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Medicine B‑class Mid‑importance

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Nothing new here, just another link

Citations, references and OR need a clean up

• The citations and references on this page are not formatted correctly. Can someone clean them up? I can also see quite a bit of original research that should be deleted. Skoppensboer 16:26, 25 November 2006 (UTC)

Pentosan

http://archinte.ama-assn.org/cgi/content/abstract/167/18/1922?etoc Systematic review finds pentosan moderately effective. JFW | T@lk 05:24, 9 October 2007 (UTC)

Additional External Link

I think a good reference for those who want to read more about IC outside of Misplaced Pages is the Interstitial Cystitis Association (ICA). I would like to add this in as an External Link. Kat Malone (talk) 21:38, 4 January 2008 (UTC)

That link is available from the existing link. Unfortunately, WP does not allow links like that from within articles, see Misplaced Pages:WikiProject_Medicine/Reliable_sources. ► RATEL ◄ 04:19, 2 May 2008 (UTC)

Misleading claims

"Research has determined that the quality of life of IC patients is equivalent to those with end stage renal failure."

This is true for a sizable percentage of people diagnosed with IC, but not all. Some patients experience lighter, less frequent problems, and different symptom triggers. Some IC sufferers can avoid symptoms altogether simply by changing their diets. I think it's important to elaborate on this and avoid generalizing the symptoms too much. 74.242.122.25 (talk) 22:43, 26 July 2008 (UTC)

This is a medical page on Misplaced Pages. We do not go by what people think is important, but rather by what research has stated. ► RATEL ◄ 02:07, 27 July 2008 (UTC)

This is what medical research has already concluded about IC. I'm just surprised it hasn't already been elaborated on. I will add the information and references myself. 74.242.122.25 (talk) 17:46, 27 July 2008 (UTC)

Mild and even moderate IC are largely ignored in statements like the one above. I think this is because until very recently, only people who had extremely severe IC were diagnosed with the condition. It is unfortunate because I think it needlessly frightens many people with IC symptoms about what their lives may become. —Preceding unsigned comment added by 216.251.190.157 (talk) 20:55, 23 September 2008 (UTC)

Pain Control

I am undoing the undo on my changes re: CAM and pain control. Just saying "there is evidence, go check PubMed" doesn't cut it. Provide references, or stop making these claims. Specifically, provide references to studies published in reputable, peer-reviewed journals that show that acupuncture, biofeedback, and massage have been shown to alleviate pain in people suffering from interstitial cystitis. All I've found are studies that do not show any effects like this one. --Transity 03:03, 7 April 2009 (UTC)

It's a shame you are not prepared to do a proper job for the encyclopedia. I'm putting it back with citations. Do not revert until I am finished, 24hrs. ► RATEL ◄ 03:27, 7 April 2009 (UTC)

It's a shame that you don't seem to understand how citations are supposed to work. One would think that bit of knowledge was critical to doing a "proper job for the encyclopedia," and one might question who is really failing to do a proper job here.

Please do add your references - that way they can be properly checked. Asking readers to do the legwork to support unsupported claims is clearly unacceptable, and I honestly don't know how you can say otherwise.

I'll gladly give you as much time as you need to find proper sources - if you need more than 24 hours, that's fine. Just let me know when you're done. Depending on what you provide, and how my week goes, it could take me some time to review them. All I ask is that you provide links so that I can actually read the studies (and not just summaries without the actual information).

I await your response. --Transity 03:54, 7 April 2009 (UTC)

Hahaha! "Asking the readers to do the legwork" -- what do you think I am, other than a reader too? You have not the most basic understanding of how this community encyclopedia works. Funny. ► RATEL ◄ 03:56, 7 April 2009 (UTC)

Oh and BTW, there is no requirement in Misplaced Pages that I link you to the full study texts. Links to published abstracts suffice. ► RATEL ◄ 04:00, 7 April 2009 (UTC)

What do I think you are other than a reader? I'll avoid the temptation to be impolite (clearly not an important Misplaced Pages guideline to you) and instead state the obvious: in this case, you are acting as an editor and not merely as a reader. In your capacity as an editor, you were defending statements that had no references and asking others to go do the legwork that you didn't want to do. I'm pretty sure if you check the policies that references need to be more than "go check on pubmed."

And yes, I know you're not required to link to full studies. It just tends to make references more useful for readers and editors alike. But of course you are free to stick to the minimum effort required for your contributions, as your reply makes clear.

I'll review your sources when I can, and I'll let you know what I find. Since only two of six are linked, you've made my job (and the job of the readers, I might add) more difficult, as I'm sure you realize. But by all means, keep laughing. Well done. --Transity 04:24, 7 April 2009 (UTC)

By editing out material as you have done, you too are an editor. Surprise, surprise! That's why you are doing a bad job, not checking pubmed and improving WP by adding the citations yourself. But looking at your history, I see you are a SPA with an agenda, so no wonder. ► RATEL ◄ 04:51, 7 April 2009 (UTC)

You also incorrectly say that "only 2 of the 6 are linked". They are all linked. You are clearly new at this, aren't you? ► RATEL ◄ 05:03, 7 April 2009 (UTC)

Yes, I am also a reader and an editor. That obvious point didn't escape me. The same way that the obvious point that you are also a reader didn't escape me a few paragraphs up. But please go ahead and continue to erroneously treat these points as "revelations" to me so that you can laugh and pretend it's at my expense. And please continue to criticize my editing practices when you tried to use "there is evidence, go check PubMed" written in a history as a reference. I'm sure that's just how it's supposed to be done. And yes, I do have an agenda. My agenda is to make sure that misinformation and patent nonsense don't make their way into Misplaced Pages. Shame on me. I am rightfully chastised.

You are correct that all six are linked. It didn't appear that way on my BlackBerry last night. So yes, I also understand what a link is, how html works, how to use a mouse, and what colors are, before you decide to make your own day by building a few more useless, inane straw men. I honestly have nothing more to say to you until I review your references.

To that end, I have looked at your references for massage. One is a study that included 10 patients with IC. That seems to me to be a terribly low number. In part, that's because only a small subset of those studied had IC, while the rest had other conditions. I would recommend removing that reference. The other study had 21 participants, also not great, but better than 10. That said, it indicated that Thiele Massage was statistically effective for their participants. How about we modify the wording so that thiele massage is called out as beneficial to some patients? That way, it doesn't sound like we're saying that a Swedish massage or reflexology can make the pain go away?

I also checked your acupuncture references. One is a review that states: "There are hardly any controlled studies on alternative curative procedures although rather good results have been obtained in chronic pelvic pain syndrome with acupuncture as an additional therapeutic modality." That's all the abstract says and the review (not a study) isn't focused on acupuncture at all. The other review leans on acupuncture as actually manipulating Yin and Yang in the body, even though there is no scientific evidence that Yin and Yang (or chi or meridiens) exist. The review refers to a 1987 study that I can't locate online (not surprisingly). I checked the main article on acupuncture, and I would suggest the following expansion to this section for both massage and acupuncture:

Theile massage has shown promise in relieving the pain associated with Interstitial cystitis, though studies with larger sample sizes are needed.

Although acupuncture has been reported to alleviate pain associated with Interstitial cystitis in several cases, it is important to note that there is no known anatomical or histological basis for the existence of acupuncture points or meridians. In addition, at least one study found that acupuncture "seems to alleviate pain just barely better than sticking needles into nonspecified parts of the body" and concluded that some of acupuncture's effects may be due to the placebo effect.

I don't want to go too far in describing acupuncture on this page, but I do think it's important to let people know more than "acupuncture is beneficial to some patients." There is no evidence for the entire premise of acupuncture (chi, meridiens, etc.), and the reviews cited don't make their case anywhere near well enough to eschew that fact. I was okay with the addition of my general statement that these treatments lack scientific evidence, but since that was removed, the only other thing I can think of is expanding the descriptions thusly.

I'll post what I learn as a result of the biofeedback references, and make appropriate suggestions for that section at that time. For now, I'll open the above two modifications for comment. --Transity 14:35, 7 April 2009 (UTC)

This is not the place for original research or a synthesis of available studies and our own judgement as to what is worthwhile. Please review WP:MEDRS. WP is a tertiary source, and we rely mostly on secondary sources, especially where medical topics are concerned. If there is a peer-reviewed, published review study that reports acupuncture or staring at the Moon as beneficial, we insert it, even if we think it is hogwash. This is not the place for you to give free reign to your hatred of alternative and traditional healing methods like acupuncture (ironically with links to papers that in fact validate "modern" acupuncture). So we insert such data. And for that purpose, abstracts are perfectly acceptable. Now you are encouraged to insert countervailing studies that suggest otherwise, of course. Regarding massage, yes, it should be more specific in describing what sort of massage is being discussed. Are you aware of the new research linking UCPPS (includes IC) to trigger points, thereby validating both internal and external pelvic massage? I'm not sure of your training, but unless you are a urologist, best not to barge in here. On second thoughts, even if you are a uro, take care, because many are not up to speed on the latest research. ► RATEL ◄ 15:11, 7 April 2009 (UTC)

Indeed this is not the place for original research. What do you view as original research in my suggested text? I added a statement saying that there is no proof for the existence of chi or meridiens (surely that isn't the part you are questioning as there are no studies that prove that these energies exist), and another stating that a meta-analysis (not done by me) found that acupuncture doesn't differ from sham acupuncture, with a link to an article (should have linked to the BMJ abstract here instead. The only thing I can think of that you feel is original research is the statement that the placebo effect is at work, but that is also discussed in the article I linked to. So what original research are you talking about? I don't see any.

And yes, I'm fine inserting the references you provided for acupuncture (which is why I left them intact in my version), but simply inserting them and walking away isn't enough, in my opinion. The statements I made after those references are also valid, and are also backed up by references. So by your own logic, they must also be included here.

And no, I'm not aware of the other massage research you mentioned. Nor are the readers of Misplaced Pages at this time. What I am aware of is that Thiele massage has been shown to have some effect here (with small sample sizes), and I think that is a perfectly valid statement to make. If and when studies for other types of massage are referenced, they can also be reviewed and added as appropriate. Are you okay with the modification proposed re: Thiele massage? --Transity 15:42, 7 April 2009 (UTC)

I do see a problem with my text, though it's with the massage section and not the acupuncture section. My statement that larger sample sizes are needed reads like my opinion. So if this is what you mean, Ratel, I concur.

Alternatives would seem to be to either to backup that claim, or to change the wording to just point out the nature of the study cited without drawing any further inferences. I'm fine with the latter. That said, the fact that the sample size was small, there was no control group, and no blinding in this study is important (yes, I agree it is probably difficult to enact proper blinding with a treatment like this). So how about:

Thiele massage, a form of transvaginal massage, has shown promise in relieving the pain associated with Interstitial cystitis in preliminary studies.

Finally, I'd prefer to move this one away from acupuncture and biofeedback. Massage, used in this way, isn't CAM. It's more physical therapy. Thoughts? --Transity 17:05, 7 April 2009 (UTC)

Alternately, we could describe the study instead of calling it preliminary:

Thiele massage, a form of transvaginal massage, has shown promise in relieving the pain associated with Interstitial cystitis in at least one uncontrolled, unblinded, open trial.

--Transity 00:34, 8 April 2009 (UTC)

This is why a little knowledge can be dangerous. In the massage area, you are not even using the correct search terms on Pubmed because you are not aware of nomenclature changes and options for this condition. (Hint: PMID 15509457 ). ► RATEL ◄ 05:02, 8 April 2009 (UTC)

What I can or cannot find on PubMed has nothing to do with this discussion. You provided these sources, not me. I just checked them. I have no idea what you're talking about here. Here are the opening sentences of the source you linked to:

OBJECTIVES: To evaluate the effectiveness of transvaginal manual therapy of the pelvic floor musculature (Thiele massage) in symptomatic female patients with interstitial cystitis and high-tone dysfunction of the pelvic floor. METHODS: A total of 21 women with documented interstitial cystitis and high-tone pelvic floor dysfunction underwent transvaginal massage using the Thiele technique twice a week for 5 weeks.

From this alone, it is clear that Thiele massage is a type of transvaginal manual therapy (or massage), that 21 women were included in the study, and that all 21 received the same treatment (hence uncontrolled, unblinded). Looking at another source for this same study (here), we can see that it is classified as a pilot study, which we can use in place of "preliminary study". So how about:

Thiele massage, a form of transvaginal massage, has shown promise in relieving the pain associated with Interstitial cystitis in at least one open, pilot study.

This has nothing to do with how well I understand IC - it is simply about checking a source and parsing what is written there. As such, my sample language for massage is valid. If you have a specific issue with it, please spell it out. If someone who knows more about, say, massage/PT and IC than either of us decides to weigh in, now or later, they can certainly do so. But until then, we have an obligation to make this the best section we can make it, and the way it reads today certainly doesn't qualify. So yes, I agree that someone with more knowledge in the field of PT and IC could improve this section greatly, but look at what's there today, and help me understand how my text isn't a clear improvement over that:

Complementary therapies such as acupuncture, massage, and biofeedback are also beneficial to some patients.

That tells readers next to nothing. In fact, it leaves the impression that massage is CAM (in this case, it certainly is not), and it leaves open what kinds of massage have been shown to be effective (Reflexology? Shiatsu? Swedish massage? I'd bet most people wouldn't come up with transvaginal massage from the statement above). In my version, I simply tried to accurately represent the study presented. And for the record, I have no issues with using targeted massage to treat specific pain. There is no scientific consensus that this type of treatment shouldn't work, so I'm not trying to make a case against this approach. I'm just trying to improve on the vague, misleading (IMO) text that appears now.

For acupuncture, my language is likewise sourced and valid, and it complies with WP policies and guidelines on how to treat such issues (WP:UNDUE) - your source presents acupuncture as successful, and mine explains that acupuncture is not statistically different from sham acupuncture, and that there is no scientific evidence for chi or meridiens. One study makes a claim, another says "yes, but..." and the readers can decide what to make of it.

Acupuncture has been reported to alleviate pain associated with Interstitial cystitis in several cases. However, it is important to note that there is no known anatomical or histological basis for the existence of acupuncture points or meridians. In addition, at least one study found that acupuncture "seems to alleviate pain just barely better than sticking needles into nonspecified parts of the body" and concluded that some of acupuncture's effects may be due to the placebo effect.

So if you have specific issues with any of my text, please spell them out. Otherwise, let's use them. --Transity 14:12, 8 April 2009 (UTC)

I don't have the time for debating this with you. Go ahead and make your changes and I'll alter them in situ. ► RATEL ◄ 00:57, 9 April 2009 (UTC)

Okay - I'll review the biofeedback references, and rework that section similarly to how I reworked acupuncture. Then I'll add these into the Pain Control section, which will likely require some reorganization of the section (as I said, Thiele massage should probably be under PT, not CAM). It'll probably take me a day or two to get it done.

Despite what you may think, my goal is to improve this section, not to squash any mention of alt med. I hope you review my revisions in that light. --Transity 03:28, 9 April 2009 (UTC)

Edits

My edits regarding Pain Control are now in place. Here's a summary of what I did, and my rationale for each change.

1) Created sub-headers under Pain Control. As discussed, Thiele massage isn't a CAM treatment, but really is Physical Therapy (that is made clear in the reference). As such, I created a sub-header for PT. I also moved the information about drugs to a Drug Treatment sub-header, and created a sub-header for CAM to house the information on acupuncture and biofeedback.

2) Moved Pain Control to the bottom of the Treatment section. Leaving it where it was made the flow of headers difficult to understand as it wasn't immediately clear that the following three headers were sub-headers to Pain Control and not their own sub-headers under Treatment.

3) Massage. I called out Thiele massage instead of just referring to massage since that is the technique that was used in the study referenced. I explained that Thiele massage is a form of transvaginal therapy to make it clear that we aren't talking about something you can get at a Day Spa. I did call out that the trial was open (no control, no blinding) and a pilot study (these qualifiers are stated in the study itself). I did this because, compared to the study referenced for drug therapy for example, it should be clear that currently there is significantly less evidence backing up this treatment.

4) TENS and PTNS. I moved these under PT as this is how they are categorized in their respective Misplaced Pages articles. I also marked these statements as needing citations. In addition, there is a statement listed under "Other Treatments" that says: "Neurostimulation techniques are not FDA approved for IC." TENS and PTNS are forms of neurostimulation. It is unclear what the FDA position is on using neurostimulation for IC symptoms - some sources I have seen say that some devices are approved for some symptoms. I have marked this statement as needing a reference for now, and moved it up to the bottom of the section on TENS and PTNS. Note that I haven't altered any of the material in this section - it is all still worded as I found it. I merely moved it all to one section, and added citation tags. In my opinion, everything stated in the TENS and PTNS section is in need of assistance.

5) Biofeedback. In the studies mentioned, and in line with the general understanding of what biofeedback is, I identified biofeedback as a relaxation technique aimed at allowing people to control various autonomic functions. The references both treated biofeedback as a complementary relaxation therapy to be used in addition to drugs and/or hydrodistention of the bladder - neither tested biofeedback as a standalone treatment. As such, I called out the tested use of biofeedback as one part of a multimodal approach.

6) Acupuncture. I left both references claiming that acupuncture is effective in alleviating IC pain. I then went on to mention that (contrary to one of these references) there is no scientific basis for the existence of acupuncture points or meridians (with references to backup that claim). I also linked to an analysis in the British Medical Journal that concluded that sham acupuncture works just as well as real acupuncture. This, I believe, is a properly balanced write-up on the use of acupuncture to treat IC pain as it presents information on both sides of the debate, weighted proportionately.

Please let me know if anyone has any questions or concerns. --Transity 20:01, 9 April 2009 (UTC)

I reorganised most of it and removed the critique of acupuncture, which is not appropriate on this page (add it to the acupuncture page please). I'm still not happy with this page, which is waaaaay behind the page at CPPS, the male version of the condition. ► RATEL ◄ 00:45, 10 April 2009 (UTC)

Nice work. I think you've improved upon the entire treatment section significantly with your latest edit. But I don't agree with your edit on the acupuncture entry. As it reads right now, I believe the entry is giving undue weight to a minority view on the efficacy of acupuncture in general, and for this condition. This is what one of the cited sources says about acupuncture and IC:

Acupuncture is over 5000 years old. Neuromodulation through acupuncture occurs by re-establishing a balanced flow of energy, termed Yin and Yang, throughout the body through 12 meridians and 1000 acupoints. A rebalance of energy flow is thought to occur by increasing endorphin production and pain ablation by stimulating A delta, large-diameter, myelinated sensory nerve fibers with the inhibition of unmyelinated sensory C-fibers. Rapkin and Kames reported the results of a study of 14 patients with pelvic pain who had 6–8 weeks of acupuncture therapy twice a week. Eleven patients had a >50% reduction in pain. Our experience at the Pelvic Floor Institute shows that IC patients need 10–20 acupuncture treatment sessions in order to achieve symptom relief. Further studies are needed to determine the efficacy of acupuncture therapy in patients with IC.

This source is clearly stating that acupuncture points and meridians and chi (yin and yang here) are behind the success of acupuncture, in general and for IC. Belief in the existence of chi falls under the header of "generally considered pseudoscience", and it is clearly a minority point of view (WP:UNDUE). From the NPOV policy concerning pseudoscience and minority points of view:

Please be clear on one thing: the Misplaced Pages neutrality policy certainly does not state, or imply, that we must "give equal validity" to minority views. It does state that we must not take a stand on them as encyclopedia writers; but that does not stop us from describing the majority views as such; from fairly explaining the strong arguments against the pseudoscientific theory; from describing the strong moral repugnance that many people feel toward some morally repugnant views; and so forth.

So yes, I agree that this is not the place to debunk acupuncture. However, the deleted text concerning the majority view about chi and acupuncture points should be added back in order to properly balance the minority view with the current scientific consensus which is that chi and acupuncture points are not real. I haven't added it back at this time, and I welcome your comments, but I feel very strongly that it cannot be omitted. --Transity 02:16, 10 April 2009 (UTC)

If you can find a study that criticises acu. in the context of IC/PBS, then go ahead and add it in. However, any criticism of acupuncture itself is a matter for the acupuncture page, otherwise it's merely you soapboxing. It's also verging on your own original research to state this argument in the IC context. And it's definitely a synthesis of data. (BTW, you seem unaware that one of the sources you gave states that acu. may work for complex neurological reasons, quite apart from all the chi/meridian mumbo-jumbo.) ► RATEL ◄ 03:27, 10 April 2009 (UTC)

I'm sorry, but I disagree with you on all counts. I'm not soapboxing, and this isn't even vaguely original research (that one's a real stretch). It also isn't a synthesis of data as evidenced by the fact that I have sources that say exactly what I'm saying here. What data had to be synthesized? Here's a quote from the NIH Consensus document:

Despite considerable efforts to understand the anatomy and physiology of the "acupuncture points," the definition and characterization of these points remain controversial. Even more elusive is the scientific basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and other related theories, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture.

There's no need for me to synthesize data or do original research when the NIH document clearly states that there is no scientific basis for Qi, meridians, etc. So please stop leaning on the argument that I'm doing original research when that claim is demonstrably untrue.

Here's the thing: your source states quite plainly that acupuncture works by realigning Yin and Yang energies at work in the body. My sources states that this is not the majority view of science. And that's why it should be (and, frankly, needs to be) included. So no, I do not have to find a study that criticizes acupuncture in the context of treating IC - that's a red herring, plain and simple, and I reject that assertion outright. My text should be added back because leaving out my text gives undue weight to a minority view in pseudoscience. Including my text remedies that problem.

For the record (and off the record as this is merely my opinion), acupuncture may well be able to relieve pain through a combination of the placebo effect and one or more physiological affects (e.g. release of endorphins/opioids). So yes, I am quite aware of the other contents of the reference you are talking about - that's not a "gotcha" to me. Of course, any effects beyond placebo are still not proven, but that doesn't fall under the heading of pseudoscience. Chi does. If this article is going to claim that acupuncture works by way of these pseudoscientific claims by citing a source that says just that, then it must also take care to make the majority view of science abundantly clear. --Transity 04:16, 10 April 2009 (UTC)

I think you'll find that adding your own cautionary words to modify the conclusions of a published study is indeed WP:SYN. It's not for us to find a conclusion here, a statement there, and tie them together to show cause. ► RATEL ◄ 04:27, 10 April 2009 (UTC)

I haven't added my words at all. I've explained where the information came from. I've referenced the WP policies that you mentioned and explained why this text isn't soapboxing, original research, or synthesis of data. Here's the description of synthesis of data:

Do not put together information from multiple sources to reach a conclusion that is not stated explicitly by any of the sources.

Here's what the source I referenced says:

Despite considerable efforts to understand the anatomy and physiology of the "acupuncture points," the definition and characterization of these points remain controversial. Even more elusive is the scientific basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and other related theories, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture.

Here's what I'd like to add to the article:

However, it is important to note that there is no known anatomical or histological basis for the existence of acupuncture points or meridians

It seems clear to me that this statement follows directly from the source material - the fact that there is no scientific basis for qi et al. But if you prefer, we can say:

However, it is important to note that there is no known anatomical basis for acupuncture points, and that there is no scientific basis for the existence of qi or meridians.

This revised text now directly mirrors the source material, without simply copy/pasting it. Problem (whether it existed or not) solved.

And how about the rest of my deleted text? That reads:

In addition, at least one study found that acupuncture "seems to alleviate pain just barely better than sticking needles into nonspecified parts of the body" and concluded that some of acupuncture's effects may be due to the placebo effect.

No synthesis of data there. This comes directly from the source materials. So again, let's add it back.

I've explained my rationale for why this text must be added back, and I've cited WP policies backing up my assertion. If you have no actual, valid arguments against adding this information back to the article, then we need to do so. The latest version of the deleted text now reads:

However, it is important to note that there is no known anatomical basis for acupuncture points, and that there is no scientific basis for the existence of qi or meridians. In addition, at least one study found that acupuncture "seems to alleviate pain just barely better than sticking needles into nonspecified parts of the body" and concluded that some of acupuncture's effects may be due to the placebo effect.

I've dropped the Mann reference. I see why it was used in the acupuncture article (statement against interests and all), but I'm happy to rely on the NIH consensus statement here if it will help you to see that there is no synthesis of data. So let's add this text (above) back. --Transity 13:26, 10 April 2009 (UTC)

• No, it's not going back in and here's why: it is WP:SYN. You need to read the SYN page more carefully. I'll paste the relevant text:

Editors should not make the mistake of thinking that if A is published by a reliable source, and B is published by a reliable source, then A and B can be joined together in an article to reach conclusion C. This would be a synthesis of published material that advances a new position, and that constitutes original research. "A and B, therefore C" is acceptable only if a reliable source has published the same argument in relation to the topic of the article.

So as I said, find a study that voices these warnings in relation to IC/PBS or it is a soapboxing piece of OR. Thank you. ► RATEL ◄ 14:06, 10 April 2009 (UTC)

Your example is patently incorrect, as I've explained already. I am not taking two sources and coming up with a statement. I am taking one source - the NIH Consensus - and using that one source to make a statement. I showed that definitively above. Simply repeating this assertion without acknowledging that fact isn't productive because your assertion doesn't apply at all to what I've actually done.

If you want to continue to make this assertion, then I assert that you have to step through what you see as my synthesis of data, or original research. Show me where and how I did that for my deleted text. Show me the two (or more) sources that I have combined. Show me how what I've said isn't stated in the NIH source alone. Frankly if my text was any more similar to the NIH text it would border on plagiarism, so I don't see how any rational person could come to the conclusion that it's WP:SYN.

There are two other statements made in my deleted text. One part says:

(Note that I replaced "study" with "review of acupuncture studies" above.) As indicated, this is a quote from the referenced source, which says the exact same thing:

It's a direct quote. Nothing could be farther from WP:SYN. The other part of my deleted text says:

Read the analysis - it clearly says that the placebo effect may be at work based on what they found. In fact, this is a pretty watered down statement, I think. The study also says, among other things:

I didn't even address that part, though it's a clear conclusion of the review. If you'd rather use that in the text, I'm fine with that and it's a direct quote.

The bottom line is that each part of my deleted text can be directly attributed to a single source. So please stop making this assertion.

I've read the WP:SYN page carefully. You, I think, need to look at what I've done more carefully. I stepped through each part of the the deleted text and showed precisely which single source each part came from. There is one source that backs up (and directly states) each position that I am asking to put back into the article. That isn't WP:SYN no matter how many times you say it is. So if that's the only argument you have against reinserting my text, then you don't have an argument. I'd love to be able to build a consensus here, and I don't want to get into an edit war, but frankly it doesn't seem that you're interested in rational discourse.

So if your position is "no, it's not going back in," then my position is that it is unacceptable to have the section as it is without my text or some reasonable version of it added back. The statement on acupuncture cannot stand as it is. Leaving it violates NPOV by giving undue weight to a minority, pseudoscientific view, as I explained above and to which you've never responded. So if you aren't willing to have an actual discussion on this, then the only thing to do is to temporarily remove the section until we can reach a consensus. I don't want to do that, but as it is right now, it is not acceptable. I am, as I have been, ready to discuss this rationally, whenever you are, and I hope we can agree on appropriate wording.

For the record, here's the way I'd like the section to read. There is definitively no synthesis of data, no original research and no soapboxing, and it conforms to the NPOV sections I linked to above:

If you want to change the last part back to the statement about the placebo effect at work, I'm fine with that, too. But the bottom line is that we have to add this back in, and let the readers make an informed decision. That's what this is all about.

I'm trying to reach an agreement here. All I ask is that you do the same. --Transity 17:38, 10 April 2009 (UTC)

Synthesis not acceptable

You said that "Your example is patently incorrect, as I've explained already. I am not taking two sources and coming up with a statement. I am taking one source - the NIH Consensus - and using that one source to make a statement. I showed that definitively above. Simply repeating this assertion without acknowledging that fact isn't productive because your assertion doesn't apply at all to what I've actually done.

I'm going to explain this one last time. You are taking negative comments about acupuncture generally from one source (where IC/PBS is not discussed), then taking studies about IC/PBS from another source (where acupuncture is found to be beneficial), then using the negative source/s to qualify the positive sources. We cannot do that as editors of a tertiary source. You need to find a source that discusses the drawbacks of acu. in the context of IC/PBS. Unless you can find that, your attempts to insert this information here are your own synthesis of data. If you are not happy with this, put it to a RfC. ► RATEL ◄ 00:55, 11 April 2009 (UTC)

Let's say you make a statement that colorfully wrapped gifts appear under the tree at Christmas time in Bulgaria, and you link to an article as reference that says that gifts do, in fact, appear and that the method behind this appearance of gifts is a jolly old man called Santa Claus who rides in his sleigh around the world and drops off presents every Christmas Eve. Then let's say I see that, and add text stating that the consensus view is that there is no scientific basis for the existence of Santa Claus, with citations, thereby directly addressing the validity of your claim. Now, in this scenario, would you delete my text and tell me that unless I can find a study that explicitly addresses how Santa Claus doesn't deliver gifts in Bulgaria that my addition should be removed? Because that's what's going on here, and it's 100% improper, and logically unsound. You are wrong.

I am referring to a consensus view of the NIH on acupuncture. Do you understand what a consensus view is? It isn't limited to one condition - they looked at numerous studies across numerous conditions to derive a consensus view. You are speaking as if you aren't aware of that fact, though you certainly must be. How you can say that a consensus view of the NIH isn't relevant here is beyond me. And how you can claim that it's WP:SYN simply boggles the mind.

In addition, you still have not addressed my statements that leaving my text out doesn't meet the requirements of WP:UNDUE as doing so gives undue weight to a minority, pseudoscientific view. Never once have you even tried to counter this argument. So I may yet take this to RfC or some other means of dispute resolution.

That said, even though I don't agree at all with what you're saying, I will comply with your request to reference a study that directly addresses acupuncture and IC treatment. That, at least, will get some of the actual science addressed in the short term. My edits are going in now. Please note that, after these edits, I still don't consider the section to be acceptable - it's just a step in the right direction. --Transity 03:40, 11 April 2009 (UTC)

Undue weight does not apply here. It would apply here if there were studies criticising acupuncture in relation to IC/PBS, and I were trying to exclude them and only allow studies that support the use of acupuncture for IC/PBS. But I'm not doing that. I see you managed to find a negative study about acu. and IC/PBS. Now that's the way to go. ► RATEL ◄ 06:28, 11 April 2009 (UTC)

Actually you're still wrong. The section still gives undue weight to pseudoscience because right now it gives equal weight to each side. That is undue weight. Not allowing a consensus view that contradicts the referenced fringe view is in violation of WP:UNDUE.

Also it's frustrating for you to delete my references that criticize acu, then delete my further reading link to the same thing by saying that it references something that isn't discussed because you deleted it. Of course it is discussed because one of your refs supports the existence of qi, so you're wrong about that, too.

Either put back the further reading link or remove the questionable ref that refers to yin and yang. In fact if you remove that ref, I'd agree that the section is doing right by WP:UNDUE and call it acceptable because that way it presents two studies with conflicting results with no mention of any mystical forces. No consensus view needed, no further reading link needed - just a section stating that tests of acu for IC have been conflicting.

What do you say? --Transity 13:42, 11 April 2009 (UTC)

I say you should make your arguments on the acupuncture page where they belong. The word acupuncture is wikilinked and readers can read the various arguments, pro and con, on that page, where they logically belong. Otherwise you will end up doing something illogical and invalid (and against the WP rules), which is to edit every single page acupuncture is mentioned on wikipedia to insert your warnings. I am not going to debate this further with you. Please ask for 3rd opinions or RfC. ► RATEL ◄ 15:06, 11 April 2009 (UTC)

Request for Opinions: Acupuncture and IC

Please note, Ratel, that I don't expect a reply from you as I am aware of your position and your statement that you are not going to discuss this further.

Quite honestly, I don't have the time to take this through formal dispute resolution. I've been hoping (and I continue to hope) that another editor (or editors) will see this and weigh in on the talk page. I will restate my position here to make it easier for someone to do so. If this doesn't garner any more commentary, I may move to WP:3O or WP:RFC at some point when I have more time.

To be clear, if it wasn't for the reference that pushes the pseudoscientific fringe theory of qi and meridians, I don't think the problem would be so severe. I would still think that the NIH consensus view and the review that concluded that acupuncture doesn't seem to have any effect in general would be good additions, but they wouldn't be critical. That's why I suggested removing what I see as a bad reference. After all, it is a link to an article in which the Pelvic Floor Center who performs acupuncture states a psuedoscientific view about how the procedure works without providing any evidence to backup that claim. Here is that quote:

This source is clearly stating that acupuncture points and meridians and chi (yin and yang here) are behind the success of acupuncture, in general and hence for IC. Belief in the existence of chi falls under the header of "generally considered pseudoscience", and it is clearly a minority point of view (WP:UNDUE). From the NPOV policy concerning pseudoscience and minority points of view:

Having a source that asserts the existence of yin, yang, acupoints and meridians without balancing that with the scientific consensus that none of these things exist and with a recent review conducted on studies across many conditions which concludes that acupuncture isn't effective in general (and hence, not effective for IC either) violates WP:UNDUE by giving undue weight to a pseudoscientific fringe theory. That's why I want to take action on this article but not on every article that mentions acupuncture (each article should be looked at on a case-by-case basis, of course).

In order to restore proper balance, I believe that at least one of the following has to happen (I'd prefer a combination of these):

1) Remove the questionable reference that Ratel added. It is itself an unsourced statement by a potentially biased group (they make money in part by performing acupuncture) espousing the validity of a pseudoscientific theory. It should not be included as a reliable source in a medical article.

2) Add back the text that Ratel deleted which shows the scientific consensus on acupuncture. This includes a reference to the National Institutes of Health consensus statement on acupuncture, and a reference to a recent (2009) review which concluded that the evidence for acupuncture in general was lacking. Here is that text:

In addition, the consensus view is that there is no known scientific basis for the existence of qi, acupuncture points or meridians, and a February 2009 review of acupuncture studies found the data in favor of acupuncture lacking.

3) Add back the further reading link that Ratel deleted which links to a specific section of the WP article on acupuncture. At least this allows a reader to follow the link to read about the consensus view that there is no evidence supporting the theory behind acupuncture (chi, etc.). Here is that link:

Further information: ]

I floated all three of these ideas in an attempt to reach a compromise, but ultimately no compromise was possible as each of these suggestions were either reverted or refused (see long discussion above). Ideally, I'd like to see a combination of these added, but at least one of these is necessary in order to satisfy WP:UNDUE, in my opinion.

If anyone would like to comment, please do so. --Transity 19:52, 14 April 2009 (UTC)

• That is not how you ask for comments. Go to Help, then type in rfc. ► RATEL ◄ 23:07, 14 April 2009 (UTC)

• Yes, thanks, I know that. That's why I started my comment with a statement that I don't have time for a formal RfC or 3O right now. I'm well aware of the formal process, and in fact I even linked to WP:RFC and WP:3O above, but there's nothing wrong with trying something less formal first. --Transity 00:12, 15 April 2009 (UTC)

Hmmm, fine, I suppose, but if you check the edit history of the IC/PBS page you'll see that you are unlikely to get comments that way (low traffic). ► RATEL ◄ 00:58, 15 April 2009 (UTC)

Unlikely, perhaps, though there are readers (like myself) who came here seeking information, and instead found this remarkable discussion. Ratel, in your Wiki expertise, you seem to have ignored WP:NPA, and I apologize for having to do so myself in order to point out that you've done it. The majority of the first half of your collection of responses to Transity were snide, smug remarks that entirely ignored the topic of discussion, and despite a few salient responses, that tendency has not abated. Please stay on track. You can safely assume that those who take the time to edit here are as easily able to keep abreast of the WP policies and features as you are.

I agree with Transity's contentions. If you are to have a source referenced on a page that claims any sort of pseudoscience as true, then a contradicting reference is quite called for, in keeping with the true spirit of WP:NPOV and WP:UNDUE.

Further, the assertion that a general debunking of any field of pseudoscience does not qualify as a counterpoint to a specific claim within that field of pseudoscience is nonsensical. Transity's Santa Claus example, while perhaps difficult to relate to this discussion, is a decent analogy. For a more direct comparison, please hypothesize that a WP entry states (or links to sources that state) that iron disintegrates when subjected to water, at room temperature, that has been dyed blue. A source that indicates that metals have never been shown to disintegrate when subjected to water at any temperature would be both appropriate and valuable to a reader attempting to learn from an article on the properties of iron, whether or not it mentions blue-dyed water or the specific metal, iron. Bringing such a claim into the article in the first place opens the door to a general debunking of the basis of the claim. If the original claim which cites pseudoscience is included, then a citation that debunks such claims in general is not only appropriate, but necessary.

Your discussion of readers v. editors is an odd one (and more evidence of your tendency toward defying WP:NPA), but brings up the point: making things directly accessible (not necessarily "easy" or "simple") for casual (and non-savvy) readers should be one of the major goals of a repository of information like WP. There was misleading information on this page, and an effort was made to help casual readers find further information on the subject. Remember WP:BURO and WP:IAR, and, contradictorily, stop quoting policy and focus more on the discussion at hand. Obviously, I (and other readers) came to this page for specific reasons, and readers may or may not have the time, resources, or savvy to trawl through twenty WP entries to find out everything we're attempting to learn. Just as obviously, I (and other editors - your apparent misrepresentation of the readers/editors dichotomy seemed to be purely an attack on Transity, and I would like to think you have a better understanding of it than that) would like to make sure that any entry is comprehensive enough to counter baseless claims within the context of the entry itself, so that readers can easily find accurate information.

Finally, and preemptively, please refrain from lobbing WP:SPA at me. I came to this entry for my personal reasons as a reader, and joined WP and this discussion as an editor when I saw your behavior in this discussion; if my contribution results in any well-written and/or formatted copy, that would be due to my particular professional skills. I joined this discussion specifically because, as I read it, I felt that you were not staying on topic, were not exhibiting an interest in improving the entry, and were not following etiquette in your interactions; simultaneously, I was swayed by Transity's arguments. So keep the WP:SPA shots to a minimum. You've already tried it (just as pointlessly) on one user in this discussion, and I find it to be counter to the whole point of Misplaced Pages. Misplaced Pages's entire purpose is to collect accurate and documented information; no one user can know all information; plenty of individual users can know quite a lot about one specific topic or field of interest. I would posit that the "single-purpose account" you sneer at should be valued as a specialist, providing insight and information regarding a particular specialty (as theorized on WP:SPA itself). I'd rather have a neurosurgeon taking part in my brain surgery than some guy who likes to read neurology books in his spare time, and I'd certainly prefer the neurosurgeon to a casual trepanation enthusiast. Unless you have evidence of an "agenda" that runs counter to the purpose of collecting and presenting accurate information, jabbing at another editor with WP:SPA is irrelevant and, once again, off-topic (WP:TPG). The point of this discussion should be how to improve the content of the page it pertains to; not to argue policy or take on another editor's agenda (again, WP:TPG).

In that light, I would second Transity's suggestions; at the very least, if any citation is made which includes, in its content, baseless and unproven pseudoscience, I, as both a reader and editor of WP, believe that a citation debunking that pseudoscience, either in the specified context or across the board, is both appropriate and required. My apologies for having to quote policy in order to make this point, but try to refrain from WP:BITE-ing me. Scramblecase (talk) 04:14, 15 April 2009 (UTC)

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6. ^ Needles can stick it to pain Acupuncture lessens various kinds of pain, but so does a sham version
7. Seppa, Nathan (2009). "Needles can stick it to pain: Acupuncture lessens various kinds of pain, but so does a sham version". ScienceNews. Retrieved 2009-04-09. {{cite web}}: Unknown parameter |month= ignored (help)
8. Matias Vested Madsen, Peter C Gøtzsche, Asbjørn Hróbjartsson (2009). "Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups". BMJ. 338. doi:10.1136/bmj.a3115.{{cite journal}}: CS1 maint: multiple names: authors list (link)
9. Seppa, Nathan (2009). "Needles can stick it to pain: Acupuncture lessens various kinds of pain, but so does a sham version". ScienceNews. Retrieved 2009-04-09. {{cite web}}: Unknown parameter |month= ignored (help)
10. Matias Vested Madsen, Peter C Gøtzsche, Asbjørn Hróbjartsson (2009). "Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups". BMJ. 338. doi:10.1136/bmj.a3115.{{cite journal}}: CS1 maint: multiple names: authors list (link)
11. Seppa, Nathan (2009). "Needles can stick it to pain: Acupuncture lessens various kinds of pain, but so does a sham version". ScienceNews. Retrieved 2009-04-09. {{cite web}}: Unknown parameter |month= ignored (help)
12. Matias Vested Madsen, Peter C Gøtzsche, Asbjørn Hróbjartsson (2009). "Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups". BMJ. 338. doi:10.1136/bmj.a3115.{{cite journal}}: CS1 maint: multiple names: authors list (link)
13. Seppa, Nathan (2009). "Needles can stick it to pain: Acupuncture lessens various kinds of pain, but so does a sham version". ScienceNews. Retrieved 2009-04-09. {{cite web}}: Unknown parameter |month= ignored (help)
14. Matias Vested Madsen, Peter C Gøtzsche, Asbjørn Hróbjartsson (2009). "Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups". BMJ. 338. doi:10.1136/bmj.a3115.{{cite journal}}: CS1 maint: multiple names: authors list (link)

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