Revision as of 18:22, 4 January 2017 editJytdog (talk | contribs)Autopatrolled, Extended confirmed users, Pending changes reviewers, Rollbackers187,951 edits →Change.org again: ce← Previous edit | Revision as of 19:31, 4 January 2017 edit undoPlayalake (talk | contribs)16 edits →Unanswuestions: new sectionNext edit → | ||
Line 133: | Line 133: | ||
OK I see that they have updates now, but still are waiting to issue their final statement. But before their update, I'm curious about something. How did Misplaced Pages cover NICE? Can someone tell me this? And NICE isn't the only thing that updates. So do Cochrane Reviews and they have since moved toward more positive statememts than your encyclopedia covers. Why does Misplaced Pages update NICE findings but not Cochrane findings? <!-- Template:Unsigned --><small class="autosigned">— Preceding ] comment added by ] (] • ]) 16:50, 4 January 2017 (UTC)</small> <!--Autosigned by SineBot--> | OK I see that they have updates now, but still are waiting to issue their final statement. But before their update, I'm curious about something. How did Misplaced Pages cover NICE? Can someone tell me this? And NICE isn't the only thing that updates. So do Cochrane Reviews and they have since moved toward more positive statememts than your encyclopedia covers. Why does Misplaced Pages update NICE findings but not Cochrane findings? <!-- Template:Unsigned --><small class="autosigned">— Preceding ] comment added by ] (] • ]) 16:50, 4 January 2017 (UTC)</small> <!--Autosigned by SineBot--> | ||
{{archive bottom}} | {{archive bottom}} | ||
== Unanswuestions == | |||
You editors prefer to censor questions than answer them. I won't bring up other websites, but my questions remain unanswered. How did Misplaced Pages cover NICE before they updated? And why is everyone here quick to update based on NICE, but not care to update many Cochrane Reviews? |
Revision as of 19:31, 4 January 2017
There have been attempts to recruit editors of specific viewpoints to this article, in a manner that does not comply with Misplaced Pages's policies. Editors are encouraged to use neutral mechanisms for requesting outside input (e.g. a "request for comment", a third opinion or other noticeboard post, or neutral criteria: "pinging all editors who have edited this page in the last 48 hours"). If someone has asked you to provide your opinion here, examine the arguments, not the editors who have made them. Reminder: disputes are resolved by consensus, not by majority vote. |
This is the talk page for discussing improvements to the Acupuncture article. This is not a forum for general discussion of the article's subject. |
|
Find medical sources: Source guidelines · PubMed · Cochrane · DOAJ · Gale · OpenMD · ScienceDirect · Springer · Trip · Wiley · TWL |
Archives: Index, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34Auto-archiving period: 20 days |
The contentious topics procedure applies to this page. This page is related to complementary and alternative medicine, which has been designated as a contentious topic. Editors who repeatedly or seriously fail to adhere to the purpose of Misplaced Pages, any expected standards of behaviour, or any normal editorial process may be blocked or restricted by an administrator. Editors are advised to familiarise themselves with the contentious topics procedures before editing this page. |
The subject of this article is controversial and content may be in dispute. When updating the article, be bold, but not reckless. Feel free to try to improve the article, but don't take it personally if your changes are reversed; instead, come here to the talk page to discuss them. Content must be written from a neutral point of view. Include citations when adding content and consider tagging or removing unsourced information. |
This article has not yet been rated on Misplaced Pages's content assessment scale. It is of interest to the following WikiProjects: | ||||||||||||||||||||||||||||||||||||||||||||||||
Please add the quality rating to the {{WikiProject banner shell}} template instead of this project banner. See WP:PIQA for details.
{{WikiProject banner shell}} template instead of this project banner. See WP:PIQA for details.
{{WikiProject banner shell}} template instead of this project banner. See WP:PIQA for details.
{{WikiProject banner shell}} template instead of this project banner. See WP:PIQA for details.
|
To-do list for Acupuncture: edit · history · watch · refresh · Updated 2012-02-16
|
Individuals with a conflict of interest (COI), particularly those representing the subject of the article, are strongly advised not to edit the article. See Misplaced Pages:Conflict of interest. You may request corrections or suggest content, or contact us if the issue is urgent. See also community discussion on COI for alt-med practitioners. |
Petition regarding this page
Notice of the petition has been given. The other discussion in this section is about the topic and not about improving this article. Closing per WP:TPG Jytdog (talk) 18:58, 3 January 2017 (UTC)The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.
change.org/p/jimmy-wales-clean-up-the-wikipedia-acupuncture-page-to-reflect-medical-and-scientific-consensus (site in spam blacklist) - I haven't gone through their claims in detail, but editors experienced on this page may wish to go through and see if they've put forward anything that would be useful - David Gerard (talk) 23:46, 29 December 2016 (UTC)
- Thanks but change.org has been considered in the past with an epic response—Misplaced Pages:Lunatic charlatans. Johnuniq (talk) 00:26, 30 December 2016 (UTC)
- What does Jimmy Wales have to do with this? Sure he managed to settle the debate with an excellent response last time through, but do they not understand that he doesn't dictate what this (or any) page says? A few of the sources they list are interesting, such as the AHRQ's , which is excellent. On the other hand they're vastly overstating its conclusions, and the report does not "recommend" acupuncture at all. (In fact as a HTA-report it isn't supposed to give recommendations.) The NICE report (available at , their link doesn't work) states that acupuncture may be considered when other treatment is unsuitable or does not work, but that isn't very different from what our article already states. Many of the reports they list are either old and outdated or otherwise inadequate as per WP:MEDRS and WP:DUE. If they try to pressure us in any way I think it should be made known that this action will not result in change — and they are welcome to discuss the page here in civil debate weighing sources against one another. However, creating silly petitions will not sway us. Especially so when their rub seems to be with the labeling if acupuncture as pseudoscience, which is fully backed by the sources included in the article. There's also a precedent set in a 2009 ArbCom case. I will further dive into the sources once I have more time, but for now I suggest we ignore this and combat any of the vandalism it may promote. Carl Fredrik 💌 📧 01:10, 30 December 2016 (UTC)
- "The NICE report (available at , their link doesn't work) states that acupuncture may be considered when other treatment is unsuitable or does not work, but that isn't very different from what our article already states." For tension-type headaches, acupuncture is recommended as a first-line treatment for prophylaxis (it's actually the only treatment recommended for prophylaxis) (https://www.nice.org.uk/guidance/cg150/chapter/Recommendations).
- "they are welcome to discuss the page here in civil debate weighing sources against one another." Looking at the petition, I think their point specifically was that those who have tried doing that were quickly banned. What you call 'civil debate' has been labelled by others here as 'challenging consensus' and resulted in immediate ban. Looking through the dialogue on this page, I'd be very interested to understand the distinction. Banning too quickly means that commenters are left with no choice but to try to influence through means outside of Misplaced Pages, which isn't ideal.86.153.15.89 (talk) 09:24, 31 December 2016 (UTC)
- There has been no such thing as "banning too quickly". Only those who continually show an unwillingness to consider evidence, incapacity to accept consensus and who have acted rashly and disruptively have been banned. The fact is that this is more or less ideal — seeing as trying to exert external pressure will not and can not succeed. Guy's reply below is excellent, but I felt I could not let this slip.Carl Fredrik 💌 📧 12:09, 31 December 2016 (UTC)
- "Consider" is not the same as recommend. Nothing in that NICE document is in any way inconsistent with the current article. Note also that it's approaching 5 years old; here's what happened when NICE reviewed the similar guidance for low back pain: . Medical science is getting better at blowing away the dust. Nonsensical therapies, with homeopathy being top of the list, are the inevitable casualties. Guy (Help!) 10:34, 31 December 2016 (UTC)
- "Consider a course of acupuncture" is the recommendation for TTH prophylaxis just like "Consider aspirin" is the recommendation for acute headache. None of the recommendations begin with the word "recommend." If you're not sure how medical guidelines work, feel free to ask rather than misinterpret them. It isn't relevant if a clinical guideline is 5 years old as long as it's current, particularly as the evidence has become stronger in the interim.
- As an aside, which medical guidelines recommend homeopathy? I wasn't aware of any but it's interesting if you're saying that there are and that now support is being removed.31.51.233.8 (talk) 10:18, 2 January 2017 (UTC)
- First, "consider" is not the same as saying it works; second, the guidance on back pain was recently revised and acupuncture removed, so the age of this guidance is relevant. It's likely the next review cycle will see this downgraded still further. Neither of these things goes tot he core of the problem, though, which is that acupuncture is based on refuted doctrines, and supported by poor quality evidence, largely beset with obvious bias and conflicts of interest, and even then shows only tiny effect sizes in a few arbitrary conditions with no indication why these would be physiologically different from the many for which it is shown not to work. The trajectory of evidence is pretty clear. Scientists have become better at removing bias, and the more bias is removed, the more likely a trial is to show no effect. This is entirely consistent with the absence of evidence for any of the core doctrines of acupuncture. Guy (Help!) 10:30, 2 January 2017 (UTC)
- ""consider" is not the same as saying it works" - Sure, what it means is that NICE performed an exhaustive evidence review and has come to a consensus to recommend acupuncture based on the strength of the evidence and compared to other available treatments. This is evidence that conventional medical organisations disagree that it is pseudoscience, as they don't recommend pseudoscience. Medical guidelines are considered by Misplaced Pages to be high quality MEDRS for a reason, regardless of whether or not their conclusions happen to coincide with your beliefs. Unfortunately, future evidence reviews that have not yet happened that you guess will have conclusions that are magically identical to your particular beliefs are not MEDRS. Current published reviews are, whether or not you personally agree with their conclusions.167.98.3.58 (talk) 09:05, 3 January 2017 (UTC)
- NICE accepts current practice with a pretty low bar. If acupuncture were a new treatment it would geta full review; existing treatments also periodically get a full review, and that is what happened with back pain. Guess what? Acupuncture was removed.
- We have at present three conditions for which acupuncture is stated to have net positive evidence. Given the number for which evidence is net negative, and given the absence of any credible difference between the many conditions where it's net negative and the few where it's net positive, and given the refuted nature of its fundamental premise, and givent he documented difficulty of rmeoving bias in trials and the equally well documented fact that bias is the strongest predictor of a positive outcome, and given the small effect sizes of most trials, the most parsimonious explanation is that the net positives are false positives, consistent with P=0.05. That's the actuality of it. Guy (Help!) 09:23, 3 January 2017 (UTC)
- "NICE accepts current practice with a pretty low bar. If acupuncture were a new treatment it would geta full review" - well now I'm really confused. Acupuncture was a "new" traetment to the NHS when the migraine and TTH review was created.
- Now personally, I have been involved in NICE guideline development. However, according to your profile it says that you're Dell employee. Do you have any medical, research, or guideline development background? I just ask because you say a lot things about how NICE guidelines are developed but none of them seem to be true, at least according to my experience or that of my colleagues. For example, when talk about NICE accepting 'current practice with a pretty low bar', what would be an example of the differences in methods and criteria for literature review, evidence syntheses and strength of evidence to support a recommendation? Can you provide a specific example of the point you're making or any evidence to support it? I've simply never come across what you're claiming. It sounds an awful lot like you're making things up to support your opinion about acupuncture.167.98.3.58 (talk) 15:14, 3 January 2017 (UTC)
- Misplaced Pages being what it is, we allow anyone to contribute, within limits. You might believe that NICE applies exactly the same standards to existing treatments as it does to new ones or withdrawal of recommendations. That's not what I have concluded from reading the literature. Of course I could be wrong. I'm not an expert, and expertise is not recognised on Misplaced Pages. What is unquestionably true is that the evidence shows no reason to believe qi exists; no evidence for the existence of meridians; no consistency about acupoints between traditions; no mechanism for evidence-based correction of error; it makes no difference where you stick the needles, or even whether you insert them at all; most conditions show net negative evidence; effect size is always small; and the chances of a positive result are mainly down to the scope for bias to creep in. Guy (Help!) 16:09, 3 January 2017 (UTC)
Detailed response |
---|
The following discussion has been closed. Please do not modify it. |
|
- Small nit: "Clinical evidence is by nature probabilistic, and P=0.05 means one in twenty positive results will be false even if all bias is eliminated." This is wrong. P=0.05 means one in twenty results will be positive even if all bias is eliminated - if there is only random chance at work. If there is only random chance at work, all positive results will be false, not just one in twenty. The proportion of false positives among the positives is not constant, but it can be computed using the Bayes formula. This misunderstanding is very common, and it is probably one of the causes of belief in things like acupuncture: "we have that many positive results, and only 5% of them are false positives, so there is an effect". --Hob Gadling (talk) 10:42, 2 January 2017 (UTC)
- You're right, of course. I meant that one in twenty could still be false, but your vwersion is better and clearer. Guy (Help!) 13:10, 2 January 2017 (UTC)
no new sources brought to actually support changing the article; WP:NOTFORUM |
---|
The following discussion has been closed. Please do not modify it. |
|
He-said-she-said
Herbxue, one of our more assiduous trypanophile editors, is keen to include the following:
- Andrew Vickers, lead author of the original 2012 paper and chair of the Acupuncture Trialists' Collaboration, rejects that analysis, stating that the differences between acupuncture and sham acupuncture are statistically significant.ref name=Vickers2013/>
I think it should be excluded as WP:UNDUE - Vickers published a pro-acupuncture review which was criticised, and this is his response saying the tiny effect sizes are statistically significant but failing entirely to address the actual point made, which was that they are clinically irrelevant. It's a non-sequitur and special pleading from someone committed to promoting acupuncture. Guy (Help!) 22:47, 3 January 2017 (UTC)
- I looked at Vicker's review, and I'm rather shocked by the disconnect between the results and the conclusion. The results were that acupuncture is no different from sham treatment, no matter how you vary the acupuncture, (except that "moar needles = moar results!" which can't possibly have anything to do with the placebo effect...) So yeah, UNDUE by a long bit. Sorry about forgetting my <sarcasm></sarcasm> tags in that last sentence. I figured you guys can puzzle out where they belong. MjolnirPants Tell me all about it. 14:22, 4 January 2017 (UTC)
NICE
NICE is being held out as an arbiter of truth based on the current guidelines for migraine etc. which say to "consider" acupuncture. I think it's worth looking at what NICE said about acupuncture and back pain at the time this guidance was written:
- Your doctor should offer you a choice of one of the following treatment options:
- An exercise class that is appropriate for your particular needs.
- A course of manual therapy, which will include manipulation of the spine.
- A course of acupuncture.
- Your doctor may offer you another of these options if the chosen treatment doesn't result in much improvement in your back pain.
Fast forward to March 2016:
- The draft guideline recommends exercise, in all its forms (for example, stretching, strengthening, aerobic or yoga), as the first step in managing low back pain.
- Massage and manipulation by a therapist should only be used alongside exercise because there is not enough evidence to show they are of benefit when used alone.
- The draft guideline also recommends encouraging people to continue with normal activities as far as possible.
- The draft guideline no longer recommends acupuncture for treating low back pain because evidence shows it is not better than sham treatment. Paracetamol on its own is no longer the first option for managing low back pain. Instead, the draft guideline recommends that non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin should be tried first. Weak opioids, such as codeine, are now only recommended for acute back pain when NSAIDs haven’t worked or aren’t suitable.
That's science for you. The evidence develops to better exclude bias and confounding, and if it turns out a treatment doesn't work after all, well, so be it. Has this stopped acupuncturists and chiropractors form continuing to offer treatment for low back pain? Of course not. It's always legitimate to ask: what evidence will cause you to change your mind? In the case of acupuncturists, I honestly believe there is no evidence that will cause them to question their fundamental assumptions. It is resistant to refutation, for the same reason as homeopathy and any other religious dogma.
Hence the issues seen on this talk page. Science says one thing, belief says another. Misplaced Pages goes with the science. Sorry, guys. Guy (Help!) 11:01, 4 January 2017 (UTC)
Change.org again
Per WP:TPG the purpose of this page in Misplaced Pages is to discuss specific changes to this article. It is not to discuss petitions on another website nor for general discussion of the topic nor how WP works. Jytdog (talk) 18:21, 4 January 2017 (UTC)The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.
The Change.org petition lists the many problems with this article. I come here and see you editors locking discussion about it. Now NICE is being accused of being problematic. NICE is made of scientists who the NHS takes recommendations from. If you editors want to be on the opposite side of scientific officials, and pretend to have a scientifically backed article, shame on you. — Preceding unsigned comment added by Playalake (talk • contribs) 15:00, 4 January 2017 (UTC)
- Did you bother to read the section above this? Saying that "NICE is being accused of being problematic" here is straight up bullshit: editors have had it explained to them that NICE is not the end-all on medical matters, that NICE isn't anywhere near as supportive of acupuncture as pro-acupuncture editors are claiming, and that recommendations for practical medicine (i.e. making people feel better) don't distinguish between treatments that only work through the placebo effect and treatments that are only as effective as the placebo effect. That is nothing like anyone accusing NICE of being "problematic". Furthermore, the article is well-sourced. Try checking out some of the sources used in it to figure out why the article says the things it says, instead of coming here with your preconceived notions about truth and trying to impose them upon the facts. MjolnirPants Tell me all about it. 15:27, 4 January 2017 (UTC)
OK I see that they have updates now, but still are waiting to issue their final statement. But before their update, I'm curious about something. How did Misplaced Pages cover NICE? Can someone tell me this? And NICE isn't the only thing that updates. So do Cochrane Reviews and they have since moved toward more positive statememts than your encyclopedia covers. Why does Misplaced Pages update NICE findings but not Cochrane findings? — Preceding unsigned comment added by Playalake (talk • contribs) 16:50, 4 January 2017 (UTC)
The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.Unanswuestions
You editors prefer to censor questions than answer them. I won't bring up other websites, but my questions remain unanswered. How did Misplaced Pages cover NICE before they updated? And why is everyone here quick to update based on NICE, but not care to update many Cochrane Reviews?
Categories:- Misplaced Pages controversial topics
- All unassessed articles
- B-Class China-related articles
- Top-importance China-related articles
- B-Class China-related articles of Top-importance
- WikiProject China articles
- B-Class medicine articles
- Mid-importance medicine articles
- All WikiProject Medicine pages
- B-Class Skepticism articles
- High-importance Skepticism articles
- Skepticism articles needing attention
- WikiProject Skepticism articles
- B-Class Alternative medicine articles
- Misplaced Pages pages with to-do lists