepts. In fact, there are dozens of different acupuncture styles: there's family lineage-based styles like Worsley 5 Element style, or Tung style, there's classical styles that were orally transmitted 5,000 years ago and were recorded 2,000ish yrs ago, during the Warring States period. They do not resemble TCM style acupuncture whatsoever. As a matter of fact, in classical-style, the tools used are the "9 needles" one being strikingly similar to a scalpel and was used to drain accesses almost exactly the way they are done now in the West. There's Japanese styles of acupuncture and Korean styles, and they are widely practiced, very popular and do not share any relationship to TCM in philosophy, diagnosis, or method of treatment. So do you see why it is really, really wrong to criticize TCM in the lede on acupuncture? It would be like criticizing Protestantism in the lede on Christianity. Yes, there are plenty of reliable sources that criticize Protestantism, but quoting these sources wouldn't stick for a second on a page like Christianity (unless it was overrun with very zealous Catholics:)

Issue #2 Misplaced Pages forbids us to state seriously contested assertions as facts. When different reliable sources make conflicting assertions about a matter, we are supposed to treat these assertions as opinions rather than facts, and we are never to present them as direct statements, such as "TCM is largely pseudoscience with no valid mechanism of action for many of its treatments." Just because a source says it, doesn't mean we can use it. NPOV forbids it in this context. Listen, for the record, I do not believe TCM is pseudoscience. I'm not a practitioner, but something of a lay-scholar on Classical Chinese Medicine, with a formal education in Chinese language and cultural history. I receive acupuncture treatments constantly, and have tried many different styles. TCM was the first style I tried, while I was living in China. While, today, I don't have great affection or even much respect for "TCM", I definitely don't believe it's pseudoscience, and there's plenty of sources, in part of whole, that say otherwise. But it's not what I think that matters here. It's Misplaced Pages's policy. I know of reliable sources that essentially say, "TCM is superior, in many regards, to western medicine and successfully treated many diseases before Western medicine even discovered them". Would I even think about putting a quote like that into the article? After all, the source says it. But it's against policy to use it like that. You're using Misplaced Pages's voice to say this. You can't do that. Neutral point of view policy is very, very clear on this. LesVegas (talk) 22:53, 14 December 2014 (UTC)

Issue 1 at least is debatable. However, issue 2 is laughable: there's no serious contest to TCM being pseudoscience. As explained multiple times in this discussion, that doesn't mean that every treatment derived from TCM is ineffective, simply that the explanation provided by TCM has no foundation in reality.—Kww(talk) 13:45, 15 December 2014 (UTC)

I explained it in my edit summary the problems with the previous text. This text was about the imaging and was not the summarised evidence. I tagged some MEDRS violations. QuackGuru (talk) 05:23, 14 December 2014 (UTC)

I'm sorry I just now noticed this comment. This whole section is somewhat disorganized, it's difficult to wade through the muck and see responses. I'm glad you see that issue #1 is debatable. To me, issue #2 is still very debatable, especially since this citation is from an article in Nature, representing the opinion of one author and not a large scientific consensus. If there was a large body of scientists who agreed TCM=pseudoscience, then we could quote this consortium in the current manner. But there isn't such a body, that I'm aware of, plus there actually are citations from Chinese government's national medical institutes, which are on par with the NIH or CDC, which always talk very positive about the scientific validity of TCM, and those views are not being expressed in this rather broad statement that's written in Misplaced Pages's voice. Anyway, since we have at least some common ground here, here's what I propose: I want to make sections on various styles of acupuncture (Japanese, Classical, Family-Lineage based, TCM, etc.) and within the TCM section we can have this comment, but only attributed to its source, Nature, not in Misplaced Pages's voice. Then, we can add an notable MEDRS-compliant opposing views stating that TCM has scientific validity for balance. I've always wanted to expand the article to include various styles of acupuncture anyway so this accomplishes several tasks. What do you think? LesVegas (talk) 00:49, 19 December 2014 (UTC)

I think you already know that discretionary sanctions apply to the apology of pseudoscience. Don't parse words in order to deny obvious facts. TCM is and will remain pseudoscience, since it appeals to mystical "energies" (in physics there are no energy fields, there are just force fields, which are abstractions). Tgeorgescu (talk) 13:36, 19 December 2014 (UTC)

I think that your goal is to make TCM sound as if it has validity. There's no aspect of TCM that isn't pseudoscience. The Nature review does reflect scientific consensus.—Kww(talk) 13:56, 19 December 2014 (UTC)

There are some aspects of TCM that have some scientific basis such as acupuncture and some forms of herbal medicines. -A1candidate (talk) 14:07, 19 December 2014 (UTC)

Making a quick catch-up with the recent discussion:

1. Appeals to mystical "energies"? Maybe. Pre-dates science? Definitely. With due all respect, Tgeorgescu, I don't quite follow your logic here.
2. Kww, instead of good-for-nothing speculation, I'd like to suggest that all the editors follow MEDRS, so we will avoid the problems. If the reality is that TCM is inefficient, then naturally our MEDRS compliant sources will express that.
3. Reporting the Nature source, we can phrase it as: "According to an editorial in Nature'..." or something like that. It should solve the problem.

Dear fellow editors, I'd like to remind you all that this is Talk:Acupuncture. The right venue to discuss TCM related issues would be at Talk:traditional Chinese medicine. Cheers! Jayaguru-Shishya (talk) 20:20, 20 December 2014 (UTC)

Even a broken clock is right twice a day. Tgeorgescu (talk) 14:30, 19 December 2014 (UTC)

TCM is not a household appliance. -A1candidate (talk) 14:34, 19 December 2014 (UTC)

Of course not, it is pseudoscience. -Roxy the dog™ (resonate) 14:42, 19 December 2014 (UTC)

Show me a good review article that makes that conclusion. -A1candidate (talk) 14:45, 19 December 2014 (UTC)

We are going in cycles here, aren't were? Repeating the same comment multiple times doesn't make it any better. Jayaguru-Shishya (talk) 20:20, 20 December 2014 (UTC)

I'll ask in good faith, A1candidate: do you have an ESL difficulty that made it difficult for you to understand Tgeorgescu's meaning?—Kww(talk) 14:52, 19 December 2014 (UTC)

No, but I do have low tolerance for people who debate with unsuitable metaphors. -A1candidate (talk) 15:04, 19 December 2014 (UTC)

A1candidate, it's a perfectly suitable metaphor. No one is claiming that TCM is intentionally wrong, or that the people that developed it did so with the intention of creating dangerous and ineffective treatments. As a result, they may have some practices that have some degree of validity. That doesn't mean the theoretical underpinnings have any validity at all.—Kww(talk) 16:09, 19 December 2014 (UTC)

The claim that "all aspects of TCM are pseudoscientific" is not supported by scientific literature. If you disagree, do show me a good review article that says something along that line. -A1candidate (talk) 16:56, 19 December 2014 (UTC)

The burden is on you: show a source for any effective treatment that indicates the theoretical underpinning of TCM provided a valid scientific explanation of the effect. Not a source that says "this particular herb may be effective", but a source that says "this particular herb may be effective, and the TCM theory of five phases/chi/meridians/qi provides an accurate explanation of why it is effective". You won't be able to find anything, because the theoretical foundation of TCM is pseudoscience.—Kww(talk) 19:26, 19 December 2014 (UTC)

Actually, the scientific validation of TCM concepts and therapies is done by government and mainstream health agencies in China, Singapore, Taiwan, Japan, etc. In fact, worldwide, there's much more agreement that TCM isn't pseudoscience than the opposite. I'm afraid that in this matter, as A1Candidate said, you need to show a source strong enough to back up the claim that TCM is definitively pseudoscience. The citation does not support the claim. Essentially, editors here are invoking WP:BLUE, but wrongly. "It's obviously pseudoscience, we don't have to support it with any more than an opinion piece in a magazine." If the claim was so easy to support, there would be no shortage of high quality sources and you wouldn't have to use a magazine article. As it stands, it's OR and doesn't pass the verifiability test. LesVegas (talk) 19:34, 19 December 2014 (UTC)

I am quite disappointed to see that the same arguments keep popping up over and over again. I can hardly see how the theoretical fondation of TCM could be pseudoscientific as TCM pre-dates what we call as "science". However, this article is till about acupuncture, and issues regarding traditional Chinese medicine should be discussed at talk:traditional Chinese medicine. Time to move on ladies and gentlemen? Cheers! Jayaguru-Shishya (talk) 20:20, 20 December 2014 (UTC)

As I have suggested, it is more a problem of physics than of medicine: there is no such thing as an energy field. Tgeorgescu (talk) 20:16, 19 December 2014 (UTC)

If you need a source: http://www.csicop.org/si/show/acupuncture_magic_and_make-believe Tgeorgescu (talk) 20:21, 19 December 2014 (UTC)

That's not a scientific source. The magazine is not indexed in scientific databases and it has no impact factor. It's not even owned by a reputable academic publisher -A1candidate (talk) 20:28, 19 December 2014 (UTC)

• Kww, see PMID 24122014 for herbs and PMID 21870056 for acupuncture. -A1candidate (talk) 20:18, 19 December 2014 (UTC)

Unfortunately, I don't see that this source could be used. Jayaguru-Shishya (talk) 20:20, 20 December 2014 (UTC)

Tgeorgescu, I understand your point, but that still doesn't substantiate the claim with the source. There's policies being violated here. The only substantiation for the sentence in question is the preconceived notions of a few editors here, and that's no substantiation at all. We have to rely on sources. But, listen, since you've made this an academic debate, on physics, I wouldn't mind adding a brief lesson in Chinese language here and how it relates to your point. The Chinese character for Qi is steam arising from rice. That's the "energy" which "Qi" means. That's the exact same "energy" we use in physics. The whole energy nonsense in TCM is really overblown by a bunch of hippies and European vitalists who are responsible for the misconception. It has no true academic basis in the Chinese language. LesVegas (talk) 20:48, 19 December 2014 (UTC)

Energy is measured in Joules, so how many Joules of Qi does one have? The CSICOP article on acupuncture has been reprinted somewhat differently in Shermer's Encyclopedia of Pseudoscience. And what better sources are there telling us what amounts to pseudoscience? As pointed at User:Jytdog/Why MEDRS?, biology or medical articles don't usually handle pseudoscience or make claims that a treatment would be pseudoscientific. So the only people busy with identifying pseudoscience are debunkers like Shermer. Tgeorgescu (talk) 21:33, 19 December 2014 (UTC)

Debunker websites are not MEDRS compliant sources. -A1candidate (talk) 22:29, 19 December 2014 (UTC)

See WP:REDFLAG. Obviously a society that systematically does what they can to ward of badness will find some remedies that at least help to make people feel better, however the claims about energy and what-have-you are pseudoscience because they are claims about how stuff works that are not supported by sources that are reliable for scientific matters. Per REDFLAG, strong sources are not needed to debunk unreliable claims. Johnuniq (talk) 23:02, 19 December 2014 (UTC)

Agree. Tgeorgescu, I have one simple advice for you: should you make a claim on medical efficiency, please lean to MEDRS compliant source. It will save you a lot of trouble. Cheers! Jayaguru-Shishya (talk) 20:20, 20 December 2014 (UTC)

Tgeorgescu, precisely how much dopamine is secreted in the state of joy? Same language, you're just talking emphasis on quantitative versus qualitative. And listen, Shermer has his opinions as does that author for Nature. Does Shermer represent worldwide scientific consensus? There's standards on Misplaced Pages, especially when over one half of the world says it's science. REDFLAG certainly doesn't apply if insurance companies reimburse for acupuncture, (and not for gemstone healing or chakra balancing) and it receives favorable mentioning by the NIH and NHS. Not when the scientific validation of TCM concepts and protocols are done in mainstream academia and policy-making health organizations all over Asia. When all you can do is find a couple of little non MEDRS compliant references that think it's pseudoscience, you're on shaky ground. But listen, I'm sure some editors will never be convinced. I suppose we'll have to file an RfC to sort the matter out. LesVegas (talk) 23:19, 19 December 2014 (UTC)

The existence of dopamine convinced organized skeptics. The existence of Qi didn't. There is a way of identifying dopamine, a way of knowing what it is made of, its molecular mass is known, there aren't such things for Qi. Tgeorgescu (talk) 02:56, 20 December 2014 (UTC)

Misplaced Pages's purpose is to summarize scientific literature. It's not for pushing the POV of "organized skeptics" and other dubious groups. -A1candidate (talk) 09:51, 20 December 2014 (UTC)

Organized skeptics = the scientific community. That's what CUDOS means. Tgeorgescu (talk) 00:20, 21 December 2014 (UTC)

This dubious "scientific community" has yet to publish any scientific articles to support your WP:FRINGE claims. -A1candidate (talk) 02:18, 21 December 2014 (UTC)

Hilarious! Organized skepticism=one of the five norms of doing science, per Robert K. Merton. There is nothing fringe about dopamine being identifiable and measurable, the WP:FRINGE/PS stuff is the claim that Qi would be real, identifiable and measurable (in Joules?). Tgeorgescu (talk) 16:04, 21 December 2014 (UTC)

The fringe claim is that all aspects of TCM are based on pseudoscience. Merton is not a scientist but a sociologist, a profession which I generally have very low opinion of. -A1candidate (talk) 16:19, 21 December 2014 (UTC)

Tgeorgescu I'll ask you one last time in good faith: Please show me a scientific source, prefably an MEDRS compliant review, that explicitly states that all aspects of TCM are pseudoscientific. Thanks -A1candidate (talk) 16:23, 21 December 2014 (UTC)

Per User:Jytdog/Why MEDRS? that would be a highly unusual source ("People who are not experts in the field have no way of knowing which research papers have been left in the dust by the scientific community. These papers are not retracted nor are they tagged in any way. They just sit there, ignored."). Per WP:REDFLAG no such source is needed. About Merton: sociologists are busy with the scientific study of science, so you cannot leave them out if you want to scientifically understand science. Tgeorgescu (talk) 16:28, 21 December 2014 (UTC)

WP:REDFLAG does not say that we can assert non-scientific claims without citing a source. On the contrary, all assertions that are likely to be challenged should be well-sourced. User:Jytdog/Why MEDRS? is not a WP guideline but an unrelated, user-generated essay that has little to do with this discussion. Would greatly appreciate if you stop pushing the POV of Merton and other sociologists because I have no interest in them. -A1candidate (talk) 17:16, 21 December 2014 (UTC)

WP:REDFLAG says that extraordinary evidence has to exist in order to affirm in Misplaced Pages's voice that the existence of Qi would be plausible. By default, it belongs to mystical vagaries. So TCM is now pseudoscientific because it advocates medicine relying upon mystical vagaries instead of evidence-based medicine. Tgeorgescu (talk) 18:57, 21 December 2014 (UTC)

This discussion is not about qi. -A1candidate (talk) 19:40, 21 December 2014 (UTC)

...or believes pre-dating science? Jayaguru-Shishya (talk) 19:42, 21 December 2014 (UTC)

That's kind of the point, isn't it? TCM is based on beliefs that predate science, and no one has come up with a sound scientific basis for it. Efforts by dubious journals to pretend that it has a scientific basis place it into the modern category of pseudoscience, even if it began as something more accurately described as "folk belief". Acupuncture itself, while founded in TCM, seems to have some limited effect, but there's no consensus as to when it is actually effective. There isn't even a strong consensus that the effects it has aren't explained by the placebo effect. As for the relationship between TCM and acupuncture, I don't think anyone here is disputing that acupuncture's origins lie in TCM, are they?—Kww(talk) 19:54, 21 December 2014 (UTC)

Which dubious journals are you referring to? -A1candidate (talk) 21:20, 21 December 2014 (UTC)

Hi Kww, did you notice my earlier suggestion for improving the flow of the text?

If the article would say that "Acupuncture has its roots in traditional Chinese medicine", going on about TCM would be reasonable. At the moment, the article just suddenly jumps into TCM, even the article is indeed about acupuncture. Jayaguru-Shishya (talk) 21:17, 14 December 2014 (UTC)

What do you think? Cheers! Jayaguru-Shishya (talk) 19:59, 22 December 2014 (UTC)

It already states "Traditional acupuncture involves needle insertion, moxibustion, and cupping therapy. It is a form of alternative medicine and a key component of traditional Chinese medicine (TCM). ". Why do we need a stronger linkage to justify discussing TCM?—Kww(talk) 21:29, 22 December 2014 (UTC)

Indeed, it is a key component of traditional Chinese medicine, but does it derive from TCM? I tried to look for a source, but I couldn't find any so far. If we just had a source that would clearly say that acupuncture stems from TCM, it'd be quite natural to express that the very foundation of acupuncture (TCM) is pseudoscience per se. But now we are jumping out of the blue to state that "TCM is largely pseudoscience with no valid mechanism of action for many of its treatments.". Whether we will have a source that will tie this loose comment to the general context, or then we will move it to the article it belongs (whichs is traditional Chinese medicine, obviously). Merry Christmas folks! Jayaguru-Shishya (talk) 17:13, 23 December 2014 (UTC)

Finding Merton's position upon organized skepticism unreasonable is a symptom of lacking even a basic understanding of how science is being done. Tgeorgescu (talk) 01:19, 22 December 2014 (UTC)

I don't find it unreasonable, I simply have no interest in sociology and I request that you stop bringing it to this discussion. -A1candidate (talk) 01:32, 22 December 2014 (UTC)

It was not a point about sociology, it was a point about how science gets done, in any empirical science. Tgeorgescu (talk) 01:35, 22 December 2014 (UTC)

Science is based on the scientific method. All hypothesis (including the hypothesis that TCM is pseudoscientific) must be tested for validity before it's accepted. -A1candidate (talk) 01:53, 22 December 2014 (UTC)

Every scientific claim is considered unproven until there is enough evidence for it. In this case the scientific claim that TCM would be scientific is considered invalid until proven valid (instead of being considered valid until proven invalid). That's what the philosophic burden of proof means. According to Karl Popper scientists are always busy with debunking the theories of other scientists. So the most well established philosophy of science concurs with the judgment of organized skepticism. Scientists take nothing for granted, they always apply critical thinking skills to any scientific paper they read. In sciences which rely upon experiments, only repeated, reproducible experimental results really prove something, see e.g. the OPERA experiment and how reluctant was the physics community to accept it as valid (even when they did not knew that the results were due to a bad cable). Tgeorgescu (talk) 02:15, 22 December 2014 (UTC)

I'm not claiming that TCM is scientific. -A1candidate (talk) 04:19, 22 December 2014 (UTC)

Kww I am disputing that acupuncture has its origins in TCM. That would be like saying the practice of prayer has its origins in big Protestant mega-churches. The style known as "TCM" was created in the 1950's under orders from Mao who appointed a commission composed of Western trained Chinese medical professionals and scholars who had a knew very little about the acupuncture classics. They blended it with Western medical organ concepts, and the whole end result is radically different from the styles of practice which came before it. It would be more accurate to say that acupuncture has its origins in classical texts such as the "Huang Di Nei Jing Su Wen" (Yellow Emperor's Inner Classic) although in this text we read acupuncture needles had been used for many years prior to it. So, in other words, the practice of acupuncture predates "TCM" by at least a couple thousand years. There's so many other styles. TCM style is predominate in modern day China, and that's about it. Nobody who lived under Imperial rule in China ever practiced it. So in addition to modern Chinese, modern Chinese-American practitioners practice it, but, from my experience, most Western-born acupuncturists do not (even the ones who graduate TCM-style schools.) There's so many other styles of acupuncture anyway, there are Japanese styles, Five Element style (very popular in California and the North-East, from my experience), classical style based on the previously mentioned text, and there's even modern trigger point styles used by chiropractors and physical therapists. Scholastically, this article is kinda embarrassing in its mentioning of TCM as the style in which acupuncture originated; it's not even close to being accurate. And that's not to disparage anybody who thinks TCM is thousands of years old, either. When I first found out about acupuncture in China, that's what I thought as well. It's a common mistake, but why perpetuate it on this encyclopedia? "TCM" is a misnomer as well. It's not "Traditional" because it's only been around since 1950, it's not even really "Chinese" because, it's heavily influenced by Western medical concepts. If there were a "TCM bias tag" on Misplaced Pages, II would put it at the top of this article, because the whole thing is written around just this style alone. LesVegas (talk) 01:04, 23 December 2014 (UTC)

The source is not a review, but speculation, and we don't do that on WP, per WP:NOT/ If ifs and buts were candy and nuts, it would be Christmas every day. Furthermore, the source is a rather low impact journal, not the type of source that would suffice for extraordinary claims per WP:REDFLAG. Dominus Vobisdu (talk) 23:31, 4 January 2015 (UTC)

Hi Dominus, this point was discussed in this edit above. You might not have seen it because this thread is quite disorganized. BTW, journal impact factor has no bearing on whether or not a source can be used. If it's low, then we place it lower than journals with a higher impact factor but we don't disregard the source. Regardless, it actually does have a rather solid impact factor, higher than many other journals we source from regularly on this and other articles. It is also definitely a secondary source since it comments on primary ones, but, anyway, I go into that in further detail in the diff I provided. LesVegas (talk) 23:55, 4 January 2015 (UTC)

Well it looks like Bull Rangifer and I came to the same conclusion, and no, I don't buy your case. It does not conform with our policies and guidelines on sourcing or NPOV. Dominus Vobisdu (talk) 00:05, 5 January 2015 (UTC)

Actually, I made these points after Bull Rangifer's explanation and showed that it was a review, per Misplaced Pages's definition. He never responded, even after pinging him, so I assume he gave up his objection. Would you mind explaining your objections in greater detail than "I don't buy your case"? And which policies and guidelines, specifically, does it not meet? What part of NPOV does it violate? Again, please be as specific as possible because it's hard to understand where your objections lie when you are this vague and abstract. I'm sorry to make you go through this much effort but I really want to engage in a thoughtful discussion with you on this matter, instead of edit warring ad-nauseum. Also, did you read my points? Specifically, what did you think about my point regarding MEDRS's definition of a "review", and how it defines literature and narrative reviews? LesVegas (talk) 03:35, 5 January 2015 (UTC)

Citation out of context

The citation: "TCM has been described as mainly pseudoscience, with no logical mechanism of action for the majority of its treatments" has bee largely discussed at RfC: Is the Nature article an appropriate source for the claim it is attached to?. As several editors have brought up, the citation is taken out of context. The paragraph in whole says the following:

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.

There are multiple issues with respect to using the source:

1. The editorial does not say that traditional Chinese medicine is pseudoscience. Moreover, it just lists that as a possibility.
2. The paragraph is bringing forth the both sides, and it gives pretty much equal weight for both.
3. Nature is not using their own voice claiming that TCM would be pseudoscience, it is merely describing that as the position of opponents.
4. When restoring the context, it is mainly about TCM; this article is about acupuncture, and acupuncture that article does not discuss (cf. "...interactions between different ingredients in traditional therapies.")

I'd like to suggest removing the entries - that have been backed up by the Nature editorial - concerning the pseudoscience question. We don't need to force an out-of-context citation that doesn't fit the article when there are better sources available. For the evident, there must be. Jayaguru-Shishya (talk) 01:15, 11 January 2015 (UTC)

I think the consensus at the recent discussion at Talk:Traditional Chinese medicine contradicts you, and most of us think that the editorial is clearly describing TCM as pseudoscience. The remainder of the editorial makes it pretty clear that the "advocates" can't be taken seriously. Later in the same editorial, you can find the text "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.". That's not a suggestion that it's possible that it may be pseudoscience, that's a direct statement that the field is fraught with pseudoscience. You phrased this as a suggestion, so may I make a suggestion of my own? I would like to suggest that the next time you want to misrepresent the contents of a source, you should refrain from doing so.—Kww(talk) 04:43, 11 January 2015 (UTC)

Consensus? I counted all the votes, and it seems that 10 editors supported, and 10 editors opposed. One of the supports was a "weak support", which is pretty ambiguous. There were also two votes (Yobol and Matthew Ferguson 57) that were rather ambiguous as well.

As we very well know, "consensus is not a vote". What matters is the quality of arguments. According to WP:CON:

The quality of an argument is more important than whether it represents a minority or a majority view. The arguments "I just don't like it" and "I just like it" usually carry no weight whatsoever.

Taking this into account, it seems there is a majority opposing the RfC (7-10). We don't give any weight for "I just don't like it". Cheers! Jayaguru-Shishya (talk) 15:18, 11 January 2015 (UTC)

Neither can we give much weight to people that either intentionally or unintentionally misread the quote. The review doesn't just "list as a possibility" that TCM is pseudoscience, it directly states that the field is "fraught with pseudoscience". Recognizing that TCM is based on superstition goes beyond just "not liking it".—Kww(talk) 17:45, 11 January 2015 (UTC)

Weight violation

I deleted the WP:MEDRS violations. They are not reviews. I also fixed the wording for the 2011 review and added safety information from a review. I also fixed the formatting for refs in the other conditions section. QuackGuru (talk) 08:46, 14 December 2014 (UTC)

I previously explained the text that was recently added was about the images. The misleading text was asserted in Misplaced Pages's voice and was not the conclusion the source made. I also explained the problem with the wording for another sentence. I explained this in my edit summary the wording for the 2011 review but no specific objection was made by other editors. The MEDRS violations were restored along with other non-neutral text. The formatting for the sources in the other conditions sections were fixed but it was reverted without explanation and sourced text to a review in the safety section was also deleted without explanation. This shows an editor blindly reverted because the editor deleted information from the safety section. QuackGuru (talk) 05:22, 15 December 2014 (UTC)

The contents I careless deleted during I revert the deletion from you had been re-added. Now the problem got solution. Miracle dream (talk)

There are still other problems with your edits such the MEDRS violations. I went ahead and restored the other sentence you deleted to the correct section and fixed the refs again. QuackGuru (talk) 20:41, 15 December 2014 (UTC)

"A 2012 analysis of data on individual participants in acupuncture studies looked at migraine and tension headaches. The analysis showed that actual acupuncture was more effective than either no acupuncture or simulated acupuncture in reducing headache frequency or severity." This was a cut and past. See Acupuncture#Headaches and migraines.

"A 2014 Australian clinical study involving 282 men and women showed that needle and laser acupuncture were modestly better at relieving knee pain from osteoarthritis than no treatment, but not better than simulated (sham) laser acupuncture." This was a cut and past. See Acupuncture#Extremity conditions.

"According to NCCAM, results of a systematic review that combined data from 11 clinical trials with more than 1,200 participants suggested that acupuncture (and acupuncture point stimulation) may help with certain symptoms associated with cancer treatments." This was a cut and past. See Acupuncture#Cancer-related conditions.

There is no need to use a poor source when we are citing systematic reviews and Cochrane reviews. This is a WP:weight violation (and possible MEDRS violation) IMO. Rather than cite NCCM we should cite the systematic review itself and high-quality reliable sources. See WP:SAYWHEREYOUREADIT. QuackGuru (talk) 23:00, 15 December 2014 (UTC)

In the context of an article already bloated with weak positive studies, seemingly included in order to cast doubt on the consensus view that the weak positive results are fully consistent with the null hypothesis, I agree that Cochrane review is all we should need here. Guy (Help!) 09:52, 17 December 2014 (UTC)

@ JzG: Where is the proof that this is the consensus view let alone a majority one? Source(s) meeting WP:RS/AC? On the contrary, the best MEDRS we have (Vickers, an IPD meta-analysis) finds for efficacy for several kinds of pain; the sources criticizing it don't even come close to being at the same level as MEDRS's; and contrary to the assertions of acu-critics, there are other mainstream sources that accepted it (Medscape outweighs Novella and Gorski). See my comment at recent ArbCom request , and feel free to provide rebuttal. Based on your respective comments, you or Kww apparently fail to understand the literature or WP:MEDRS. For example, it appears (from what you consider to be sci consensus) that you seem to think that a bunch of blogs by alt-med critics, which are barely MEDRS's, outweigh sources like Medscape and a peer-reviwed IPD meta-analysis. --Middle 8 (contribs • COI) 12:21, 8 January 2015 (UTC) (edited to add diff 13:09, 8 January 2015 (UTC))

No, Middle 8, I don't think blogs "outweigh" MEDRS sources. What I do think is that if you study a placebo often enough, you will wind up with a group of MEDRS sources that are false positives: slightly flawed studies that hint at some kind of effectiveness. Combine that with politically-motivated organisations like NCCAM, and it's easy to construct an article that either falsely gives the impression that acupuncture has medical validity, or, at the very least, an article that is so bloated with cherry-picked references that the reader has a hard time picking up on the fact that it has no medical validity. I think the whole "evidence" novella we have here should be replaced with a short summary, something close to "the benefits of acupuncture are likely nonexistent, or at best are too small and too transient to be of any clinical significance". Our current style of "this study found inconclusive ..." followed by "this study found inconclusive ..." followed by "this study found inconclusive ..." serves to do nothing but highlight false positives and obscure the central point: repeated studies of acupuncture have not found any substantial and repeatable effect relative to placebos.—Kww(talk) 13:39, 8 January 2015 (UTC)

@ Kww - I partially agree with you re waffling about inconsistent results: we should be concise and explicit where uncontradicted sources themselves report inconsistent results (i.e. some trials being positive, some not, as is so with Cochrane reviews do for most conditions). In those cases, we should simply list those conditions in a single paragraph or sentence and be done with it. We do so in the section Acupuncture#Other_conditions and perhaps could put other conditions there, or create another section if needed. (Note that some of the wordiness in the efficacy section and elsewhere is due to one editor, an very active acu-critic, who is very dug in with their stance that virtually any paraphrasing is OR.) That said, when multiple sources (MEDRS's i.e. reviews) contradict one another, we must so indicate, even if you and/or Novella disagree. That's because not all MEDRS agree with Novella; he could be wrong about the few conditions where there is debate. Again, a number MEDRS that disagree with him are as strong or stronger MEDRS than his editorial or his blog posts, so we can't frame the former the way the latter would. That's the state of the literature, which we are obliged to depict per NPOV. --Middle 8 (contribs • COI) 14:10, 8 January 2015 (UTC)

Sticking to notable medical publications should take care of that. It is not our job to speculate whether the peer review procedure of some respected journals are wrong, or if someone thinks that a mistake must have happened. No twisting the sources in either way, I'd say. When it comes to blogs, wasn't it concluded that blogs could be used on a case-by-case basis if the blog complements claims that have been backed up by sound MEDRS?

The paraphrasing issue has been noticed by several editors already, and we can start working on that one too. Important is that we avoid plagiarism by not including pieces of text too close to the source. "Be bold", of course, but I'd like to encourage editors to also include such problematic passages here on the Talk Page for public view so that a larger audience could easily work on them. Cheers! Jayaguru-Shishya (talk) 17:09, 9 January 2015 (UTC)

Previously, I don't know much about the rule for MEDRS. Hence, I don't know what is the difference between the reliable source required in this article and in others. For other articles, it must be an undoubtedly reliable source which is from official organization from U.S. government. However, I don't know the rule in this article. Hence, I wait others comments.

Now user User:BullRangifer opened a discussion in Misplaced Pages talk:WikiProject Medicine#NCCAM as a MEDRS?.I knew User:BullRangifer thought NCCAM was unbelievable. User:QuackGuru, you also joined in that discussion , I don't know why you opened a new discussion. From I read by now,it seems it hard to say source from NCCAM is MEDRS violation. The comment made me believe this is someone wrote like this" says: "Statements and information from reputable major medical and scientific bodies may be valuable encyclopedic sources. These bodies include....U.S. National Institutes of Health"

Based on this comment, I read the . It clearly said "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" It means the rule of MEDRS thought the source from U.S. National Institutes of Health is MEDRS compliant. As we know, NCCAM is a part of U.S. National Institutes of Health. It made me very confused every source from NIS is MEDRS compliant why NCCAM is MEDRS violation. Then for the ongoing debate in Misplaced Pages talk:WikiProject Medicine#NCCAM as a MEDRS?. It seems someone really agreed that NCCAM is MEDRS compliant, such as User WhatamIdoing. By now, the discussion is ongoing. It means consensus hasn't been reached.

For the contents I cited, I use the comments from User WhatamIdoing

• • In the instant case, the statement says, "A 2012 analysis of data on individual participants in acupuncture studies looked at migraine and tension headaches. The analysis showed that actual acupuncture was more effective than either no acupuncture or simulated acupuncture in reducing headache frequency or severity."
  • The source cited was What the Science Says About the Effectiveness of Acupuncture-For Heaache from National Center for Complementary and Alternative Medicine.
  • The relevant contents of the NCCAM website are, "A 2012 analysis of data on individual participants in acupuncture studies looked at migraine and tension headaches. The analysis showed that actual acupuncture was more effective than either no acupuncture or simulated acupuncture in reducing headache frequency or severity"—word-for-word what the NCCAM webpage says. (There's no copyvio here, because there's no copyright in US government works.)
  • Is this webpage reliable for these contents (i.e., for describing the contents of some other source)? Yes.
  • Would the underlying "analysis of data in... acupuncture studies" be exactly the sort of meta-analysis that MEDRS promotes? Yes. Or, at least, it is presumably the sort of source that MEDRS holds in highest esteem, although it's possible that there would be some serious failing (e.g., not ever having been published).
  • In particular, it would be really silly to say that it's excellent for a Misplaced Pages editor to read that meta-analysis and write his own description of it, but that it's impossibly bad to have actual professionals read that study and write a description of it. Amateurs are not always better than professionals, especially when it comes to evaluating something technical. Also, if your information comes from NCCAM, then WP:SAYWHEREYOUGOTIT applies, and you aren't permitted to cite the original meta-analysis (unless and until you obtain the paper and read it).

I don't know whether it's Ok to use other Users' comment. If it is some rule violation, please notice me and I will delete these comments from User WhatamIdoing. However her comments is some kind of what I agree with.

I made a conclusion here. The rule at least what I read in clearly said source from U.S. National Institutes of Health is MEDRS compliant. Then NCCAM is part of U.S. National Institutes of Health. It should be compliant based on this rule. Then there is an ongoing discussion in Misplaced Pages talk:WikiProject Medicine#NCCAM as a MEDRS?. The consensus hasn't been reached. Hence,you cannot get the violation from this discussion. I think users can join the discussion in that page instead of this one. Then some reason why NCCAM is MEDRS violation like "NCCAM is populated and operated mostly by pro-AM people" " Even Cochrane reviews are becoming dubious sources, so even with reviews we must be wary" "Our MEDRS guideline is much better than the standards of NCCAM and most peer reviewed medical journals. We should be proud of that and not lower our standards." from User:BullRangifer made me feel like a wiki academic research result by wiki Users which I thought it's totally an original research. 17 December 2014‎ Miracle dream (talk)

NCCAM was set up by believers in woo, is designed to produce evidence supportive of woo, and has a history of publishing credulous articles about woo. That said, for the expenditure of something like one and a half billion dollars, it has yet to validate a single alternative treatment. And its latest rebranding suggests it's not even going to try any more. Guy (Help!) 23:21, 20 December 2014 (UTC)

Hmm... Moving from the level opinions to the level of evidence-backed claims, NCCAM is set up by the U.S. Federal Government. As far as I understand, its focus is on objective investigation on the usefulness of CAM; trying to present only positive results is not part of their agenda. Small quotes from their website:

The National Center for Complementary and Alternative Medicine (NCCAM) is the Federal Government's lead agency for scientific research on complementary and alternative medicine. We are 1 of the 27 institutes and centers that make up the National Institutes of Health (NIH) within the U.S. Department of Health and Human Services.

On their mission and objectives (emphasis added):

The mission of NCCAM is to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care. Develop and disseminate objective, evidence-based information on complementary and alternative medicine interventions.

"Woo studies" will most likely have "woo results", or even employ "woo methods". If there is some publication bias in favour of pro-CAM research results, though, I am quite sure there are studies about that available. There are different statistical methods, such as funnel plot, that scholars employ in order to study the presumed publication bias. If a national body like NCCAM would blatantly exhibit such bias, it'd surely have been studied and reported. Cheers! Jayaguru-Shishya (talk) 17:31, 21 December 2014 (UTC)

"A 2012 analysis of data on individual participants in acupuncture studies looked at migraine and tension headaches. The analysis showed that actual acupuncture was more effective than either no acupuncture or simulated acupuncture in reducing headache frequency or severity." There is a lack of consensus for this text. See Acupuncture#Headaches and migraines. We are currently using better sources including a Cochrane review in this section.

"A 2014 Australian clinical study involving 282 men and women showed that needle and laser acupuncture were modestly better at relieving knee pain from osteoarthritis than no treatment, but not better than simulated (sham) laser acupuncture." There is a lack of consensus for this text. See Acupuncture#Extremity conditions. We are currently using better sources including a Cochrane review in this section.

"According to NCCAM, results of a systematic review that combined data from 11 clinical trials with more than 1,200 participants suggested that acupuncture (and acupuncture point stimulation) may help with certain symptoms associated with cancer treatments." There is a lack of consensus for this text. See Acupuncture#Cancer-related conditions. We are currently using better sources including a Cochrane review in this section.

See Misplaced Pages:Identifying reliable sources (medicine)#Medical and scientific organizations: "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. The reliability of these sources range from formal scientific reports, which can be the equal of the best reviews published in medical journals, through public guides and service announcements, which have the advantage of being freely readable, but are generally less authoritative than the underlying medical literature."

I think the key word is reputable, according to the wording of MEDRS. For example, the reputations of NIMH and NCI are significantly different than that of NCCAM. Therefore, the question is clearly due weight. Since it is not clear that NCCAM (see National Center for Complementary and Integrative Health#Criticism) is a reputable organisation we should leave the text out of the Acupuncture#Effectiveness section, especially when effectiveness is bloated with a number of better sources. QuackGuru (talk) 23:05, 31 December 2014 (UTC)

Maybe you didn't notice the very comment above? Cheers and Happy New Year! Jayaguru-Shishya (talk) 00:36, 1 January 2015 (UTC)

• Sigh... the problem here is that both proponents and opponents of acupuncture are trying to use this article to "prove" that their view point is correct. The solution is to avoid doing so... and that goes for both sides of the debate. It is fact that proponents make all sorts of claims about the benefits of acupuncture... it is fact that many if not most of those claims are refuted by the medical community. That is really all the article needs to say. There is no need to go into details and site studies to "prove" and "disprove" that acupuncture works.

The debates that keep cropping up at this article would be resolved if Misplaced Pages treated alternative medicine topics the way we treat religious topics. We should discuss the topic in terms of belief... state who believes what (cited by sources supporting the fact that they believe it), but stop there. Have some respect for the fact that different people believe different things... and don't try to "prove" that those beliefs are true or correct. In terms of belief... a statement like "Acupuncture cures cancer" is really not all that different than a statement like "Jesus died for our sins." Blueboar (talk) 15:47, 1 January 2015 (UTC)

It appears editors who have concerns with the source at project medicine are User:BullRangifer, User:Stuartyeates, and User:Tgeorgescu. See Wikipedia_talk:WikiProject_Medicine/Archive_57#NCCAM_as_a_MEDRS.3F. The tags were removed right after I made this comment. This was not a response to my previous comment. We should remove the poor evidence because we are using much better sources. We should not use poor evidence to argue against higher-quality evidence. We should strive to use the best evidence rather than continue to bloat the sections with bad sources. QuackGuru (talk) 21:44, 1 January 2015 (UTC)

Why is there a need for "evidence" at all... we don't bother to provide "evidence" in religion articles... we present the fact of belief, and leave it at that. The same can be done here. Blueboar (talk) 23:00, 1 January 2015 (UTC)

"Jesus died for our sins" isn't falsifiable. "Acupuncture heals many diseases" is falsifiable. Tgeorgescu (talk) 19:45, 2 January 2015 (UTC)

Just to let everyone know, the issue of NCCAM sources has been resolved on the wikiproject medicine talk page where it received broad support amongst uninvolved editors because it is part of the NIH. The NIH is explicitly mentioned in MEDRS as a reliable source. I hope this resolves any misunderstanding and keeps these sources from being tagged in the future. LesVegas (talk) 21:07, 3 January 2015 (UTC)

Les, I disagree with you on a lot of things, but this is the first time I have caught you blatantly lying. There's nothing in the linke you have cited that could even be misunderstood as "broad support amongst uninvolved editors". Nothing at all.—Kww(talk) 21:13, 3 January 2015 (UTC)

Kww, it appears MiracleDream, Tgeorgescu, MrBill3 and Brangifer are involved editors who posted their opinions about it. That leaves Whatamidoing and Mast Cell as the ones I meant who were uninvolved as I don't believe they have edited here before. Am I wrong here? Anyway, I would appreciate if we could all keep from calling each other liars before hearing the other party out. No big deal, I forgive you, I just don't want the talk page to turn into more of a battleground environment than it already is. For the record, here are a couple of comments from these uninvolved editors:

I personally have a pretty dim view of NCCAM (although it has improved somewhat over time from its especially inauspicious beginnings). That said, NCCAM clearly meets our sourcing bar as described in WP:MEDRS; it's part of the NIH and thus falls under "reputable major medical and scientific bodies". MastCell Talk 21:42, 17 December 2014 (UTC)

I agree. In the end, we have to choose between publishing what established (perhaps "entrenched" would be a better word) editors believe is The Truth™, or publishing what the sources say, giving the various viewpoints in due proportion to their prominence. If you're doing the latter, then you have to take NCCAM on the same footing as NIMH or NCI. WhatamIdoing (talk) 00:04, 18 December 2014 (UTC)

Anyway, I hope that clears things up, KWW. Peace!LesVegas (talk) 21:33, 3 January 2015 (UTC)

In what universe does two editors constitute "broad support" in a discussion where you had to discard twice as many opinions? I stand by my characterization: you are intentionally misrepresenting the contents of the discussion.—Kww(talk) 23:09, 3 January 2015 (UTC)

His statement says broad support amongst uninvolved editors. You are taking it out of context -A1candidate (talk) 23:29, 3 January 2015 (UTC)

2 for 2 is not "broad support" under any definition of the term.—Kww(talk) 23:36, 3 January 2015 (UTC)

Taking a quick glance at the discussion, I don't see any uninvolved editor opposing NCCAM per se. In any case, it's the strength of the arguments that counts, not the number of votes. -A1candidate (talk) 23:41, 3 January 2015 (UTC)

Actually, Kww, there was a third editor, an anonymous one who also supported it. But that's beside the point. It appears an involved editor, Brangifer, took the question to the WikiProject Medicine page as a sign of good editing, since said user was involved in the removal of the NCCAM sourcing. Brangifer asked, Miracle Dream also involved, also chimed in, and uninvolved and respectable editors replied that NCCAM is the NIH and therefore MEDRS. As is usually characteristic of this article, a number of involved editors also made their way to the argument but I'm not counting those names. The whole purpose of posting on a page like ProjectMedicine talk is to get an outside POV and that outside POV was unanimously in favor of the sources. I'm glad Brangifer took the issue to this page instead of edit warring. I'm also glad uninvolved editors chimed in. And, anywho, I stand by what I said. These editors (except the anonymous one) repeatedly and passionately argued their points as well. No other uninvolved dissenting opinions weighed in on the meat of the issue, so that's why I said what I said. You said there's nothing that could even be "misunderstood" as broad consensus, do you still stick by that? Kew, listen, I should probably address an issue with you: on John's talk page you said that you wanted me and other editors banned even though we use good behavior. You think my POV is dangerous, and I suppose this could be seen as an issue where you're trying to smear me in hopes of achieving your goal. Call me whatever you want, it's fine, but this is the last response you will hear from me on this issue. Ultimately, talk pages are for discussing the article and this is already enough of a battleground zone. I'm only going to respond to the actual point at hand here on out. LesVegas (talk) 00:12, 4 January 2015 (UTC)

I think your fervent defense of your misrepresentation of facts speaks pretty much for itself, and any reader that comes across your statement will quickly recognize that you were misrepresenting the discussion. Yes, I do consider editors that misrepresent sources and discussions to be a danger to the encyclopedia, and find it a shame that other admins are deceived by the polite facade. It really does come down to petty things like this: describing statements by two editors as "broad support" isn't a difference of opinion, it's a lie. That you would repeat it magnifies the sin, and that A1candidate defends it makes him an accomplice.—Kww(talk) 00:22, 4 January 2015 (UTC)

Wow wow wow... let's keep the cool, shall we?

Les, I disagree with you on a lot of things, but this is the first time I have caught you blatantly lying. Kww(talk) 21:13, 3 January 2015 (UTC)

WP:CIVIL is something we all absolutely have to follow, isn't it?

As far as I am concerned, I clarified in this edit that NCCAM is an organization set up by the U.S. Federal Goverment, and that "its focus is on objective investigation on the usefulness of CAM; trying to present only positive results is not part of their agenda.".

If one seriously wants to question a governmental organization and their objectivity, please do present some sources. If there is some criticism/bias, it sure has been investigated by statistic methods in academic literature. If it has not been studied, well there is an obvious reason why it has not been studied. Of course, there still exists the "conspiracy section", but Misplaced Pages isn't a place for that kind of nonsense. Cheers! Jayaguru-Shishya (talk) 00:48, 4 January 2015 (UTC)

FWIW, I would have opposed that as well had I seen it. The basic idea is that NCCAM is not accepted as an authority by the scientific community to the same degree as other branches of the NIH (which should indeed be treated as reputable authorities). In response to the request for sources, I searched the Nature and Science archives (search terms: NCCAM criticism, NCCAM reputation, etc) and found:

• Nature Reviews Cancer: "the subject of rancorous scientific and political debate over its mission and even continued existence"
• Clinical Rheumatology: "The criticism repeatedly aimed at NCCAM seems justified, as far as their RCTs of chiropractic is concerned. It seems questionable whether such research is worthwhile."
• Nature News: "still draws fire from traditional scientists", "Many US researchers still say such funding is a waste of time and money."
• Science News: " is a political creation"; "This kind of science isn't worth any time or money" (quoting Wallace Sampson)
• Science Policy Forum: " was created by pressure from a few advocates in Congress"; "NCCAM funds proposals of dubious merit; its research agenda is shaped more by politics than by science; and it is structured by its charter in a manner that precludes an independent review of its performance"; "NCCAM is unable to implement a research agenda that addresses legitimate scientific opportunities or health-care needs"

Of course some of these also say some good things about NCCAM, e.g. saying that they've gotten better in recent years, and I also found a couple of articles that are generally positive (while acknowledging the criticism). Likewise I found other critical sources that are weaker or make mainly indirect statements. This set of links is just to demonstrate the point. :-) Sunrise (talk) 02:24, 5 January 2015 (UTC)

Thanks Sunrise! That's exactly what I mean, sources to back up claims :-) Anyway, I took a quick look over the sources, and it seems that only one of them is publicly available. Besides the exact quotes, of course, the reader needs to know the exact material, many times the whole text too. Anyway, the Nature News source that I was able to access though, says the following things (boldings mine):

Well, for better or worse, the Nature News source isn't exactly MEDRS compliant, and has been refused here even earlier. I'll see if I can access the rest of the sources through my University network at better time though, this weekend at the latest. Or if you don't mind, would you care sending me those studies? =P Cheers! Jayaguru-Shishya (talk) 17:00, 5 January 2015 (UTC)

I hatted the quotes to make the page easier to read (I hope you don't mind!) I'm happy to send you the articles/post more context/post links if you can't access them yourself.

I completely agree that the sources contain both positive and negative statements. Like I said, my comment was only intended to illustrate that plenty of negative statements exist. This is sufficient to prove the point: NCCAM is frequently criticised in high-quality publications in a way that the other NIH branches are not.

Also, the question of the reliability of NCCAM is AFAIK not itself subject to MEDRS; i.e. we can use high-quality non-MEDRS sources (such as Nature News) to help determine whether a source is MEDRS. Regardless, there are MEDRS sources in the list. :-) Sunrise (talk) 01:45, 6 January 2015 (UTC)

Greetings Sunrise! Could you do that? I would truly appreciate it! I'll email you here through Misplaced Pages so you'll get my email address!

With that Nature News source, it reresented just individual opinion by this guy named Steven Novella. :P Cheers! Jayaguru-Shishya (talk) 15:35, 6 January 2015 (UTC)

Just a note -- I agree that Sunrise's quotes demonstrate a significant view among scientists that NCCAM is of dubious reliability. But they don't necessarily indicate a general level of skepticism across the scientific community as a whole. Sunrise's quote "The basic idea is that NCCAM is not accepted as an authority by the scientific community to the same degree as other branches of the NIH" could be taken as saying the former and/or the latter, and I don't agree that the quotes support the latter. Regards to all. --Middle 8 (contribs • COI) 20:54, 8 January 2015 (UTC)

So you are inclined to reject an accurate statement because you believe it may imply another statement? Can you provide a wording to say that "The basic idea is that NCCAM is not accepted as an authority by the scientific community to the same degree as other branches of the NIH" that you wouldn't reject with such an argument?—Kww(talk) 21:02, 8 January 2015 (UTC)

@ Kww -- No, the burden is on those who want to assert anything more than the significant view supported by Sunrise's quotes. Same idea with regard to pain and nausea: given sources indicating a significant view (and equally-good sources that disagree), editors are tending to make the unjustified leap that those same sources prove consensus. --Middle 8 (contribs • COI) 22:25, 8 January 2015 (UTC)

@Jayaguru-Shishya: I haven't received your e-mail. On the Nature News source, it's a regular article (not opinion or newsblog), so it's subject to editorial review. This makes it no less reliable (quite a bit more actually, in this context) than a regular article in the New York Times or Washington Post.

@Middle 8: Yeah, saying it's a significant view is all I was trying to establish (well, that and the corollary on source reliability). No ambiguity intended! I hoped my last few sentences would make that clear, but perhaps not. @Kww: From the first sentence of Middle 8's comment, I'm pretty sure they're agreeing. :-) Sunrise (talk) 01:12, 9 January 2015 (UTC)

Well, agreeing up to the point of it actually making a difference in article content. Then there seems to be a certain reticence to actually treat NCCAM as a less reliable source of information or describe it as such.—Kww(talk) 01:57, 9 January 2015 (UTC)

Greetings Sunrise! Did you receive my email already? :P Anyway, if I remember right about using "Nature News", it was here at acupuncture or traditional Chinese medicine where it got discarded as a source? Well, I believe that other editors are wiser with this one, so I leave it up to them :-) I'll try to have a look at a better time. Jayaguru-Shishya (talk) 17:15, 9 January 2015 (UTC)

In March 2009 a Washington Post staff writer reported that the impending national discussion about broadening access to health care, improving medical practice and saving money was giving a group of scientists an opening to propose shutting down the National Center for Complementary and Alternative Medicine, quoting one of them, Steven Salzberg, a genome researcher and computational biologist at the University of Maryland, saying "One of our concerns is that NIH is funding pseudoscience." They argued that the vast majority of studies were based on fundamental misunderstandings of physiology and disease, and have shown little or no effect. See Alternative_medicine#cite_ref-Brown2009_185-1. QuackGuru (talk) 07:11, 11 January 2015 (UTC)

Salzberg doesn't like the NCCAM? Well, it must not be a MEDRS, then, that surely settles it. --Middle 8 (contribs • COI) 14:58, 11 January 2015 (UTC)

A 2006 policy forum in Science concluded, "We believe that NCCAM funds proposals of dubious merit; its research agenda is shaped more by politics than by science; and it is structured by its charter in a manner that precludes an independent review of its performance."

Marcus, D. M.; Grollman, AP (2006). "Science and Government: Enhanced: Review for NCCAM is Overdue". Science. 313 (5785): 301–2. doi:10.1126/science.1126978. PMID 16857923.

I think this matter is settled. QuackGuru (talk) 02:27, 12 January 2015 (UTC)

I think it was settled long ago when all the uninvolved editors at Wikiproject Medicine page said NCCAM was valid because it's the NIH. This has been brought up again on this page, essentially because the NCCAM has received criticism. But so has National Institute on Drug Abuse, NIDA. The fact remains that the very definition of the NIH is the 27 bodies which compose it. Like it or not, one of those bodies is the NCCAM. And MEDRS is very clear that the NIH is a MEDRS source. The NCCAM is valid as far as I'm concerned and there's plenty of other editors who will back me up on that. But I understand that we also should scrutinize where necessary. As I see it, if editors want to pursue their objections further, perhaps a better place might be on the MEDRS talk page? If the NCCAM is so objectionable to some here, why don't you propose that MEDRS be amended to say "The NIH is valid, but one body which composes it, the NCCAM, is not." LesVegas (talk) 01:28, 15 January 2015 (UTC)

Depending on your accounting, either one or two "uninvolved editors" commented in that discussion. I really wish you would stop distorting facts and misrepresenting discussions.—Kww(talk) 01:38, 15 January 2015 (UTC)

Kww, I told you before it was three editors. You never contested that. Why are you saying it's one maybe two? LesVegas (talk) 01:48, 15 January 2015 (UTC)

Because I was too busy being dismayed by your brazenness to focus on petty details? You described "... Whatamidoing and Mast Cell as the ones I meant who were uninvolved", and I didn't notice your attempt to describe an IP as uninvolved (lacking psychic powers, I have no idea how you would decide that). Describing WhatAmIDoing as "uninvolved" in altmed articles is questionable, but doesn't rise to the level of intentional falsehood. Your efforts to paint statement by one to two editors as a conclusive decision when they represented a minority view does rise to the level of intentional falsehood.—Kww(talk) 02:37, 15 January 2015 (UTC)

Kww, first, I said "when all the uninvolved editors at Wikiproject Medicine" and that's correct. There were three and they concluded the NCCAM is a valid source. More could have joined in but didn't. A lack of contrarianism and debate on highly visited talk pages is indicative of consensus as well. I'm sorry I can't see, from any angle, how you could possibly claim I'm intentionally promoting a falsehood. But let's get real for a moment. QuackGuru often claims consensus where there is none. Yet I have never seen you call him a liar, and you even unabashedly defend his bad behavior because you share his strong POV. Could I please ask that you put your POV aside and stop being uncivil towards me on these talk pages? I know you are a much more experienced editor than myself, so I feel rather uncomfortable to have to keep reminding you that talk pages are for content discussion and not personal attacks. Please don't keep putting me in that position. Back to the topic, I noticed a lack of response on your part to any of my points. Do you have anything you would like to say about them? LesVegas (talk) 17:38, 15 January 2015 (UTC)

The best way out of your position is to simply retract your false claim of broad consensus and apologize for having made it. Moving forward from that would be fairly simple.—Kww(talk) 19:57, 15 January 2015 (UTC)

Wow wow wow, I think the best way is to calm down and keep one's cool, don't you agree? Kww, I have advised you multiple times already to rely on sources. If there is some sort of bias concerning a Federal Government's agency, there sure are studies to show this bias. So far, user Sunrise has been the only one who has participated the discussion by providing sources. So far, I have only been able to go through the Nature News source. I just received yesterday the other sources from Sunrise (thanks for that Sunrise, I appreciate that!), and I'll let you all know my position after I've gone through those as well.

Should there be any publication bias with NCCAM, sure we can drop out the source. Therefore, let's stick to the sources and drop out personal opinions, right? Cheers! Jayaguru-Shishya (talk) 20:38, 15 January 2015 (UTC)

This isn't a question of whether or not NCCAM is actually a good source, it's a question of why anyone would misrepresent either one or two editors taking the minority position in a discussion as representing a broad consensus. Whether or not NCCAM is actually a good source is a separate discussion.—Kww(talk) 01:12, 16 January 2015 (UTC)

No single scientific consensus on efficacy for pain or nausea

Lately I've seen some comments suggesting there is a single scientific consensus on acupuncture's efficacy overall (i.e. for any condition). That stance isn't supportable; disagreement remains on pain and nausea (but not most other conditions, where consensus is "no good evidence for efficacy" and/or "good evidence for no efficacy". (There is of course a certain range beyond which there's no disagreement; no major MEDRS argues for a large effect size, AFAIK.)

See e.g. above from JzG/Guy (diff) and at Arbcom from Kww (diff). Both assert a general consensus covering all conditions, yet neither meets the burden of evidence, and can only show the existence of a significant view (which nobody ever doubted). That's because there are multiple excellent MEDRS's that disagree with one another. For pain, Vickers' review contradicts the Ernst's recent ones, and if anything Vickers is a stronger MEDRS than Ernst. It's the strongest type of the strongest MEDRS: a meta-analysis using individualized patient data (IPD), which is the most rigorous approach, the "gold standard", a way to find information other good reviews have missed . Far from being generally discredited as skeptics tend to assume (from within the bubble of the skeptical blogosphere?), Vickers was accepted by other good sources, e.g. the well-respected Medscape .

For more, see my comments at Arbcom (diff) responding to Kww, and at WP:AE (diff 1; (diff 2). No hard feelings toward either editor, of course; apart from this misreading of the literature, they're both highly clueful (and I hope it's obvious that I raise the issue for its own sake, not to be vexatious). Anyway, I was able to provide sources at least as strong as the sources Guy and Kww did, proving that there is >1 significant view on nausea and pain. But again: there's no discernible consensus view for either condition (and I'm not even sure there's a discernible majority view). And there will be no consensus as long as excellent MEDRS's disagree with one another. --Middle 8 (contribs • COI) 22:10, 8 January 2015 (UTC)

There are two distinctions to be made. First, the claim that it does relieve pain or nausea would require a strong consensus, as it's a remarkable claim and there is no consensus as to exactly how it could do either of those things. Second, the claim that the both views are equally supported by "excellent MEDRS's" is questionable: NCCAM's reliablity is in question, and many of the other supporting studies come from China, where there is certainly a political pressure to find positive results. The bias of Chinese studies is also supported by reliable sources.—Kww(talk) 23:42, 8 January 2015 (UTC)

I agree with Kww partly. I consider it's even more likely that there are studies about the possible publication bias concerning NCCAM (a Federal Government's agency in the U.S.); the Chinese language itself might set certain barriers when it comes to studies conducted in Chinese language. I remember some publication bias studies concerning Chinese scientific literature in the field of economics; it was research called "Meta-analysis of China’s business cycle correlation", and there was also studied whether the Chinese publications had any bias concerning the research. Well, as I said, the language-barrier might be a quite restrictive one; the study was carried out, thanks to the help of a Chinese research assistant.

However, claims on medical efficiency do require MEDRS compliant secondary sources. The scientific literature will discuss the consensus, that's not something we need to speculate. Cheers! Jayaguru-Shishya (talk) 17:21, 9 January 2015 (UTC)

@Kww - re your #1, it's simple; we just weight sources properly. If we have two reviews of comparable quality (good methodology, good journal), and one finds evidence for nausea and another doesn't, we just summarize and present them, and mechanism isn't really relevant (there are lots of possibilities, none of which require invoking qi). Most of the time, in this topic area, reviews will tend to be negative, but when they're not, we don't have to reinvent the NPOV wheel.

re #2 - you're right, it all depends on the source. For pain, Ernst and Vickers are both at the highest level, so again, we just present them side-by-side. --Middle 8 (contribs • COI) 20:16, 9 January 2015 (UTC)

No, when one journal is making an an extraordinary claim without plausible explanation and the other one doesn't, we go with the one that doesn't and dismiss or downplay the one that does. That's weighting sources properly. Your method highlights false positives because, unsurprisingly, it's those false positives that people are so eager to include.—Kww(talk) 22:10, 9 January 2015 (UTC)

Agree with KWW, per WP:REDFLAG and WP:GEVAL. Extraordinary claims require extraordinary sourcing, and in this case the burden of proof is on the side making the extraordinary claim, not the scientific default of non-effective. Dominus Vobisdu (talk) 22:53, 9 January 2015 (UTC)

Kww, as much as I appreciate your enthusiasm to the article, that's certainly something we should leave for the scientific research to decide. If we have a notable source, it is not our job in Misplaced Pages to speculate on the quality of their peer review process. If positive results do exist, then we will include within the range of proper weight naturally. Cheers! Jayaguru-Shishya (talk) 23:36, 9 January 2015 (UTC)

As above, Jayaguru-Shishya, no. Such an approach will invariably drift towards overemphasis of false positives. That's why WP:REDFLAG and similar concepts exist. Our role as editors is to compensate for source bias.—Kww(talk) 02:02, 10 January 2015 (UTC)

Incidentally, User:Middle 8, I would consider Vicker's "Although the data indicate that acupuncture is more than a placebo, the differences between true and sham acupuncture are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to therapeutic effects" and Novella's "the benefits of acupuncture are likely nonexistent, or at best are too small and too transient to be of any clinical significance" to be in substantial alignment, differing primarily in the value judgement of whether a trivial impact is worth paying for, not in whether the impact is trivial. Vicker's judgment continues that "Even though on average these effects are small, the clinical decision made by physicians and patients is not between true and sham acupuncture but between a referral to an acupuncturist or avoiding such a referral". i.e. the value of acupuncture including the placebo effect is enough that he considers it worth the payment. There's no controversy that if there is an actual, non-placebo based benefit derived from acupuncture, it's small. There is a scientific consensus on that point. No reputable source is claiming that there is a substantial benefit relative to placebos.—Kww(talk) 02:36, 10 January 2015 (UTC)

That is a reasonable (and intelligent) observation. Saying that we should exclude Cochrane reviews whose conclusions we don't accept is not (reasonable). The benefit (if it is real and not an artifact of bias) is small or modest (like Advil or Zofran): nobody who is reality-based disputes that. What is debated is whether it is clinically relevant, and a "yes" conclusion in a meta-analysis is not to be treated as a Fortean phenomenon. --Middle 8 (contribs • COI) 09:03, 11 January 2015 (UTC) edited21:03, 11 January 2015 (UTC)

What I've been arguing is that this giant rack of reviews does nothing but obfuscate the issue. Our section on effectiveness should be clear, because consensus is clear. Something like

The physiological benefits of acupuncture are non-existent or trivial. Most, if not all, of the benefits are derived from the placebo effect, where ineffective treatments appear to have an impact because the patient believes it will have an impact.

We add citations to both the studies that think placebos are worth paying for and those that don't, but we don't bring in text that gives the false impression that acupuncture is effective. Then we kill off this giant list of studies that hint at trivial effect because they serve no purpose but to mislead the reader. —Kww(talk) 15:19, 11 January 2015 (UTC)

Kww -- We agree that the section on efficacy badly needs pruning (and I believe we agree that the Safety section also needs pruning). We disagree on weighting the positive conclusions. Your italicized sentence pretty much reflects the consensus for most conditions, and we know this because the best reviews are in agreement. But we can't infer that this consensus fully extends to pain and nausea, because the best reviews are not fully in agreement. Reviews are what indicate consensus, or lack thereof. What else would indicate consensus? --Middle 8 (contribs • COI) 21:59, 11 January 2015 (UTC)

What review indicates that there is a substantial benefit for pain and nausea that is not accounted for by the placebo effect? Vickers and Ernst both reach the conclusion that the primary benefit is placebo. You've agreed above that anyone "based in reality" agrees on that. There's some disagreement between "non-existent" and "trivial", which I covered with "non-existent or trivial". So where's the disagreeing study?—Kww(talk) 23:11, 11 January 2015 (UTC)

Here is what Vickers says: Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo."

Kww, I already said it: I agree with your depiction of consensus for most conditions, "But we can't infer that this consensus fully extends to pain and nausea". I am being very reasonable about where we overlap, and you appear to be IDHT-ing over where we differ.

As an ICD meta-analysis , Vickers is the best of the best of MEDRS's. To add to that weight, Vickers is cited by e.g. Medscape and NHS. There's no way it doesn't weigh. So can you budge a little? --Middle 8 (contribs • COI) 00:31, 12 January 2015 (UTC)

P.S. FWIW, I've crunched the numbers the way Gorski did. The minimal clinically important difference comes from both placebo and verum; placebo alone doesn't quite get you there. Which (cf. what Jytdog said on my user page ) is what matters to a lot of docs clinically, even though that thinking is offensive to others, including yourself . I respect that fact. We still have to cover all views. --Middle 8 (contribs • COI) 00:31, 12 January 2015 (UTC)

I still don't understand your objection: Vickers states "Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest" and " Even though on average these effects are small, the clinical decision made by physicians and patients is not between true and sham acupuncture but between a referral to an acupuncturist or avoiding such a referral. The total effects of acupuncture, as experienced by the patient in routine practice, include both the specific effects associated with correct needle insertion according to acupuncture theory, nonspecific physiologic effects of needling, and nonspecific psychological (placebo) effects related to the patient's belief that treatment will be effective." He's clear: the difference between sham and real is very small, and he is considering the placebo effect while determining the ultimate value of the therapy. His data clearly shows that. Is it my use of "trivial" as a synonym for "very small" that bothers you? Perhaps "The physiological benefits of acupuncture are non-existent or small. Most, if not all, of the benefits are derived from the placebo effect, where ineffective treatments appear to have an impact because the patient believes it will have an impact." would align with the way you read the study better? I'm quite serious, here: Vickers did not say that acupuncture supplies a substantial benefit beyond placebo, he said that some benefit appears to exist, but it was small, both in absolute terms and in relative terms. "Most, if not all, of the benefits are derived from the placebo effect..." accurately summarizes Vickers and, so far as I can determine, any competent review. —Kww(talk) 01:21, 12 January 2015 (UTC)

Kww Belatedly: You keep "rounding down to zero" when plainly I keep saying that sometimes nonzero is not seen as trivial; FWIW, please take a second to consider WP:OPPONENT. Yes, I do disagree with your use of "trivial" or "very small" in the case of pain and nausea, since there remains disagreement over whether the effect size -- though small -- exceeds placebo and is clinically relevant. For example, ibuprofen has a small effect size but is still clinically relevant, and acupuncture is about 2/3 as strong as ibuprofen, according to Vickers, and is almost certainly way safer. (That 2/3 number does not include placebo effects.) (a) Pain: Vickers is clear that specific effects exceed placebo, and that both specific and nonspecific effects contribute to clinical significance. (b) Nausea: Lee (from Cochrane) is clear that P6 stimulation is as good as anti-nausea drugs; Ernst doesn't necessarily disagree, but says that entiemetic drugs themselves are of dubious value and therefore so is P6. So there is no apparent consensus for, at minimum, pain and nausea.

Bit more: (c) There's also a significant view that the studies themselves aren't conclusive because designing controls remains a problem; just see the responses to Vickers, for example. (d) And there's the view (cf. Jytdog's comments recently ) that sorting out specific from general effects is irrelevant as long as it helps people (Ernst mentions this view). We need to cover all of this (cf. multiple MEDRS position statements); will propose wording later. --Middle 8 (contribs • COI) 01:43, 22 January 2015 (UTC) revised 05:32, 22 January 2015 (UTC)

I'm not the one "rounding down to zero". Some sources say it's zero. Some say it's "very small". But Vicker's clearly says that the component that can be traced to any physical effect from acupuncture is small in comparison to the placebo effect. Vickers clearly does not state that the physiological component exceeds placebo, he states that there is a physiological component in excess to the placebo effect. There is no reliable authority that is claiming that the delta between the total effect of acupuncture and the placebo effect of acupuncture is large: the strongest claim is that it is a small, yet clinically relevant effect. Jytdog's position (and those that agree with him) is irrelevant to the discussion of efficacy: any placebo will be more effective if more people recommend it. Indeed, the placebo effect relies upon deceiving the patient. That's not a valid argument for exaggerating a treatment's effectiveness. I'd be happy with "Acupuncture, if effective at all, is less effective than Tylenol and far more expensive", but I would suspect people would raise WP:OR objections. Still, whatever "wording" one comes up with needs to make it clear that the effects we are discussing here are so tiny that the people that study them argue about whether the things they sense are experimental error.—Kww(talk) 05:51, 22 January 2015 (UTC)

To simplify, my objection is to the dispute between whether the effects are "zero" or simply "small" being used to obfuscate the situation. The article should not use that discussion to leave it open that "oh, since scientists can't agree on the size of the effect, maybe it's really wondrous". There is a consensus that the physiological impact of acupuncture ranges from non-existent to small.—Kww(talk) 06:00, 22 January 2015 (UTC)

Kww -- That's a helpful simplification, thanks; and imo largely a reasonable one, based on which I don't think there's that much daylight between us. Some of it will boil down to WP:WTA. We may or may not disagree on how to weight the views that (to varying degrees) studies are inconclusive due to the old chestnut that "study designs are dicey" (cf. STRICTA -- which are actually quite sensible guidelines, but do not totally invalidate research to date; far from it). Such views aren't saying it might be wondrous, just that the jury's out, and it's not time to move on. That's a view I've seen coming from academic centers. Self-serving somewhat, sure (like much else that says "let's study this some more"), but it's still part of the mainstream. --Middle 8 (contribs • COI) 11:15, 26 January 2015 (UTC) edited 18:34, 26 January 2015 (UTC)

P.S. Note that costs comparisons with NSAIDS (not the same as Tylenol btw) should factor in dosage (one acu treatment = multiple doses of NSAIDS) and the costs of adverse effects from NSAIDS (it appears to be billions of dollars). --Middle 8 (contribs • COI) 18:34, 26 January 2015 (UTC)

Couple more comments, fwiw: (A) a caveat about sham, and (B) an example of a sympathetic view (the kind I just mentioned above). (A): Not all controls are placebos. Sources have noted that sham needling isn't inert, although it's obviously a valid control for point specificity. There is some analgesia at needling sites; it's called the "needling effect" (and Brangifer might know of sources). As you probably know -- but I'll say this anyway for others' sake -- needling at or near painful regions is common practice. That kind of treatment is analogous to massaging a tender area, and is a valid and ethical way to practice, as long as reasonable claims are made. A truly inert control, one that controls only for the "theatrical" and other placebo effects, would be faux laser stimulation, which was used by Hinman's (2014) study on knee arthritis . Guess what, Hinman found that real needling, real laser and faux laser were all about the same. (B) Ernst noted that Hinman provides "more evidence to show that acupuncture is a ‘theatrical placebo’". Contrast that with Peter Wayne at Harvard Med, whose view is typical of proponents; he says that it's just one smallish study, we still don't know the whole story, and it's worthwhile to refer because of the clinically significant difference from no-treatment. Those are good examples of contrasting mainstream views, and may be worth mentioning as such. --Middle 8 (contribs • COI) 18:34, 26 January 2015 (UTC)

I want to add to something Middle 8 said regarding study design being flawed. Many researchers agree on that, and in fact, there is an ongoing movement towards improving research. I'm not a scientist by any means, but what I have learned is that some scientists often try measuring acupuncture identically to how they measure drugs. But acupuncture's effects are dependent on a much larger array of variables, and researchers agree that it takes time for research science to catch up. When measuring the effects of a pharmaceutical drug, there are few variables involved. Who administered the pill? When was it taken? With food, or without? That's about it. With acupuncture, you have all sorts of different styles. Everything from Japanese acupuncture to modern trigger point therapy. The size of needles used. The type of stimulation used. Needling depth. Practitioner credentials and experience. When measuring the placebo, you also have to question if the dummy point you're using is actually a point in another family lineage system actually used to treat the condition. Sometimes it's just the act of needling itself which causes physiological response. I saw a statistic once where acupuncture was only 10 percent more effective than the control for high blood pressure, but the control itself was powerful, something around 30 percent. Even the "placebo" outperformed some BP drugs. But what we do know is that there is no consensus on acupuncture being effective or ineffective for things like pain and nausea. My insurance covers both, in fact, and if it were proven ineffective there would be no way they would pay for it. Insurance companies absolutely rely on scientific consensus to make their decisions. To my knowledge, no governmental health body has stated there is consensus in acupuncture's efficacy, no major research bodies, just a few editors on Misplaced Pages who interpret the literature one way. In fact, our most prestigious health bodies, like the NIH or WHO, have positive things to say about acupuncture. To say otherwise is the very definition of original research and to make edits from that standpoint, instead of relying on what the statements and research actually say, isn't good for the encyclopedia. LesVegas (talk) 18:48, 22 January 2015 (UTC)

LesVegas, scientists are divided between only between whether acupuncture has no effect beyond placebo or little effect beyond placebo. I am trying to devise a summary of the research and consensus that does not mislead our readership into believing that research has left open the possibility that acupuncture has a substantial physiological effect. It doesn't: the dispute is between "zero" and "small", and as to whether it is ethical to pay for the placebo effect. That ethical dispute is a separate discussion from the nature of any physiological effects, but it is the basis for why insurance pays for it: they care only whether it makes people feel better in proportion to the dollars expended, not whether that benefit is based in delusion or reality.—Kww(talk) 22:00, 22 January 2015 (UTC)

When acupuncture has a 40% positive affect for blood pressure, insurance does not pay for that. Why? Because the treatment group only outperforms the control by 10% so it's not considered to have efficacy. It's considered unproven and only 10% effective. Kww, by your logic, insurance would still pay for it because it helps their customers. But they don't, at least not that I'm aware, because they rely on strong scientific data. Regarding your other statement, I'm all for summarizing "research and consensus" and hope that if you do this, you will post it here. Frankly, for some time, I've been meaning to work on translating some of the research from Chinese language journals for us to add to the article and it might make for a decent addition to what you're starting. Anyway, let me know when I need to get off my duff and get to work and add some of these. There's some of the richest data over there because they know the medicine very well and have been researching it with modern research methods for a very long time. Come to think of it, I also want to add some cool sinological and historical stuff to the article too. Hopefully, I'll get more time and energy real soon. Only so many hours in the day! LesVegas (talk) 01:21, 23 January 2015 (UTC)

Outdenting, and replying to Middle 8's "clarification" ( you really shouldn't edit comments after I've replied to them: it makes it look as if I have replied to something I didn't get a chance to read): again, the study you point at as pro says "Keep in mind that the differences were quite small—like a 1-point reduction in pain on a scale of 0 to 10". Your source completely supports my statement: scientific consensus is that the effect of acupuncture ranges from none to trivial/small/"quite small"/"very small". There is no reliable source that says that acupuncture has a substantial effect, only that it may have a measurable effect. Using a study like that to try to obfuscate the fact that there is agreement that acupuncture does not have a large effect on pain and nausea is just that: obfuscation. Choose what synonym you want for "trivially small", and let's put a plain English summary of the scientific consensus in place of this long laundry list of studies: "The physiological benefits of acupuncture are non-existent or small. Most, if not all, of the benefits are derived from the placebo effect, where ineffective treatments appear to have an impact because the patient believes it will have an impact." Even your pro acupuncture studies align with that summary.—Kww(talk) 06:01, 28 January 2015 (UTC)

@Kww: Hang on -- I didn't point to any study as pro, and I'm NOT saying that a 1-point reduction on a 10 scale is big or even modest (nor that it's clinically relevant). I said that Peter Wayne's comments here are a good example of an acu-sympathetic POV: that we don't know enough yet, which doesn't square with your proposed summary. I also don't think an effect size comparable to Zofran or Advil is trivially small. (I don't believe I edited any comments after you replied, but which are you referring to?) --Middle 8 (contribs • COI) 09:03, 28 January 2015 (UTC)

I'm quoting Pendick (yes, editorial, not study) as saying the effects are small: "quite small" is a direct lift from the editorial point. Wayne is a heavily biased source: chairman of a pro-acupuncture society being quoted in a blog. And look at what he says:

• “This is a small study that replicates what we already know”: Yes, that's true: we know acupuncture has little to no physiological effect on pain, and this study confirmed that. It falls right in line with the conclusions of Ernst and Vickers.
• “When you compare acupuncture to no treatment, there seems to be clinically meaningful differences for many pain conditions, including back pain and knee pain.” Also not disputed by anyone: when the placebo effect is included in the total comparison, there's a clinically meaningful response.
• Based on this pragmatic comparison, if I were deciding whether to send a family member or friend for a pain-related acupuncture treatment, I would say ‘yes’.” Editorializing about his personal belief about the ethics of prescribing placebos, not a statement about the physiological effects of acupuncture.

Again, there's nothing here that would contradict "The physiological benefits of acupuncture are non-existent or small. Most, if not all, of the benefits are derived from the placebo effect, where ineffective treatments appear to have an impact because the patient believes it will have an impact" as a summary. BTW, this clarification occurred after my last contribution to this thread.—Kww(talk) 14:40, 28 January 2015 (UTC)

Here's what else Wayne says, and can't be assumed to be consistent with your proposal of consensus: “I would be careful saying acupuncture doesn’t work for all pain conditions and no one should do it; we simply do not know enough yet”. I'm surprised you didn't catch this, since I've at least twice mentioned the view that we don't know enough yet (about efficacy). That view is consistent with both (a) the qualifiers that most reviews have (re: conclusions being limited because further research being needed), and (b) doubts that some scientists express about study design.

Your proposed wording is virtually identical to the invited "anti" editorial by Colquhoun and Novella. Do you see the problem with using one side of an invited pair of editorials as your source for consensus? Novella says that extant reviews are consistent with the null result and at best indicate tiny, clinically insignificant effects. Novella says we can draw definite conclusions from extant reviews. But some scientists don't buy that; they argue that the studies (on which those same reviews are based) are themselves conclusive. Surely you can see this, even if you vehemently disagree with it and believe that it obfuscates the truth. I'm not saying I much agree with that view -- on the contrary, I don't think it's very reality based -- but it's significant, and it doesn't accord with your proposed summary. The likes of Wayne weigh and are mainstream sources: Wayne is with an academic center at Harvard. Almost by definition, "quackademics" are mainstream sources, because they're academics at major universities. Or are you saying that pro-acupuncture sources aren't part of the mainstream just because they're pro-acupuncture? If so, that's putting the cart before the horse and contravenes NPOV.

BTW, I'm just not grokking your objection to the timing of my clarification; I posted at your talk page. Happy editing! --Middle 8 (contribs • COI) 16:27, 28 January 2015 (UTC)

So propose something that captures that fact that even the pro-acupuncture side is saying there is only a small effect, You are right that Novella is arguing that the effect is non-existent. Others are arguing that it exists, but concede that it is "small", "quite small", "small in relation to the placebo", or any of a number of qualifiers. The fact remains that all sources are either saying the physiological benefit is non-existent or small. That's there some argument between "none" and "small" doesn't mean that there isn't a scientific consensus that it isn't "large", "overwhelming", "gigantic", or some such. The only argument is whether the difficulty of controlling acupuncture studies is creating an illusion of effectiveness or whether there is actually some small effect. I won't go so far as to say that people that practice acupuncture are completely unreliable, but at this point, anyone proposing that acupuncture has any effect beyond "small" is getting into fringe territory, and people that head pro-acupuncture groups are certainly biased, even if they are not 100% wrong. That's why we rely on studies like Ernst and Vickers in the first place: to try to weed out flawed studies put on by biased groups.—Kww(talk) 16:49, 28 January 2015 (UTC)

The more I think about it, the more I see your statement as more of a significant view than a consensus, because it goes further than many reviews do (more below). I've already said that I don't think your statement is consistent with pain or nausea.

• Pain not "small": Vickers' numbers show that specific effects (verum) range in size from 40% - 70% of the size of general effects (sham). Not bigger than sham, but hardly teeny-tiny in comparison either.
• Nausea not "small": Lee & Fan don't say it's small, they say it relieves PONV, and is comparable to anti-emetics. Ernst appears to contradict this, which means we cite both, not just Ernst.
• Reviews in general hedge: your statement is more definite than the reviews themselves, which frequently hedge by saying conclusions are uncertain because of low trial quality, blah blah (example: ). Your statement doesn't reflect this hedging, but rather Novella's and Colquhoun's interpretive attempt to cut through it. Do you not yet see the problem with relying so heavily on the "anti" editorial of an invited pro & anti pair? A good deal of the "obfuscation" you're complaining about in this article actually reflects the reviews themselves. The views of academics like Wayne, and Ted Kaptchuk and others -- whether optimists or pragmatists -- reflect and emphasize the "wiggle room" in reviews. I doubt if they'd argue the effect size is likely, with further research, to turn out to be huge, but I see no indication they'd go so far as to call it tiny or trivial -- and I'm sure you realize that the burden lies with you here since you're arguing for a consensus.

If reviews hedge, then we do too, even if it annoys Novella and people who agree with him. His dismissal of the hedging typical in Cochrane reviews is a sig view, but not a consensus, just as other academics' rather credulous "embrace" of that hedging is also sig view.

Are there any sources meeting WP:RS from which we can discern consensus, or speak in WP's voice? Medical textbooks? Note the discussion at WT:MEDRS on how to infer scientific consensus; some lean toward Cochrane while others lean toward position statements by expert bodies, so we should look to those as well. The NHS is an example . Happy editing.... --Middle 8 (contribs • COI) 08:53, 29 January 2015 (UTC) edited11:32, 29 January 2015 (UTC)

Ernst, Vickers, and all quality reviews that we quote use "small" or a synonym to describe the actual physiological effects of acupuncture. While they hedge, it's a hedge in both directions: the studies that do the best job of simulating all the placebo effects with none of the actual practice find the least residual effect, so an ideal study is more likely to find no effect than the ones we have so far. I'm not proposing language from Novella, I'm simply providing a layman summarization of Ernst and Vickers. "Non-existent or small" covers that hedge quite neutrally, saying the the con side might be found wrong, and there is an actual effect for some inexplicable reason, while "non-existent" indicates the pro-side might be wrong and there is no actual effect at all. It specifically uses the neutral terms "placebo" and "believes", as opposed to a harsher formulation such as "works primarily by deceiving the patient into believing something useful has been done". If you wanted to add a sentence such as "Studies continue in order to quantify precisely what, if any, the effects of acupuncture are and to clarify whether the studies are returning evidence of genuine benefit or are simply returning false positives", I could live with that.—Kww(talk) 15:03, 29 January 2015 (UTC)

I think its generally best to simply quote the conclusions of the systematic reviews, there will always be disagreements about how we color them when paraphrasing or summarizing. Herbxue (talk) 16:45, 29 January 2015 (UTC)

The primary issue is to eliminate the impression that there is some significant controversy about the effectiveness of acupuncture. Listing technical jargon extracted from hundreds of studies serves only to overwhelm the reader with words that most of them don't understand. What part of my summary do you believe fails to adequately translate technical jargon into lay English?—Kww(talk) 17:22, 29 January 2015 (UTC)

The primary issue is to properly represent reliable sources. To imply that there is consensus on the question of efficacy goes beyond what the sources say. Herbxue (talk) 19:34, 29 January 2015 (UTC)

But there is consensus that the physiological effects of acupuncture are small and less than the placebo effect. Can you point to any source with the reliability of either Ernst or Vickers that disagrees, Herbxue?—Kww(talk) 22:31, 29 January 2015 (UTC)

"less than placebo"? What source says that? Vickers says "Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo." - it goes on to say the difference is "modest" - ok, quote that. They still concluded a. It works and b. there are specific effects above and beyond placebo. It literally says both of those things. Now, we don't use that to over-generalize ("acupuncture is proven to work for pain" for example), even if it would technically adhere to the meaning of a sentence in the source, it would be stretching the source to make a broader statement than the source makes. Our job is to faithfully report on reliable sources, not to do original research. Herbxue (talk) 15:40, 30 January 2015 (UTC)

Vickers does say that the actual effects of acupuncture are less than the placebo effect. "On average these effects are small" and "these differences are relatively modest". "These differences are relatively modest" explicitly categorizes the difference (i.e. the physiological effect) as being small relative to the effect of the placebo (sham acupuncture). Why would you have us complicate the summary by including a pile of quoted sentence fragments? Our job is to summarize, not to quote.—Kww(talk) 15:52, 30 January 2015 (UTC)

@ Kww - Answering in order of my points above:

• Agree Vickers is consistent with "small" or "relatively modest" (Vickers uses both terms), as long as we're clear that verum's contribution is smaller than sham but not small relative to it. We should say sham rather than placebo because general effects aren't always the same as placebo: some kinds of sham that involve needling aren't inert. See e.g. NHS (§ "Some positive evidence", 4th para; also § "Assessing the evidence", final para).
• I didn't see you respond re Lee & Fan (Cochrane) for nausea; we can't take their "equivalent to anti-nausea drugs" as meaning they also think it's equivalent to "small" or "smaller than sham". They don't (IIRC) say.
• Re reviews' hedging, the issue is how that hedging is taken by scientists. Here the caveat is the same as with nausea: When scientists say we don't know, we cannot assume they'd agree with your statement. I know you (and Novella) believe that acu is not taken seriously or widely studied, but it in fact is. We know this because of the plenitude of Cochrane reviews that are always being updated, and Vickers and Ernst, and stuff like this from Stanford. I don't think it would be so widely studied if your statement were widely embraced.

Finally -- and particularly in light of the thread at WT:MEDRS about how we determine sci consensus -- I would be a lot more comfortable with your formulation if we had consensus statements from MEDRS's that said substantially the same thing (which isn't a matter of my having to prove they don't; that burden doesn't fall to me). The WT:MEDRS thread says that such statements are at least equal to systematic reviews as sources for sci consensus. Some examples: The National Institute for Health and Care Excellence (NICE) recommends a course of acu for low back pain, headache and migraine. Mayo Clinic enumerates multiple conditions, as does NHS. (§ "Some positive evidence"). These statements are not necessarily either consistent or inconsistent with your statement; we cannot assume either. It's more than reasonable -- if anything it's necessary -- to ask whether such sources have themselves made the translation that you have (and isn't that a SYN??). I'm not seeing that they have, which is why I think your summary is probably not a statement of consensus, but rather a sig view. (Addendum: I've said before that it's entirely possible, and maybe likely, that such expert statements will eventually converge toward summaries like yours and Novella's. But global consensus is that we lag rather than lead these kinds of sources.) --Middle 8 (contribs • COI) 09:17, 31 January 2015 (UTC) edits (prior to any replies): copyedit for clarity, add parenthetical at end 18:53, 31 January 2015 (UTC). Add sources for NICE 18:58, 31 January 2015 (UTC). Minor copyedit 23:19, 31 January 2015 (UTC)

Middle 8, why do you keep bringing up irrelevant objections about people recommending acupuncture as a treatment? I'm not arguing, nor have I argued, that there's a consensus that people shouldn't recommend acupuncture for the treatment of pain. What there is a consensus for is that the strongest effect of acupuncture is due to its placebo effects, and that the physiological component, if it exists at all, is small in relation to the placebo effect. Why do you think the fact that many people are comfortable recommending a treatment that is primarily effective due to the placebo effect somehow contradicts the consensus that it is primarily a placebo? They are logically completely unrelated topics.—Kww(talk) 00:16, 1 February 2015 (UTC)

Kww, a few things: first, I notice that you are making an argument for "scientific consensus" based on just two sources: Ernst and Vickers. But we have so many more sources. Really, if scientific consensus is to ever exist on something like acupuncture, it's going to have to be a large scientific body to make a statement like that anyway. As highly as I regard everyone's opinion, I have to admit that Wikipedians arguing on an online talk page will never be qualified to make consensus statements about anything, much less something like this. One way or the other. And you especially can't do it when, out of the hundreds to thousands of good sources on pain, you are arguing for a scientific consensus opinion based on two of them, and one of those two doesn't say what you're wanting it to say so you're editorializing it and OR'ing it.

Actually, Vickers's point about the decision being to refer or not refer is a good one, and I think there's a larger point implied in it. In China, acupuncture studies never use placebo controls. They believe it is unethical to give a group of human beings no treatment at all in the name of science. So all their studies in acupuncture or herbs or whatever, are tested versus some sort of pharmaceutical or pain patch or whathaveyou. They still use controls, but the overall effect is what's most important. Placebo response in acupuncture is difficult to measure because of a high amount of variables anyway. Based on my knowledge of Chinese medical history, this is likely something the Chinese figured out a long time ago. In China and in most of Asia, the decision to treat with acupuncture is made when considering: 1) performance versus the alternative, and 2) known or potential side effects of the alternative. So you routinely see studies where acupuncture outperforms hydrocodone in both subjective pain assessment as well as in things like objective anti-inflammatory markers, and for those conditions acupuncture is recommended. In other conditions, let's say choleocystitis, an acupuncture protocol might only have a 60% cure rate so surgery is always recommended to be scheduled and acupuncture is done up until then to try obtaining a resolution. And if acupuncture has alleviated the symptoms, then ultrasound or whatever is recommended to be done, to see if the stones are actually gone before cancelling the surgery, things like that. Because they understand acupuncture and use it in modern integrative settings already, their literature is much more "real world" in that regard, and I really need to start posting some of it here. I think it's much more of a help to Misplaced Pages's readership to read about acupuncture's efficacy vs something else than 'acupuncture did X vs the placebo in this study and did Y vs the placebo in this other study.' Really, I can't imagine being a reader and reading this article, it's abstract, contradicting and confusing. So I see why you want to streamline all of it, but in my opinion, OR and overlooking many other sources is the wrong way to go about it. LesVegas (talk) 00:45, 2 February 2015 (UTC)

Kww: practice guidelines are "irrelevant"?!?! They're are about as good for sci consensus as sources get! See WP:MEDSCI. Your assumption that the NICE, et. al., are recommending acu for its placebo effects is just that, an assumption, and it's up to you to demonstrate it's correct, not up to others to prove otherwise. If they were recommending acu as a placebo, why don't they recommend it for a huge range of conditions? Where else on their site are they recommending placebos? --Middle 8 (contribs • COI) 02:10, 2 February 2015 (UTC)

You two are infuriating ... I am not making a single assumption, I am simply reflecting the unpleasant reality of what the sources you insert into the article say: the medical benefits of acupuncture are small relative to its placebo effect. As for Chinese studies, LesVegas, I'm well aware that they don't follow standard practice and don't use reliable controls. That's why they aren't particularly relevant and are frequently disregarded by other medical journals..—Kww(talk) 02:24, 2 February 2015 (UTC)

To continue, Middle 8, I don't have any objection to a sentence that indicates that it is frequently prescribed and funded, so long as that is not used to pretend that it has any substantial effect.—Kww(talk) 02:27, 2 February 2015 (UTC)

@ Kww -- That's a good addition, but the fundamental problem with sci consensus remains. If you find it "infuriating" that I argue from practice guidelines (of all things), then consider WP:TIGER. I think it applies, given your comments at ArbCom case requests, where you made the surprising and extreme assertion that acupuncture's effectiveness isn't under wide and serious study. But of course it is, which means no single consensus exists in some areas, efficacy for a few conditions being one of them. That's a very mild position, only an extreme one if you believe (as you obviously do) that Colquhoun and Novella's "anti" editorial coincides with sci consensus.

Sci consensus is shown not only in reviews, but in how reviews are taken by scientists (hence practice guidelines), and that's what you're missing. If you can prove that the NICE et. al. are recommending a treatment that they believe is primarily a placebo, then yes, we can be sure they're consistent with your summary. Not otherwise. I'm pretty sure the NICE doesn't recommend placabos, but who cares what I think? You're the one making the generalization, so it's about what you can prove. --Middle 8 (contribs • COI) 07:20, 2 February 2015 (UTC)

P.S.: Correction: Above I mentioned a thread at WT:MEDRS that proposed a revision to MEDSCI; however, my comments in this thread rely on MEDSCI in its present form. Still it's an interesting thread that underscores how important practice guidelines are. --Middle 8 (contribs • COI) 07:20, 2 February 2015 (UTC)

Practice and science are unrelated topics: it is you that are committing original research by conflating the two, especially given the explicit statements by the sources that are actually attempting to analyze actual effects vs. placebo effects (which NICE does not make any explicit statements about).—Kww(talk) 13:51, 2 February 2015 (UTC)

"Practice and science are unrelated topics." WOW. Yes, that's why there's no such thing as evidence-based medicine. Come to think of it, I've heard that before: from Randy in Boise. And since there's no EBM, there's no Cochrane, and no widespread, serious study of acupuncture. Yes, it all makes sense now. No wonder editors who argue otherwise need to be topic-banned: this will "help provide an environment that will allow our scientifically-minded editors to prevail". --Middle 8 (contribs • COI) 23:34, 2 February 2015 (UTC)

Don't accuse me of incompetence. Practice is a social issue, one that combines a number of factors. "Unrelated" was strong, but there's no cause and effect: the fact that something is practiced doesn't permit the conclusion that there's a scientific foundation, nor does something having a sound scientific foundation necessarily lead to it being practiced. Evidence of one cannot lead to the conclusion that the other is true. Vickers explicitly states that acupuncture has a strong placebo component, which leads to his recommendation that it be practiced. That in no way refutes the concept that it is primarily a placebo. You are conflating two separate concepts. "It's widely practice" in no way invalidates the summary of ""The physiological benefits of acupuncture are non-existent or small. Most, if not all, of the benefits are derived from the placebo effect": that accurately summarizes Ersnt, Vickers, and you have yet to provide a source that attempts to quantify the proportion that refutes it. You simply assert that these bodies don't recommend any procedure that has a strong placebo component while providing no evidence to support that assertion beyond you being "pretty sure that's true".—Kww(talk) 23:52, 2 February 2015 (UTC)

Evidence → practice guidelines (that's what EBM is about) and practice guidelines are indeed sci-consensus sources (MEDSCI). --Middle 8 (contribs • COI) 03:05, 3 February 2015 (UTC)

Any evidence that the practice guidelines assiduously reject all placebo effects before making their decisions? That they reject Vickers's concept of evaluating the total effect, and proceed as Novella would, looking only at the delta between the placebo treatment and the total effect? That's a pretty strong claim, and its pretty hard to see how any competent authority could recommend acupuncture on that basis. It would seem that only Vickers's approach of evaluating the total effect could ever lead to endorsing acupuncture.—Kww(talk) 13:59, 3 February 2015 (UTC)

Let me ask you a question, Kww. What can you tell me about acupuncture placebo? How many more variables do you think acupuncture placebos contend with versus, say, the sugar pills our readers think about when seeing the word "placebo"? The Chinese don't even use it in their research. You think that makes them less of scientists? Wow, I really can't believe what I'm hearing from you. You said earlier that this makes them irrelevant and disregarded by other medical journals. However, some other medical journals simply have publishing policies which pre-exclude any non-placebo controlled studies from publication because that's the ethical and scientific standard adopted by the Occident only. We could get into a long debate about that, but what matters is that they do use controls, and that's more relevant for clinical settings anyway. If acupuncture outperforms hydrocodone for lumbar pain relief, I suppose, by your rationale, that makes hydrocodone "worse than a placebo". I say stick to the sources and let them speak for themselves. But if we are to do any editorializing, it needs to be away from making judgements about whether or not something is equivalent to a placebo (since half the world's scientists disregard that anyway) and more towards its clinical practice. LesVegas (talk) 18:26, 3 February 2015 (UTC)

I am sticking to the sources, including the widespread skepticism about Chinese investigations into aspects of Chinese Traditional Medicine.—Kww(talk) 19:38, 3 February 2015 (UTC)

Listen, Kww, you're saying you stick to the sources, yet just a few weeks ago, you said We shouldn't report it until multiple studies report the same conclusion I agree with Middle 8 that WP:Tiger describes this situation perfectly. It seems to me that you are a well-meaning editor who wants to help here, but you do perceive your biases as neutral POV. I'm starting to believe that my own personal editing philosophy is to AGF until there is no other possibility but to assume bad faith. But when you called for me and other editors to be topic banned, I still made an effort to AGF, but I could only assume good faith in the worst way: that you are overcome with such strong biases that you assume anyone arguing with you to be violating NPOV. Of course, you received no support at ArbCom, and many protested against you, but that didn't seem to entice you to stop and reflect for a moment. That's the real source of the conflict, and until that's resolved, I believe that arguing along these lines will be fruitless and talk page arguments will extend ad infinitum. Seriously, until you stop to consider how your biases might be getting in your way I don't think we will make any progress at improving the status of this article. LesVegas (talk) 23:20, 3 February 2015 (UTC)

I perceive my bias as the scientific POV, which is the only one that matters in relation to this particular discussion. If I was trying to alter the article to say that all acupuncturists and herbologists should be jailed for fraud, or anything like that, your comment would have merit, as that's an an issue where other POVs do have weight. At this point, all studies that address the issue of the proportion of acupuncture's effect that is due to placebo effects and the proportion that is due to an actual physiological effect come to the conclusion that the physiological effects are small in relation to the placebo effect, so small that there is widespread argument that they don't actually exist. Even Vickers, the most pro-acupuncture general review anyone can point at, agrees that the non-placebo effects are small. You have yet to demonstrate any review that comes to a different conclusion, supplying only a vague handwave at studies that don't meet any accepted standard for controls. Can you demonstrate any actual controversy with my proposed summary in terms of legitimate reviews of placebo-controlled medical studies that are of a higher quality than (or even equivalent to) Ernst and Vickers?—Kww(talk) 01:32, 4 February 2015 (UTC)

I perceive my bias as the scientific POV, which is the only one that matters in relation to this particular discussion.

That is not a scientific POV, but a pseudoscientific POV.

If I was trying to alter the article to say that all acupuncturists and herbologists should be jailed for fraud, or anything like that, your comment would have merit, as that's an an issue where other POVs do have weight.

If you want to send a large proportion of practicing physicians to jail, go ahead. Just don't complaint if you ever fall ill.

At this point, all studies that address the issue of the proportion of acupuncture's effect that is due to placebo effects and the proportion that is due to an actual physiological effect come to the conclusion that the physiological effects are small in relation to the placebo effect, so small that there is widespread argument that they don't actually exist.

Regarding the the physiological effects of acupuncture, the American Academy of Otolaryngology – Head and Neck Surgery says: "The mechanism of action of acupuncture in the treatment of AR is unknown. Studies suggest that acupuncture inhibits cytokine synthesis, such as interleukin-10 in patients with AR and interleukin-6 and interleukin-10 in patients with asthma; however, it remains unclear whether these findings correlate with clinical effect." (http://oto.sagepub.com/content/152/1_suppl/S1.full)

There is no mention of the placebo effect whatsoever. If the placebo effect is indeed relevant in the treatment of allergic rhinitis using acupuncture, surely it would have deserved a brief mention?

You have yet to demonstrate any review that comes to a different conclusion, supplying only a vague handwave at studies that don't meet any accepted standard for controls. Can you demonstrate any actual controversy with my proposed summary in terms of legitimate reviews of placebo-controlled medical studies that are of a higher quality than (or even equivalent to) Ernst and Vickers?

See PMID 20359961 and PMID 20070551

-A1candidate 14:26, 4 February 2015 (UTC)

Thank you A1Candidate for those excellent points and sources. I particularly think the Hopton/Macpherson source makes an excellent point: if acupuncture is more effective than placebo shouldn't the research towards shifting research priorities away from asking placebo-related questions and towards asking more practical questions about whether the overall benefit is clinically meaningful and cost-effective? Perhaps we Misplaced Pages editors should be doing the same? LesVegas (talk) 20:34, 4 February 2015 (UTC)

If "acupuncture is more effective than placebo", there would be studies showing that. There aren't. Acupuncture has been shown to be effective, but only in non-placebo-controlled studies. — Arthur Rubin (talk) 02:00, 5 February 2015 (UTC)

That overstates things, Arthur Rubin. Reliable studies have found a delta. There are reasonable arguments that they are statistical artifacts or that they are the result of small study flaws, but they are there.—Kww(talk) 02:29, 5 February 2015 (UTC)

Perhaps. But were the studies triple-blinded (in addition to the patient and the researcher, the the person inserting the needles should not know whether it's "real" acupuncture or "sham" acupuncture)? If not, there's still a significant uncontrolled placebo effect. I haven't noticed any such remarks. But I haven't read all the literature, even that available without cost (or through JSTOR).) — Arthur Rubin (talk) 02:36, 5 February 2015 (UTC)

Regarding See PMID 20359961, it confirms my summary, User:A1candidate: "In general, effect sizes (standardized mean differences) were found to be relatively small." As for PMID 20070551 the abstracts do not reveal any finding of the relative magnitude of the response vs. the placebo controls, only that the total is larger than placebo (something that I am not disputing). Can you share a statement out of the study that asserts that assessed separately, the physiological benefit of acupuncture isn't smaller than the placebo effects?—Kww(talk) 02:10, 5 February 2015 (UTC)

Regarding See PMID 20359961, it confirms my summary, User:A1candidate: "In general, effect sizes (standardized mean differences) were found to be relatively small."

This quote is not taken from PMID 20359961 but PMID 20070551. The authors summarized the effect sizes in the abstract as "relatively small" (which is not the same as "small"). A closer look at the full text would reveal what relatively small actually means:

"The collated results indicate that in the short term, acupuncture provided statistically significant effective pain relief compared with sham controls in low back pain, chronic osteoarthritis of the knee (with the caveat that this holds provided outcomes were measured after treatment was completed—one inconclusive outcome was based on a 4-week time point, well before trial treatments ended), and headache. These differences remained statistically significant in the longer term at 6 to 12 months-, for knee pain and chronic headache (with the caveat that outcomes were based on completed treatments—one inconclusive outcome was before the end of treatment). The differences between acupuncture and sham for low back pain in the longer term were inconsistent; one of these reviews found a statistically significant effect of pain relief maintained at 6 to 12 months,16 while another was inconclusive. Overall, the effect sizes were small to moderate"

As for PMID 20070551 the abstracts do not reveal any finding of the relative magnitude of the response vs. the placebo controls, only that the total is larger than placebo (something that I am not disputing).

Have you mistakenly mixed up the papers? PMID 20070551 clearly discuses the magnitude of the response vs. the placebo (sham) controls in the abstract.

-A1candidate 09:21, 5 February 2015 (UTC)

A1candidate, it states that there is a significant effect difference. There's nothing about the relative sizes of the effect in the abstract, and that is what this enormous discussion has been about. There isn't consensus that the physiological effects of acupuncture are insignificant, but there is a consensus that the effects of acupuncture that are not attributable to placebo effects are small. There's a big difference between being statistically significant and being large.—Kww(talk) 14:03, 5 February 2015 (UTC)

(e/c) @ Kww: I first mentioned expert statements on Jan. 31 : These statements are not necessarily either consistent or inconsistent with your statement; we cannot assume either. It's more than reasonable -- if anything it's necessary -- to ask whether such sources have themselves made the translation that you have (and isn't that a SYN??). Five replies later, you're still trying to shift the burden.

My point, cf. WP:MEDSCI, remains: for sci consensus, we look not only to reviews, but to how they are taken. You need to produce evidence that the practice guidelines (and all the other sig POV's mentioned) specifically agree with you: silence doesn't necessarily mean agreement.

Sounds like we're headed for an RfC/A or something like that. I'm pretty busy for the next month. Whoever handles this, let's keep the wording neutral, please. (How not to do it: )

And quite apart from everything I just wrote about practice guidelines, you still haven't answered re nausea. It doesn't appear Lee and Fan's review found the same as Vickers did in terms of effect size (w.r.t. sham). They found P6 stimulation as effective as anti-nausea drugs. Ernst later said neither P6 nor drugs were clinically effective, but that's a sig view, not a consensus. Any reply on that?

And there's the meta-level problem: your plain-language proposal appears to be the first of its kind. We should be working from plain-language summaries from consensus-level sources: following sources, IOW, not leading them. --Middle 8 (contribs • COI) 11:11, 5 February 2015 (UTC)

Middle 8, the problem is that you keep pointing at things that do not address the issue at hand, say "these don't address the issue", and then think it misses something. Every source that compares the size of the placebo effect to the difference between the total effect and the placebo effect says that delta is small. Some say is it small but significant, some say it is small but insignificant, some say it is so small as to be imaginary, but they all say small. That some study authors said nothing means just that: they said nothing. Practice guidelines take the totality of effect into account: placebo and actual together, and the claim that they completely exclude placebo effects in their analysis is the extraordinary one, because virtually all medical treatments include some placebo component: that's why we have to have blind trials. Silence means just that: silence.—Kww(talk) 14:03, 5 February 2015 (UTC)

As for the RFC, probably about 10 days from now: I have vacation looming. Perhaps an RFC will attract some discussion from editors without profound conflicts of interest and we can get somewhere.—Kww(talk) 14:18, 5 February 2015 (UTC)

A1candidate, it states that there is a significant effect difference. There's nothing about the relative sizes of the effect in the abstract, and that is what this enormous discussion has been about.

If you don't have access to the full text, ask for it, please. The full text says "Overall, the effect sizes were small to moderate".

Every source that compares the size of the placebo effect to the difference between the total effect and the placebo effect says that delta is small. Some say is it small but significant, some say it is small but insignificant, some say it is so small as to be imaginary, but they all say small.

Read PMID 20359961 again. Since you don't have access to the full text, I'll quote the part that is relevant here:

"In a recent 11C-carfentanil PET study with fibromyalgia patients (Harris et al., 2009), acupuncture therapy but not sham acupuncture (at non-acupuncture points) elicited significant activation of mu-opioid receptor binding capacity in typical areas of the “pain matrix”, the cingulate, the caudate, the thalamus and the amygdala both short-term (after one session) as well as long-term (after 4 weeks) while with sham acupuncture, small deactivations of this matrix was noted, an effect that has been seen also with placebo analgesia (Zubieta et al., 2005)"

The differences are found in the relative magnitude and nature (activation vs. deactivation) of the effects.

That some study authors said nothing means just that: they said nothing.

No, it means you didn't read the paper and you shouldn't pretend that you've read them.

-A1candidate 14:39, 5 February 2015 (UTC)

A1candidate, I was upfront that I only had access to the abstracts, stated I couldn't find what you were claiming in the abstract, and then asked you for a statement from the full text. I don't understand why you think I "pretended" anything. OK, small to moderate: pretty wishy-washy, still covered by "small" in my judgement. Your second study appears to state that there is one effect triggered only by actual acupuncture in fibromyalgia patients (interesting study group that, as people don't seem to be able to gain consensus as to whether it is a physical or mental disorder). Does it make any assertion as to the amount of overall relief this effect provides? Most of these studies ultimately include some review where patients rate their pain before and after various treatments, and the acupuncture group reports a slightly larger relief than the control. Remember, I am not trying to claim that there is a consensus that acupuncture has no actual effect, because that certainly isn't true. What I'm not saying is that the reviews all agree that the effect beyond placebo is small.—Kww(talk) 15:02, 5 February 2015 (UTC)

Small to moderate means just that: Small to moderate. The second study (Harris et al., 2009) cited by the review says "Treatment differences were attributable largely to increases in MOR BP following TA whereas SA evoked either a small decrease in MOR BP or resulted in no change". (PMID 19501658) According to Harris et al., patients rated their pain using the short version of the McGill Pain Questionnaire. -A1candidate 15:54, 5 February 2015 (UTC)

I'll have to take that as "no, the study made no statement whatsoever about the relative magnitude of the treatement differences. That surprises me, both because it seems illogical for a study not to reach a conclusion about that and because I can't see why you would think it was relative to the discussion without it, but I've directly asked multiple times and you haven't provided a statement as to relative magnitude from the study.—Kww(talk) 18:40, 5 February 2015 (UTC)

The magnitude is not significant ("reduction in clinical pain was similar between groups") because the placebo controls also worked, albeit in the opposite manner and resulted in a reduction (rather than an increase) in MOP binding potential. I don't strongly object to describing the overall magnitude difference as small to moderate, but the significant and opposing biological effects of true vs. sham acupuncture would of course have to be highlighted separately. -A1candidate 19:02, 5 February 2015 (UTC)

Global Journal of Health Science

I don't think we should be citing papers in the Global Journal of Health Science because the journal's publisher, the Canadian Center of Science and Education, is on Beall's list of predatory publishers. The paper I am referring to is "How Effective Are Spiritual Care and Body Manipulation Therapies in Pediatric Oncology? A Systematic Review of the Literature". If no objections are raised I will remove the paper. Everymorning talk 21:06, 12 January 2015 (UTC)

That's not a review

This change inserts a source that is nowhere close to MEDRS. Yes, the title contains the word "review", but it doesn't correspond to what MEDRS means by "review". This is not far from adding a source that is a book review -- because it's a review, isn't it?

Independent of my assessment, I noticed others on this talk page have been saying the same thing, but to little avail. There may be no polite way to bring up WP:CIR, but there comes a point where it has to be done. Editors' time shouldn't be wasted like this. Manul ~ talk 18:18, 15 January 2015 (UTC)

Sorry to disagree, but just because other editors say it doesn't make it true. I have responded to these objections and have yet to hear back from them, which is why I added the source back. If editors say "it's not a review" but then fail to respond to me when I explain that it is, actually, a secondary source and then come back repeating each other without engaging in substantive discussion, isn't that actually a waste of my time? LesVegas (talk) 18:54, 15 January 2015 (UTC)

On my cursory analysis it seems like it's classed as a review article by EBCAM. But I think there's a more important question, which is whether EBCAM is reliable for this in the first place. It's not indexed in MEDLINE, and it's published by Hindawi, which has been on Beall's list of predatory publishers. In 2013 it was removed from the list, but Beall at the time said it was a "borderline case" (source). I don't think this meets the standard of MEDRS. Sunrise (talk) 00:42, 16 January 2015 (UTC)

Thanks for that link Sunrise and for noticing that it is a review, as I have always stated. As you said, it's not on Beall's list, but the source never said EBCAM was on the list, only a set of Hindwai's journals. Regarding those, here is the quote from the link you provided: A set of Hindawi's journals appeared on a version of Beall's list because he had concerns about their editorial process, but has since been removed. “I reanalysed it and determined that it did not belong on the list,” he says. It is indexed on Pubmed and has a solid impact factor for the source. Given all of that, what specific guidelines in MEDRS would exclude the source? LesVegas (talk) 01:29, 16 January 2015 (UTC)

By the way, here is the PMID for the citation. LesVegas (talk) 01:40, 16 January 2015 (UTC)

As I said above, the rest of the quote is "It was always a borderline case." But can we please not do the bolding thing? It comes across, to me at least, as similar to caps lock. :-)

Pubmed indexing is not a good benchmark for reliability - MEDLINE indexing is much better, and indeed lack of MEDLINE indexing is mentioned in MEDRS as a red flag. MEDRS also endorses Beall's evaluations as red flags, since he is cited as a source of examples of predatory publishers. I actually hadn't realized that the Nature source only said "set of," as you rightly point out. But in any case: Beall divides his list into separate categories for publishers and individual journals. Hindawi appeared on the publisher list as well. (More specifically, it appeared in the watchlist section, not the confirmed section, but as Beall says, it is borderline.)

That's not to say that any particular article from EBCAM cannot be useful. The suggestion (again, quoting MEDRS) is that for any individual article, the red flags can be overcome by showing that "the article has garnered significant positive citations in sources of undisputed reliability suggesting wider acceptance in the medical literature." Sunrise (talk) 02:12, 16 January 2015 (UTC)

Hey Sunrise! I really do appreciate you responding to each of my points. It is always helpful to find editors who are willing to have a thorough, fair and serious discussion and I am most grateful. And you're right, EBCAM (or eCAM) is not Medline indexed. WP:MEDRS says that this "might" raise red flags, but of course not red alerts. A red flag isn't a scarlet letter of shame, of course, just an indication that we want to look further into it. Looking into the Beall's list, we see that not only is the current publisher not on it any longer, we also see that, at the very time Hindwai was added to Beall's list, EBCAM was actually being published by the rather prestigious Oxford University Press where it had a high impact factor relative to its field While published under Hindwai, it has retained a similarly high Thompson-Reuters impact factor relative to its field. Given all of this, I think a rather strong case can be made that this journal is not only MEDRS compliant, but is actually a great source, and I see nothing specific in MEDRS to allow us to exclude it. But am I missing anything? LesVegas (talk) 18:08, 16 January 2015 (UTC)

I agree with Sunrise that "...the red flags can be overcome by showing that "the article has garnered significant positive citations in sources of undisputed reliability suggesting wider acceptance in the medical literature."". In my humble opinion, LesVegas has tackled this problem really well in his response. Cheers! Jayaguru-Shishya (talk) 19:18, 16 January 2015 (UTC)

Thanks! - I'm just trying to be the best editor I can. :-) As are we all, I suppose.

Impact factor can be a useful indication of reliability, but only when you get to high numbers (I would say >8-10 is probably a good benchmark in the biosciences). The lack of MEDLINE indexing, as described by MEDRS, is still a red flag, so I'm not sure what you're trying to say there. It doesn't make something automatically unreliable but it is an indication that we should be cautious. Indeed OUP is a good publisher, so perhaps you could make a case for articles published prior to the change in 2010 (from a good publisher to a poor one), but this one is from 2011.

@J-S since the quote actually refers to the individual article, not the journal, addressing that issue would involve specific citations of the article in question. Also, impact factor measures only number of citations, not quality - for example, it's possible for a journal to reach IF 4-5 using primarily self-citations to its own articles. In the case of this paper, there's actually only one citing article in Pubmed, and a couple of the authors are the same. In the biosciences, a paper being largely ignored for close to 4 years is also a bad sign, unfortunately. Sunrise (talk) 21:51, 17 January 2015 (UTC)

I looked a little more into Beall's list. First of all, I have to ask, is Beall's list the gold standard in open access journal quality? We have to keep in mind that Jeffrey Beall is a librarian and open access journals threaten his livelihood, so there certainly may be many "false positives" on his list. But when he recognizes a false-positive journal as being legit, he removes them from his list. Beall reconsidered Hindwai after representatives from the company met with him in Denver, and now they aren't even listed as "questionable". Since reconsideration is tantamount to admitting you made a mistake in the first place, I don't see how we could possibly exclude this journal on any basis. I see no reason to exclude anything published from Hindawi on the grounds that it was once on Beall's list mistakenly.

On another note, you noted that journals with an impact factor of >8-10 are a good benchmark for biosciences. But the American Journal of Sports Medicine (the highest ranked orthopedic journal) isn't even close to that high! (4.699). And eCAM isn't really biosciences, though, per se, at least not like JAMA or Nature are. If we compare it to its relative field (CAM journals) it consistently ranks amongst the very highest CAM journals. We also need to remember that MEDRS states reliability does not include a journal's "content being outside the journal's normal scope (for instance, an article on the efficacy of a new cancer treatment in a psychiatric journal or the surgical techniques for hip replacement in a urology journal)." Yet we have many journals without knowledge and expertise on acupuncture making statements on acupuncture. Now, I'd prefer not to argue that we get rid of anything published in biomedical journals on acupuncture even though it may be outside its normal scope. Personally, I think we should allow a pretty broad range of sources in. But, that said, the argument that one of the highest impact factor journals in the CAM field cannot be used to cite something in its field violates the intention of MEDRS's "journal's normal scope" rather grossly if one believes a journal that doesn't normally cover acupuncture is more reliable than eCAM regarding the acupuncture field. I can't see any reason to keep eCAM out on reliability grounds. The only hard evidence regarding reliability that I can see is actually in this journal's favor regarding its high impact factor amongst CAM journals. LesVegas (talk) 22:44, 26 January 2015 (UTC)

Yes, Beall's list is the gold standard in this area (though of course it isn't perfect), and this is also enshrined in MEDRS as I said above. If it had simply been removed from the list without comment I think that would be a reasonable argument, but again, we also have a high-quality source where Beall calls Hindawi a borderline case for inclusion on the list. In other words, on the spectrum of dubiousness/reliability it falls close to the line.

On scope, I think you meant to say that being outside a journal's normal scope is a red flag, not that it isn't. :-) If you have examples of citations from the article I'd be happy to give my opinion on them, but note that a journal's scope doesn't have to be "acupuncture" to be considered a good source for this article, e.g. a journal on pain medicine publishing articles on the use of acupuncture for pain, or Nature publishing pretty much anything. That said, I'm not sure why you brought up scope as an issue, because it's only used to argue in favor of unreliability and I didn't bring it up myself.

For impact factor, >8-10 is the benchmark for using it as an indication of reliability. That doesn't mean that lower IF journals are unreliable, but rather that we cannot use IF to support their reliability. Sunrise (talk) 23:45, 28 January 2015 (UTC)

Hey Sunrise! Thanks again for continuing on in this with me. Can I bother you to point me to where was it decided that 8-10 on IF is the standard for reliability support? Was it an RfC somewhere, on MEDRS or Project Medicine maybe? I'd like to read the analysis because it seems like it doesn't make much sense, to me, to apply an IF of 8-10 in all cases where reliability is in question. The highest rated Orthopedics journal is a 4.699! That would mean that all orthopedics journals in question would be excluded if anyone questioned them. Even the very highest one in the category! And that's a bias that favors sexier topics. Orthopedics literature happens to not get cited much because it's old and just not titillating enough. What it needs to be is not a standard 8-10 threshold but a relative impact factor to avoid "sexy bias" or whatever you want to call it. Excitement bias? I don't know. There's probably a term for what I'm talking about. LesVegas (talk) 00:45, 1 February 2015 (UTC)

I'll discuss as long as any particular topic holds my interest. :-) The specific number is my (probably generous) summary based on past experience - the larger point is in the problems with using impact factor at all. Some RSN discussions on impact factor are here and here, which are about as conclusive as RSN discussions usually get. Note that these are discussions on whether IF can be used even just for meeting RS, let alone MEDRS!

Again, the point is not that lower IF journals are unreliable, but rather that we cannot use IF to support their reliability - so e.g. observing that the highest IF orthopedic journal is 4.7 isn't relevant. It's possible there wouldn't be a consensus for any specific benchmarks, but if not, I can all but guarantee that the consensus would be to use it not at all or only with strong caveats. I'm happy to discuss more general points about impact factors my user talk page, since it's not all that relevant to the discussion here. :-) Sunrise (talk) 02:41, 2 February 2015 (UTC)

Jumping in for a moment: neither RSN seems conclusive. Both caveat relying on IF's too heavily. From the second we might glean that IF's are useful metrics within fields, which goes to the point LesVegas is making for EBCAM's being high for its field. The Beall's objection seems moot on account of Beall having recanted his concerns. Is there any evidence that EBCAM changed when it went from Oxford to Hindawi? Different editors, or whatever? If not, I'm inclined to say the source is OK. (There are several sources talking about evidence for point specificity, and even one editorial by skeptics -- the one by Colquhoun and Novella mentioned above -- cited some. We can't keep excluding it beyond a certain point.) --09:20, 2 February 2015 (UTC)

Hmm. I haven't been on this talk page for a while and I've just come across this discussion. I'm a bit disturbed by the spurious connection being made (or not) between IF and reliability. I think that we should all be clear that there is none. Although there is likely a correlation between the two, IF says nothing about reliability or quality of a source, it says more about the profile of the journal, it's accessibility and how aggressive the editors are at acquiring self-citations! The variance in IF is huge between different fields and it is a very unreliable index of reliability. There has historically been some absolutely brilliant science published in journals with a very low impact factor for a variety of reasons: because the field is so specialized that the readership is small, or because the research has few (if any) commercial applications, or because certain scientists are sentimentally attached to certain journals... any number of reasons. Sorry if all of this has been said before. As I said, I've just caught the tail-end of this discussion. Famous_dog (c) 15:46, 3 February 2015 (UTC)

Sunrise, you said "For impact factor, >8-10 is the benchmark for using it as an indication of reliability" which seemed to me like you were saying it was a standard or agreement of consensus amongst editors somewhere. So I am understanding you correctly that it is just your opinion of where it ought to be? Middle 8 was right that neither RSN seemed conclusive on this, and that the Beall's objection is moot because it's not on even the "questionable" list, and was never even once considered predatory. And I agree with Famousdog that IF says nothing about the reliability of the source. While I understand that we don't exclude sources based on IF, we could make an argument not to include them, if it appears the source is unreliable and if IF is too low. There's really no evidence that the journal is problematic, no current evidence Hindawi is, and plenty of evidence that eCAM makes a large impact in its field; a huge impact if we consider it's ranking in CAM publications. LesVegas (talk) 21:49, 3 February 2015 (UTC)

As somebody who is regularly spammed by Hindawi with requests to publish with them or requests to act as an editor, I am of the opinion that they disreputable and they parasitize the open-source movement (but that is just my opinion, albeit one forged in the fires of a thousand spam emails). The reputability of either the publisher or the journal aside, the problem with Bai et al is that it is not a review, it is a synthesis. They are taking lots of what appear to me to be unrelated papers, including three published in a very dubious source and squishing them together in a fashion that supports their theory or lends credibility. For example, the citations of research papers published in reliable MEDRS journals (such as references 40-42 on back pain) do not in any way support their central argument - they are just padding. We don't accept that sort of behavior on WP, so we shouldn't accept it in published articles. Famous_dog (c) 12:31, 5 February 2015 (UTC)

In WP:MEDRS, "reviews" refer to literature reviews, which do not present new findings, much less groundbreaking ones. The answers given by Dominus and Brangifer were already more than sufficient to explain why this source cannot be used. There are still more reasons, such as the flimsiness of the journal, as Sunrise points out. It's incredible that apparently a month has passed since the paper was first proposed. Let's not spend more pixels about this. The source is out. Manul ~ talk 03:07, 16 January 2015 (UTC)

Manul, if you read my previous argument you will see that I state MEDRS allows multiple types of reviews, such as systematic and narrative reviews. The source comments on primary studies, clearly making it a secondary source by the very definition of what a secondary source means. And yes, you're right, I have spent the last month or so on this, but only to give fellow Wikipedians ample chance to respond before I added the source back in. There's no hurry really, Misplaced Pages doesn't have deadlines, as you know. LesVegas (talk) 18:18, 16 January 2015 (UTC)

True, there is no deadline (WP:NORUSH). We can afford to take the time. Jayaguru-Shishya (talk) 19:32, 16 January 2015 (UTC)

Original research should not be restored

This change made by User:LesVegas was original research and did not summarise the source. Neutral wording:

"Despite scientific debate in the validity of meridians and acupoints has been increasing, the premise for the idea of acupuncture points and meridians in TCM has not been determined. A 2011 article, representing a theoretical basis, suggested that the human fascial network is consistent with the ancient view of the meridian network pattern, and might be considered to be the anatomical basis for acupoints and meridians within the human body. Further, the article suggested that the efficacy of acupuncture has been observed to depend on interactions with the fascia."

1. ^ Bai, Yu; Wang, Jun; Wu, Jin-peng; Dai, Jing-xing; Sha, Ou; Tai Wai Yew, David; Yuan, Lin; Liang, Qiu-ni (2011). "Review of Evidence Suggesting That the Fascia Network Could Be the Anatomical Basis for Acupoints and Meridians in the Human Body". Evidence-Based Complementary and Alternative Medicine. 2011: 1–6. doi:10.1155/2011/260510. ISSN 1741-427X. PMC 3092510. PMID 21584283.{{cite journal}}: CS1 maint: unflagged free DOI (link)

If there is consensus to restore the source that is not a review the wording must be sourced and neutrally written. So far I did not think there is consensus to restore the source. QuackGuru (talk) 20:18, 2 February 2015 (UTC)

The wording was sourced and was not OR. I explained this before when I posted the wording directly from the source here on talk and you accused me of a copyvio. Then you pulled directly from the source something completely out-of-context which sounded the opposite of what the source actually said. We've been through this nearly two months ago. You were IDHT'ing then and now you still are. The degree to which you don't hear the point, ever, really baffles me. LesVegas (talk) 19:46, 3 February 2015 (UTC)

In the text you add you claimed it was a 2011 "review". It was not a review and you did not accurately summarise the source. The wording I wrote is more accurate.

You wrote :However, a 2011 review noted that the human fascial network is consistent with the ancient view of the meridian network pattern, and could be the anatomical basis for acupoints and meridians within the human body." But the source said "Specifically, this hypothesis is supported by anatomical observations of body scan data demonstrating that the fascia network resembles the theoretical meridian system in salient ways, as well as physiological, histological, and clinical observations." The source also said "In this paper, a convergence of evidence from various fields related to fascial anatomy and physiology were reviewed and considered with respect to the possibility that the fascia might be the physical substrate referred to as the meridian system in TCM." The entire paper is clearly speculated and the fascial network. QuackGuru (talk) 00:22, 4 February 2015 (UTC)

Oh, too bad that's not the only thing the source said. The source also said this: "The anatomy of the fascial network in the human body, as demonstrated through VCH and living body imaging studies, is consistent with the traditional view of the meridian network pattern, and the efficacy of acupuncture has been shown to rely on interactions with the fascia." Please don't accuse me of OR again while you try justifying your disruptively taken, out-of-context edit which you pulled from the first line of the abstract, something you claimed you didn't do IDHT'ing all the way until I posted the abstract here on talk to show it. LesVegas (talk) 01:03, 4 February 2015 (UTC)

Allergic Rhinitis

A new systematic review has concluded that "acupuncture could be a safe and valid treatment option for AR patients" There is a section on allergies in the article, but I was unsure how to introduce this new review into the current section, in light of older reviews that are already included there that came to different conclusions. — Preceding unsigned comment added by 108.181.201.237 (talk) 18:33, 16 January 2015 (UTC)

Hello and welcome to the talk page! I'm glad you found this excellent review and I will add it into the article. To answer your question, newer reviews are placed ahead of older reviews in chronological order. If it contradicts older and dated research, say from 2-3 years but definitely 5, then we remove the older research in place of the fresh reviews so that the science stays up to date. Oh, and one thing, if you add four of these ~ at the end of your posts on talk, it automatically signs your name. Anyway, welcome to the article! LesVegas (talk) 18:47, 16 January 2015 (UTC)

I just added it and noticed it was a meta analysis and not a systematic review. For your information, these generally carry more weight than systematic reviews themselves, since they are a statistical approach derived from underlying systematic reviews. LesVegas (talk) 19:14, 16 January 2015 (UTC)

This is an example of precisely why I think having this rack of individual studies distorts the POV of the article. If this new study had documented the prevailing view on acupuncture, would there have been such a rush to add it? I think not. Instead, because it takes the unusual point of view that jamming needles into one's body will impact the immune system, it gets presented here, well in advance of the remainder of the scientific community having an opportunity to examine and reject it.—Kww(talk) 20:27, 17 January 2015 (UTC)

And when the rest of the scientific community examines it, we'll quote that too. LesVegas (talk) 00:46, 18 January 2015 (UTC)

Kww, there is no deadline. The editors are encouraged to add the latest findings of MEDRS compliant sources. Indeed, I find you statement: "If this new study had documented the prevailing view on acupuncture, would there have been such a rush to add it?" very curious. Also, as we keep getting new research results, "the prevailing view" will also get more precise, right? I find your thought, according to which we should only present research result that conform the historical data, extremely absurd. In statistical terms, it'd mean that you'd accept only either positive or negative values, and omit the others. :-D

I don't think you are doing yourself a favour here. Instead of serving your personal opinions, please stick to sources. And if discussing the statistics, please discuss the statistics instead of serving opinions as mentioned above. Cheers! Jayaguru-Shishya (talk) 23:35, 18 January 2015 (UTC)

And while we wait, we get another advertisement for acupuncture. Funny how that works. I would suggest that we remove it unless and until it is confirmed by supporting studies.—Kww(talk) 05:52, 18 January 2015 (UTC)

It's just another reliable source that says what it says, and we should use it, without over-generalizing its findings. No reason to not include it, and no reason to not be accurate by just saying "A 2015 meta-analysis shows…" Kww are you saying that this source is considered a primary source? It is not according to MEDRS. Are you saying that Les Vegas' wording over-generalizes its findings? Herbxue (talk) 15:15, 18 January 2015 (UTC)

No, I'm saying that the overall scientific consensus is that acupuncture works primarily through the placebo effect, and little to none of any effect it has on the patient are genuine physiological effects induced by the treatment. Any study reporting positive results is more likely to be a false positive than a genuine result. We shouldn't report it until multiple studies report the same conclusion.—Kww(talk) 16:38, 18 January 2015 (UTC)

To not include this source based on your thoughts about "consensus" that may or may not exist would be original research. I have only read the abstract, but it does not appear to even address the question of whether it worked by specific effects of treatment or non-specific effects. If another reliable source says this study shows positive results but thats probably due to placebo effect, then we could include that too. In the present state of the literature the right thing to do is include the conclusions, but not give any suggestion that this is generalizable or that there is a known mechanism of action.Herbxue (talk) 17:00, 18 January 2015 (UTC)

"Any study reporting positive results is more likely to be a false positive than a genuine result.", again serving your own opinions, Kww. Seems like a one-man-struggle against scientific publications. Jayaguru-Shishya (talk) 23:37, 18 January 2015 (UTC)

No, editorial judgement is not original research. Two separate concepts. If I were to write "in a probable false positive, a 2015 meta-analysis showed a significant reduction in nasal allergies ...", that would be original research. To simply omit the study until there are confirming studies is editorial judgement. I think that we should omit 95% of this entire section, and include only that the two most widely-accepted reviews (Ernst and Vickers) agree that most of the effects of acupuncture are placebo effects. The only controversies that remain are whether the remaining effects that can't be explained as placebo are study errors or legitimate indications of a trivial effect, and whether health agencies and insurance companies should pay for it based on the effects because it helps people feel better, even when they know most of that "feeling better" is based on the placebo effect.—Kww(talk) 17:14, 18 January 2015 (UTC)

Why don't we burn all the books (except what we like, we'll keep that) and base our editorial decisions on the available literature at that time? Sounds like a plan to me. While we're at it let's make Socrates drink poison, imprison Galileo, and sit on our hands while we allow editors to grossly break all the rules in the name of editing from our POV? LesVegas (talk) 19:43, 18 January 2015 (UTC)

Aaaah ... the scientific equivalent of Godwin's law: comparing criticism of pseudoscience to the persecution of Galileo.—Kww(talk) 20:15, 18 January 2015 (UTC)

"To simply omit the study until there are confirming studies is editorial judgement." Seriously, maybe we will keep in the phase of the scientific study, not in the phase of one editor's moods. Jayaguru-Shishya (talk) 23:41, 18 January 2015 (UTC)

"I think that we should omit 95% of this entire section, and include only that the two most widely-accepted reviews (Ernst and Vickers) agree that most of the effects of acupuncture are placebo effects." You think? I am afraid that we are interested what the sources say on the topic, not what individual editors think on the topic. Cheers! Jayaguru-Shishya (talk) 23:44, 18 January 2015 (UTC)

Which part are you claiming isn't what reliable sources say, Jayaguru-Shishya? Ernst, Vickers, and Novella, certainly do agree that the bulk of acupuncture's effect is due to the placebo effect. Vicker's "Although the data indicate that acupuncture is more than a placebo, the differences between true and sham acupuncture are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to therapeutic effects" and Novella's "the benefits of acupuncture are likely nonexistent, or at best are too small and too transient to be of any clinical significance" are in substantial alignment, differing primarily in the value judgement of whether a trivial impact is worth paying for, not in whether the impact is trivial. Ernst's conclusions aren't much different. What widely noted review has claimed an effect for acupuncture that was large compared to the effect for placebo? —Kww(talk) 00:51, 19 January 2015 (UTC)

It seems odd to try and compare Ernst/Vickers review and this review. Sources from Ernst and Vickers used in the article are examining chronic pain and pain treatment/outcomes, whereas this systematic review that is under question examined the literature about allergies and allergy treatment/outcomes, such as nasal symptom scores (stuffiness and drippiness), medication usage and serum IgE. I have read through MEDRS guidelines and this systematic review seems to clearly fit as the highest form of evidence available - a secondary source published in a medline-indexed peer-reviewed medical journal within the past 5 years. 108.181.201.237 (talk) 01:33, 19 January 2015 (UTC)

That's right. The source is as good as they come. Kww I generally support editorial judgement over strict guideline enforcement but in this case we have a contentious article, so MEDRS does the work for us. The caution you recommend is the caution MEDRS requires us to take when evaluating primary studies. In this case, the errors that we are at risk of committing are minimized by choosing secondary sources over primary, and this one in particular has a solid sample size and great p values. It is not ambiguous.

Now, there is a separate concern that you bring up - is the clearly demonstrated benefit due to specific effects or placebo effect? For the source in question, that issue is not even brought up - the source just says it works for this condition. Does it work better than slapping people in the face? We don't know, the study did not seek to answer that question. We can only report on what they found in relation to the question they sought an answer for. Since this is a reliable secondary source, we include it, but we do NOT over-generalize and pretend that this means acupuncture works for everything, and we do not use it to make a point about acupuncture being more than placebo.Herbxue (talk) 04:27, 19 January 2015 (UTC)

It's certainly a false positive of the highest quality, I'll give it that. To study acupuncture and not rate its performance compared to a placebo would appear to be a purposeful sin of omission, however, which is one of the reasons I fully expect this study to not be supported by others. Any general reader reading this excerpt is likely, however, to leap to the erroneous conclusion that there is some form of evidence that indicates that acupuncture is now believed to be an effective treatment for allergies.—Kww(talk) 05:56, 19 January 2015 (UTC)

It looks like there may be some confusion about the source. I see that it's been referred to as a "study" and therefore, it's easier to assume it's an outlier. But it's not, it's a meta-analysis, and all the studies which composed it did test it versus placebo. The n's and p's in the analysis were astounding. And there's really nothing better than a meta-analysis. The only thing better are meta-analyses using individual patient data. Even better than that would be only using studies with very robust reporting standards, like CONSORT, so that researchers can know things like needle size used, stimulation methods used, and whether or not trained acupuncturists administered the acupuncture in the studies. They even know what type of placebo control was used, and where and how it was placed. Details like these matter, and as the research improves we will see richer outcomes and, perhaps, even new findings. Anywho, I hope this clarifies a few aspects about both the source and research as well. LesVegas (talk) 18:03, 19 January 2015 (UTC)

Misrepresenting the source

The conclusion was "Our meta-analysis suggests that that acupuncture could be a safe and valid treatment option for AR patients." The source is about safety.

How did an editor conclude "A 2015 meta-analysis showed a significant reduction in nasal allergies, medication scores, and serum IgE levels in patients receiving acupuncture versus the control group. "? QuackGuru (talk) 19:52, 16 January 2015 (UTC)

? The source says "we collected and analyzed the randomized controlled trials (RCTs) of acupuncture for the treatment of AR patients to assess its efficacy and safety"Herbxue (talk) 20:02, 16 January 2015 (UTC)

Hi QuackGuru, under results, the source says "Compared with control group, acupuncture treatment group exerted a significant reduction in nasal symptom scores (weighted mean difference : -4.42, 95% confidence interval : -8.42 to -0.43, p = 0.03), medication scores (WMD: 1.39, 95% CI: -2.18 to -0.61, p = .0005), and serum IgE (WMD: -75.00, 95% CI: -91.17 to -58.83, p < 0.00001)." In the future, please assume good faith before claiming the source is being misrepresented. LesVegas (talk) 20:06, 16 January 2015 (UTC)

You misrepresented the source. Read the comment by Herbxue. We should summarize the conclusion. QuackGuru (talk) 20:15, 16 January 2015 (UTC)

I'm still confused, what was misrepresented? My comment above is that the source states it assessed both safety and efficacy. The wording in question comes right from the results section. Herbxue (talk) 20:38, 16 January 2015 (UTC)

Ehm... Herbxue quoted that "...we collected and analyzed the randomized controlled trials (RCTs) of acupuncture for the treatment of AR patients to assess its efficacy and safety...". And LesVegas reported the very findings of the source concerning what Herbxue quoted, isn't it? Quite impressive p's, don't you think? Cheers! Jayaguru-Shishya (talk)

Herbxue, the conclusion was not summarised. QuackGuru (talk) 20:43, 16 January 2015 (UTC)

Oh I get it now, the text added to the article came from the results section rather than the conclusions. Are we trying to only use the conclusions of studies and not cite anything from the body? I would be generally ok with that if we're doing that across the board. And yes JS, those p values are lovely :) Herbxue (talk) 20:49, 16 January 2015 (UTC)

The results were not the conclusion. The text is summarised as other text in the same section. The source sad "Compared with control group, acupuncture treatment group..." The acupuncture treatment group does not represent acupuncture as a whole. Obviously the text was original research. QuackGuru (talk) 21:13, 16 January 2015 (UTC)

QuackGuru, as you said, the source said, "Compared with control group, acupuncture treatment group.." and the edit said "in patients receiving acupuncture versus the control" which is a valid representation of the source. And obviously, by stating acupuncture vs. control the edit wasn't trying to represent acupuncture as a whole. It was attributed to a 2015 meta-analysis, afterall. You're essentially claiming that the edit said, "Acupuncture causes XYZ in all cases, in all cases, everytime, everywhere" Why are you misunderstanding what is rather obvious? LesVegas (talk) 21:27, 16 January 2015 (UTC)

A control group from the results section does not represent the conclusion of acupuncture in general. This is also undueweight to include a control group. What you want to include appears to contradict the conclusion. QuackGuru (talk) 21:57, 16 January 2015 (UTC)

QuackGuru, seriously? With due all respect, but I think your comment shows that you are not really familiar with statistical science. Indeed QuackGuru, that's the "sample". How representative the sample is, is another issue. Jayaguru-Shishya (talk) 22:17, 16 January 2015 (UTC)

"Thirteen full papers that met our inclusion criteria were included, and a total of 2365 participants, including 1126 as treatment group and 1239 as control group, were enrolled", pretty good n as well. Can't see any reason why we can't use this systematic review. Jayaguru-Shishya (talk) 22:22, 16 January 2015 (UTC)

The citation does not say acupuncture in general. Nor does it imply acupuncture in general. It says acupuncture vs. control group. It said "A meta-analysis showed.." Meta-analyses are, by their nature, never representative of a treatment modality. You've added meta-analyses to the article and should know that they aren't entire representations of a modality. Nor does anyone think this. In fact, nearly every meta-analysis cited in our article goes something like, "A 2013 meta-analysis showed acupuncture, compared to sham, showed X." No reasonable person would think acupuncture in general is being stated here. QG, listen, you really need to work towards being more collaborative rather than undoing work. Constantly misunderstanding editors on talk pages and quibbling over obviously implied wording really doesn't help us build a good encyclopedia either. I'm afraid this is such an ongoing problem with you, I have no other option than to report this. LesVegas (talk) 22:08, 16 January 2015 (UTC)

You wrote "A 2015 meta-analysis showed a significant reduction in nasal allergies, medication scores, and serum IgE levels in patients receiving acupuncture versus the control group." This is a broad and misleading claim.

The read conclusion: "Our meta-analysis suggests..."

The raw data was not what the meta-analysis showed. After the researchers reviewed the raw data they came to a limited conclusion. I fix the wording. The individual studies distorted the POV of what the actual meta-analysis concluded. QuackGuru (talk) 20:54, 17 January 2015 (UTC)

QuackGuru, about a month ago you decided to twist an edit I made by framing the premise from the abstract as though it was a conclusion. So, just for the record, it is ok to quote an abstract out of context as a conclusion, but it's not okay to quote results from a meta-analysis? (even though we all do that pretty frequently, and you know that) If we should only quote from the conclusions, as you say, then how do you explain this edit? You added (or ineffective) to it, which was not in the conclusion, but rather from the "background" portion of the source I'm not here to play games with you, I'm here to build an encyclopedia. LesVegas (talk) 00:34, 18 January 2015 (UTC)

I never said it is not appropriate to quote from the results for certain situations. But for this meta-analysis I do think it is inappropriate (read my previous comments). Your providing an old diff. I continued to try to improve the wording for the source that most editors think is not MEDRS compliant.

The source is about "Acupuncture for the treatment of allergic rhinitis" in general. The individual symptoms from the results are what the researchers evaluated to come up with the conclusion for allergic rhinitis. QuackGuru (talk) 04:13, 19 January 2015 (UTC)

Rewording Nature citation

Re the Nature editorial about TCM :

At Talk:Traditional Chinese medicine, there has been an RfC: Is the Nature article an appropriate source for the claim it is attached to?. After input from ca. 20 editors, an uninvolved admin, Shii, closed the RfC; see section here (and diff here).

Based on their determination of consensus, I'm making the same change at this article: According to Nature, TCM is "fraught with pseudoscience". (Diff of change: ). Already made change at Traditional Chinese medicine article. --Middle 8 (contribs • COI) 08:46, 26 January 2015 (UTC) edited 09:03, 26 January 2015 (UTC)

Thank you Middle 8. For whatever it is worth, I emailed Nature asking them to clarify as to whether or not their position on TCM is that it is pseudoscience, since this was the contention. Here was their response:

Dear Les, Thank you for getting in touch regarding the editorial ‘Hard to Swallow’.

The best advice I can give you is just to quote the piece exactly as it is written and attribute it to Nature as a whole. The editor who was in charge of editorials in 2007 is no longer in that position and the current editor in not able to comment.

I am sorry not to be able to be of more help on this occasion.

LesVegas (talk) 19:33, 26 January 2015 (UTC)

Midle8, you violated consensus. The closing was only a suggestion and the wording was already changed. See diff. QuackGuru (talk) 22:30, 26 January 2015 (UTC)

QuackGuru I see no such violation of any consensus. This wording is what you alone support. I don't see any editors on the TCM talk page supporting this version. Most say they want it attributed. Please don't tell others they're violating consensus as justification to make edits only you support. LesVegas (talk) 22:57, 26 January 2015 (UTC)

It is attributed in the body and the part "with no logical mechanism of action for the majority of its treatments." was deleted for no good reason. QuackGuru (talk) 22:58, 26 January 2015 (UTC)

Explained in closing admin's comment section here (and diff here): "Accordingly, the following wording should not be employed...". Which I referenced multiple times: just above , mainspace diff , and in two diffs at TCM article . --Middle 8 (contribs • COI) 00:35, 27 January 2015 (UTC)

The text is attributed to Nature and you have failed to explain why you deleted "with no logical mechanism of action for the majority of its treatments."

11:55, 12 May 2014

5:40, 25 June 2014

01:09, 4 July 2014

23:57, 4 July 2014

You were warned to not make changes like that. QuackGuru (talk) 00:46, 27 January 2015 (UTC)

Kww asked me to make sure there was consensus before making any similar edits, and very obviously, I edited precisely according to the consensus that the closing admin determined. Your diffs are cherry-picked and your complaint is WP:GAME-ing: the exact same kinds of edits were being made by you and others . Seems to me you're IDHT-ing, ignoring consensus and dredging up old WP:GAME-ing. Don't do that. You should be officially warned for this kind of conduct. --Middle 8 (contribs • COI) 03:29, 27 January 2015 (UTC)

You are continuing to avoid explaining why you deleted "with no logical mechanism of action for the majority of its treatments." on 08:53, 26 January 2015.

You did roughly the same thing against consensus before on 11:55, 12 May 2014. QuackGuru (talk) 03:34, 27 January 2015 (UTC)

The wording was recently changed to closely reflect the source. I don't see any editor wanting to revert back to Middle 8's bold change now that the wording was adjusted. QuackGuru (talk) 20:54, 27 January 2015 (UTC)

QG - the now-closed discussion indicates that the intent of the nature source's wording is unclear, that it is a weak source for the claims it is being used to make, and that the wording within the source is describing prevalent opinions rather than expressing that opinion. The consensus is that we use that source to say something like "a Nature editorial notes that TCM is characterized as fraught with pseudoscience". It is not productive to keep arguing about this source. The source is not strong enough to support the text "no valid mechanism for the majority of its treatments". I was gone for six months and we're still talking about this same article. Maybe we should remove it altogether so some progress can be made?Herbxue (talk) 22:40, 27 January 2015 (UTC)

You wrote "Maybe we should remove it altogether so some progress can be made?" That is unproductive. Other editors have also edited the text to improve it. I disagree with your proposals. QuackGuru (talk) 23:07, 27 January 2015 (UTC)

I too disagree with removing it, but I understand Herbxue's frustration with beating this horse, especially given the RfC. --Middle 8 (contribs • COI) 16:58, 28 January 2015 (UTC)

Am making a bold revert to original RfC wording ("fraught with pseodoscience") and removing the rest about mechanism and drug discovery for the simple reason that Nature is talking about herbs, not acupuncture. That's unambiguous. The cite is fine re pseudoscience, but it's undue weight to discuss herbs except in passing -- especially in the lede. For the criticisms of the mechanisms of acupuncture -- which I agree obviously weigh -- we should rely on sources that actually discuss that point, not sources that discuss herbs. We actually mention this already under Effectiveness, with another Nature source: A 2014 Nature Reviews Cancer article found that "contrary to the claimed mechanism of redirecting the flow of qi through meridians.... --Middle 8 (contribs • COI) 01:41, 28 January 2015 (UTC)

Comment on attack list of diffs above: QuackGuru, I find your postings above of my four similar edits of a Nature citation to be WP:GAME-y. You're implying that my multiple edits were improper, when you too were making multiple edits to the exact same citation:

20:00, 24 May 2014

19:59, 5 June 2014

3:01, 29 June 2014

and most recently this 22:25, 26 January 2015, which -- unlike any of my edits you listed -- was flagrantly in violation of consensus. Specifically, you reverted against Shii's finding of consensus in an RfC: section here (and diff here).

More on your talk page:

I see a different problem. We haven't explained why the statement "TCM is fraught with pseudoscience" is relevant to this article. In addition to attempting to imply synthesis by adjacency, the argument:

• Acupuncture is based on TCM
• TCM is (fraught with) pseudoscience

Therefore

• Acupuncture is (fraught with) pseudoscience.

is quite faulty. If Nature commented on acupuncture, that would be a different matter, entirely. I'm not sure which RfC or noticeboard results I am disputing, if any, but there is something rotten in the State of Denmark. — Arthur Rubin (talk) 01:01, 29 January 2015 (UTC)

It may be relevant in the body, which discusses TCM in more detail, but not in the lead, even if acupuncture is a "core belief" in TCM. — Arthur Rubin (talk) 01:04, 29 January 2015 (UTC)

Arthur Rubin, I'm not as concerned about it simply for WP:SNOWBALL reasons; we have editors here (one in particular) who want to see pseudoscience mentioned as often and as prominently as possible, even when the sources don't match the assertion.

On a related note, see the lede's 2nd para, 3rd sentence: "A systematic review of systematic reviews found that for reducing pain, real acupuncture was no better than sham acupuncture and concluded that there is little evidence that acupuncture is an effective treatment for reducing pain." Again, the source doesn't support the claim; the relevant sentence is taken out of context. My analysis here. We actually had a discussion on this at WT:MED, and agreed on a bold edit by User:Manul (previously Vzaak) to fix the wording. I've tried to restore it , but one editor (QuackGuru) insisted otherwise, despite initially supporting the consensus. Such is the editing environment here. --Middle 8 (contribs • COI) 02:43, 29 January 2015 (UTC)

QG, I feel your pain. It's clear to me that the RFC reached the wrong conclusion, as it was started by someone that played a logical game with the opening sentence. He failed to take into account the interplay between that opening line of "one answer is that it is largely pseudoscience, with no rational action for the majority of its treatment" with the subsequent "fraught with pseudoscience" quote. The Nature editorial clearly says just what you think it does, and your edits, in a perfect world, would be fine. However, the misphrased RFC was then closed by an editor that didn't pay heed to any of the comments that indicated how the RFC had been swayed by the misleading opening statement, and now we're stuck. In a few weeks, I'll try to reopen the RFC, but for now, lay off. It's a flawed consensus, no doubt about that, but it is against the text you are trying to preserve.—Kww(talk) 03:02, 29 January 2015 (UTC)

I understands me some grammars purty well, as do some of the others who expressed doubt. I agree it's not slam-dunk clear, although I don't strongly object to your an QG's reading. The statement about mechanism is stronger than, and doesn't necessarily follow from, the "fraught" statement. Given reasonable doubt among editors, I see no harm at all in simply quoting the unambiguous section of the text. It's a reasonable compromise. That accords with what Nature's staff suggested to Les Vegas, per above. Besides, we have plenty of other sources that are unambiguous in their criticism. --Middle 8 (contribs • COI) 05:37, 29 January 2015 (UTC)

Imo, I find it unacceptable that some editors dig their heels in and refuse to compromise continuously, breaking policies constantly, ignore consensus constantly while constantly engaging in battleground behavior by accusing others of exactly that, while good and decent behavior (like making concessions only because a snowball would ensue, or nobly declaring a possible COI) is rejected. Misplaced Pages shouldn't work this way. LesVegas (talk) 17:00, 29 January 2015 (UTC)

Middle 8 worte "That accords with what Nature's staff suggested to Les Vegas, per above." That's what was deleted from the body. The quote. QuackGuru (talk) 18:21, 29 January 2015 (UTC)

@ QuackGuru -- Two different issues.

• (1) Should the Nature editorial about drug discovery and herbs be quoted at length (including pro and con arguments about herbal preparations) in this article? No, and especially not in the lede; talk about undue weight! And THAT is why I removed the text from this article on 28 January. I explained this three times before: above at 1:41, 28 Jan); in my ES; and at FTN.
• (2a) Should either article depict Nature as saying TCM is "largely PS with no valid mechanism..."? According to the RfC closure, no. Hence my edits here and at the TCM article . I explained those edits no less than five times, as I pointed out on your user talk (version here).
• (2b) However, can we rephrase the text neutrally and use at in the TCM article? Yes. Per the RfC closure, the version on the left hand side of this diff is not OK, but the version on the right is. I'm sure that you, QG, will understand this since you wrote (or helped write) both versions.

Again, QG, I hope these answers help. But if you still wonder, just keep asking! I'll be happy to answer as often as you'd like. --Middle 8 (contribs • COI) 07:48, 30 January 2015 (UTC) removed redundant commment 19:58, 30 January 2015 (UTC)

Yes, when a respected and neutral editor wants to remove the source altogether from the Acupuncture lede and Middle 8 shows restraint in order to keep the peace around here, don't you see how over the top it is to make attacks at him? Saying there is a violation of consensus when there is none is bad enough. It's even worse when there is consensus on TCM not to use certain wording, and you're editing against it. LesVegas (talk) 21:27, 30 January 2015 (UTC)

Consensus per RfC

Past behavior

11:55, 12 May 2014

5:40, 25 June 2014

01:09, 4 July 2014

23:57, 4 July 2014 Kww warned Middle 8 to not make changes like that without consensus.

Current behavior

User:HJ Mitchell also warned Middle 8 "to respect Misplaced Pages policies on neutrality, consensus, and verifiability as well as all other applicable policies. Should you fail to adhere to this warning, there is a high probability that you will face substantive sanctions in the future."

Middle 8 was also notified of the sanctions specifically for acupuncture by User:Callanecc from the Arbitration Committee.

Middle 8 wanted the wording to be "According to Nature, TCM is "fraught with pseudoscience". So what did Middle 8 do? He replaced the wording with what he wanted without gaining consensus first.

Note: In the context of TCM, the traditional therapies in China are TCM. The Nature editorial is about TCM, and the mention of traditional therapies is clearly a referral to TCM's traditional therapies. There is nothing in the editorial that suggests otherwise.

Violation of consensus by Middle 8.

Violation of consensus again by Middle 8.

There were "many requests for proper context and phrasing to be supplied." See Talk:Traditional Chinese medicine#Result.

Shii (tock) wrote "My point in setting out that example sentence was to show what views could be attributed directly to Nature and not to say that only three words could be used and the rest could not be mentioned." See Talk:Traditional Chinese medicine#Result.

I requested confirmation that the result from the RfC was what I knew all along. Middle 8, if you follow WP:COIADVICE this may not happen again. QuackGuru (talk) 20:56, 5 February 2015 (UTC) QG, drop this line of argument. Consider this an administrative warning. There was a recent RFC. As flawed as the problem statement in that RFC was and as ridiculous as the close was, Middle 8's edits are largely in compliance with it. If you want to find a wording that conforms to the RFC and is a little more forceful than the current statement, feel free to propose it, but bringing up nine-month-old edits in an effort to paint him making those particular edits in bad faith is unreasonable.—Kww(talk) 21:26, 5 February 2015 (UTC)

Confusing misplaced text is stepping on WP:SYN

The text is misplaced and was not a response to both Edzard Ernst and David Colquhoun. QuackGuru (talk) 18:21, 29 January 2015 (UTC)

Actually, Vickers makes this exact point (paraphrased) both in the original paper and in his response to Ed & Dave; apparently he anticipated their criticism. I'm happy to cite either or both if you like. --Middle 8 (contribs • COI) 20:56, 29 January 2015 (UTC)

It was not a direct response to Edzard Ernst and David Colquhoun. The text is misplaced and undue. The source written in the article is "A 2012 meta-analysis conducted by". The reader does not know what is "Vicker's". The sentence does not make any sense as written. QuackGuru (talk) 21:08, 29 January 2015 (UTC)

Fine, so tell me how you'd like to see it improved. Point taken re the reader not knowing who Vickers is; we can mention that. Should we mention Vickers' point before Ernst and cite to Vickers original review, or mention it after Ernst and cite to his response to Ernst? Or both? Like I said, he makes the same point in both.--Middle 8 (contribs • COI) 21:30, 29 January 2015 (UTC)

Since it was not a direct response to Edzard Ernst or David Colquhoun it should not be used to counter the point made by Edzard Ernst or David Colquhoun. You can't improve a SYN response. QuackGuru (talk) 17:53, 30 January 2015 (UTC)

Like I said, Vickers addresses their point twice: in his review (where he apparently anticipated it), and in his published response. Per NPOV we need to cite at least one of these. --Middle 8 (contribs • COI) 20:03, 30 January 2015 (UTC)

Vickers' review :

• Our finding that acupuncture has effects over and above those of sham acupuncture is therefore of major importance for clinical practice. Even though on average these effects are small, the clinical decision made by physicians and patients is not between true and sham acupuncture but between a referral to an acupuncturist or avoiding such a referral.

Vickers' reply to Colquhoun and Ernst :

• The one critique in the scientific press, published on the website of the BMJ, came from David Colquhoun, a well-known critic of complementary therapies. He stated that ‘acupuncture does not work to any useful extent … Vickers et al showed that the difference is far too small to be of the slightest clinical interest’.2 Colquhoun’s point appears to be that ‘clinical interest’ depends on the difference between acupuncture and sham, whereas we argue that that the decision taken in clinical practice is between referring to acupuncture or not doing so.

Vickers also says that the difference between sham and verum -- the same difference Colquhoun speaks of -- is comparable to NSAIDs. Additionally, re Ernst's criticism and that of one blogger, he says:

• Edzard Ernst was cited in several media outlets as stating: ‘I fear that, once we manage to eliminate this bias … we might find that the effects of acupuncture exclusively are a placebo response’.6 One blogger asserted that acupuncture ‘has an effect size that is very small and, in my opinion, overlaps with no effect at all’.3 It is simply bizarre to dismiss years of careful statistical analysis on the grounds that results ‘might’ change; similarly, it should go without saying that whether an effect size overlaps with no effect is not a matter of opinion but of CIs.

He also refuted Ernst's criticism about unblinding (which Novella also voiced). In general we weight Vickers insufficiently: it's not explictly mentioned in the lede despite being the most rigorous type of meta-analysis (IPD), and in the body we say relatively little as well. We don't even specify which kinds of pain they reviewed. --Middle 8 (contribs • COI) 09:48, 31 January 2015 (UTC)

I'm happy with stating Vicker's primary conclusion in the lead, that any actual effect of acupuncture is small relative to the placebo effect. What I would oppose is placing any strong emphasis on his comfort level with recommending placebo therapies: that's a social issue, not an issue of facts related to what acupuncture is. That's really the major argument between Vickers and others: Vickers vehemently argue that we should compare acupuncture to non-treatment, where others compare it to placebo treatments only. All major reviews agree that the delta between placebo treatments and acupuncture is small, and that statement of consensus belongs in the lead.—Kww(talk) 01:04, 1 February 2015 (UTC)

Vickers, A. J.; Maschino, A. C.; Lewith, G.; MacPherson, H.; Sherman, K. J.; Witt, C. M. (2013). "Responses to the Acupuncture Trialists' Collaboration individual patient data meta-analysis". Acupuncture in Medicine. 31 (1): 98–100. doi:10.1136/acupmed-2013-010312. ISSN 0964-5284. PMID 23449559.

Including both lengthy quotes is too much. Please make a specific propose using a reliable source. I thought there was a previous discussion that found "Acupunct Med" was unreliable. Maybe someone can check the archives. I'm not sure if we can use this specific source. QuackGuru (talk) 01:11, 1 February 2015 (UTC)

Okay, I just checked the archives and found it, and yes, there was actually consensus. But actually the consensus was that it's reliable and you were IDHT'ing. Scroll down to your comment, "The proposal to use the fringe Acupuncture in Med journal makes no sense" LesVegas (talk) 02:05, 1 February 2015 (UTC)

See Wikipedia_talk:Identifying_reliable_sources_(medicine)/Archive_8#Question_about_a_journal. QuackGuru (talk) 03:03, 1 February 2015 (UTC)

AAO-HNS has included acupuncture as a treatment option for allergic rhinitis

In Clinical Practice Guideline: Allergic Rhinitis, released February 2, 2015, the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) has included acupuncture as a treatment option for allergic rhinitis:

Clinical Practice Guideline

http://oto.sagepub.com/content/152/1_suppl/S1.full

Executive Summary

http://oto.sagepub.com/content/152/2/197.full

Plain language summary for patients

http://www.entnet.org/sites/default/files/uploads/PracticeManagement/Resources/_files/allergic-rhinitis-plain-language-summary.pdf

Allergic Rhinitis Diagnosis and Treatment Flow Chart

http://www.entnet.org/sites/default/files/uploads/PracticeManagement/Resources/_files/fig2-diagnosis-and-tx-flow-chart-ar.pdf

-A1candidate 13:48, 4 February 2015 (UTC)

Yes basically says low quality evidence supports the use of acupuncture for allergic rhinitis. It also says "Research is needed to determine the safety and efficacy of acupuncture for AR. There is a relative paucity of data in the English-language literature regarding the use of complementary and integrative medicine for AR. As such, specific recommendations for or against these treatments could not be made. Higher levels of evidence regarding these therapies need to be obtained through well-designed clinical trials and/or systematic reviews of existing data." Doc James (talk · contribs · email) 15:28, 4 February 2015 (UTC)

Grade B evidence is not considered low quality. The rest of the statment deals with "complementary and integrative medicine" generally, not acupuncture. -A1candidate 15:36, 4 February 2015 (UTC)

You two are obviously not reading the same study. — Arthur Rubin (talk) 16:54, 4 February 2015 (UTC)

This is more of a clinical practice guideline than a "study". -A1candidate 17:02, 4 February 2015 (UTC)

Yes, you are correct that these are clinical practice guidelines and that grade B evidence is not low quality. Also receiving a grade of B was "control of environmental factors" (recommending getting rid of pets, dust mite avoidance, air filter change, etc.) and IgE skin testing, both of which are pretty routine standards of care. LesVegas (talk) 20:49, 4 February 2015 (UTC)

The recommendation was apparently not based on evidence of effectiveness. At least there is no indication of such in the executive summary. It was recommended because it is not expensive and is unlikely to cause harm. — Arthur Rubin (talk) 02:01, 5 February 2015 (UTC)

Read it again carefully. The decision by AAO-HNS to allocate a Grade B level of evidence is based on RCTs and observational studies. This is explicitly stated in the full text of the executive summary. -A1candidate 09:32, 5 February 2015 (UTC)

Open this http://oto.sagepub.com/content/152/1_suppl/S1.full and search for "Higher levels of evidence regarding these therapies need to be obtained through well-designed" and you will see the text I have copied and pasted above. Doc James (talk · contribs · email) 13:31, 5 February 2015 (UTC)

Nobody is doubting your ability to copy and paste. The evidence was rated as Grade B based on RCTs and observational studies. Further research is of course warranted -A1candidate 13:46, 5 February 2015 (UTC)

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