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This article is written in British English with Oxford spelling (colour, realize, organization, analyse; note that -ize is used instead of -ise) and some terms that are used in it may be different or absent from other varieties of English. According to the relevant style guide, this should not be changed without broad consensus.

This article was nominated for deletion on 20 November 2013 (UTC). The result of the discussion was no consensus.

Clarifying controls

It would be helpful if the article said which bogus points were used: i.e. where were they on the body with respect to the affected area, other acupuncture points, or other acupuncture meridians. For example, if the knee pain study used non-acupoints at or very near the knee, that would mean that the control could have been active according to TCM theory. (TCM suggests needling points close to a painful area even if those points are not traditional acupounts, especially if those same points are painful or ashi points.)

Needling shallowly at a verum point is also active.

Overall, it would be good to note that both controls, though less active than the treatment, are still potentially or actually active according to TCM theory. Ideally, we could use a source saying this in context of GERAC, to avoid coming even close to WP:SYN. But it could still be mentioned in a brief background section without violating SYN as long as we avoided putting a big "however" qualifier in the conclusion.

Some editors may say that the above sounds like special pleading, but the reasoning comes straight from the IOM . They say that the study of traditional medicines must take into account the traditional context of its practice: i.e., how treatments are formulated (which goes to theory) and delivered. The fact that the IOM makes this point establishes it as a well-weighted, mainstream scientific approach to acupuncture. This is obvious on the merits: It's very hard to see how anyone would argue that the possible use of active control group should be ignored unless that person were scientifically illiterate or disingenuous. --Middle 8 (talk) 22:53, 28 May 2012 (UTC)

Unfortunately the source doesn't elaborate on the bogus points, and as far as I understand they could have been ashi points (not very likely, though, given the fact that no de-qi was reached). However, if you want to include this allegation in the article, we would have to find a source for it - otherwise it would be Original Research. Cheers, --Mallexikon (talk) 04:30, 29 May 2012 (UTC)

(super-belatedly) -- interesting, just noticed this, which says a little about GERAC's controls (and makes a rather dumb argument against "sham" acu generally -- of course a nonspecific noxious stimulus is gonna be more active as a placebo/nocebo than a sugar pill). And this (pdf), which gives more detail. Based on a quick reading, it sounds like GERAC actually used pretty good controls -- it's hard to argue they'd be active other than as "local points" (the activity of which we know in biomedical terms as the "needling effect"; see dry needling). --Middle 8 (talk) 10:36, 1 December 2013 (UTC)

Primary sources tag

I found a good secondary source and just added it to the references... Don't have time to go through it right now and it's all in German, but this source should be able to cover most citations in this article. Will come back to it. --Mallexikon (talk) 03:02, 5 November 2013 (UTC)

I don't see good secondary sources. This article relies heavily on primary sources. All content that relies on primary sources must be deleted now. QuackGuru (talk) 02:11, 20 November 2013 (UTC)

This is a secondary source? QuackGuru (talk) 02:44, 20 November 2013 (UTC)

The secondary source is from the Gemeinsamer Bundesausschuss. Please read WP:MEDREV: "When using a primary source, Misplaced Pages should not overstate the importance of the result or the conclusions." It does NOT say that primary sources can not be used at all, or have generally considered to be not reliable. Your unreliable source tagging, and questioning the primary source regarding how many health insurances actually initiated GERAC, appears pretty pointy here. --Mallexikon (talk) 03:03, 20 November 2013 (UTC)

The secondary source is from the Gemeinsamer Bundesausschuss? Don't you mean it is a primary source. You did not show how this is a secondary source. QuackGuru (talk) 03:48, 20 November 2013 (UTC)

The Federal Joint Committee (Germany), and other the primary sources are unreliable. The source Gemeinsamer Bundesausschuss is not reliable. QuackGuru (talk) 03:52, 20 November 2013 (UTC)

Agree, this article needs to be filleted - in fact probably deleted, with any usable remnant merged into the main acupuncture article. Alexbrn 03:57, 20 November 2013 (UTC)

I don't think there is a single sentence that is usable for the main acupuncture article. QuackGuru (talk) 04:11, 20 November 2013 (UTC)

There is Ernst's comment .... Alexbrn 04:14, 20 November 2013 (UTC)

This text is sourced using unreliable sources. "In 2000, the paramount decision-making body within the self-government of medical service providers and statutory health insurance companies in Germany, known as the Joint Federal Committee (Gemeinsamer Bundesausschuss), ruled that acupuncture treatment may not be covered by statutory health insurance companies except within the framework of field studies."

Gemeinsamer Bundesausschuss 2007, p. 2

"... beschloss der Gemeinsame Bundesausschuss (B-BA) am 16. Oktober 2000, dass Akupunktur nur noch im Rahmen von Modellvorhaben ... von der Gesetzlichen Krankenkasse bezahlt werden kann." ("... on October 16th 2000, the Joint Federal Committee ruled that acupuncture may only be covered by statutory health insurance companies within the framework of field studies ..." As seen at: Endres et al. 2007, p. C101

These are unreliable sources. QuackGuru (talk) 03:58, 20 November 2013 (UTC)

This is getting silly. We are talking about huge RCTs published in respectable medical journals, and the Federal Joint Committee (Germany). Why would these be unreliable sources? And no, the RCTs being primary sources is not a reason to generally throw them out. Please read WP:MEDRS more carefully. --Mallexikon (talk) 04:19, 20 November 2013 (UTC)

These are not secondary sources or reliable sources. AFD or redirect are the only options. Don't make this harder than it has to be. QuackGuru (talk) 04:46, 20 November 2013 (UTC)

You do know there are primary sources in the article. The primary sources are being challenged because they are not WP:SECONDARY sources. These trials are not notable because there are very few reliable sources that discuss the trials. QuackGuru (talk) 04:52, 20 November 2013 (UTC)

"As a result of the GERAC trials, the Joint Federal Committee (Gemeinsamer Bundesausschuss) decided to include acupuncture into the catalogue of services covered by the German statutory health insurances, for the treatment of low back pain and knee pain."

Joint Federal Committee (Gemeinsamer Bundesausschuss) is too close to the event. Please provide a secondary source for the text. QuackGuru (talk) 05:24, 20 November 2013 (UTC)

Federal Joint Committee (Germany)

Is the Federal Joint Committee (Germany) article notable. Does it meet Misplaced Pages notability guidelines? Hmm. QuackGuru (talk) 05:08, 20 November 2013 (UTC)

Sure, man. In your wrath against acupuncture and everybody who is not 100% against it, why not delete the whole Healthcare in Germany article? --Mallexikon (talk) 05:18, 20 November 2013 (UTC)

I propose redirect Federal Joint Committee (Germany) to Healthcare in Germany#Regulation. QuackGuru (talk) 05:33, 20 November 2013 (UTC)

Propose AFD or redirect

In 2006, Edzard Ernst noted that the German Acupuncture Trials (GERAC) had attracted criticism for not controlling the risk of patient de-blinding, and said that they " to conclusively answer the question whether acupuncture helps patients through a specific or a nonspecific effect".<ref>{{cite journal|doi=10.1111/j.1365-2796.2005.01584.x|title=Acupuncture - a critical analysis|year=2006|last1=Ernst|first1=E.|journal=Journal of Internal Medicine|volume=259|issue=2|pages=125–37|pmid=16420542}}</ref>

I propose we add this text to Acupuncture#Modern era after the article has been deleted or redirected.

This is the one of the few references I could find in the article that discusses the trials. The Federal Joint Committee (Germany) is not reliable. It is an organization comprising of the Central Federal Association of Health Insurance Funds, among others. The dated RCTs are the trials. We don't have enough secondary sources or reliable sources on the trials for a separate article. QuackGuru (talk) 04:46, 20 November 2013 (UTC)

a) The Federal Joint Committee is a medical organization as defined by WP:MEDRS. b) Primary sources can be used in medical articles - and this article here is a good example for it because it's mainly descriptive. For trial conclusions and claims of medical efficacy, primary sources won't do but we don't use for that here. And the GERAC are notable because they had a direct impact on the FJC's decisions concerning reimbursement of acupuncture treatment. --Mallexikon (talk) 05:14, 20 November 2013 (UTC)

The primary sources must be deleted now. The Federal Joint Committee is too close to the event. I request secondary sources. QuackGuru (talk) 05:27, 20 November 2013 (UTC)

I deleted the sources. I previously gave my reasons for these types of sources. QuackGuru (talk) 05:53, 20 November 2013 (UTC)

This was not a reliable secondary source. QuackGuru (talk) 05:55, 20 November 2013 (UTC)

No, so far I haven't heard any real rationale from you why you reject the FJC as a reliable source. It's an independent medical body, and they reviewed not just the GERAC, but quite a few other acupuncture trials before their decision (which makes them a secondary source). Please read their English abstract on p. 2. And please stop this disruptive tagging. --Mallexikon (talk) 06:05, 20 November 2013 (UTC)

"As a result of the GERAC trials, the Joint Federal Committee (Gemeinsamer Bundesausschuss) decided to include acupuncture into the catalogue of services covered by the German statutory health insurances, for the treatment of low back pain and knee pain."

The Joint Federal Committee initiated the project to compare the effectiveness of acupuncture to conventional therapy for pain. Four randomized studies were done as part of the German Acupuncture Trials (GERAC). The Joint Federal Committee is part of this event. Since they are too close to the event I requested secondary sources. QuackGuru (talk) 06:11, 20 November 2013 (UTC)

I have executed a WP:NUKEANDPAVE, which has resolved the problems noted. Alexbrn 06:25, 20 November 2013 (UTC)

That fixes the advertizement problems. QuackGuru (talk) 06:27, 20 November 2013 (UTC)

I'm still not convinced that this topic merits a standalone article, though it does seem to be mentioned a bit in the literature (as an exemplar of misleading suggestions from RCTs, it seems). Maybe a sentence or two in the main acupuncture article would be due? Alexbrn 06:30, 20 November 2013 (UTC)

A couple of sentences in the Acupuncture#Modern era might work. A redirect would work but I think an AFD may be the only way to resolve this situation with the previous edit history of this article. QuackGuru (talk) 06:41, 20 November 2013 (UTC)

These are reliable sources. Your requests to throw out the secondary source "being part of this event" doesn't make sense. We're talking about the highest control body in the German healthcare system other than the ministry of health - and it's independent. As I pointed out before, the use of primary sources is also permissible as long as it doesn't cover the conclusions of a trial or claims of medical efficiency. I've asked for comment from the reliable sources noticeboard. Let's wait what they say before you nukeandpave again. --Mallexikon (talk) 07:06, 20 November 2013 (UTC)

I don't think you understand Misplaced Pages policy on secondary sources. Advertizements do not belong in articlespace. QuackGuru (talk) 07:09, 20 November 2013 (UTC)

Poorly-sourced health information; neutrality

I notice A1candidate has re-added a large quantity of poorly-sourced health information to the article that fails WP:MEDRS (specifically for being either a primary source, a non-medical source for health information, or for failing WP:MEDDATE). Conversely Howick, one of only two genuine secondary sourced has been removed (N.B. Howick gives a "negative" assessment of the worth of these trials). This edit appears to be non-neutral. Alexbrn 08:07, 20 November 2013 (UTC)

No, your edits seem to be non-neutral. This is clearly not poorly sourced, and instead of nukeandpave, you could just as well wait what the discussion at the reliable sources noticeboard results in. The Federal Joint Committee is an independent medical organization, and their source is a review of different primary sources regarding acupuncture. --Mallexikon (talk) 08:18, 20 November 2013 (UTC)

Deleting reliably-sourced content (Howick) and adding poorly-sourced content does not advance us towards neutrality. Sourcing health-related content to the output of a middle tier government committee six years ago fall afoul of WP:MEDRS, and including it all gives undue weight. Alexbrn 08:26, 20 November 2013 (UTC)

Sources seem reliable to me (academic journals). The references are messy (cite journal template should be used), but overall I cannot support removal of that information. --_{Piotr Konieczny aka Prokonsul Piotrus| reply here} 08:35, 20 November 2013 (UTC)

Errr, are you familiar with WP:MEDRS? For biomedical content, academic journal ≠ good source, necessarily. Alexbrn 08:38, 20 November 2013 (UTC)

No, its' you who doesn't seem to be too familiar with WP:MEDRS. Nowhere it says that generally, primary sources can't be used. They can't be used (for long) for studies' conclusions and for medical efficacy claims... But we're merely talking about the description of an RCT here. Of course they can be used for that. --Mallexikon (talk) 09:14, 20 November 2013 (UTC)

The Joint Federal Committee (Gemeinsamer Bundesausschuss) source is heavily used in this article and they initiated the trials. Does not pass WP:SECONDARY because they are too close to the event. QuackGuru (talk) 08:42, 20 November 2013 (UTC)

I'm afraid you have to read more closely. It was a couple of statutory health insurances who initiated GERAC. The Joint Fed. Committee is a higher-level body who exempted acupuncture from being reimbursable, and only allowed it for reimbursement for two indications (low back pain, knee pain) after the results of GERAC came out. --Mallexikon (talk) 09:09, 20 November 2013 (UTC)

See WP:SECONDARY: Primary sources are original materials that are close to an event, and are often accounts written by people who are directly involved.

Based on your own comments The Joint Fed. Committee is a primary source because they were part of the event. Even if the The Joint Fed. Committee was a secondary source there are newer sources presented. That means The Joint Fed. Committee fails MEDRS and SECONDARY.

The article should be about how the results of the trial influenced policy in Germany. The trial itself in not what this article is about. The details about the trials itself is not notable and not the direction of an encyclopedia article. QuackGuru (talk) 19:01, 22 November 2013 (UTC)

Ok, I get a little tired repeating myself here... Please show some evidence for this suspicion of yours that the Joint Fed. Committee was "part of the event", since they're clearly not. Independent entities. The people of the Committee and the people responsible for GERAC are different people. Thus, the Committee is a secondary source. And why you personally think the details of this trial are not important eludes me... This is an article about the GERAC so it should be able to answer all the questions a reader could have about it (how many patients involved? What concept of sham acupuncture did they use? What concept of standard control? etc. etc.). --Mallexikon (talk) 03:12, 24 November 2013 (UTC)

The Federal Joint Committee (Germany) decided to reimburse acupuncture treatment for low back pain and knee pain. That makes them a primary source because they are part of the event. The details of this trial are not important because this is not a medical article and it is not notable. It is an article about how a clinical trial impacted society. QuackGuru (talk) 03:29, 24 November 2013 (UTC)

Yes, but this article is not about some kind of "event". It's also not about "how a clinical trial impacted society". It's about the trial itself. Of course, GERAC is notable because of its impact on health care in Germany: The Fed. Joint Committee looked at GERAC plus several other acupuncture trials (would you please, please read their English summary on page 2?) and then decided to have acupuncture reimbursed. However, I'm not interested in explaining this again and again. Please take it to the reliable sources noticeboard if you still think that the FJC should be considered a primary source. --Mallexikon (talk) 04:51, 24 November 2013 (UTC)

This article about the trial itself is a WP:COATHOOK. We don't have articles about specific studies. All the medical information about the trial itself should be deleted. The Fed. Joint Committee originally looked at GERAC. You must provide secondary sources and not use The Fed. Joint Committee source itself or the trial itself as a source. QuackGuru (talk) 00:28, 25 November 2013 (UTC)

I started the cleanup process to delete the non-notable information about the trial itself. There is no reason to keep low level details about the trial itself. QuackGuru (talk) 00:39, 25 November 2013 (UTC)

The medical information about the trial itself was restored for no valid reason. QuackGuru (talk) 01:37, 25 November 2013 (UTC)

Mallexikon wrote: "GERAC is notable because of its impact on health care in Germany". Any sources for this (not contemporary news items or primary sources)? Alexbrn 05:18, 24 November 2013 (UTC)

Could you please explain why the Spiegel quote shouldn't be good enough? --Mallexikon (talk) 09:09, 24 November 2013 (UTC)

I'm looking for evidence of WP:CONTINUEDCOVERAGE. Alexbrn 04:38, 25 November 2013 (UTC)

Not needed. GERAC has had a WP:LASTING effect (inclusion of acupuncture into the list of services covered by the statutory health insurances). Please also read WP:EVENTCRIT again ("Events are probably notable if they have enduring historical significance and meet the general notability guideline, or if they have a significant lasting effect. Events are also very likely to be notable if they have widespread (national or international) impact and were very widely covered in diverse sources, especially if also re-analyzed afterwards..." --Mallexikon (talk) 05:34, 25 November 2013 (UTC)

According to WP:MEDRS in opening paragraph, "it is vital that the biomedical information in all types of articles be based on reliable, third-party, published sources and accurately reflect current medical knowledge". The overview section is a massive WP:WEIGHT violation because it contains low level details and coat rack information. The article is about the event. It is not about the trials itself. So, I made this change. QuackGuru (talk) 19:43, 27 November 2013 (UTC)

Recent problematic edits / faithfully representing sources

There have been some edits to the article recently that appear to misrepresent the sources and have the unfortunate effect of skewing POV. For example just now, Mallexikon has removed the words "The trials found no significant differences between acupuncture and sham acupuncture" with the comment "deleting material not supported by the source given ...". Yet the source states: "the difference between real and sham acupuncture in the GERAC trial was not statistically significant". Mallexikon - have you got an explanation? Alexbrn 07:07, 24 November 2013 (UTC)

Yes. Edit conflict. I wanted to delete "Within the academic community, the trials have received criticism for failing to show that needling has any effect", which was sourced with the quote "These programmes of research do not confirm the hypothesis that needling at specific points is essential to achieve satisfactory clinical effects of acupuncture". But you deleted it simultaneously , which resulted in my edit merely being a paraphrasing and actually no deletion. --Mallexikon (talk) 07:19, 24 November 2013 (UTC)

I see. So, we have still ended up with a misrepresentation and a deletion; please repair the damage cause by the edit conflict by restoring the text that got lost and citing it correctly per WP:INTEGRITY. This brings me to a second problem, the use of a fringe journal Acupuncture in Medicine for commenting on acupuncture; this is not a usable source since (most obviously) it lacks independence of the topic (the article cited is written by Mike Cummings, a director of the British Medical Acupuncture Society); it needs to be removed. Alexbrn 07:45, 24 November 2013 (UTC)

Beg to differ. If a director of the British Medical Acupuncture Society points out findings that are contrary to TCM beliefs, that's the opposite of bias. --Mallexikon (talk) 07:59, 24 November 2013 (UTC)

It doesn't matter what he's saying, but having Misplaced Pages state that he "points out" something clinical is contrary to WP:FRINGE. Meanwhile, the content from the reliable secondary source remains deleted! Alexbrn 08:08, 24 November 2013 (UTC)

Could you please produce some evidence that acupuncture is WP:FRINGE? And what content from a reliable source remaining deleted are you talking about? --Mallexikon (talk) 08:27, 24 November 2013 (UTC)

WP:FRINGE applies to all "Alternative medicine" articles on WP by definition. I specify the text you deleted in the opening message of this section. Alexbrn 08:35, 24 November 2013 (UTC)

Could you please show me that definition? And I'm still not sure what text you mean. --Mallexikon (talk) 09:04, 24 November 2013 (UTC)

"By definition" here means it defines itself: alternative medicine is outside the mainstream and so fringe by definition. If you doubt this, the folk at WP:FT/N could comment but it would be a waste of that noticeboard's time to ask in my view. I actually quote the words you erroneously deleted in my opening comment here; I can't really be more explicit than that. When you were notified of the edit conflict by the Wikimedia software, did you not check to see what was happening to the text as a result? there is text missing an a mis-used source now. Alexbrn 09:35, 24 November 2013 (UTC)

@Alexbrn -- re "fringe" -- acupuncture is near the line of demarcation, and some of it might cross over (even past the fuzzy part of the line), depending on where the non-fringe research goes. (And note that "alt-med" sometimes means "what MD's don't usually do", which doesn't always coincide with pseudoscience -- e.g. massage.) --Middle 8 (talk) 11:23, 1 December 2013 (UTC)

Your statement about acupuncture automatically being WP:FRINGE will be discussed at the AfD... Regarding the quoted words I allegedly erroneously deleted ("The trials found no significant differences between acupuncture and sham acupuncture"): calm down. I only paraphrased them ("It has been pointed out that the GERAC study couldn't find any advantage of needling specific acupuncture points in contrast to random points") . --Mallexikon (talk) 05:42, 25 November 2013 (UTC)

"It has been pointed out..." undermines the source. The fringe journal has been restored. The Acupuncture in Medicine is as fringe as it gets. There are better sources. QuackGuru (talk) 19:01, 25 November 2013 (UTC)

If Acupunct. Med. really were fringe, Cochrane wouldn't use it, nor would it be cited in review articles in unquestionably mainstream journals. --Middle 8 (talk) 11:30, 1 December 2013 (UTC)

That's not a "paraphrase" of the deleted content. Alexbrn 05:47, 25 November 2013 (UTC)

"No difference between A and B"... "no advantage of A over B"... why would this not be a paraphrase? --Mallexikon (talk) 05:54, 25 November 2013 (UTC)

Primary sources

I've left primary source citations next to secondary source citations at quite a few places now... The reason for this is that the primary source citations are more reader-friendly (English translation given), while their data is the same. One could argue, however, that the primary sources should generally eliminated. Comments? --Mallexikon (talk) 08:33, 25 November 2013 (UTC)

Yes, and that includes nearly all of the material coming from the Gemeinsamer Bundesausschuss. Alexbrn 08:37, 25 November 2013 (UTC)

The primary sources were replaced with more primary sources. All the primary sources and dated sources about the trials itself must be deleted. The dated Gemeinsamer Bundesausschuss source is being misused in this article to discuss medical information. QuackGuru (talk) 19:10, 25 November 2013 (UTC)

It is mainly being used to describe the set-up and outcomes of the RCTs. It is a clear secondary source even if you stubbornly repeat it was primary. On top of that, Misplaced Pages:Reliable sources/Noticeboard#GERAC consensus has made very clear that no, all the primary sources and dated sources must not at all be deleted. --Mallexikon (talk) 01:55, 26 November 2013 (UTC)

You did not tell other editors this is not a medical article and that you used the source to discuss unimportant low level details about trial itself.

The entire German Acupuncture Trials#Overview section is a coat rack. I propose the entire section must be nuked unless anyone likes a WP:SOAPBOX article. QuackGuru (talk) 18:08, 26 November 2013 (UTC)

Its not. Its simply letting the reader know about the findings of the trials, according to secondary sources. -A1candidate (talk) 18:13, 26 November 2013 (UTC)

Do you think this is a medical article about the trials itself? QuackGuru (talk) 18:21, 26 November 2013 (UTC)

"Only registered physicians with an additional license for acupuncture and at least two years of clinical experience in acupuncture treatment qualified as performing acupuncturists."

This text does not seem relevant to this page. QuackGuru (talk) 22:04, 26 November 2013 (UTC)

How can this not be relevant? Every acupuncture proponent feeling miffed by the results of the trials could just claim that the performing acupuncturists were just not skilled enough. --Mallexikon (talk) 03:07, 28 November 2013 (UTC)

Exactly right. It's experimental details like this help us figure out what's going on. The point Mallexikon raises is actually a valid complaint about some other studies; GERAC did it more or less properly, and the results still weren't flattering to TCM ideas about point specificity. Seems to me that any skeptic, any honest person interested in discovering the truth, would want these details left in the article. --Middle 8 (talk) 07:14, 4 December 2013 (UTC)

Dated 2003 source does not summarise the body

According to Schweizer Fernsehen, the total cost of the trials amounted to 7.5 million Euros.

The low level details using unreliable sources are used everywhere in this article. QuackGuru (talk) 19:35, 26 November 2013 (UTC)

This is a violation and WP:WEIGHT and WP:LEAD. Is there a reason to keep the low level details. QuackGuru (talk) 17:50, 27 November 2013 (UTC)

Low level unimportant details failed verification

The trials received coverage from most of the major media outlets in Germany. This article is very poorly written. The source an editor added failed verification. QuackGuru (talk) 19:38, 26 November 2013 (UTC)

Unreliable sourced under the reference section

I removed the unreliable sources. The unreliable sources are not needed in the reference section. They were not used to verify the text. QuackGuru (talk) 19:42, 26 November 2013 (UTC)

The unused primary sources have been restored inside the reference section. QuackGuru (talk) 01:42, 27 November 2013 (UTC)

Dated 2005 Deutsche Medizinische Wochenschrift as unreliable

The trials were published in 2006. How could a dated 2005 source be reliable? This seems too old when there are newer sources. QuackGuru (talk) 20:24, 26 November 2013 (UTC)

The trials were covered in the media and in academic sources from the early 2000s onwards. 2005 isn't old. -A1candidate (talk) 14:18, 27 November 2013 (UTC)

You removed the tag because you believe it is reliable. I agree it is reliable. I added text to the the lead from the reliable source. QuackGuru (talk) 04:24, 1 December 2013 (UTC)

Reference 78

• Ernst, E. (2006). "Acupuncture - a critical analysis". Journal of Internal Medicine. 259 (2): 125–37. doi:10.1111/j.1365-2796.2005.01584.x. PMID 16420542.
• Wettig, D (2005). "Die GERAC-Gonarthrose-Studie". Der Schmerz. 19 (4): 330–1, author reply 331–2. doi:10.1007/s00482-005-0404-0. PMID 16145742.

There are two sources but I think only one is used to verify the text. QuackGuru (talk) 20:43, 26 November 2013 (UTC)

Pointed out

News magazine Der Spiegel pointed out that the results of GERAC couldn't be brushed aside by the Federal Joint Committee anymore. The words pointed out is not neutral. QuackGuru (talk) 01:57, 27 November 2013 (UTC)

Fine. Changed it. --Mallexikon (talk) 02:49, 27 November 2013 (UTC)

"Pointed out" is neutral. -A1candidate (talk) 14:17, 27 November 2013 (UTC)

It's expressly listed as a problematic formulation at WP:CLAIM (obviously so, since it implies a true thing is being revealed). Alexbrn 14:22, 27 November 2013 (UTC)

The BBC pointed out that the study "echoes the findings of two studies published last year in the British Medical Journal, which found a short course of acupuncture could benefit patients with low back pain". "Pointed out" is not neutral. QuackGuru (talk) 18:19, 27 November 2013 (UTC)

Tagging

Please stop tagging everything in this article. If you have serious issues with a particular source, there's already an ongoing discussion at Misplaced Pages:Reliable_sources, so why not wait and listen to the opinions of other editors first, before mass tagging? -A1candidate (talk) 14:26, 27 November 2013 (UTC)

If anyone still has doubts that QuackGuru is disruptive, have a look at this: . And here: User_talk:Middle_8#User_conduct:_QuackGuru. --Middle 8 (talk) 08:57, 2 December 2013 (UTC)

Insurance companies in Germany have stopped reimbursement for acupuncture treatment.

"This trial was one of the first large-scale controlled clinical trials of acupuncture in the world. The results suggested that there was no difference between acupoints and non-acupoints, and some insurance companies in Germany stopped reimbursement for acupuncture treatment. The trial's conclusion has had a negative impact on acupuncture and moxibustion in the international community."

The abstract of the 2013 source. QuackGuru (talk) 02:30, 28 November 2013 (UTC)

So this journal is no fringe in your opinion? --Mallexikon (talk) 02:33, 28 November 2013 (UTC)

It's a fringe journal alright, and so not usable for any claims on fringe topics that are not otherwise verifiable in good RS. For statement that are not in the fringe space, it is however usable. Alexbrn 05:37, 28 November 2013 (UTC)

Great! Definitely no objection to using this source from my side. --Mallexikon (talk) 06:00, 28 November 2013 (UTC)

You deleted most of the text. The text must stay in the body too. Looks like whitewashing. QuackGuru (talk) 08:03, 16 December 2013 (UTC)

Looks like even more whitewashing. The text is supposed to be in the body and then summarised in the lead. 08:08, 16 December 2013 (UTC) QuackGuru (talk)

I don't follow you. Why would the text have to be in the body as well? And if it did, where do you want to put it? The subsection it was in was wrong - do you want to create a new subsection about "results overview"?--Mallexikon (talk) 08:50, 16 December 2013 (UTC)

The text has to be in the body because the lead summarises the body. QuackGuru (talk) 16:25, 16 December 2013 (UTC)

The problems have not been fixed but the template was removed. QuackGuru (talk) 08:20, 16 December 2013 (UTC)

The only places we use the primary sources now is where we explain the trials' set-up, and we use them as an additional source (next to a secondary) in a few places as well... I don't understand how this would be too much reliance on primary sources...? --Mallexikon (talk) 08:50, 16 December 2013 (UTC)

You dumped a lot of text that relies on primary sources. The overview section relies on primary sources and the text is a weight violation with all the low level details. QuackGuru (talk) 16:25, 16 December 2013 (UTC)

Reference, Notes

The references include extensive notes/quotes. These should be broken out into a notes section. The general references should be broken out into a bibliography section (preferably with anchors). Once the editing disputes have settled down some I will perform these edits unless there is objection. Once that is done it will probably be appropriate to edit down the notes. We don't need to quote extensively from sourcesĕ those interested can refer to the sources, again this needs to wait until contention has subsided. The quoting is support for various arguments about the article but does not belong in an encyclopedic article. - - MrBill3 (talk) 11:39, 28 November 2013 (UTC)

Agreed. --Mallexikon (talk) 16:36, 28 November 2013 (UTC)

There are numerous unreliable sources in the articles that should be removed first. The extensive quotes should be removed. These should not be broken out into a notes section. This article contains coat rack information and adding the coat rack information to a notes section is not right at all. QuackGuru (talk) 17:32, 28 November 2013 (UTC)

I cleaned up the article and removed most of the coat rack information. The extensive quotes and other nonesense has been removed. QuackGuru (talk) 19:16, 29 November 2013 (UTC)

You did not just remove the quotes, you removed everything that is directly related to the trials, included the results. That's why I reverted you. -A1candidate (talk) 22:39, 29 November 2013 (UTC)

Seriously, A1candidate. The article is awful. You restored tons of low level details. You didn't see how bad the article was? It was terrible, an affront to the intelligence of our readers. I cleaned up the article according to the many concerns raised at the Misplaced Pages:Articles for deletion/German Acupuncture Trials. I previously explained that this article is about the impact the trials have had on the society and politics. The specific information about the trials was coat rack text and excessive details. You restored many primary sources against WP:SECONDARY and you restored extensive quotes against WP:WEIGHT. The extreme detailed information about the trials itself is also dated information that went against Misplaced Pages:Identifying reliable sources#Medical claims. QuackGuru (talk) 03:29, 30 November 2013 (UTC)

I cleaned out some of the more obvious fluff. aprock (talk) 04:18, 30 November 2013 (UTC)

If you check the edit history I cleaned up most of the nonsense. I think things will move along much faster if we start from here. QuackGuru (talk) 04:22, 30 November 2013 (UTC)

Quotes remain in references, they should be split off into a notes section. Some of the recent edits eliminated specific page numbers. The same reference can be used with different page numbers using the harvnb template. I will make a few edits to provide examples. - - MrBill3 (talk) 04:40, 2 December 2013 (UTC)

The quotes were removed from the article but an editor restored the quotes and other excessive details to the article. The quotes should not be split off into a notes section. They should be deleted. QuackGuru (talk) 04:50, 2 December 2013 (UTC)

If there is consensus to remove the notes by all means do so. I support removal of the notes. Please try to keep the references intact. I have split the notes off.

I propose a standard format for refs: last, first initials, display authors 2, numeric format for dates, etc. Just to make them consistent. I would also suggest breaking the three refs that have 5 plus citations into a bibliography section and using harv format for them in the references section. - - MrBill3 (talk) 05:54, 2 December 2013 (UTC)

I don't have a strong opinion regarding the quotes but what exact problem do you see with them? I always thought more transparency is good...? --Mallexikon (talk) 07:17, 2 December 2013 (UTC)

My opinion is not that strong either, only three remain and they are pretty decent. My support is based on a preference for a clean tight article, concise. Also anything worth saying should go into the text unless it is needed for explanation of a brief statement. To play the devil's advocate I would say: encyclopedic, due and OR. Again not a major bone of contention for me (the previous quoted content was excessive, now reasonable). Willing to bend to consensus, see what others have to say.

I am probably going to boldly edit the format of the refs. I wish the page numbers hadn't been removed from several refs.

Any comments on breaking out multiply cited refs into a bibliography section? I don't know if its needed or appropriate. - - MrBill3 (talk) 08:06, 2 December 2013 (UTC)

Never crossed my mind... But no objections to it either. --Mallexikon (talk) 08:12, 2 December 2013 (UTC)

Excessive details

The excessive details and other nonsense was restored. It was a cut and paste copy that was part of an old version of the article. QuackGuru (talk) 04:21, 1 December 2013 (UTC)

The nonsense had been restored again. QuackGuru (talk) 04:38, 1 December 2013 (UTC)

Alright, one thing up front: I'd actually not like to hear the term "nonsense" anymore when you talk about my edits. Now, these are not excessive details, but vital information about the trials - we're talking about the results for God's sake. And because of these results the Fed. Joint Comm. decided as it did. --Mallexikon (talk) 04:51, 1 December 2013 (UTC)

Your using primary sources again and dumping in a lot of low level details. "It is "vital" that the biomedical information in all types of articles be based on reliable, third-party, published sources and accurately reflect current medical knowledge." See Misplaced Pages:Identifying reliable sources#Medical claims. QuackGuru (talk) 04:59, 1 December 2013 (UTC)

We're not talking about generalized statements which have to be updated here... We're talking about one very specific trial and its results. It has been pointed out to you repeatedly and by 3 different editors at Misplaced Pages:Reliable sources/Noticeboard#GERAC (, , ) that there's no problem with our sourcing as it is, even as we use primary sources, because we do it sparsely and far from exclusively. Your very deep in WP:ICANTHEARYOUland by now. And the Fed. Joint Committee source is a secondary one anyway. --Mallexikon (talk) 06:14, 1 December 2013 (UTC)

I previously explained the excessive details is also a weight violation. QuackGuru (talk) 06:18, 1 December 2013 (UTC)

No, there's no also here, so alleging a WP:WEIGHT violation would be your only rationale... Since the results of a trial tend to be of some interest, especially in a trial with consequences like GERAC, I think your allegation can be safely dismissed. --Mallexikon (talk) 06:53, 1 December 2013 (UTC)

The trial results should not be detailed as that violated WP:MEDRS. Even detailing the trial setup strikes me as a little undue, but heh ... I'll not argue over that. What you really need here is to use a secondary source that gives a historical perspective and a mainstream, current view. Alexbrn 07:01, 1 December 2013 (UTC)

It has been pointed out to you as well at the RS noticeboard ("I don't see how the use of these sources in GERAC presents a reliability issue"): there's no problem with our sourcing as it is, even as we use primary sources, because we do it sparsely and far from exclusively. On top of that, the FJC source is a secondary one even though you try to abstrusely argue that it's not. --Mallexikon (talk) 07:41, 1 December 2013 (UTC)

You're using primaries to report clinical findings in the face of a reliable secondary that says they can't be trusted for that. That's a big no-no. The way to do this which is due is to do it through Howick (e.g.) by saying something like "While taken overall the trials reported that acupuncture was significantly better than conventional treatment, later assessment found that they were unlikely to have emitted clinically significant findings because of flaws in the design of the placebo control". (ref this to Howick, or something). This satisfies MEDRS and FRINGE, and is not too wordy either ... (Add: if if is really intractable - it shouldn't be - how about trying some kind of dispute resolution: DRN maybe?) Alexbrn 07:51, 1 December 2013 (UTC)

The dispute you talk about is not about the findings themselves, it's about their interpretation. And it's fine to include dissenting opinions (from secondary sources - we have more than one) regarding the interpretations, of course. However, the results themselves, the raw data, are not disputed by anyone. They're an important aspect of the trials, we have reliable sources for them (certified by the RS noticeboard) - of course they should be in the article. The reader has to be able to understand why the FJC decided how it did, no? --Mallexikon (talk) 08:14, 1 December 2013 (UTC)

I disagree; we don't include medical content that contradicts secondaries - this is exactly the coat rack fear that came up at AfD. Anyway, it's probably time for dispute resolution rather than this dragging on here ... Why not try and draft a concise statement of what the dispute *is* ? Alexbrn 08:19, 1 December 2013 (UTC)

It has been pointed out at AfD as well that the coatrack allegation is unfounded (both by User:Bluerasberry and User:ImperfectlyInformed)... The main point of dispute here is your attempt to irrationaly label the FJC source as primary. Besides, I'd like to hear the exact quote from Howick you want to use as a source - because I doubt that we have anything in our article that actually contradicts him. --Mallexikon (talk) 08:57, 1 December 2013 (UTC)

My concern is simply that we don't include bogus health information. Since I've said this many many times now, and am suggesting a way forward to settle the dispute, I really don't want to have to re-state it again, but ... here goes: as I see it, you want to include medical "results" from out-of-date, discredited sources (either directly, or laundered through a non-MEDRS source). Why? There's no need. Alexbrn 09:20, 1 December 2013 (UTC)

@Mallexicon: Agree the FJC is secondary; the article isn't about the FJC nor even their decision, but about GERAC. The FJC is an independent regulatory body, and as such is an excellent secondary source, being both independent and scientifically credentialed.

@Alexbrn: (a) I'm not clear on what you mean here: "You're using primaries to report clinical findings in the face of a reliable secondary that says they can't be trusted for that." Which RS are you referring to, and with regard to which findings? The equivalence of sham (of one kind or another) and verum acupuncture, and both being superior to some kind of no-needling control, is far from an uncommon finding. (b) Re your concern about excluding bogus information: think of GERAC as something historically relevent (history of science and public health policy); surely we can note where it's been superseded? (c) Although you characterized FJC as non-MEDRS, it looks to me like it falls under Misplaced Pages:MEDRS#Medical_and_scientific_organizations. --Middle 8 (talk) 09:56, 1 December 2013 (UTC)

You have been told your edit violated RS. Please move on. QuackGuru (talk) 18:19, 1 December 2013 (UTC)

No need to use my talk page when here will do. I'm cutting and pasting your comments here. You wrote,

(begin QG comment) Violation of Misplaced Pages:Identifying reliable sources#Medical claims: You restored the disputed primary sources against WP:SECONDARY and you restored excessive details against WP:WEIGHT. Your edit violated the WP:RS guideline. Editors at the talk page disagree with you. See WP:CON.

Ideal sources for biomedical assertions include general or systematic reviews in reliable, third-party, published sources, such as reputable medical journals, widely recognised standard textbooks written by experts in a field, or medical guidelines and position statements from nationally or internationally reputable expert bodies. Being a "medical source" is not an intrinsic property of the source itself; a source becomes a medical source only when it is used to support a medical claim. It is "vital" that the biomedical information in all types of articles be based on reliable, third-party, published sources and accurately reflect current medical knowledge. See Misplaced Pages:Identifying reliable sources#Medical claims. Please be more careful next time. (end QG comment)

My reply to your comment, QG: Under MEDRS, as you well know, primary sourcs are acceptable in some situations. My edit was per the discussion at Misplaced Pages:Reliable_sources/Noticeboard#GERAC, where multiple editors agreed that the sourcing was fine; see Mallexicon's reply to Alexbrn above. The article is not intended to be about current medical consensus, but rather a notable experiment; to whatever degree it's been superseded, the article can and should say so. --Middle 8 (talk) 02:20, 2 December 2013 (UTC)

What sources should and should not be used?

Before deciding what information should go in the article perhaps we should consider what sources ought to be cited. Could we decide which sources are primary and which are secondary? Here are some sources for consideration. Please add others, and most importantly, let's identify secondary sources. Here are some sources that seem significant, but which may be primary. Is there anyone here who thinks that these sources should form the base of the article?

• Template:Cite PMID
• Template:Cite PMID
• Template:Cite PMID
• Template:Cite PMID
• Template:Cite PMID
• Template:Cite PMID

Additional suggestions by Alexbrn

• Foot, Doug; Ridge, Damien (2012). "Constructing the placebo effect in the placebo wars: What is the way ahead?". Health Sociology Review. 21 (3): 355. doi:10.5172/hesr.2012.21.3.355.
• Jeremy H. Howick (23 February 2011). The Philosophy of Evidence-based Medicine. John Wiley & Sons. pp. 92–94. ISBN 978-1-4443-4266-6.

Additional suggestions by QuackGuru

He, W.; Tong, Y.; Zhao, Y.; Zhang, L.; Ben, H.; Qin, Q.; Huang, F.; Rong, P. (2013). "Review of controlled clinical trials on acupuncture versus sham acupuncture in Germany". Journal of traditional Chinese medicine. 33 (3): 403–7. PMID 24024341. {{cite journal}}: Unknown parameter |displayauthors= ignored (|display-authors= suggested) (help) (a fringe journal)

What are some better sources? Has discussion centered around individual sources already happened? Blue Rasberry (talk) 13:01, 1 December 2013 (UTC)

For details on the methodology of the trials themselves, these sources are perfectly fine. For medical claims in this article, it is better to use secondary sources to summarize the results, as shown below:

-A1candidate (talk) 13:31, 1 December 2013 (UTC)

Per WP:MEDMOS, tables like the one shared above are not standard for inclusion into Misplaced Pages articles. If this is added it would require broad input - at least dozens of other opinions to address the years of other opinions which say that this is not appropriate. I do not favor inclusion of this kind of information unless the article is otherwise developed in the usual way first, and I would not participate in discussions about unorthodox additions like this myself. This kind of data has no particular meaning to anyone; even if it is from a secondary source it is primary data which needs to be interpreted, and I am not sure right now that much interpretation should go into this article. Other thoughts from others? Blue Rasberry (talk) 18:11, 1 December 2013 (UTC)

The extreme details in the table is about the trial itself. That is not what this article is about. The acupuncture article does not even go into this kind of details no matter what sources are used. QuackGuru (talk) 18:14, 1 December 2013 (UTC)

I think several of the suggested sources could be used to improve the article. The discussion of the trials and their impact could be expanded. - - MrBill3 (talk) 04:13, 2 December 2013 (UTC)

Results should not be should be limited in the article

Results from these studies should not be included in the article as they are medical claims. A statement that the studies showed positive results but have since been discredited is appropriate. We can't have old, discredited medical claims presented. Details of the studies methodology are undue (especially since the studies have been discredited superseded). This article is not the place for a discussion of research methodology, particularly flawed methodology. Essentially what we have is that these studies were conducted, they were fairly large, they had an impact, they were discussed in popular, political and scientific publications, they have been largely discredited widely criticized, some of the legal/financial impacts have been revised. That is the subject of this article. The specifics details of the studies are undue and not MEDRS. Detail on the impact of the studies, the depth and nature of discussion of the studies and changes that resulted from the discussions are what belong in this article. - - MrBill3 (talk) 00:43, 2 December 2013 (UTC)

I very much disagree. a) The results are important in order to understand what was going on (although I agree that adding the raw data might be superfluous). 2.) I still haven't seen any evidence that these studies "have since been discredited". I've seen criticism, yes, but it seems quite petty to me. All in all, the results of GERAC seem to be very much in line with those of the newest research (= some effectiveness of acupuncture, but not necessarily over sham). --Mallexikon (talk) 01:32, 2 December 2013 (UTC)

Thanks for your input Mallexikon. I await consensus and discussion re: discrediting of studies. It seems to me that no effectiveness over sham = no effectiveness. If a medicine has no more effect than a sugar pill (or other placebo) the medicine is not judged effective. By what standard is the effectiveness of a treatment judged if not significantly greater than sham? - - MrBill3 (talk) 02:22, 2 December 2013 (UTC)

+1 re Mallexicon's comments. Not sure what's been discredited here, although it is plainly not meant to be current. I don't see any effort to misrepresent the sham vs. versum results; can you elaborate? Re currency of results, consider this an historical article; after all, it's about GERAC, not the state of current research. As an extreme example, the article on phlogiston talks about Priestley's results, while making clear they are not current. We can do the same here. (Although the results are consistent with many recent findings re sham vs. verum; though not all, cf. Vickers.) Thanks, Middle 8 (talk) 02:32, 2 December 2013 (UTC)

I spoke brashly (see my self edits) discredited is not an entirely accurate description. My primary point remains that the focus of the article should be on the event. I don't know what level of detail is needed and am open to discussion. I think there is too much detail now. As long as it is made clear that the article is discussing the studies in a historical context and that they have been superseded discussion of the results is appropriate, subject to due weight (fairly heavy as the studies are the subject of the article). I think the coverage of the impact and discussion of the studies should be increased in the article. I don't assert a misrepresentation of sham vs. verum, I do insist it be made/remain clear.- - MrBill3 (talk) 03:04, 2 December 2013 (UTC)

Thanks, MrBill, this discussion is a very pleasant contrast to what I've gotten used to here in the last weeks... So, if we'd take the raw data, the numbers from the article, would that address your concerns? --Mallexikon (talk) 03:51, 2 December 2013 (UTC)

There was a discussion at the AFD about the coat rack material. There is consensus to delete the coatrack material. Uninvolved editors comments about the many problems with this article. See Misplaced Pages:Articles for deletion/German Acupuncture Trials. The results is not what this article is about. It should be deleted. QuackGuru (talk) 03:56, 2 December 2013 (UTC)

Yeah, I'm not even going to comment on that any more.--Mallexikon (talk) 04:01, 2 December 2013 (UTC)

I think taking the numbers out would do the trick. That would keep it from seeming like a report of current medical claims. Local consensus can be achieved by reasonable discussion objections to reasonable consensus forming can be taken elsewhere as can any necessary steps to curb disruption as needed. On reading the article in it's current state it actually looks pretty good, excepting the ref/notes issue I will revisit in the appropriate section. Best.- - MrBill3 (talk) 04:10, 2 December 2013 (UTC)

That might work -- could someone do it, so we can see how it would look? (Maybe you've already started; I'll stay tuned.) BTW, I'm still not clear on what you're referring to when you say the results were superseded and that the studies were widely criticized; which other sources are you referring to? thanks, Middle 8 (talk) 09:01, 2 December 2013 (UTC)

Nonsense deleted

The specific results should be deleted. QuackGuru (talk) 20:46, 12 December 2013 (UTC)

More nonsense deleted. QuackGuru (talk) 19:02, 14 December 2013 (UTC)

Please don't remove reliably sourced material against consensus. Thanks. --Mallexikon (talk) 04:15, 15 December 2013 (UTC)

Editors have repeatedly been concerns about the coat rack material. See Misplaced Pages:Articles for deletion/German Acupuncture Trials. See WP:LOCALCON. You have been told this article is about the event but not about the trials itself. Results from the studies itself cannot not be included in the article as they are medical claims. QuackGuru (talk) 04:45, 15 December 2013 (UTC)

Yes, and more editors have stated their opinion that the coat-rack allegation is bogus... Let me quote from WP:COATRACK: "A coatrack article is a Misplaced Pages article that ostensibly discusses the nominal subject, but in reality is a cover for a tangentially related biased subject". What tangentially related biased subject do you suspect this article be the cover for, if I may ask? --Mallexikon (talk) 05:02, 15 December 2013 (UTC)

"The coats hanging from the rack hide the rack – the nominal subject gets hidden behind the sheer volume of the bias subject. Thus the article, although superficially true, leaves the reader with a thoroughly incorrect understanding of the nominal subject. A coatrack article fails to give a truthful impression of the subject." Per WP:COATRACK. Editors know this is not a medical article. QuackGuru (talk) 05:11, 15 December 2013 (UTC)

Our article gives a very truthful impression of the nominal subject - which is GERAC. Interistingly, it is you who tries persistently to limit information about the trials - for example, by trying to delete material about their set-up. --Mallexikon (talk) 11:57, 18 December 2013 (UTC)

Editors agreed there is a problem with this article. The information about the set-up is still in the article. QuackGuru (talk) 16:17, 18 December 2013 (UTC)

OR tag

There is OR in the lead. I propose the OR should be removed. QuackGuru (talk) 05:14, 15 December 2013 (UTC)

Editing complexities

Enough. I filed a complaint at Misplaced Pages:Administrators' noticeboard/IncidentArchive822#Disruptive editing by User:QuackGuru. --Mallexikon (talk) 09:39, 15 December 2013 (UTC)

I am here and I would help. Could you help break the issue into small points which could be discussed? For example, could you please take 1-2 statements at the center of the controversy, put them here with a reference, and let us talk about this together? It would be very difficult for either anyone on ANI or anyone on the medicine board to give comments on this article because the points of contention are not obvious despite the large amount of discussion here. I know that you recognize problems because you are here. Can you please, without too much commentary, say what you propose to include in the article with the source? Thanks. Blue Rasberry (talk) 20:19, 17 December 2013 (UTC)

Thanks a lot, Blue Rasberry ! There's two main points of contention here as far as I can see:

• 1.) The report of the Federal Joint Committee: Gemeinsamer Bundesausschuss (2007-09-27). Zusammenfassender Bericht des Unterausschusses 'Ärztliche Behandlung' des Gemeinsamen Bundesausschusses über die Bewertung gemäß §135 Abs.1 SGB V der Körperakupunktur mit Nadeln ohne elektrische Stimulation bei chronischen Kopfschmerzen, chronischen LWS-Schmerzen, chronischen Schmerzen bei Osteoarthritis (PDF) (in German). {{cite book}}: Unknown parameter |trans_title= ignored (|trans-title= suggested) (help) ... but they included an English summary on page 2.

This is a review of GERAC and several smaller acupuncture studies. On the basis of this report, the Federal Joint Committee concluded that acupuncture should be included in the list of services reimbursable by Germany's statutory health insurances. I've used this source throughout the article, mainly for information about the set-up and outcome of the trials. User:QuackGuru wants to ban this source on the grounds of it being a primary source (he's just tagged it again ).

• 2.) QG opposes including material about the trials' results (as in subsection German acupuncture trials#Individual trials). This view was shared by other editors; please find the discussion at Talk:German acupuncture trials#Results should not be should be limited in the article. We found consensus to limit the information about the results; however, QG opposes this consensus as well. --Mallexikon (talk) 04:39, 18 December 2013 (UTC)

The Federal Joint Committee primary source is being used to discuss the specific results of discredited studies. The low level details is a gross WP:WEIGHT violation. QuackGuru (talk) 04:46, 18 December 2013 (UTC)

User:QuackGuru, is it correct to say that you feel that the available sources do not sufficiently and duly back the insertion of the following?

1. The FJC authorized state-run insurance programs to reimburse acupuncture providers for delivery of treatment to the general insured public who met requirements to receive treatment
2. These payments were actually made for some period of time

Also QG, have you ever made a suggestion about how the results of this study could be reported? Can you suggest a way to report the results of this study which would not be a weight violation, violate MEDRS, or otherwise mislead readers? How would you characterize whatever outcome the study had which led the FJC to start disbursing payments?

Thanks, and please excuse my asking you to repeat information. Blue Rasberry (talk) 19:09, 18 December 2013 (UTC)

For 1 and 2 there is similar text in the article that characterises whatever outcome the study had. "As a result of the GERAC trials, the German Federal Joint Committee ruled in April 2006 that the costs of acupunctural treatment for chronic back pain and knee osteoarthritis will be covered by public health insurers in Germany."

A summary of the trials is seen in this version. I don't see a reason to include the extreme details for each specific trial. QuackGuru (talk) 19:29, 18 December 2013 (UTC)

Mallexikon, QuackGuru is proposing text which seems to me to meet what you expressed wanting. Could you be explicit in stating what you want in addition to this? Show the links to the history if you already attempted to execute your proposal. Blue Rasberry (talk) 19:51, 18 December 2013 (UTC)

Mallexikon wants to keep an unlimited amount of coat rack information in the article but Mallexikon admitted that We found consensus to limit the information about the results. QuackGuru (talk) 20:00, 18 December 2013 (UTC)

I don't want to include unlimited information, but I want to include how these trials were done. It's important to have information on how many test subjects they had, how sham acupuncture was designed, how well the acupuncturist were trained, how the "standard care" control group was treated etc. And it's also important to say what the outcome was: the FJC made their decision because verum and sham acupuncture was more effective than standard care (in treatment of back pain and osteoarthritis). And the TCM community was miffed because verum and sham were shown to have no efficiency difference . In short, the text I want to add is this. --Mallexikon (talk) 02:22, 19 December 2013 (UTC)

All you did was revert back to the old version you last edit with all the disputed coat hook information and POV language. You even restored the original research I removed. QuackGuru (talk) 02:30, 19 December 2013 (UTC)

Your coat hook allegation is irrational. This sourced information you deleted yesterday is making sure that this article does not turn into a coat hook - because it makes sure that we give a truthful impression of the nominal subject. And what do you mean by POV language? --Mallexikon (talk) 03:37, 19 December 2013 (UTC)

You added a ton of POV language from discredited studies to the overview section. QuackGuru (talk) 04:08, 19 December 2013 (UTC)

1.) Please give an example of POV language, I can't see it. 2.) Please provide MEDRS evidence that these studies are discredited. --Mallexikon (talk) 04:14, 19 December 2013 (UTC)

Here are some examples. The academic community section discredited these studies. QuackGuru (talk) 04:20, 19 December 2013 (UTC)

No, no more diversionary tactics... in the diff you gave, there is not single example of POV language. If you really got one, please write it down here. And the same goes for the wikilink you provided - there is not a single MEDRS in there "discrediting" GERAC. If you're not just bluffing, please provide one here clearly for everybody to see and discuss. --Mallexikon (talk) 05:32, 19 December 2013 (UTC)

It is the definition of POV language according to WP:MEDDATE. QuackGuru (talk) 07:38, 19 December 2013 (UTC)

There is no definition of POV language in WP:MEDDATE. And I'm still waiting for a single MEDRS that GERAC has been "discredited". You're just throwing these allegations around without a shred of evidence. --Mallexikon (talk) 07:55, 19 December 2013 (UTC)

The dates sources are "discredited" because we have newer sources on the topic. QuackGuru (talk) 07:58, 19 December 2013 (UTC)

Alright, so you mean outdated but you write discredited - now that's what I call POV language. And you're misusing WP:MEDDATE for your POV crusade too: it says "These instructions are appropriate for actively researched areas with many primary sources and several reviews and may need to be relaxed in areas where little progress is being made or few reviews are being published". Since we're talking about GERAC here (and not about a medical claim like "acupuncture is efficient in treating low back pain"): how on earth do you get the notion that there should be active research about a 2006 trial? --Mallexikon (talk) 09:00, 19 December 2013 (UTC)

"POV language": In the outcome, true acupuncture and sham were significantly more effective than standard therapy; however, there was no statistical significant difference between the effectiveness of true and sham acupuncture.{{refn|group=n|In the GERAC back pain study, 1162 patients with chronic low back pain were randomized. The studies found the effectiveness of acupuncture to be almost twice that of standard therapy with 6-month response rates being 47.6, 44.2 and 27.4% for true acupuncture, sham and standard groups, respectively.<ref name= "shenker"/>}}<ref>{{harvnb|Gemeinsamen Bundesausschusses|2007|pp=309–10}}</ref>

Here is one example of the discredited POV language you restored against consensus above.

You added the obsolete text but you previously said there is consensus to limit the information about the specific results. You did restore information about the has-been GERAC medical claims gibberish but this article is about the outcome of the trials. You're not WP:LISTENING. QuackGuru (talk) 18:52, 19 December 2013 (UTC)

Relax, man, I'm a very good listener actually :)... The consensus was to take out the numbers - to stay with the example you've given above, numbers like the "response rates being 47.6, 44.2 and 27.4% for true acupuncture, sham and standard groups, respectively". And those numbers are long gone. --Mallexikon (talk) 08:51, 20 December 2013 (UTC)

You know there is consensus to limit the information about the results. So why did you restore the dated information along with the extreme unimportant details that are not helpful to the reader. QuackGuru (talk) 20:07, 20 December 2013 (UTC)

Mallexikon, but would you be kind enough to split this information for me? Pull out 1-2 contentious statements with their sources, replicate them here, and then let me comment. Otherwise confirm that you like the statement that I pulled and the way I am framing this. I am looking at what you and QuackGuru have done and I expect that I have a third opinion different from what either of you are doing. I think it would be more useful to talk about 1-2 items initially to see if we can work together rather than for me to try to comment on those 5 points you made all together. Let me start with something -

Here are the items requested:

1. number of test subjects
2. design of sham treatment (treatment control)
3. training of acupuncturist
4. rationale for FJC outcome
5. response of stakeholders (TCM community)

(1) I like the idea of giving the number of test subjects because it is a fundamental question for any clinical trial. I recognize that this information is coming from a primary source, but I that since it is a defining characteristic of a trial, if a trial is worth describing the the number of participants is worth mentioning. Is there opposition to including this number whenever a trial is mentioned? Is there opposition to mentioning the names of trials which constitute the "German acupuncture trials"?

No opposition on my side to any of these points. --Mallexikon (talk) 04:58, 19 December 2013 (UTC)

(2) If the design of the sham treatment and the training of the acupuncturist are mentioned, then that should go into a critical response section and be tied to a source which is not a paper published by the study coordinators. Right now I see

The acupuncture point selection was partially predetermined.<ref name="da1"/> Needles were to be manipulated until arrival of ] sensation.<ref name="da1"/> For sham acupuncture, needles were inserted only superficially (3 mm at most), and at bogus points; there also was no subsequent manipulation.<ref name="da1"/> Thus, only the patients (not the performing acupuncturists) could be ].<ref name="da1"/> Assessment regarding the therapy's efficacy was undertaken by blinded interviewers.<ref name="da1"/>

which is all taken from a primary source, right? Why can all of this not be summarized simply by saying "sham acupuncture was used"? If no secondary source is identified to cite for this information and interpret it, then why include it at all? Is it correct to say that Mallexikon, you feel this information must be included? If so, is it correct that there is no secondary source and that you would like this referenced to a primary source? Why should there be an exception to the general rule in this case? Blue Rasberry (talk) 04:23, 19 December 2013 (UTC)

The specific design of the sham acupuncture is very important, especially regarding the findings of GERAC that verum and sham had the same efficiency... The first thing that miffed TCM proponents jumped on was to allege that the sham acupuncture was badly designed (e.g. in this source).

We do have a secondary source for all this information (the FJC report). However, while the primary source explains that and how the sham design was the same for all GERAC sub-trials, the FJC report discusses/describes each sub-trial separately. Thus, it would be quite hard to work their information into a summary about sham design without risking allegations of OR.

Also I'd like to emphasize that it has been emphasized already (by User:Podiaebba, User:TimidGuy and User:Andrew Lancaster) at the RS noticeboard discussion () that MEDRS doesn't forbid primary sources in general, it just tells us to use them with caution. --Mallexikon (talk) 04:58, 19 December 2013 (UTC)

The secondary source you cited says, "The control methods of sham acupuncture used in Germany may not be standardized and may not be suitable for acupuncture clinical trial research." The summary which I pulled above is a series of statements on treatment which cannot possibly mean anything to anyone without highly specialized knowledge not available on Misplaced Pages - would you not agree? Why do you feel it is necessary to include this? What insight do you expect a typical reader to gain from reading this? And if you assert that this comes from secondary sources, why use a primary source as your citation? Blue Rasberry (talk) 03:45, 20 December 2013 (UTC)

1.) No sorry, there seems to be a misunderstanding. The secondary source I would cite is the FJC report. I think what you are citing is a Chinese source that QG contributed, it's a review of several different acupuncture studies done in Germany without giving information about the GERAC in particular.

2.) You're right that the typical reader will not gain too much from this material, but that can be said about a lot of material in science-related articles in WP... And if 10 or 20% of the readers of this article would gain something from it, wouldn't that be worth including this material? What reason is there to exclude it?

3.) I tried to explain why I would prefer to use the primary sources instead of the secondary source (from the Federal Joint committee), but maybe that makes things too complicated here - I'll be happy to just use the secondary source if you think that'd be better. --Mallexikon (talk) 08:31, 20 December 2013 (UTC)

3) The issue in this case is less about primary and secondary sources and more about primary or secondary data. The interpretation that a control group was used is secondary data based on primary data describing all the practices which were actually done. If this article included a description of all the things done to create the control group, then this would be meaningless data until someone interpreted it. Misplaced Pages is not supposed to contain much data which needs interpretation unless it is widely agreed that the public is supposed to know what it means. The kind of data that I would expect to see is something on the order of "The scientists assigned a control group, the FJC recognized its suitability, other groups challenged its credibility". The data presented above is in prose form, but actually it is just jargon. I am not sure how to properly articulate this, but I am going to try to give an example. It could be written as

Control group setup
*De-qi = positive
*location = incorrect
*Insertion = 3mm

which is meaningless in the broader context of Misplaced Pages. In contrast, secondary information will be some translation of the data:

Control group evaluation
*Coordinating scientists = valid
*government = valid
*critics = invalid

How do you feel about my framing of the prose as a list of data?

2) There is harm in presenting information on Misplaced Pages in which is open to too much interpretation. I am in favor of the reader having access to links to read about the setup of a trial, but the kind of parameters cited above are beyond what is usual here. To cite Misplaced Pages rules, data like this should not be included because of WP:PRIMARY, but still, rules can be ignored in the service of readers. Tell me about this 10-20% of people who need to know how the trial was conducted. When they see this paragraph, what will they think? Are they going to make some assessment about the validity or lack of validity of the trial based on this information? Thanks. Blue Rasberry (talk) 13:02, 20 December 2013 (UTC)

I definitely support the type of paraphrasing that Blue Rasberry is proposing. This is how a WP article should read. I do not think a discussion of the set up of the trials is encyclopedic or useful. References and external links allow those who have the expertise and interest to examine the details of the studies. This article should focus on the interpretations of the studies and on published analyses of the impact of the studies. This maintains the historical distinction (as opposed to medical information). The notability of this article was established based on the impact of these studies in legal and financial arenas and the discussion in the scientific and medical community of these studies, not on the scientific findings of these studies. Third party secondary sources commenting on this should make up the content of this article. - - MrBill3 (talk) 08:22, 21 December 2013 (UTC)

@ Blue Rasberry : When the 10 to 20% of readers I talked about (readers with some knowledge about acupuncture, like me) read this paragraph, they will see that the verum-not-more-effective-than-sham result of these trials carries a lot of weight... According to the traditional concept, the ultimate sign that the acupuncturist's needling is actually effective is the onset of a certain sensation (reported by the patient) called de-qi - and de-qi is more likely to be elicited in the center or immediate vicinity of an acupoint, but not really dependent on it; it would also come up, e.g., at A-Shi points (that can pop up everywhere on the body). If the sham acupuncture (where no subsequent manipulation was allowed) showed the same efficiency even though they were supposed to actually elicite de-qi in the verum group, that raises a lot of (more) questions about traditional acupuncture practice.

@MrBill3: I personally think the great thing about WP in contrast to other encyclopaedias is that we can include more material... However, I so understand your and Bluerasberry's concerns, and I see that there is consensus forming to not include this material. So if you'd rather delete it, that's also fine with me. --Mallexikon (talk) 01:51, 22 December 2013 (UTC)

Responding to Mallexikon's cmt to Bluerasberry, a very interesting analysis of the importance of some particular information from the studies. In my opinion this is more appropriate for the acupuncture article and should be found discussed in up to date MEDRS. If you can find any secondary source discussing this in terms of GERAC I would support it's inclusion here. Absent that couldn't those with interest follow links to the publication of the studies for such information?

Probably not... it's in German. Also couldn't find a secondary source discussing this. --Mallexikon (talk) 07:24, 22 December 2013 (UTC)

Re WP and more it is an ongoing balance between completeness and conciseness. Sometimes readers value getting all the information they are looking for on a subject, sometimes readers appreciate getting the core information quickly and laid out accessibly. I like to think that multiple editors working to consensus builds a good compromise. - - MrBill3 (talk) 06:38, 22 December 2013 (UTC)

Quote

"the results suggested that there was no difference between acupoints and non-acupoints, and some insurance companies in Germany stopped reimbursement for acupuncture treatment." QuackGuru (talk) 06:23, 18 December 2013 (UTC)

Ok. --Mallexikon (talk) 07:03, 18 December 2013 (UTC)

You did not restore the information to the lead to summarise the body. But I did restore the information to the lead. QuackGuru (talk) 16:19, 18 December 2013 (UTC)

Federal Joint Committee source

I got a sneaking suspicion that nobody here actually wants to deal with this source as it's written in German... So I'll add the English summary for reference:

"Abstract

The paramount decision-making body of the joint self-governance is the Federal Joint Com-mittee (the so-called “Gemeinsamer Bundesausschuss” ). The G-BA has been estab-lished as a legal entity under public law. It has wide-ranging regulatory powers. The various duties and wide-ranging powers of this committee are laid down in Volume Five of the Social Code Book (SGB V), which governs statutory health insurance. One of the main tasks of the G-BA is to assess and to appraise benefit (efficacy and safety), efficiency and necessity of new health care interventions. Future coverage of interventions within the statutory health insurance system depends on a favourable conclusion after the review process. The result of any evaluation and decision making process is published as a Health Technology Assessment (HTA) report.

Acupuncture was evaluated by the former Federal Joint Committee (the so-called “Bunde-sausschuss der Ärzte und Krankenkassen”, the predecessor of the G-BA) in the years 1999 and 2000 for many different indications. In the decision of the Committee of October 16th, 2000 “body acupuncture with needles without electric stimulation” was excluded from reim-bursement of the statutory health insurance system except for the three indications „chronic headache“, „chronic pain of the lower back“ and „chronic pain in osteoarthritis“. These three indications could be reimbursed within scientific investigations under the terms of § 63 of the Volume Five of the Social Code Book (SGB V). Results of randomised controlled trials which were performed in Germany following the above decision were the underlying data of the actual consultations of the G-BA.

The recent consultations of the G-BA included questions of the methodology of acupuncture studies, assessment of the safety of acupuncture and assessment of efficacy of acupuncture in „chronic tension headache and migraine“, „chronic pain of the lower back“ and „chronic pain in arthritis of the knee and hip“. The randomised trials included in the consultations on acupuncture at the G-BA were not only results of the German acupuncture studies but also of an additional systematic literature research.

As far as the indications „chronic pain of the lower back“ and „chronic pain in arthritis of the knee“ are concerned the G-BA was able to relate to the positive results of these studies. The decision was determined by the findings of the studies that acupuncture therapy in these cases showed significant advantages compared to „standard therapy“. Whether the specific selection of acupuncture points according to Traditional Chinese Medicine (TCM) had any influence on these findings remained unclear but did not lead to a negative vote of the G-BA. The consultations on the indication „chronic tension headache and migraine“ did not reveal similar valid evidence of an advantage of acupuncture therapy over standard therapy. The G-BA’s final session of consultation and decision making on Acupuncture took place on April 18th and September 19th, 2006. The G-BA decided to include “acupuncture with needles without electric stimulation” for the indications „chronic pain of the lower back“ and „chronic pain in arthritis of the knee“ into the benefits catalogue of the statutory health insurance sys-tem. Acupuncture for „chronic tension headache and migraine“ and all other indications were excluded from coverage in the ambulatory treatment sector. On January 1st, 2007 the directive which was supplemented by recommendations on quality assurance has come into force."

This is a primary source. Is there any specific proposal? QuackGuru (talk) 04:30, 19 December 2013 (UTC)

As you can see very clearly, this report is a review. That makes it a secondary source. --Mallexikon (talk) 05:02, 19 December 2013 (UTC)

What is proposed to be done with this? Make a simple proposal without spending much time, get feedback, and expand after establishing what is non-controversial. Blue Rasberry (talk) 03:48, 20 December 2013 (UTC)

This discussion is now merging into the one above :)... I'd like to use this source for material like the one you cited way above: "The acupuncture point selection was partially predetermined. Needles were to be manipulated until arrival of de-qi sensation. For sham acupuncture, needles were inserted only superficially (3 mm at most), and at bogus points; there also was no subsequent manipulation. Thus, only the patients (not the performing acupuncturists) could be blinded. Assessment regarding the therapy's efficacy was undertaken by blinded interviewers." --Mallexikon (talk) 09:18, 20 December 2013 (UTC)

To keep the extreme technical details about the set-up in the article is pointless. A summary is better. QuackGuru (talk) 20:07, 20 December 2013 (UTC)

1. ^ Cite error: The named reference shenker was invoked but never defined (see the help page).
2. ^ Mao, Jun J. (2010 Mar). "Acupuncture in Primary Care". Primary Care: Clinics in Office Practice. 37 (1): 105–117. doi:10.1016/j.pop.2009.09.010. PMC 2830903. PMID 20189001. The GERAC trials were being conducted to compare acupuncture to sham acupuncture and guideline-oriented standard therapy. Unlike ARTs though, GERAC found very little difference between acupuncture and sham acupuncture. In results published by Scharf et al. in 2006, the success rates (defined as a 36% improvement in WOMAC scores at 13 and 26 weeks) were 53.1% for acupuncture, 51.0% for sham acupuncture, and 29.1% for standard therapy. Both acupuncture and sham acupuncture were significantly better than standard therapy. {{cite journal}}: Check date values in: |date= (help); Italic or bold markup not allowed in: |journal= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)CS1 maint: date and year (link)
3. ^ Taylor, Frederick R. (13 October 2006). "Abstracts and Citations". Headache: the Journal of Head and Face Pain. 46 (9): 1464–1473. doi:10.1111/j.1526-4610.2006.00594.x. The proportion of responders, defined as patients with a reduction of migraine days by at least 50%, 26 weeks after randomization, was 47% in the verum group, 39% in the sham acupuncture group, and 40% in the standard group (P= .133). {{cite journal}}: Italic or bold markup not allowed in: |journal= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
4. ^ Linde, K (2009 Jan 21). Linde, Klaus (ed.). "Acupuncture for tension-type headache". The Cochrane database of systematic reviews (1): CD007587. doi:10.1002/14651858.CD007587. PMC 3099266. PMID 19160338. The meta-analyses on response, headache days per 4 weeks and intensity are heavily influenced by the large, rigorous trial by Endres 2007. For headache frequency (response and headache days per 4 weeks), this trial found statistically significant benefits over sham acupuncture. Interestingly, for the predefined outcome measure of this trial, the difference was not statistically significant (P = 0.18). The predefined outcome measure was the proportion of patients with at least 50% reduction at 6 months, but patients with protocol violations were counted as non-responders. For example, patients who changed from one analgesic to another were reclassified as non-responders. Thus, only 33% in the true acupuncture and 27% in the sham group were counted as responders, while the commonly used response criterion without reclassification yielded responder proportions of 66% and 55%, respectively. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
5. "Acupuncture 'like migraine pill'". BBC. 2 March 2006. Retrieved 26 November 2013. The researchers then returned to the patients between 23 and 26 weeks later and checked on whether they had been "migraine free" for 50% of days. It was found 47% of those receiving traditional acupuncture, 39% of those given sham acupuncture and 40% of those in the drug treatment group had been migraine-free for at least 50% of the time.
6. ^ Linde, K (2009 Jan 21). Linde, Klaus (ed.). "Acupuncture for tension-type headache". The Cochrane database of systematic reviews (1): CD007587. doi:10.1002/14651858.CD007587. PMC 3099266. PMID 19160338. The trial by Endres 2007 was originally designed to include a third arm of patients randomized to amitriptyline, the currently most widely accepted therapy (Diener 2004). However, as patients were unwilling to participate in a trial with the possibility of being randomized to amitriptyline, this arm was dropped after 1 year of very poor accrual. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

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