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Outstanding issues

Acupuncture and placebo

The first review found some evidence that "biological differences" exist between a placebo response and sham acupuncture. The second review concluded that "acupuncture is more than a placebo". Are there any recent reviews that suggest otherwise? -A1candidate (talk) 02:31, 11 August 2014 (UTC)

Nocebo

Article fails to discuss the nocebo effect of acupuncture:

-A1candidate (talk) 02:31, 11 August 2014 (UTC)

Allergy

Article fails to mention acupuncture treatment for allergic diseases:

-A1candidate (talk) 02:31, 11 August 2014 (UTC)

Mechanism of acupuncture

Article fails to mention mechanism of acupuncture:

-A1candidate (talk) 02:32, 11 August 2014 (UTC)

Acupuncture and the brain

Article fails to mention acupuncture's effect on the brain:

-A1candidate (talk) 02:32, 11 August 2014 (UTC)

We might add a bit about contraindications for certain points, i.e. the "fordidden points" during pregnancy like LI4, SP6, and GB21. I don't remember the source that mentioned that but AFAIK it was a MEDRS. --Middle 8 (leave me alone • talk to me • COI?) 03:09, 14 August 2014 (UTC)
These studies are of the brain's reactions to the body being poked with sharp things. They don't lay the foundation for the effectiveness of acupuncture, just that the brain does, indeed, react to the body being poked with a sharp object. I'm not aware of anyone that denies that.—Kww(talk) 13:37, 13 August 2014 (UTC)
No, they do. Read the meta-analyses carefully. -A1candidate (talk) 13:56, 13 August 2014 (UTC)
Please provide exact quotes from the meta analysis which you find relevant, something that tells us more than is already obvious, which is that every spot in the body has areas in the brain which not only control it but also areas which react to anything which affects it. That's too basic and "duh". What do you have from that source which we can use? -- Brangifer (talk) 23:58, 13 August 2014 (UTC)
e.g. (bold text indicates subsection header): Acupuncture at non-acupuncture points in close proximity to acupuncture points" Two third (64%) , – of 25 studies showed that acupuncture treatments were associated with more activation, mainly in the somatosensory areas, motor areas, basal ganglia, cerebellum, limbic system and higher cognitive areas (e.g. prefrontal cortex). That's 16 of the studies. Different or contradictory results were found in the remaining 9 studies. Also see other quotes under section titled Descriptive findings of differences between verum and sham acupuncture. --Middle 8 (leave me alone • talk to me • COI?) 03:20, 14 August 2014 (UTC)

Brain studies are not about acupuncture effectiveness or theory. There is specific information in the article about the mechanism of action. QuackGuru (talk) 02:18, 7 October 2014 (UTC)

They are relevant in the scientific section. You removed them for different reasons than what you are protesting here. Why? LesVegas (talk) 03:01, 7 October 2014 (UTC)
I think User:Middle 8 put it pretty well above. QuackGuru, the Kww's comment you quoted here, are there any sources supporting that? I think a source for that would be the easiest way to solve this since unfortunately we can't use mere opinions to discard sourced material.
I can't see any "strong disagreement with using these sources" either, as it was stated in some deletion summaries. Jayaguru-Shishya (talk) 14:55, 7 October 2014 (UTC)
I did explain the problems with the edits. Highly technical information about brain activity studies is confusing to the reader, is not directly about the acupuncture treatment itself, and it does not show whether acupuncture is effectiveness. This is undue weight. However, there is better information in the section that explains that the evidence suggests that acupuncture generates a sequence of events that include the release of endogenous opioid-like substances. QuackGuru (talk) 19:51, 7 October 2014 (UTC)
re QuackGuru's comments:
  • In the diff, QG wrote "Brain studies are not about acupuncture effectiveness or theory." So? The article isn't limited to those topics. Brain studies about acu are certainly on topic.
  • "Highly technical" information is all over Misplaced Pages, and this isn't that technical.
  • "is not directly about the acupuncture treatment itself, and it does not show whether acupuncture is effectiveness" -- again, the article isn't only about those things, no matter how much QG might like to make it that way. Indeed, it's undue weight to only cover the topics QG mentions without coving other aspects.
  • Endorphins -- sure, that's an aspect. But how is it "better"? The sources are fine and the arguments for excluding them are very thin. Aside: as Guy pointed out here, part of QG"s excessive OWN-ership of this article and chiropractic has included arguing that deleting any RS is bad. Now QG's wants to exclude RS material on thin grounds? This is self-serving. --Middle 8 (contribs • COI) 09:56, 10 October 2014 (UTC)
So far, only Kww has commented on the topic. QuackGuru, you have earlier quoted that comment by Kww, but it remains completely unsourced, right? Individual ponderings indeed might be interesting, but "unfortunately" need to be something reliably sourced to make it's way to Misplaced Pages. Jayaguru-Shishya (talk) 15:10, 13 October 2014 (UTC)
Self serving you say? My irony meter is off the scale. -Roxy the dog™ (resonate) 10:43, 10 October 2014 (UTC)
Delightfully clever as always, Roxy, but have you so soon forgotten this exchange? And I don't think you have an irony meter. Not when you get all righteous and dramatic about reverting wording when I use it, but not when, say, QuackGuru and Doc James do. And that in the purported defense of reason and objectivity.... --Middle 8 (contribs • COI) 16:10, 11 October 2014 (UTC)
Yet you still carry on with your same old "I don't have a COI" schtick. -Roxy the dog™ (resonate) 16:53, 11 October 2014 (UTC)
Not true. --Middle 8 (contribs • COI) 22:33, 12 October 2014 (UTC)
It should be noted any COI editors and any COI editor should follow the advise of WP:COI. QuackGuru (talk) 06:14, 13 October 2014 (UTC)

Article does not conform to scientific consensus

This article fails to conform to scientific consensus

Mayo Clinic
"The current scientific theories provide a basis for stating that acupuncture has an effect on the nervous system"
Johns Hopkins School of Medicine
"The modern scientific explanation is that needling the acupuncture points stimulates the nervous system to release chemicals in the muscles, spinal cord, and brain."
National Cancer Institute (USA)
"Acupuncture may work by causing physical responses in nerve cells, the pituitary gland, and parts of the brain"
National Health Service (Britain)
"It is based on scientific evidence that shows the treatment can stimulate nerves under the skin and in muscle tissue."
A Scientific Statement From the American Heart Association
"In the manual form of acupuncture, the mechanism of effect appears to be through sensory mechanoreceptor and nociceptor stimulation induced by connective tissues being wound around the needle and activated by mechanotransduction. In the case of electroacupuncture, the effects appear to additionally involve the stimulation of peripheral nerve fibers, including vagal afferents, that in turn activate central opioid (and other) receptors or anti-inflammatory reflex pathways. Reflex increases in sympathetic activity may also be reduced by electroacupuncture. The role of mechanoreceptor stimulation in the BP reductions in animal models is supported by the ability to attenuate this effect by gadolinium, which blocks stretch-activated channels. Both forms of acupuncture have similar central nervous system effects, although electroacupuncture tends to have a greater intensity of effect as determined by functional magnetic resonance imaging studies in humans." (PMID 23608661)

-A1candidate (talk) 02:32, 11 August 2014 (UTC)

These are really good MEDRS's that we've neglected but I don't see how they meet WP:RS/AC any more than some of the meta-analyses we quote. --Middle 8 (leave me alone • talk to me • COI?) 03:31, 14 August 2014 (UTC)
Excellent summary by A1! Given there is still doubt about exactly how acupuncture works, a true 'Mechanism of Acupuncture' section is probably still premature, but you have undoubtedly presented an outstanding case for rewriting the article to make it consistent with current scientific thinking and including a 'Possible Mechanism of action' section. Yet, we have been here before! I painstakingly set up a 'Possible Mechanism of Action' section for this article over a year ago - see: https://en.wikipedia.org/search/?title=Acupuncture&oldid=561592493. It lasted about a week before its reversion. The subheadings for that section are still current and in-line with A1's summary, although some of the refs might need updating. I'd consider putting it back in again, but would this put me up for another bout of reversion and a caution? Tzores (talk) 21:47, 12 August 2014 (UTC)
It seems you have made your homework pretty well, A1candidate! I find it quite impressive all the sources you have listed above. With respect to the scientific consensus issue, what would you suggest? =P Jayaguru-Shishya (talk) 10:37, 13 August 2014 (UTC)
We already state, of scientists, that "They, along with acupuncture researchers, explain the analgesic effects of acupuncture as caused by the release of endorphins, and recognize the lack of evidence that it can affect the course of any disease." This (or some tweaked form of it) is enough - much more would be undue and a section on 'Possible Mechanism of Action' especially so, probably veering into OR territory. Alexbrn 05:24, 13 August 2014 (UTC)
Huh? You'd omit MEDRS even if they don't fully accord with what you just wrote (re: no point specificity)? See PLOS One source supplied by A1Candidate above and my diff giving e.g.'s of quotes from same . --Middle 8 (leave me alone • talk to me • COI?) 03:28, 14 August 2014 (UTC)
First of all, Misplaced Pages is an encyclopedia, not a scientific research paper. Its articles are not supposed to "conform to scientific consensus", although they do report it. They are encyclopedic articles, and of a special nature, largely because of our NPOV policy, which requires coverage of all significant aspects of a topic, unlike normal encyclopedias.
Secondly, those nice snippets are basically saying "duh". Those are not surprising or unique results, and are about the same results as would be expected if you pinched someone or scratched them. Acupuncture does actually touch the body. It affects the body. It's not Therapeutic touch, where hands are waved over the body without actually touching it. These are real effects, but they are non-specific responses to external influences on bodily tissues. This proves nothing special about acupuncture, and says nothing about any specific and unique results from a specific poke in a specific acupoint. There is no consistent, specific, and reproducible reaction from acupuncture which applies to everyone.
There do seem to be some generalized reactions, sometimes of a somewhat positive nature (pain relief), but nothing one can count on, or that could not be obtained by any other method which triggered endorphin production, and certainly not better than, or as strongly or consistently or reproducibly as any of several standard analgesic drugs. That electroacupuncture seems to have a stronger effect is also unsurprising, and it's NOT acupuncture. It's electrotherapy.
So, what specific wordings are you proposing to make to the article? This is all speculation about possible mechanisms, but it really adds nothing we don't already know, so do you have something specific and unique to acupuncture which is a new addition to the article? -- Brangifer (talk) 06:28, 13 August 2014 (UTC)
You obviously failed to read the articles above. Scientific consensus isn't "speculation". It's something we summarize and conform to. -A1candidate (talk) 09:31, 13 August 2014 (UTC)
Brangifer, do you have anything aside from your own ponderings? Jayaguru-Shishya (talk) 10:37, 13 August 2014 (UTC)
A1, those aren't statements of "scientific consensus", they are simple statements of evidence, and that evidence is not special. Anyone, even the most ardent skeptic, will admit that they are true statements. So "...acupuncture has an effect on the nervous system". Duh! Of course it does. Has anyone denied that? No. So "... treatment can stimulate nerves under the skin and in muscle tissue." Duh! Of course it does. Has anyone denied that? No. I could go on with each one of the statements.
This amounts to a two year old finding a penny and presenting it to its mother and thinking that it has found something which no one else in the world knows about, and now it thinks it has taught its mother about the existence of money. The mother says "Oh, what a pretty penny!" If that same child does this every day, all the way up into its twenties, the mother replies "Duh. This is getting old."
So, we need to know what you're getting at, because you haven't brought anything new or enlightening to the table. How would you use these statements in the article? Don't we already acknowledge that the body does sense when it is poked? I don't think we deny that fact. The body is sensitive to anything which touches it. Duh! So what. We need more than what we already know and what we already acknowledge in the article. -- Brangifer (talk) 13:24, 13 August 2014 (UTC)

I love the smell of inappropriate use of sources in the morning. Here, we have promotions for acupuncturists at Mayo and Johns Hopkins being touted as representative of scientific consensus on acupuncture. The others are lay descriptions of acupuncture used to describe services that the scientific community still dismisses as being no more effective than a placebo. That certainly is a creative way to describe the sources, but hints at a strong desire to distort reality.—Kww(talk) 13:33, 13 August 2014 (UTC)

The article in Mayo Clinic Proceedings is classified in PubMed as a review article, not a promotion piece. -A1candidate (talk) 13:52, 13 August 2014 (UTC)
I can't find anywhere on that page where it's referred to as a "review article", but that's really beside the point. It is a RS, in the general sense of the word, but for what purpose in this connection? What you've quoted from it isn't really worth using, even if it was a "review article" which passed the criteria in MEDRS, so what are you proposing that we can do with it? -- Brangifer (talk) 00:36, 14 August 2014 (UTC)
The current scientific theories provide a basis for stating that acupuncture has an effect on the nervous system, but its effects cannot be explained with a single mechanism. -A1candidate (talk) 16:29, 14 August 2014 (UTC)

@A1candidate: you are seriously misrepresenting the NHS source. I only checked that one since I used it not so long ago and did not remember it conforming to your description. And so it does not. This gives me very little confidence that the rest of your edits may be taken at face value. Perhaps a specific proposal where we can all vet your use of sources would be better received? - 2/0 (cont.) 17:23, 14 August 2014 (UTC)

I quoted from NHS exactly as it is stated on their website. If it looks different from what you last saw, that's because the page was changed last month. They update their articles evey two years, so you need to check with the newest version.
If you want a specific proposal from me, see Talk:Acupuncture#Protected_edit_request_on_20_July_2014_2. There's still no consensus over there, so your input is very much welcome -A1candidate (talk) 18:00, 14 August 2014 (UTC)
Nobody said you messed up the copy/paste. Please read more carefully to avoid wasting the time of your fellow editors. You are misrepresenting the conclusions of that source; read it again to see how they treat the subject compared to your proposed use here. They do not conform. This is *never* appropriate. We must only and exactly provide a fair representation of the sources without cherry-picking or quoting out of context. - 2/0 (cont.) 18:38, 14 August 2014 (UTC)
And you are misrepresenting what I propose, which is that acupuncture stimulates the nervous system. That is exactly what the source says. -A1candidate (talk) 18:43, 14 August 2014 (UTC)
I think we all agree that inserting needles under the skin has an effect on the nervous system, at least based on discussion above. Please strike or modify your above aggressive comment in accordance with WP:CIVIL and WP:BATTLEGROUND. - 2/0 (cont.) 19:04, 14 August 2014 (UTC)
(e/c) 2/0, I may be missing something, but I don't see A1 giving any worse than he's getting from you on the aggression front; you both sound exasperated, and it may be just a misunderstanding. The NHS page , as of today, indeed includes verbatim the quote "It is based on scientific evidence....". Is there some other dispute about that source that I'm missing? What misrepresentation are you referring to specifically? Forgive some entirely possible denseness on my side (literally; my sinuses are all too dense at the moment, and it's radiating to what's left of my brain), but I'm not understanding what A1C is proposing to do with the NHS source beyond simply citing or paraphrasing that quote. --Middle 8 (leave me alone • talk to me • COI?) 19:25, 14 August 2014 (UTC)
oh -- you mean that A1Candidate is overstating the degree to which the NHS source represents scientific consensus? If so: yes, I think that several of these sources aren't as close to meeting WP:RS/AC as A1C is suggesting. But the NHS source is an excellent MEDRS, one of the best, and I think there's room for disagreement over how close it is to representing sci consensus. A1C, I hope you're reading this as well: The problem, which Brangifer has imo correctly identified , is that there is no unified sci consensus on most aspects of acu (other than its not being an established treatment). That's why there's such a broad range of views, and so much polarization; the extremes at each end (in real life and on WP) piss each other off. That there are good reasons to use it as a complementary therapy for pain and stress is a mainstream view; that that same view is unsupportable is also a mainstream view. (Note I said "good reasons", which is a superset of "good evidence". Patients really liking it is an example of what many consider a good reason.) So I think it would be better for A1C to portray his sources not as representative of sci consensus, but as MEDRS's (many of them excellent ones) that we need to weight adequately, and so far haven't been (perhaps because editorial consensus has thus far been overaggressive about depicting acu as wholly fringe). A1C, would you consider not reaching quite so far? You're losing some editors by doing so, editors who are reasonable enough to (gasp) accept that we can use good MEDRS's that don't wholly dismiss acu. The fact that many of the sources you're presenting haven't been given more (or any) weight shows how excessively editorial consensus had tended to swing past skepticism into outright, undue debunking. We need less hyperbole all around. It's not hyperbole to say that A1C has found no more and no less than a bunch of MEDRS's, not all but some about as good as they get, that deserve proper integration and weighting. --Middle 8 (leave me alone • talk to me • COI?) 20:14, 14 August 2014 (UTC)
Note. Stimulating nerves does not mean it is effective. QuackGuru (talk) 19:16, 14 August 2014 (UTC)
This is about the mechanism of action, not its effectiveness. -A1candidate (talk) 19:20, 14 August 2014 (UTC)
Exactly; it's a different aspect of point specificity (which I'm sure the text of the article will make clear). --Middle 8 (leave me alone • talk to me • COI?) 19:29, 14 August 2014 (UTC)
The text is under the heading "Theory" not mechanism of action. QuackGuru (talk) 19:34, 14 August 2014 (UTC)
It is referring to the theories about the mechanism of action -A1candidate (talk) 20:04, 14 August 2014 (UTC)
Is the fact that "acupuncture has an effect on the nervous system" some sort of great or new discovery? Has it EVER been denied? Is there any other possible "mechanism of action" when one touches or pokes the skin? (Hormones could also get involved, but that too is not specific.) I'm still not getting what this is about. It's still "duh", uninteresting, not unique, and not evidence for or against any claimed specific effects of acupuncture.
Please make a specific, precisely worded and sourced, proposal that isn't as foolish as the child with the penny, who is now twenty years old and is still presenting the same penny to its mother as if it has invented money. Please place your proposed edit here, in this thread. -- Brangifer (talk) 00:33, 15 August 2014 (UTC)
Just doing a search for "mechanism" in the current version turns up not even a "penny"-type comment. We have:
  1. "TCM is pseudoscience with no valid mechanism" (in lede and body);
  2. "The most common mechanism of stimulation of acupuncture points employs penetration of the skin by thin metal needles";
  3. "... making many scholarly efforts to integrate evidence for efficacy and discussions of the mechanism impossible"; and
  4. "... even if research is still unable to explain its mechanism."
Similarly unhelpful stuff (with respect to mechanism) appears when one searches for the syllables "nerv" and "neur" (including examples of what is massive undue weight to serious adverse events). And the section Scientific view on TCM theory is almost absurdly weighted to sources from the skeptic movement, and at any rate only mentions endorphins. We can do better than that! Even if a penny is all there is to be found (and there does appear to be more, e.g. point-specific neurological responses), readers at least deserve to know that the damned thing is round, shiny (for awhile), coppery, and a little bigger than a dime. Let's.... de-escalate a little in terms of confrontational approach. What's obvious to editors is not always obvious to the reader. A1Candidate has found some terrific ones, and I'd rather encourage them to keep at it. A1C, how would you do this? There's probably some stuff in those sources on fascia, no? There's stuff from Napadow and Kaptchuk.... a whole lot of stuff has been neglected, which is what happens when too few editors are involved. A1C and Brangifer, you're both great assets here; don't alienate each other. --Middle 8 (leave me alone • talk to me • COI?) 05:41, 15 August 2014 (UTC)
Does the source say that "It is based on scientific evidence that shows the treatment can stimulate nerves under the skin and in muscle tissue."? If it does, what's the problem? In my opinion, we better stick to the sources instead of our own ponderings. Jayaguru-Shishya (talk) 18:09, 17 August 2014 (UTC)

Yes, fascia (connective tissue) is discussed in the consensus statement of the American Heart Association as follows:

In the manual form of acupuncture, the mechanism of effect appears to be through sensory mechanoreceptor and nociceptor stimulation induced by connective tissues being wound around the needle and activated by mechanotransduction.

PMID 23608661 -A1candidate (talk) 09:32, 15 August 2014 (UTC)

I added "The mechanism of action for acupuncture is still unclear. Evidence suggests that acupuncture generates a sequence of events that modulate pain signals within the central nervous system." QuackGuru (talk) 17:55, 15 August 2014 (UTC)

You're doing it without consensus. The source is from 2008 and is way past WP:MEDDATE. We have many newer reviews to use -A1candidate (talk) 21:46, 15 August 2014 (UTC)
I added the source you proposed adding to the article. I added this source because it meets MEDRS and it was not ambiguous. QuackGuru (talk) 02:53, 16 August 2014 (UTC)
We should use the newest reviews, which are not ambiguous. -A1candidate (talk) 03:02, 16 August 2014 (UTC)
This was the specific source you wanted in the article and now you don't like what the source said? I added the source that was specifically about the mechanism of action for acupuncture, which was not vague or confusing. QuackGuru (talk) 03:20, 16 August 2014 (UTC)
I was proposing to use it to replace the editorials only. I am not entirely against your edit, but I think it needs to be formulated in a different way. "Modulate pain signals" is an ambigous phrase that requires explanation. -A1candidate (talk) 09:43, 16 August 2014 (UTC)
"They, along with acupuncture researchers, explain the analgesic effects of acupuncture as caused by the release of endorphins, and recognize the lack of evidence that it can affect the course of any disease." There is an explanation in the article. QuackGuru (talk) 16:49, 16 August 2014 (UTC)
Endorphins aren't pain signals. -A1candidate (talk) 17:34, 16 August 2014 (UTC)
The release of endorphins modulate pain signals. QuackGuru (talk) 02:22, 17 August 2014 (UTC)
That is what the article should say to reduce ambiguity -A1candidate (talk) 04:54, 17 August 2014 (UTC)
I added the context from the source according to the summary. QuackGuru (talk) 06:01, 17 August 2014 (UTC)

Arrhythmias

7 individual herbal therapies along with acupuncture and yoga have been studied and reported as having an antiarrhythmic effect:

Despite methodological shortcomings, these studies support acupuncture as an effective treatment for AF (atrial fibrillation), paroxysmal supraventricular tachycardia, inappropriate sinus tachycardia, and symptomatic premature ventricular contraction

-A1candidate (talk) 10:26, 15 August 2014 (UTC)

Good stuff -- hope you're being bold and adding at least some of these as you go, because good MEDRS's shouldn't be controversial -- as long as you're not removing others at the same time. If you also want to remove a MEDRS (for whatever reason), others might object to that part, so I'd do such an edit separately. (See situation below where an editor combined both good and bad edits into one big edit and it got reverted -- that was justified but could have been avoided.) --Middle 8 (leave me alone • talk to me • COI?) 07:50, 17 August 2014 (UTC)
Have these been added into the article? If not, I don't mind helping you guys out here. LesVegas (talk) 16:33, 30 August 2014 (UTC)

Academic centers

As mentioned above, acupuncture is used at a number of academic centers. This certainly belongs in the article; for starters, I've added its own subsection under Acupuncture#International_reception . It's used at a great many such places, and at some point we might have so many that it may be a good idea to create a list.

I know acupuncture is a fringe topic, and I would like to apologize in advance for pushing mainstream POV into it. :-) --Middle 8 (POV-pushing • COI) 14:44, 28 August 2014 (UTC)

This is a good edit. I tweaked the text to indicate that the list presented is not exhaustive. We of course need to be careful not to imply that just because these centers use the practice that they know how it works (or even where it is effective), but we do need the information that it is used at hospitals as well as at stand alone clinics. A third or maybe even a fourth example citing non-US use would be good to help reflect a worldwide view. Maybe one from China and one from Germany or somewhere like that? - 2/0 (cont.) 15:25, 28 August 2014 (UTC)
Thanks; yes, good idea re worldwide view. We can also talk about acu's role in medical education worldwide; in China, IIRC, TCM is taught as anywhere from (very roughly) 5% to 50% of the curriculum. --Middle 8 (POV-pushing • COI) 12:00, 30 August 2014 (UTC)
I agree, that's valuable piece of information. The sources are perfectly reliable to illustrate the use of acupuncture at academic centers. I'll try to see if I can find anything about the situation in Finland (HYKS, KYKS, OYKS, TYKS and TAYS). Jayaguru-Shishya (talk) 11:57, 1 September 2014 (UTC)
Acupuncture is among popular CAM treatments in all five Nordic countries but it is used less in Finland.
Since acupuncture is deregulated in Finland many people without education in healthcare are able to give acupuncture treatment.
I have included specific information about Finland. QuackGuru (talk) 20:05, 5 September 2014 (UTC)

Discussion re sourcing -- i.e. are the sites of these medical centers RS for their use of acu -- continues below at Talk:Acupuncture#RSN:_Sourcing_medical_centers.27_use_of_acu. --Middle 8 (contribs • COI) 05:31, 13 October 2014 (UTC)

Primary sources/poor sources and original research

http://www.brighamandwomens.org/Departments_and_Services/medicine/Services/oshercenter/acupuncture.aspx

This source is a link to a hospital website. It is unreliable.

http://medicine.yale.edu/psychiatry/psychology/predoc/sites/cmhc/substanceabuse.aspx

This source is a link to a School of Medicine website. Where does this link mention acupuncture? Auricular acupuncture and acupuncture are different. The sentence is poorly sourced and partly fails verification. See WP:CIR. QuackGuru (talk) 02:02, 30 August 2014 (UTC)

IMO, the above criticisms from QuackGuru lack merit and the bit about competence (CIR) is gratuitous. Anyone else think QG is making any valid points here? --Middle 8 (POV-pushing • COI) 12:00, 30 August 2014 (UTC)
You are not addressing that you are adding primary sources and text that failed verification. I previously explained, Auricular acupuncture (ear acupuncture) is not acupuncture. You ignored it was original research. See WP:IDHT. Adding even more primary sources or poor sources is not appropriate. You have not shown how the sources are reliable in accordance with WP:SECONDARY. QuackGuru (talk) 17:41, 30 August 2014 (UTC)

QG is correct that even Misplaced Pages has a separate article on Auriculotherapy. jps (talk) 17:58, 30 August 2014 (UTC)

QG is incorrect. Ear acupuncture is a common form of acupuncture. See the meta-analysis below. -A1candidate (talk) 18:37, 30 August 2014 (UTC)
Did you read the entry for Auriculotherapy? Do you understand this is a primary source that says Auricular Acupuncture? User:John Carter warned you about nonproductive editing on the article talk page.
"This systematic review evaluated the effects of ear acupuncture, ear acupressure and auriculotherapy for cigarette smoking cessation (SC) at end-of-treatment (EoT), three, six and 12 months follow-up."
According to the source ear acupuncture, ear acupressure and auriculotherapy are a bit different or is the source ambiguous? Middle 8's comment does not make sense given the evidence. QuackGuru (talk) 03:50, 31 August 2014 (UTC)

I did discuss the problems with this edit on Jayaguru-Shishya's talk page. Jayaguru-Shishya largely ignored my concerns or did not understand. "He wrote If you have a specific edit you'd like to discuss, please let me know. So far, you have said that "there is original research in the article using a primary source", and you are giving me a diff where QTxVi4bEMRbrNqOorWBV says at the Talk Page that "even Misplaced Pages has a separate article on Auriculotherapy". I am sorry, I don't really see the connection here? I did let him know the issues. See WP:CIR. I left a message on his talk page. QuackGuru (talk) 19:16, 5 September 2014 (UTC)

The source does not verify the claim "several". This confirms the source does not say "several". QuackGuru (talk) 19:33, 5 September 2014 (UTC)

So if Misplaced Pages has a separate article on Auriculotherapy, how is it connected to original research? :D I alrady provided you a source (which seriously nobody needs). As Middle 8 well put it: "just as auricular acu is a kind of acu, and chocolate milk is a kind of milk". Just common sense.
QuackGuru, do you know what "paraphrasing" means? I think user NuclearWarfare has already noticed you about "getting caught over specific wording", right? If you have problems with paraphrasing yourself, please leave it to other editors, that's what I'd like to suggest. Cheers and happy weekend! Jayaguru-Shishya (talk) 20:27, 5 September 2014 (UTC)
Indeed, indeed... "Being of a number more than two or three but not many" (http://www.thefreedictionary.com/several) Jayaguru-Shishya (talk) 20:44, 5 September 2014 (UTC)
I fixed the issues by using another source that verified the claim rather than use a source that was ambiguous. As a bonus, I expanded the sentence and included Duke. QuackGuru (talk) 20:41, 5 September 2014 (UTC)

I had a discussion on Jayaguru-Shishya's talk page: You added largely duplication using primary/poor sources. Rather than use poor sources I replaced it with independent sources. In my edit summary I explained one of the sources failed verification. This was discussed on the talk page. The section for the US under International reception already states "Acupuncture is used at many places in the US, including Harvard, Stanford, and Yale." Independent sources were being used but you restored the text using a bunch primary sources. There is no need for duplication or a separate section. The text for each country can go into each specific section for each country in the Acupuncture#International reception section. Please stop adding poor/primary sources when better sources were found. Please don't continue to WP:BATTLE. QuackGuru (talk) 21:22, 1 September 2014 (UTC)

After I explained it too Jayaguru-Shishya that there is still problems with the text and many is closer to the source he ignored my concerns and restored the original research and unneeded primary sources. He also restored the tag without consensus. User:RexxS also explained Jayaguru-Shishya removed well sourced text. See Acupuncture#Reception for the current text. QuackGuru (talk) 15:57, 6 September 2014 (UTC)

Do you mean the discussion which resulted to an administrative warning to you? The one where you were making accusations against me? Well, let's see dear.
    • The first diff where you claim that I "largely duplication using primary/poor sources", it has been already discussed at the Talk Page. Consensus? No problem for using primary sources to illustrate the use of acupuncture at mainstream medical centers.
    • The second diff, you said that: " I explained one of the sources failed verification". That's not true, I'm afraid. When one opens your diff, the edit summary merely says: "failed verification and duplication". So where is the "explanation you mentioned? Answer: there is none.
    • The third diff, you are saying that it was discussed that the source above failed verification. Let's see your diff more closely: it is pertaining to user QTxVi4bEMRbrNqOorWBV's comment "QG is correct that even Misplaced Pages has a separate article on Auriculotherapy." So, what does this have to do with "a source failing verification"? You just picked up a random comment from the Talk Page and use it to "support" something that has nothing to do with it...?
    • You said: "Please don't continue to WP:BATTLE.". Funny, you got warned by an administrator for your post.
    • "... he ignored my concerns and restored the original research and unneeded primary sources". Please see this section and participate the discussion if you have something meaningful to say. Jayaguru-Shishya (talk) 19:43, 6 September 2014 (UTC)

Template POV: When to remove the tag

Hi guys, just so we're all on the same page here and there's no confusion, I wanted to post this information from Template:POV on when to remove a tag:

When to remove

This template is not meant to be a permanent resident on any article. You may remove this template whenever any one of the following is true:

  1. There is consensus on the talkpage or the NPOV Noticeboard that the issue has been resolved.
  2. It is not clear what the neutrality issue is, and no satisfactory explanation has been given.
  3. In the absence of any discussion, or if the discussion has become dormant.

Since #3 is clearly not applicable to this highly discussed page, and since #2 is not applicable since I listed the many outstanding neutrality issues, we have one way to remove the tag, which is to #1 resolve the neutrality issues with consensus. Now I know that may sound like an impossible task, but I believe everyone here is capable of collaboration. Now let's hold hands and sing Kumbaya! LesVegas (talk) 01:21, 6 September 2014 (UTC)

I agree. I don't see consensus to remove the tag, and edit-warring over a tag is VERY lame. There are good-faith and policy-based reasons to keep it, including integrating some of the sources A1Candidate has put forth. As I've said before, although A1C sometimes overstates the weight of those sources, they are MEDRS's, and properly weighted, generally should be integrated into the article. The tag invites more eyes, and more eyes are good: it's been hard to find a middle ground between excessively entrenched "pro" and "anti" acu views, and more than one very good editor has become disillusioned about that state of affairs and left. So let's get more eyes on this article and break the logjam. --Middle 8 (contribs • COI) 04:18, 6 September 2014 (UTC)
Agree. I can't really see why the template should not be there. Jayaguru-Shishya (talk) 11:10, 6 September 2014 (UTC)
If that tag is really that offensive to some, perhaps a compromise choice of a different tag would work. --Middle 8 (contribs • COI) 04:25, 6 September 2014 (UTC)

A general note -- I'm really impressed with LesVegas's enthusiasm and being able and willing to provide specific ideas. They've been around for only two months, and that level of cluefulness and collaborative spirit is unusual in such a recently-joined editor. Once again, welcome LesVegas! Your contributions are very much appreciated! --Middle 8 (contribs • COI) 04:34, 6 September 2014 (UTC)

User:Dawn Bard explained "I don't see that a case has been made here for the POV tag." There is no need for any kind of tag. See Talk:Acupuncture#The tag was removed multiple times. QuackGuru (talk) 16:10, 6 September 2014 (UTC)

I should have gone a bit farther, actually, User:QuackGuru - not only do I not think a case has been made for the tag, but reading everything here, I do think a case has been made against the tag. Thanks to everyone who's participating here; it's clear a lot of effort has been made. Cheers, Dawn Bard (talk) 18:40, 6 September 2014 (UTC)

I think that there should be a {{alt-med}} template which implies a neutrality dispute, because it is implicit in any Misplaced Pages article touching on alternative medicine that it will either display a reality-based bias and thus be hated and reviled by the quacks that support the therapy, or it will not yet have gained attention from the reality based community and will therefore be non-compliant with NPOV. This may be a slightly cynical view... Guy (Help!) 22:24, 6 September 2014 (UTC)

Bias can go in any direction if there are WP:OWN issues and tendentiousness; it all depends upon the balance of editors. True for any article. --Middle 8 (contribs • COI) 03:03, 7 September 2014 (UTC)

So anyway, trying to determine consensus re the issues for which the article was tagged. As Les Vegas pasted in from Template:POV, it's ok to remove once "There is consensus on the talkpage or the NPOV Noticeboard that the issue has been resolved."

  • No NPOV concern; don't need tag - QuackGuru, Dawn Bird, Guy (I think), 2/0 (I think), Tgeorgescu (I think)
  • NPOV concern; do need tag - LesVegas, Jayaguru-Shishya, myself, A1Candidate (I think)

I may have missed a few, but even so I don't see consensus here. The reasons for concern are non-trivial: weighting of sources, specifically integrating A1Candidate's suggested MEDRS's, which do weigh even if A1C sometimes overestimates their weight. I would also add the concern of too much given to sources on adverse events. Kww, e.g., was dubious about putting <<5 known deaths in 10 years>> in the lede.

The explicit purpose for that tag is new editorial eyes. Surely THAT cannot be a bad idea. In order to avoid edit warring I'm not going to put it back right away. In the meantime: is this reasoning flawed? --Middle 8 (contribs • COI) 09:07, 7 September 2014 (UTC)

Well, in general it's a bad idea to rely much on counting editors, because (as it is said) consensus is not a vote (WP:CON, WP:VOTE, WP:DEM). But if the purpose is just to get new editorial eyes, an easy way around having to deal with this tag dispute would be to request input from a page like the NPOV noticeboard. Sunrise (talk) 00:23, 8 September 2014 (UTC)
@Sunrise: - Certainly true that consensus isn't only about numbers, but numbers can factor in; it's hard for me to see how ca. 35-45% of editors with NPOV concerns is compatible with concensus. I'm not going to insist on it, but my understanding has always been that the default is to keep an NPOV tag when a significant number of editors have good faith and comprehensible policy-based concerns. Do you disagree with that understanding, or do you think the concerns I mentioned in my post above (beginning with "So anyway, trying to...") aren't relevant, or what? Happy editing, --Middle 8 (contribs • COI) 20:42, 8 September 2014 (UTC)
Of course numbers can and do factor in, but they're never the end of the story. :-) Determining consensus is often pretty difficult - I have some experience as an RfC closer, and I would make two points: i) in a discussion as complicated as this one it might take hours of analysis for even the most experienced closers to determine a consensus, and ii) it is not that uncommon for consensus to be established even against the majority of editors in a discussion. I agree that the default is generally to keep a tag on the article if valid concerns have been shown, but then the question is whether the concerns are valid, and I don't think that has been established at this point. The POV tag is also somewhat of a special case that it pays to be cautious about, because it is so commonly misused as a "mark of shame." Sunrise (talk) 21:54, 8 September 2014 (UTC)
Yeah Sunrise! That's a great idea. I'll request input from the NPOV noticeboard so we can get some clarification! Thanks for your valuable suggestions! LesVegas (talk) 03:17, 8 September 2014 (UTC)
FWIW, my suggestion was that you could use it to draw attention to the article itself and any specific NPOV issues you see, and thus avoid dealing with a tag dispute. Tag disputes, not being directly related to article content, tend to be unproductive. The question you've posed at NPOVN might lead to a long dispute, but I wouldn't expect much to come out of it - we'll get a wider audience to look at the page, but it will be harder for them to contribute unless you can describe the issues that you see more clearly. Sunrise (talk) 19:14, 8 September 2014 (UTC)
@Sunrise: -- agree, when concerns are pervasive and general it's hard to boil them down for a noticeboard. Hence in part my preference for a tag; editors can browse the page and jump in and ask. What we really need is an infusion of ca. a half-dozen science-literate editors seeking a "reasonable middle", as Jytdog put it, and who aren't here to fight either side of the alt-med wars. --Middle 8 (contribs • COI) 20:42, 8 September 2014 (UTC)
I agree in part, but I would add that if specific concerns can't be established, other editors won't be able to tell whether you have a point or not, and will probably be inclined to assume that you don't. I would also add that since the ultimate goal is to accurately reflect the RS, in some cases the article may reflect somewhere between any two positions but in other cases it will not - e.g. Evolution and Global warming. Whether or not that's the case here I can't say, since I don't really want to get deep into the article content myself, although my superficial analysis is that the article is at least fairly close to neutrality on most issues. Sunrise (talk) 21:54, 8 September 2014 (UTC)
@Sunrise: This is probably stale, but I'll comment just for the record. This is probably more granular than you said you were interested in, but if you don't want to consider this further, someone else may at some point.
I agree with your two points (mentioned above in the post starting with "Of course numbers can...."), and with your observation about WP:GEVAL as applied to articles like evolution. The problem is that we have POV-warriors from the "skeptic" side who are eager to depict acupuncture research as being just as settled as that of homeopathy (i.e. that it doesn't work), and who are objecting to NPOV-tagging even subsections of the article despite good reasons being given (see section above).
With acupuncture there is a real debate in the literature, even if one side is wrong. There exist MEDRS's of equal weight disputing whether or not acupuncture is effective for some types of pain and nausea; this is apparent in the lede and body. But the article is dominated by editors who take the stance that skeptic bloggers do -- that the MEDRS's finding for efficacy are all flawed -- and gives short shrift to sources finding that it works. If NPOV and VER mean anything, they mean that we should follow the debate as reflected in MEDRS's, not as depicted in blogs, many of which are barely V RS.
So that's some of the the context for my concerns expressed above in the post starting with "So anyway, ...". See also section above, where editors Guy and QuackGuru object to simply specifying the kinds of pain a review examined, the former misusing WP:GEVAL's reasoning.
Again, my comment is mostly for the record. I think that in almost any other topic area, the tag would be kept. In the current environment -- where, e.g., one editor is allowed to dominate the whole article with impunity -- it's not even possible to keep the tag alive, let alone engage the debate that it's meant to indicate. --Middle 8 (contribs • COI) 07:01, 15 September 2014 (UTC)

Low level details restored against consensus

"" Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture. The source says it was for chronic pain. So why delete text what the source said? See Acupuncture#Pain.

"We need to be sure not to imply this is for chronic pain in general either by specifying "kinds of pain" or enumerating those kinds. I prefer shorter, but it's no biggie." User:Alexbrn explained on January 4, 2014.

The Vickers study was largely criticised by experts. Instead of deleting the controversial Vickers sources we reached a compromise with the wording. But now Middle 8 decided to add the extra details again. This edit was clearly against consensus when the previous discussion was against including it.

We already had a discussion about the details for the Vickers text. The result of the discussion back in January 2014 was against including the extra details. See Talk:Acupuncture/Archive 12#Low level details.3F. QuackGuru (talk) 01:39, 7 September 2014 (UTC)

"Consensus" at that time was among three editors and is likely to change. Sure Vickers been criticized, but the way to handle that is to weight the criticism adequately. This type of source is the gold-standard of meta-analysis: it uses individual patient data (cf. ). Yet we give it less space than multiple studies of rare SAE's in the pain section. This imbalance is primarily a result of your WP:OWN and POV-pushing and needs to change.
My proposal: A 2012 meta-analysis of individual patient data conducted by the Acupuncture Trialists' Collaboration found "relatively modest" efficiency of acupuncture (in comparison to sham) for the treatment of back and neck pain, osteoarthritis, chronic headache, and shoulder pain, and on that basis concluded that it "is more than a placebo" and a reasonable referral option.
This is too sparse:
Your proposal: A 2012 meta-analysis conducted by the Acupuncture Trialists' Collaboration found "relatively modest" efficiency of acupuncture (in comparison to sham) for the treatment of four different types of chronic pain, and on that basis concluded that it "is more than a placebo" and a reasonable referral option."
So why omit the kinds of pain?? We give that detail for all our other reviews. Am tagging the efficacy section with Template:POV-section for this reason. --Middle 8 (contribs • COI) 02:41, 7 September 2014 (UTC)
@QuackGuru: - I tagged that section at 02:44, 7 September 2014‎, and you removed it less than 24 hours later (18:15, 7 September 2014‎) without any comment here. That's completely inappropriate! --Middle 8 (contribs • COI) 06:32, 9 September 2014 (UTC)
It is inappropriate to add a tag that disputed an entire section when it was only a dispute over one sentence. QuackGuru (talk) 06:37, 9 September 2014 (UTC)
So improve it, put in a better one. Respect other editors' effort at WP:DR and don't be so OWN-y and revert so much. --Middle 8 (contribs • COI) 11:19, 9 September 2014 (UTC)
We should omit the kinds of pain because there is no evidence that acupuncture is specific, and no reason to believe that the effect on subjective outcomes like pain is due to specific effects or indeed anything other than placebo effects and other confounders. Guy (Help!) 08:49, 8 September 2014 (UTC)
@JzG: That reasoning puts the cart before the horse. Yes, acu probably isn't specific, but the existence of MEDRS's like this is why the question is still debated. Even if/though you hate it, this paper passed peer review in a legit journal and found specificity to statistical significance, and weighs not insignificantly, because of the type of meta-analysis it is (this kind). Anyway, other meta-analysis we cite, we say what type of pain it studied, and Vickers was basically four reviews in one. Also, I'm restoring the tag that QG inappropriately removed. --Middle 8 (contribs • COI) 19:57, 8 September 2014 (UTC) edited20:27, 8 September 2014 (UTC)
IOW: Misplaced Pages lags sources. How would you handle that with acu? Would you depict it as being as settled (per MEDRS) as homeopathy? --Middle 8 (contribs • COI) 01:05, 9 September 2014 (UTC)


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

Was the study was funded or ran by alternative medicine promoters? Is the funding of NCCAM notoriously indicative of very shoddy research? Were they exposed in the Skeptical Inquirer? QuackGuru (talk) 22:19, 8 September 2014 (UTC)

NCCAM funding indicates nothing other than that it pisses off some people; no V RS impeaches it definitively, it's just one view. Per NPOV we cover all views, we don't suppress major ones, especially when they pass peer review and are published in a good journal. And Skeptical Inquirer lacks PARITY with that journal. Even if you found a MEDRS of comparable weight to Vickers that impeached NCCAM, all that would mean is that we'd give the former equal coverage. Nice try. --Middle 8 (contribs • COI) 11:19, 9 September 2014 (UTC) (copy-edited, added sentence 05:34, 15 September 2014 (UTC))

Explaining sham acu to the reader in lede

ES self-explanatory. We do need to tell the reader about both kinds of sham acu (faux needling and faux points). I made sure in this edit to explain exactly what it means when real is no better than sham, i.e. no efficacy. Also semi-boldly removed Ernst '11 with its inadequate depiction of context for statement re sham (it shouldn't be there anyway while it's being challenged; those who want it haven't met WP:BURDEN). (Now a certain editor may feel the need to evert, claiming this is OR....but please read on.)

Anyway, never let it be said that I oppose discussion of sham in the lede, and what it means when real acu is no better than sham. All I insist on is proper sourcing, especially not distorting sources. Here, we manage to get the job done by simply paraphrasing existing sources on study design (and obvious scientific principles about controls) to present an uncontroversial explanation. If editors feel that more sourcing is needed, try adding a fact tag instead of reverting. After all we should be improving each others' edits whenever possible, and not edit-warring, right? --Middle 8 (contribs • COI) 13:08, 7 September 2014 (UTC)

To clarify, use of Ernst '11 in the lede is being discussed at WT:MEDRS#Acupuncture_source. My objection is to citing it in the lede without saying what he's talking about (i.e., we shouldn't make it look like it's a general statement). Half of the people who have looked at it agree that Ernst's statement about sham is specifically about one paper, not the whole body of literature. Given that, I felt that those who wanted to keep it hand't met WP:BURDEN, so I removed it -- perhaps prematurely; I certainly didn't want it to lead to drama. --Middle 8 (contribs • COI) 12:53, 8 September 2014 (UTC)
Are continuing to edit against consensus? You are continuing to try to rewrite or delete the same sentence. This is going on far too long. Now you replaced sourced text with SYN and OR. You have a failure of understanding you are repeatedly adding OR to this article. I will stop calling your edits original research when you stop adding original research to this article. QuackGuru (talk) 18:00, 7 September 2014 (UTC)
Well, SYN is a kind of OR. How is what I wrote OR? Its a rudimentary explanation of study design. --Middle 8 (contribs • COI) 03:25, 8 September 2014 (UTC)
In my impression, it is typical for you to call every edit that doesn't please you as OR. I can tell that from my own experience when you have failed to explain even I have asked you. You must learn to explain why you consider some specific edit as OR. That kind of editing is not helpful even despite of the good intentions. Jayaguru-Shishya (talk) 19:46, 8 September 2014 (UTC)
You were previously told you need a reference for when you made an edit to the lede on 31 August 2014. You made similar edit on 7 September 2014 and here we are again at the talk page. For starters, I previously explained here that the part "that indicates a lack of effectiveness" was SYN/OR. I assume you read my comment when you made these comments but you still ask what was the original research. Your edit was also not a summary of the body in accordance with lede. Do you agree you will stop adding original research to this article? QuackGuru (talk) 03:47, 8 September 2014 (UTC)
Right, Doc James said that this edit of mine needed a reference, so in this edit I used Madsen as a ref (for sham as faux needling), and fact-tagged the other bit about sham at faux points (which should be easily findable). What's the problem?
Re OR, you're saying that this is OR: "when real acupuncture is found to be no better than sham acupuncture, that indicates a lack of effectiveness (i.e., compared to placebo)." WHAT??? Sham acu is the placebo! So my statement is the same as saying "when a treatment is no better than a placebo, the treatment is ineffective," which is about the same as saying "the sun is a big bright ball in the sky!"
I will address the diffs you cite above in another post. --Middle 8 (contribs • COI) 10:56, 8 September 2014 (UTC)
QuackGuru, you are making untruthful claims here. You said: "For starters, I previously explained here that the part "that indicates a lack of effectiveness" was SYN/OR.", but when taking a look at at the diff, you do not explain anything. Why do you do this? In that diff you merely repeat your opinion that it was SYN/OR. Where are the explanations that it is SYN/OR? Not only you fail to communicate yourself here, your diffs are misleading and disrupting the development of this article. Jayaguru-Shishya (talk) 19:46, 8 September 2014 (UTC)
https://en.wikipedia.org/Acupuncture#cite_note-Madsen2009-13
That text for Madsen2009 is in a note towards the bottom of the page. It does not belong in the lede.
This is the first sentence: Acupuncture (from Latin, 'acus' (needle) + 'punctura' (to puncture)) is the stimulation of specific acupuncture points along the skin of the body involving various methods such as penetration by thin needles...
The text for non-acupoints does not belong in the lede and the reader already knows that acupuncture is stimulation at acupoints. Therefore, at non-acupoints it is not traditional acupuncture.
The part "when real acupuncture is found to be no better than sham acupuncture, that indicates a lack of effectiveness (i.e., compared to placebo)." is OR and had no citation at the end of the sentence. Do you understand now that you are replacing sourced text with OR and with text that did not summarise the body? The previous wording was sourced and is a summary of the body. QuackGuru (talk) 15:31, 8 September 2014 (UTC)
@QuackGuru: - Re Madsen, it sounds like you're objecting to my making a change simply because it changed something you'd written earlier. Madsen is a source explaining what sham is, and my edit used it that way, while you used it as a footnote. Either is acceptable. Yes, sham is different from real acu, and is a control, hence the need to explain the difference to the reader, since research is a hot topic. (There being two kinds of sham: faux needling and faux points.)
QG, no, I don't agree with you about your take on OR. Paraphrasing a source or explaining how a simple concept like a scientific control works with acu is not OR. --Middle 8 (contribs • COI) 20:19, 8 September 2014 (UTC)
Sham is placebo. We don't need a source for that, just like we don't need to cite Galileo Galilei when we say that the world is round. QuackGuru, you have been notified by admin NuclearWarfare already before about not getting stuck with specific wordings. You show complete incompetence to paraphrase sources when it comes to your comments. It's not helping to develop the article. Jayaguru-Shishya (talk) 19:46, 8 September 2014 (UTC)
@Jayaguru-Shishya: - Great analogy! BTW, I agree (entirely!) re the importance of not getting stuck over specific wording, but I don't read the diff from NW as commenting on QG's wording. --Middle 8 (contribs • COI) 20:06, 8 September 2014 (UTC)
Oooh, perhaps I have understood something wrong about it? :O I guess I have to take another look. Jayaguru-Shishya (talk) 20:21, 8 September 2014 (UTC)

I previously explained The part "when real acupuncture is found to be no better than sham acupuncture, that indicates a lack of effectiveness (i.e., compared to placebo)." is OR and had no citation at the end of the sentence. Middle 8 claimed "QG, no, I don't agree with you about your take on OR." Middle 8 was not paraphrasing a source and the edit violated lede. See WP:CIR. QuackGuru (talk) 22:06, 8 September 2014 (UTC)

@ QG - I already explained my view re OR and will only add that we have plenty of sources on study design and don't need to source every statement in the lede, especially obvious ones. CIR? Give me a break; you totally misread OR. --Middle 8 (contribs • COI) 11:21, 9 September 2014 (UTC) ...... comment moved to proper section 11:29, 9 September 2014 (UTC)
A study design in not a summary of the body and the edits were largely OR. The previous version before your edit was sourced. Your view on OR is to WP:IAR? QuackGuru (talk) 15:48, 9 September 2014 (UTC)
Not "a" study design. The general concept of a scientific control, as underlies all sham studies, where sham is the placebo control. --Middle 8 (contribs • COI) 16:20, 9 September 2014 (UTC)

Important: Could you clarify?

Hi QG, this is important, so please read it and respond.

At WT:MEDRS you wrote:

"To clarify, we do cite the systematic review 2011 not the older Suarez-Almazor 2010 source for the text. We usually don't use randomized controlled trials (RCTs) as good MEDRS. We typically use the reviews who cite the RCTs and/or other sources."

First question: This sounds like you're acknowledging that when we cite Ernst '11 in the lede, we are citing it as a summation of what Suarze-Almador is saying, as opposed to his summary of the literature as a whole. Is that true? If not, could you explain your reasoning?

Second question: Would you please answer my question from WT:MEDRS, regarding your quote above -- and if not, again, could you explain your reasoning? Here:

"Are you agreeing that Ernst's statement "real acupuncture was no better than sham" can be cited for Suarez-Almazor 2010 and only for Suarez-Almazor 2010? If you and other editors agree, then we can close this. (In no way to I dispute what Ernst's view of the bigger picture is)."

Thanks! Since you're accusing me of misconduct at Kww's user talk, I'm sure he (let alone I) would very much appreciate seeing a straight, clear answer from you, in order to know you're being clear and aboveboard. We all want to de-escalate and avoid drama, and open communication is the best way to do that. Feel free to either answer here or just cut and paste this and reply at my user talk. Also for question #2, obviously, please go ahead and reply at WT:MEDRS. But please don't ignore either question.... they are very important, imo, to WP:DR right now. --Middle 8 (contribs • COI) 12:11, 8 September 2014 (UTC)

The above comment by Middle 8 was moved from my talk page to here.

We should cite the 2011 systematic review of systematic reviews for the text not the older source or another source. See diff. It is irrelevant to this discussion on Misplaced Pages what Ernst is citing for his conclusion. We should not continue to second guess MEDRS compliant sources and we should not use another source such as Suarze-Almador to cite the text. QuackGuru (talk) 15:31, 8 September 2014 (UTC)
@QuackGuru: QG, sorry, I don't understand what you mean. Both questions are "yes" or "no" questions. Could you start by stating "my answer to Middle 8's question one is and my answer to Middle 8's question 2 is ", and then briefly explain your reasoning if the answer to either is "no"? I'd appreciate that very much. I think the answer to both may be yes, and we disagree on how to frame Ernst '11 in the lede, but I want to be sure. Thanks for your help here. --Middle 8 (contribs • COI) 19:50, 8 September 2014 (UTC)
Suarez-Almazor, Maria E.; Looney, Carol; Liu, Yanfang; Cox, Vanessa; Pietz, Kenneth; Marcus, Donald M.; Street, Richard L. (2010). "A randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient-provider communication". Arthritis Care & Research. 62 (9): 1229–1236. doi:10.1002/acr.20225. ISSN 2151-464X. PMID 20506122.
Ernst, E.; Lee, Myeong Soo; Choi, Tae-Young (2011). "Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews" (PDF). PAIN. 152 (4): 755–764. doi:10.1016/j.pain.2010.11.004. ISSN 0304-3959. PMID 21440191.
What specifically does Ernst's statement "real acupuncture was no better than sham" refer to? It is not applicable to improving the acupuncture page whether Ersnt cited the Suarez-Almazor 2010 source for the text.
First question: It is completely irrelevant what Ernst cited. We don't question reliable sources.
Second question: According to MEDRS we cited recent reviews not RCTs or primary sources. We are using Ernst 2011 as a conclusion.
According to your Misplaced Pages:Disruptive editing you think we should not use Ersnt 2011 for sham verus real acu or it seems you think we should add context that is your own personal interpretation or add unsourced text to the lede. There is a footnote that explains what sham is. It is not a summary for text in the lede. QuackGuru (talk) 22:06, 8 September 2014 (UTC)
@ QG - (see below re your WP:KETTLE-ish "disruption" allegations.) See, I was hoping you'd just give a straight answer, not dodge the question by saying "It is not applicable to improving the acupuncture page whether Ersnt cited the Suarez-Almazor 2010 source for the text." It's this kind of unwillingness to have a simple dialogue that frustrates consensus-building, and is why I sometimes use bold edits: to try to get a productive discussion moving.
It makes a big difference what Ernst is referring to when he says "real acupuncture was no better than sham". Context matters, and to argue that it doesn't is not only tendentious, it's absurd. We can't just pick any statement made by Ernst in that review and then say "Ernst said that"; that's obvious. And of course we do say in the body that Ernst's statement is about more recent trials (actually just Suarez-Almador), so I think you know it is relevant.
I'm not saying Ernst is endorsing acupuncture at all; 2/0 got it exactly right at WT:MEDRS, and I agree Ernst's prediction is clear, is consistent with Suarez-Almador, and has largely proven correct. Nor do I want to keep sham out of the lede (obviously, per my last edit that so offended you). I'm just saying, let's get it right, per WP:ENC, and provide context.
All this argument over such a basic thing! No wonder most editors don't stick around here! --Middle 8 (contribs • COI) 12:24, 9 September 2014 (UTC)
To clarify: If we were to cite any given statement without context, we'd get contradictions: e.g. Ernst also said "The majority of the early reviews arrived at negative conclusions , while the majority of the 57 recent reviews were positive." That statement and the statement "real acupuncture was no better than sham" cannot both be true about the same thing. And of course the former (green) statement refers to the dataset (the 57 reviews) while the latter refers to the more recent trial by Suarez-Almador. So of course we need to say, in the lede, what Ernst's latter statement is referring to, and that's why Vzaak's bold compromise edit from 9 July was accepted.
So here I am, explaining how context matters to the editor who just said that it didn't. I doubt that you actually believe your statement "It is not applicable to improving the acupuncture page whether Ersnt cited the Suarez-Almazor 2010 source for the text." But the kind of disingenuous tendentiousness exhibited in your comment attracts no warning from admins. I know very well that some admins read these exchanges. Apparently, striking a "skeptic" pose allows an editor to get away with actions that harm the encyclopedia: in this case, allowing a content error to remain in the lede. --Middle 8 (contribs • COI) 06:03, 15 September 2014 (UTC)
@QuackGuru -- I'll discuss those "disruptive" diffs of mine that you posted . First consider how dramatically you've affected the editing environment for anyone else here; see Wikichecker: acupuncture. You have 206 mainspace edits since May 29th. That's more than the next 10 editors combined. You dominate the article and you are not helpful at talk. Sometimes you don't reply, while ignoring other editors' concerns in mainspace: see above section, and here, and here. Or you reply inadequately, e.g. refusing to answer a simple question just above. Or you use the talk page in just plain odd ways, like here.
Under those circumstances, the occasional bold edit makes sense: see BRD: Cases for use. But you revert and then say I'm editing against consensus? Dude, a great deal of the "consensus" here is just you! Maybe the real problem is that I'm challenging your "ownership" and that pisses you off.
So here are the diffs, A, B, C, xx and D. (xx is a duplicate of B).
  • 8 July, A: Bold and justified, and worked out well: Triggered a debate resulting in another bold edit by Vzaak , which was accepted; see talk: Bold edit to resolve the issue. Vzaak's edit: "A systematic review of systematic reviews highlighted recent high-quality randomized controlled trials which found that for reducing pain real acupuncture was no better than sham acupuncture." Addresses my concerns re context in the lede nicely (cf. above) and was fine by others too. You liked Vzaak's compromise also; your words: "It is a good compromise with the in-text attribution." (Why the change of heart since?)
  • 27 August, Doc James reverts, being (almost certainly) unaware of earlier discussion & consensus. 30 August, I notice that and revert back to consensus version by Vzaak: . 31 August, Doc reverts again and opens discussion above at Talk:Acupuncture#Summarize. I join discussion and make mildly bold edit B, which is my first edit attempting to define sham for the reader and explain the simple concept of placebos and efficacy -- the stuff you think is OR. However Doc James once again reverts, wanting a source , which I assume was meant for the two types of sham.
  • On 1 Sept, I make a moderately bold edit, rewording to satisfy Doc James while being faithful to the spirit of Vzaak's compromise: edit C, i.e. A systematic review of systematic reviews of acupuncture for pain concluded that there is little evidence that acupuncture is an effective treatment, i.e. that real acupuncture may be no better than sham acupuncture. This is a different angle, a shorthand way of describing Ernst's feelings that the results of newer trials may well generalize to future research; my ES implies this but could've been clearer. Pretty simple idea, that in the future we may see the general result of real = sham.... but given your highly literal and narrow take on OR, you disliked this, of course. And less than 9 hours later, you reverted , and complained at Talk about how we'd covered this, somehow forgetting about Vzaak's compromise edit that we all liked (except Doc James who wasn't around for the discussion). At this point, I file at WT:MEDRS and continue to discuss above.
  • 7 September: Again to break an impasse I try a bold edit, this time improving on my edit B by using a source per request: edit D. This was like B except: (1) it partly sourced sham, using Madsen, which you'd added as a note to the header about sham as faux needling. (Yes, I know I changed your note around... it's a wiki). (2) I fact-tagged the other aspect of sham (faux points); not a disputed concept. (3) Removed Ernst's wording entirely -- and this I would not have done in hindsight, but the whole business of WT:MEDRS had me wikistressed and not thinking clearly. After "sleeping on it" I actually decided to self-rv, but you'd already done so. It would have been better to somehow retain the spirit of Vzaak's compromise, and I stand corrected, or rather reverted.
So all these edits are good ones, except part of D where I the outright removed of Ernst '11 rather than improving wording. I'm obviously sticking close to the consensus version and I'm improving rather than reverting outright. Yet you don't recognize good edits; you see only someone doing it differently than you, which you can't stand.
Why is it bad when I make changes, but not when other editors do? Others are outright reverting more than I am. Why do I get the special treatment of your clamoring to take me to AE?
Finally a general note: We need to remember that a certain amount of good-faith reverting is inevitable, and doesn't somehow "disrupt" the article when it's non-combative and infrequent, as here. In that situation, "disruption" just becomes a convenient excuse to go after "undesirable" editors (which is a bit reminiscent of when cops in places like Ferguson, Missouri arrest people for "trespassing" in public places, or "disorderly conduct" for peaceful gatherings).
So overall there's no disruption except in the world where you, QG, own this page and any challenge to your ownership is intolerable. You need to de-escalate with me specifically; don't ever do this selective evidence thing with me again . And you need to disengage from your extreme ownership of this page imo. --Middle 8 (contribs • COI) 16:24, 9 September 2014 (UTC) copy-edited 06:09, 15 September 2014 (UTC)
Don't worry, another user who quickly stopped by at the article, he also noticed the same thing. :-) Jayaguru-Shishya (talk) 17:31, 9 September 2014 (UTC) This comment originally came right after the final bullet point in my post above dataed 16:24, 9 September 2014. Moving it so that it's not splitting latter comment --Middle 8 (contribs • COI) 22:23, 15 September 2014 (UTC)

The text for the systematic review of systematic reviews was redundant. It was simplified into one sentence rather than have two separate sentences. The edits by User:Middle 8 did not improve the page. Ignoring WP:V and WP:LEDE is not productive. QuackGuru (talk) 16:33, 9 September 2014 (UTC)

And that comment takes the cake for IDHT, given how you just repeated yourself about those diffs so quickly after I discussed them in detail and refuted your claim. And no, omitting context is not redundant. Later. --Middle 8 (contribs • COI) 16:44, 9 September 2014 (UTC)
And those five diffs, how do they not improve the page? How do they ignore WP:Vand WP:LEDE? The thing that's not productive here is you. If you do not have the capability to communicate yourself, I'd advise you to choose an easier topic. I do assume good faith with you, but "The proverbial bull in a china shop might have good intentions, but he's clearly bad for business." WP:CIR Jayaguru-Shishya (talk) 17:36, 9 September 2014 (UTC)
I was not responding to your specific comment above. I was making a note about the redundant text and to explain to other editors that your edits violated V and LEDE. Middle 8 continued to violated original research and LEDE but does not acknowledge his mistakes. The reason he rearranged the part that real acupuncture is no better than sham is because he thinks the source doesn't support general statement. But the text is obviously sourced. QuackGuru (talk) 16:51, 9 September 2014 (UTC)

MEDDATE

The above section seems to have gone off the rails a bit, so I am starting a new one, with an admonishment to please stick to the talk page guidelines instead of sniping at each other (@Jayaguru-Shishya, @QuackGuru, @LesVegas).

My reading of the WP:MEDDATE guideline is right there in the header for the section: use up-to-date evidence. The bit about capturing a full review cycle seems key. The way we know that evidence is not up-to-date is that it has been superseded by a source of similar or higher quality; most of the time, updated sources will indicate that the text should be tweaked - scientific revolutions are rare. Rather than wholesale deleting verifiable material, I respectfully suggest that we use {{update inline}} and update the material as new sources are found. - 2/0 (cont.) 18:15, 12 September 2014 (UTC)

We don't wholesale delete verifiable material because it is older than five years and we don't tag sources older than five years. When newer sources are found then we update the material. You don't see on other articles editors tagging sources just because they are a bit old. Lost of articles have sources older than five years. The tag 'updateinline' wikilinks to Misplaced Pages:Manual of Style/Dates and numbers#Chronological items. That makes no sense. Tags for medical claims are only used to delete the source. QuackGuru (talk) 18:23, 12 September 2014 (UTC)
I agree with you 2/0. I think tagging the old sources is a lot better way than to just delete an outdated source straight away. This is how the other editors can easily pay attention to sources needing update as well. Jayaguru-Shishya (talk) 19:33, 12 September 2014 (UTC)
The tag you used is not about tagging older sources. I previously explained the tags are not relevant to medical claims and the tags for medical claims are typically used for deleting older sources when there are newer sources or for deleting unreliable sources. What is the benefit for a tag that wiklinks to Misplaced Pages:Manual_of_Style/Dates_and_numbers#Chronological_items? QuackGuru (talk) 19:38, 12 September 2014 (UTC)

2/0, I want to thank you for having the article protected and for moderating this discussion. Yes, I completely agree, tagging outdated sources is what needs to be done here. Science changes all the time and we need to find updated sourcing. I don't agree that tags for medical claims are only used to delete the course, that is only one potential outcome amongst several. More likely, we find a new source to back it up, or we modify whatever statement is being made based on whatever the newer sourcing says. But a tag buys us time to do that. And I may be wrong here, but in Misplaced Pages's policies and guidelines I don't see anywhere where it says we are required to tag it, only that old medical sourcing can't be used. I just feel that tags are a much more reasonable solution than just going out and immediately deleting everything outdated. LesVegas (talk) 18:38, 13 September 2014 (UTC)

You have not given a reason to tag numerous sources. You wrote "I don't see anywhere where it says we are required to tag it". There is no need to tag source after source. QuackGuru (talk) 18:53, 13 September 2014 (UTC)
My point was we could just outright delete them. Would you prefer that or the tag? LesVegas (talk) 19:14, 13 September 2014 (UTC)
It is not appropriate to suggest we delete solid MEDRS compliant sources and you know it is not required to tag sources. QuackGuru (talk) 19:19, 13 September 2014 (UTC)
Part of MEDRS compliance is MEDDATE. I'm going to ask kindly that you please don't twist my words. LesVegas (talk) 19:29, 13 September 2014 (UTC)
Do you think it is required to tag solid MEDRS compliant sources? QuackGuru (talk) 19:34, 13 September 2014 (UTC)
No, because a solid MEDRS compliant source meets all requirements for reliability, including MEDDATE. And thank you for deescalating your questions, and giving me an actual question. I do appreciate it QuackGuru. LesVegas (talk) 19:39, 13 September 2014 (UTC)
Even if a source is over 10 (or even 20) years old, it is still a solid MEDRS source unless you can present a newer source. QuackGuru (talk) 19:59, 13 September 2014 (UTC)
Yes, well there are exceptions made for history sections, Cochrane Library reviews that have been updated and seminal works in the field. If it's an area where few reviews are being published in the field, then it's okay. If other, newer reviews are published, we use those instead and delete the older reviews. First we should tag them, though. And all other cases MEDDATE says we want sources to be within the last 5 years, but preferably the last 2-3. Further, review articles should use recent primary studies. I'm afraid I have to disagree with keeping it because it was once a solid MEDRS source. Some of these sources are aged rockstars with potbellies trying to sing well past their prime. LesVegas (talk) 20:47, 13 September 2014 (UTC)
I think you are still missing the point of MEDDATE, LesVegas and Jayaguru-Shishya. The timespans are given to provide context for what the guideline means by "recent"; the term is relative, and interpretation could be a point of contention if that context were lacking. A source is only actually outdated and in need of replacement if the research has moved on; that is why the focus on capturing a complete review cycle - different fields update at different rates. If further clarification is required, WT:MED or WT:MEDRS should be able to provide. - 2/0 (cont.) 21:24, 13 September 2014 (UTC)
Yes, MEDDATE does talk about looking for reviews within one full review cycle. But only relying on the idea of a review cycle creates a great deal of ambiguity. What are the date ranges we should be using? Do date ranges then not apply at all? This seems especially inapplicable since, worldwide, the acupuncture literature is updated on a very regular basis. Further, we have seen a recent increase in the reporting standards in acupuncture literature due to the STRICTA checklist becoming the official extension of CONSORT in 2010. Many reviews published before that time used studies which used poor quality reporting standards. Not all literature follows CONSORT, but now there's defined parameters, we know if they do not follow it, they can be criticized for not doing so. Coincidentally, it is now nearly 2015, and it's been five years after the adoption of these standards. All the more reason for us to follow Misplaced Pages's MEDDATE guidelines of 5 year maximum lifespan, there actually is wisdom in these numbers. Of course, I don't mind replacing the outdated literature with newer stuff myself. But when we're not sure if there's newer stuff, we should use {{update inline}} so we can get other editors on board to check. LesVegas (talk) 00:38, 14 September 2014 (UTC)
I previously explained that tag links to Misplaced Pages:Manual of Style/Dates and numbers#Chronological items. That makes the tag irrelevant to medical claims. You want to use a tag that is not applicable? Until there is a newer source the current source is reliable. QuackGuru (talk) 00:44, 14 September 2014 (UTC)
No it doesn't. Update inline wikilinks to here, explaining it needs an update. LesVegas (talk) 00:51, 14 September 2014 (UTC)
This is the Template:Update inline. Click where it says . When you click on the tag it links to Misplaced Pages:Manual_of_Style/Dates_and_numbers#Chronological_items. Click on the tag. QuackGuru (talk) 01:02, 14 September 2014 (UTC)
OK, you're right, when you click on that it does go to Manual of Style. I do apologize. But it does indicate there the need for updating, which is helpful. Alternatively, I see that we could use the tag, and since the source falls outside the range, it violates one aspect of MEDRS. Any opinions? LesVegas (talk) 01:18, 14 September 2014 (UTC)
The Update inline tag does not indicate there a need to use a newer source. That is not what the tag is used for. I created the MEDRS tag to tag an unreliable source. You haven't shown what source is unreliable. QuackGuru (talk) 01:32, 14 September 2014 (UTC)

The contention that a source is outdated needs to be supported by a more current source. Per MEDRS, "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." Consideration of the level of quality of the source is also appropriate, a brand new low quality source carries less due weight than a solid high quality source that is not as recent. Another consideration is the weight given the source in other publications. If an older source is frequently cited by recent publications it still carries weight. - - MrBill3 (talk) 05:53, 14 September 2014 (UTC)

Like I stated here at WP:Med, "I think that WP:MEDDATE is clear on the matter; we should not remove a medical source simply because it's not published in the last five years or so. Unless, of course, more recent reviews are available. But WP:MEDDATE points out, "Within this range, assessing them may be difficult. While the most-recent reviews include later research results, do not automatically give more weight to the review that happens to have been published most recently, as this is recentism." And it gives space to areas that are less researched, stating that sourcing "may need to be relaxed in areas where little progress is being made or few reviews are being published." My opinion on the particular case you are citing is that "we leave it alone until newer sources of similar caliber are identified." Flyer22 (talk) 17:03, 14 September 2014 (UTC)
The steps to take are fairly obvious to anyone used to dealing with MEDRS:
  • If a source is more than about five years old (less where the literature is extensive, more when it isn't), then identify the quality of the source by using the guidance at MEDRS.
  • Next start examining the best literature for a newer source of the same or better quality. Again MEDRS indicates what sort of journals and what type of secondary sources represent the highest quality.
  • If no newer sources of the same or better quality exist, then the old source remains the best we have and will stay. Never replace a source with one of a lower quality even if that one is newer. Never delete a source purely on the grounds of age. In some fields that I am familiar with, the seminal work was done 70 years ago.
  • If there is a newer source of equal or better quality, then see if the content needs to be amended (often a newer review comes to the same conclusions as the previous one). If no change is needed, you can just replace the older source.
  • If the newer source of equal or better quality indicates an amendment to the content, then make the changes and replace the old source with the new one. At that point, you will probably find you may have to justify both your summary of the newer source and your assumption that the newer source is no worse than the older one it replaces.
The purpose of tagging is to attract more editors to an article; it is not to cast doubt on the content. If there is a lack of editors engaging at a particular subject, then tagging is justified; otherwise it isn't. In this case {{update}} and its section- and inline- variants really isn't the tag to warn of potential problems with MEDDATE.
In the event of disagreement, the article talk page is the first place to discuss issues. The talk page at WT:MED is watched by a editors with a broad range of interests and considerable experience with MEDMOS and MEDRS and is probably the best place to seek further opinions related to those topics. --RexxS (talk) 17:57, 14 September 2014 (UTC)

Okay, so now we have discussed the interpretation of MEDDATE and how strictly we should follow the 5 year limit. How about the {{inline update}} tag, what's the sentiment on that one? QuackGuru and RexxS seemed to agree that it should not be used. 2/0 said at some point that we can use it though. How about MrBill3 and LesVegas, what's your opinion? Jayaguru-Shishya (talk) 14:20, 21 September 2014 (UTC)

I was trying to reach for a compromise, but the consensus is crystal clear on both tags. - 2/0 (cont.) 16:06, 21 September 2014 (UTC)
I see the discussion going on about the {{cn}} tags, but not about the {{update inline}} tags. That's why I am asking for clarification from MrBill3 and LesVegas actually. I'd suggest that let's wait for their answers (and why not anybody else aswell) first. =P Jayaguru-Shishya (talk) 16:18, 21 September 2014 (UTC)
I don't think the "update inline" tag is appropriate unless there is good reason to believe the material has been superseded by more recent quality references. Perhaps when there are several recent lower quality sources and a more current review/meta-analysis is expected. The tag might be appropriate when there is a updated Cochrane review to call attention to an editor who has full access or another high quality source is available but not free, thus calling attention to the content so an editor with access can update it. For content that there is no more current, high quality source the tag is not appropriate. It is to call attention for editors to update the content from more current sources, not to insert an editor's opinion that the subject of the content should be studied again. If the academic/medical community considers the subject important enough or the earlier results/conclusions currently inadequate new studies will be done and they will be analyzed and discussed, otherwise the tag is based on WP editors' opinions. TLDR: MEDDATE and WP policy defer to the scientific consideration of the medical/academic consensus. - - MrBill3 (talk) 07:27, 22 September 2014 (UTC)
The "update inline" tag links to Misplaced Pages:Manual of Style/Dates and numbers#Chronological items. That makes the tag irrelevant to medical claims. The tag is not applicable in this situation. See Template:Update inline. QuackGuru (talk) 16:48, 22 September 2014 (UTC)
Yes, I agree with QuackGuru here in that update inline is a manual of style tag and we likely should not use it in these cases. We could use the unreliable MEDRS tag, but another user said we should only tag citations if the page has few editors. I'm starting to agree. Sources shouldn't be tagged on the acupuncture article, we should simply remove them if they are out of date and irrelevant, keep them if they are out of date and relevant, or replace them if they are out of date and there is a better source on the subject (whether it comes to the same conclusion or the opposite one). I could be wrong though and maybe there is precedent set for the use of this tag elsewhere? LesVegas (talk) 03:55, 26 September 2014 (UTC)
You don't exactly agree with me. We must not use a tag that is irrelevant to medical claims and no reason has been given to use the MEDRS tag I created. QuackGuru (talk) 04:01, 26 September 2014 (UTC)
If a source is indeed outdated and there is a strong belief that new sources are available, but are not yet on the article, then I think the MEDRS tag would be appropriate. You said you created the tag, but it's for unreliable sources. And MEDDATE, properly applied, pertains to reliability. Older sources are unreliable when newer ones are likely available. I noticed you used the MEDRS tag for old sources here and here. What was your reasoning in those two instances? Why did you use it to tag old sources there? What am I not understanding? LesVegas (talk) 05:19, 26 September 2014 (UTC)
There are newer sources that say relatively the same thing. QuackGuru (talk) 05:32, 26 September 2014 (UTC)

Early superstition

The source given for this material appears to be in Chinese, but the text itself is readily supported by Taylor 2005 later in the paragraph. Would there be any objection to restoring the text using that as a source? - 2/0 (cont.) 18:49, 12 September 2014 (UTC)

We can request to go back to this version to fix all the problems rather than continue arguing or we can wait for the article to be unprotected. QuackGuru (talk) 18:56, 12 September 2014 (UTC)
Good. I find it important that the {{cn}} tags are kept. That helps the editors to evaluate the text and whether it's properly sourced or not. Jayaguru-Shishya (talk) 19:33, 12 September 2014 (UTC)
There is even unsourced text in the lede for mundane claims. The tag was used to delete the text. The tag is for editors. It is not for readers. QuackGuru (talk) 19:42, 12 September 2014 (UTC)
@Jayaguru-Shishya: I am having trouble parsing your comment as pertains to this discussion. Do you support restoring the text you removed using the source I verified? Do we have consensus to use {{editprotected}} to edit the material back into the article? - 2/0 (cont.) 17:38, 14 September 2014 (UTC)
I don't think we need a edit protected request. The incompetent editors who deleted sourced text and/or tag MEDRS compliant sources need a vacation from this article. If you insist on an edit protected request I support a larger revert before the incompetent edits were made. See Talk:Acupuncture#Larger revert. QuackGuru (talk) 17:48, 14 September 2014 (UTC)
Sorry for the late answer 2/0. Yes, we can use Taylor 2005 in order to restore the text. Would you suggest the old phrasing or something else? For example, the source goes as follows:

Mao called for the 'co-operation of Chinese and Western medical doctors' in Yan'an in 1944, but was not explicit as to how such a co-operation might be achieved. His slogan was interpreted as a general 'scientification of Chinese medicine and popularization of Western medicine. In order to remove the feudalist and superstitious elements of Chinese medicine, some physicians attempted a rigorous transformation of the medicine according to the foremost precepts of the Communist revolution, i.e. those of the 'new', 'scientific', and 'unified'. Acupuncture came to represent this 'new' medicine largely because of its practical value during wartime. The term 'new' implied free from superstition and the heavy links to a feudal past. Instead of the components of the new culture would have to be forward-moving and enterprising. Mao advocated that such a change would be possible through the use of 'science'. By 'science' Mao was not so much referring to the science linked with the Western investigation of nature, but more to the Marxist ideal of science as the criteria for true knowledge. For Mao stated that 'this type of new democratic culture is scientific. It is opposed to all feudal and superstitious ideas: it stands for seeking the truth from facts, it stands for objective truth and for unity between theory and practice'.

The edit protect, I think the "Edit protected" template is not needed as long as we don't have to make a mass revert back to the version where all the {{cn}} tags were removed. It's much easier to make fixes to the current version rather than the version some 24-29 edits (?) ago. Cheers! Jayaguru-Shishya (talk) 17:52, 15 September 2014 (UTC)
The old phrasing or something else is not relevant to this discussion. It is much easier to revert back to the version before the mass tags were restored all over the place and before you deleted sourced text. You deleted sourced material per what? QuackGuru (talk) 18:39, 15 September 2014 (UTC)
Focusing specifically on this discrete improvement to the article, I find the old text adequate but would not object to something else along the same lines. That whole section could use more detail anyway.
@QuackGuru: if we decide to do a larger revert, the edit proposed here will just be subsumed in it - no harm done, easily fixed. In the meantime, it looks like we are much closer to consensus that this material improves the article. Would you be open to providing this material to our readers now while we finish discussing everything else? - 2/0 (cont.) 19:13, 15 September 2014 (UTC)
There never was consensus in the first place to delete the text or add tags all over the place. You can request WP:UNPROTECT now and we can move on. QuackGuru (talk) 19:21, 15 September 2014 (UTC)
No tags have been added, the existing ones just have been restored. Jayaguru-Shishya (talk) 19:30, 15 September 2014 (UTC)
I previously explained I self-reverted my own edit. Now you have to explain why you want tags everywhere. Are you adding tags to other articles? QuackGuru (talk) 18:44, 16 September 2014 (UTC)
Perhaps you should try to follow up the discussion more carefully, QuackGuru? Please see the latest discussion here. A quote from there: "I still can't understand, however, why {{cn]] tags are being removed from sections where obviously no sources have been given. (See Acupuncture#Theory)." Jayaguru-Shishya (talk) 18:57, 16 September 2014 (UTC)
I previously asked, "Are you adding tags to other articles?" Apparently not. QuackGuru (talk) 19:01, 16 September 2014 (UTC)

Protected edit request on 12 September 2014

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Listed on Add "|displayauthors=9" where 9 authors are listed in a citation. Hamish59 (talk) 19:00, 12 September 2014 (UTC)

This can be done after the text is restored otherwise it may make it difficult to revert back to the previous version. QuackGuru (talk) 19:14, 12 September 2014 (UTC)
 Done. If we revert over the change, it is easy enough to fix. - 2/0 (cont.) 19:16, 12 September 2014 (UTC)
I think "|displayauthors=4" is preferable there is no need to list nine authors. Four is pretty much standard on WP. Just my 2¢. - - MrBill3 (talk) 05:43, 14 September 2014 (UTC)

Larger revert

Above, QuackGuru suggests that we revert to an earlier version of the article and discuss from there; diff of convenience. It looks like that would quell a bit of cite-bombing basic aspects of the article (good), some update-inline (discussed elsewhere), a restore wikilink to Quackwatch (I think that is the first instance in the article, so linking is indicated), and restore the three edits I just mentioned as accurately cited. A wholesale revert to this version would be fine with me, or we can work on it piecemeal. - 2/0 (cont.) 19:05, 12 September 2014 (UTC)

I think it'd be much easier to keep working from the current version of the article. The alternative would be this large wave of 24 subsequent edits. These edits have not been discussed at all. Compared to that, restoring three edits is a lot easier option. Jayaguru-Shishya (talk) 19:55, 12 September 2014 (UTC)
You wrote "These edits have not been discussed at all." So where is the previous discussion or consensus for the tags in the first place? I undid my own edits when I removed the tags. QuackGuru (talk) 19:57, 12 September 2014 (UTC)
"I had the time to check up only the 4 first of your tag removals. The others should have be inspected as well. I'll recover the other edits you made". Clear and simple, if there is a claim that we have unsourced material in the article, sure it needs to be inspected. Indeed, you could easily have explained at the Talk Page if you found unnecessary {{cn}} tags. Jayaguru-Shishya (talk) 20:08, 12 September 2014 (UTC)
You have not given a reason to have the unnecessary tags and they should be removed or do you want to delete more text? I explained it in my edit summary I undid my own edit. Were the tags discussed? See here. I was only undoing my own mistake. QuackGuru (talk) 20:20, 12 September 2014 (UTC)

2/0, I wouldn't mind reverting back to that version and taking out and altering problematic edits as you and QuackGuru suggest. However, this does bring up a larger question: when someone makes 24 rapid-fire, unchecked edits, in my view it becomes impossible not to do anything other than what Jayaguru-Shishya did in his large revert. If, out of those 24 edits, let's say 16 were good quality uncontroversial edits. How could an editor possibly handle what he thinks are 8 problematic edits piecemeal without going over the 3RR? I'm really not trying to bring up old history here, but old history is once again new history, as some other editors mentioned this sort of issue before so it seems that going forward we need something solid in place to prevent incidents like this from happening again. Jayaguru-Shishya, do you think that's a reasonable solution? Do you think we could revert back and discuss all the problematic edits? QuackGuru, what do you think could be done to prevent things like this from happening again? Or am I off base here? LesVegas (talk) 19:06, 13 September 2014 (UTC)

You haven't justified your revert. There was no 24 rapid-fire edits. QuackGuru (talk) 19:12, 13 September 2014 (UTC)
QuackGuru, you're right it wasn't 24 edits, it was actually 29. I'm trying not to go there again with you, I'm trying to have a reasonable discussion this time. LesVegas (talk) 19:24, 13 September 2014 (UTC)
QuackGuru also catches flak for making multiple changes in a single edit. I am sure neither of you, Jayaguru-Shishya and LesVegas, would bring such a complaint since it would be wildly inappropriate to try to institute a backdoor article ban in that way. Laziness is not a valid reason to revert, and the suggestion that it is smacks of trying to own the article content. We have a history function and there is no deadline.
To move the discussion back where it belongs, focusing on the content rather than the contributor: I did actually take the time to sort through the series of edits in question. It was neither difficult nor particularly time-consuming. The edit summaries were accurate and the content changes relatively simple and straightforward. Are there any policy-based objections to the changes? - 2/0 (cont.) 21:08, 13 September 2014 (UTC)

We have now had four independent MEDRS-savvy editors weigh in on tagging older sources where no better source has been identified. Does this give us consensus to go back to here and work from that base? - 2/0 (cont.) 11:55, 16 September 2014 (UTC)

There is consensus to go back this version and continue to improve the article. QuackGuru (talk) 15:17, 16 September 2014 (UTC)
You are right, I should have linked to the version sans tags. - 2/0 (cont.) 15:37, 16 September 2014 (UTC)
Well, it's possible to continue editing even if a larger revert is made. I still can't understand, however, why {{cn]] tags are being removed from sections where obviously no sources have been given. (See Acupuncture#Theory). The content of this edit (Acupuncture#Effectiveness) should equally be restored. Jayaguru-Shishya (talk) 18:35, 16 September 2014 (UTC)

Efficacy and Safety of Needle Acupuncture for Treating Gynecologic and Obstetric Disorders: An Overview

Any thoughts on using this source for stating/supporting that the evidence for use for pelvic and low-back pain during pregnancy, pain during labor, primary dysmenorrhea, and menopausal symptoms is inconclusive? - 2/0 (cont.) 00:43, 16 September 2014 (UTC)

We don't need any more fringe journals. If we allow this then we can expect a huge flood. QuackGuru (talk) 02:46, 16 September 2014 (UTC)
Works for me, thanks. - 2/0 (cont.) 11:45, 16 September 2014 (UTC)
For effectiveness we have plenty of sources. For other sections it is a case by case basis. Sometimes we can use fringe journals to fill in the blanks. The flood is over for now. QuackGuru (talk) 15:20, 16 September 2014 (UTC)

Quick MEDMOS fix

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At the end of the first paragraph of Acupuncture#Clinical practice, the sentence "For the majority of cases, the needles will stay in place for 10 to 20 minutes while you are lying still" should be replaced with "For the majority of cases, the needles will stay in place for 10 to 20 minutes while the patient remains still" per WP:MEDMOS. - 2/0 (cont.) 18:07, 16 September 2014 (UTC)

I think it should be person rather than patient. QuackGuru (talk) 18:25, 16 September 2014 (UTC)
Or just end the sentence after "20 minutes"? - 2/0 (cont.) 18:28, 16 September 2014 (UTC)
The person is also lying down. QuackGuru (talk) 18:30, 16 September 2014 (UTC)
The acupuncturist is presumably also a person, though.
What if we combine with the penultimate sentence: "A typical session entails lying still while approximately five to twenty needles are applied and left in place for ten to twenty minutes."? - 2/0 (cont.) 19:19, 16 September 2014 (UTC)
The two sentences are making separate points.
If you still don't like the word person we can use another word.
"For the majority of cases, the needles will stay in place for 10 to 20 minutes while the individual is lying still." QuackGuru (talk) 20:05, 16 September 2014 (UTC)
The points are different but not disparate. Having the extra clause in there breaks up the flow of the sentence in a somewhat awkward manner. Combining the sentences also helps with the synonym problem - we use "typically", "common", "regular", and "majority" in those four sentences cited to the same source to describe how a session usually progresses. We could try: "A typical session entails lying down while approximately five to twenty needles are inserted; for the majority of cases, the needles will be left in place for ten to twenty minutes." - 2/0 (cont.) 21:46, 16 September 2014 (UTC)
"A typical session entails lying still while approximately five to twenty needles are inserted; for the majority of cases, the needles will be left in place for ten to twenty minutes." QuackGuru (talk) 22:03, 16 September 2014 (UTC)
Very important this. Think of the complications that would ensue if the patient didn't lie still at a crucial moment, and the acupuncturist punctured the patient in the wrong place. Malpractice suits, treating patients for the wrong condition, it'd be awful. -Roxy the dog™ (resonate) 22:28, 16 September 2014 (UTC)
That wording looks good to me, thanks for working on this. - 2/0 (cont.) 23:32, 16 September 2014 (UTC)

A quick grammatical fix: the first clause of Acupuncture#Other conditions, "For the following conditions, the Cochrane Collaboration or other reviews have concluded there is no strong evidence of benefit for" should be replaced with "For the following conditions, the Cochrane Collaboration or other reviews have concluded there is no strong evidence of benefit:". - 2/0 (cont.) 18:27, 16 September 2014 (UTC)

Both Done. — Mr. Stradivarius 06:09, 17 September 2014 (UTC)
Your change differs slightly from the proposal. QuackGuru (talk) 07:16, 17 September 2014 (UTC)
Eh? It looks right to me - what is missing? - 2/0 (cont.) 10:59, 17 September 2014 (UTC)
There was an additional change made to the ref. No worries. I fixed it in my sandbox. QuackGuru (talk) 15:57, 17 September 2014 (UTC)

Regarding new consensus on MEDDATE's application

Hey all! I want to thank 2/0 for posting to the MEDRS board to get feedback regarding dating of sources. I also would like to ask questions amongst some editors here because there has been differing opinions on MEDDATE's application, even amongst individual editors here over time. Here is an example between this old diff which appears to have very different reasoning than this current diff. I would also like to highlight these edits hereherehere and here since they now differ with our current community consensus on how to apply MEDDATE to sourcing. Now I just want to make it clear, I'm not criticizing anyone or calling anyone a hypocrite because I believe we are all free to change our opinions, and hey, I happen to now agree, based on the reasoning of everyone at the MEDRS talk page. I also discovered this very subject was discussed during the drafting of MEDDATE With that in mind, I just want to get everyone's opinion on a matter. If this community now believes that we shouldn't regard the 5 year rule as sacrosanct how would everyone feel if I restored any of the content that was removed from any of the diffs showing removal of old sources, provided they are still reliable and there are no new updated sources on the subject? LesVegas (talk) 18:44, 17 September 2014 (UTC)

The old diff you cite shows you are mistaken. The ref that was older than ten years old and was replaced with a newer source. I already explained, that the older sources were removed because we are using newer sources. I don't see any reason to continue arguing about this. However, if a source was deleted that was not making a medical claim it could still be reliable. QuackGuru (talk) 19:36, 17 September 2014 (UTC)
New consensus same as the old - glad I am that we have that settled.
Your links and are arguing different points. Your protestation that you are not insinuating hypocrisy is appreciated.
: The 1997 consensus statement is now only of historical interest. We discussed this not so long ago.
: A banned tendentious sockmaster might on occasion make an edit that we would like to keep, but the present case is not the exception.
: "dated" is stronger reasoning than merely "old".
: I am not sure we should be according that source any weight anyway, but that is not a medical claim.
If you have a specific proposal for text or sourcing that should be added to the article, we should discuss that. - 2/0 (cont.) 15:34, 18 September 2014 (UTC)
2/0, please forgive me if I came across as ugly or sarcastic in any way in my post. That was not my intent in the least. I really wasn't trying to be sarcastic at all, but was trying to point out that when we come to a new consensus regarding posts we should take a moment to go back and review older edits where we operated under different beliefs about policy. Anywho, I'm sorry if I'm reading too much into your last post but it looked like you were being sarcastic about me claiming not to call others hypocritical. Seriously, that was not my intent at all. Regarding specific proposals, yes, I think we should add each of these references back in since they were removed when editors on this page believed MEDDATE states 5 year old sources must go and do not need to be replaced with new sources. I don't see where any of these were replaced with new sources, but I could be mistaken. And regarding example #5, you said "dated" is stronger reasoning than merely "old". While I don't understand what you mean by that in regards to MEDDATE, it did give me a new idea! I pulled up those instances by going to the revision history and doing a keyword search in the edit summaries for the word "dated" and that's how I pulled each of those edits up. Anywho, I just did a new keyword search for the word "old" and here are the edits I came up with: old 1 old 2old3 old4 old5 and old6 As you can see, these edits were justified because of the "old" understanding we had about MEDDATE, but now that we have a new understanding we ought to discuss these as well. Just like the "dated" bunch I found before, this group was just over the past year alone. I'm sure there's more like these, but this will give us enough to discuss for now. And, just so you know, there were several edits I found where new sources were used to replace old ones. I didn't use those here because we all agree (at least I think!) that replacing old sources with new ones are appropriate uses of MEDDATE. LesVegas (talk) 04:46, 26 September 2014 (UTC)
There is nothing to add back in because the older sources were replaced with newer sources. QuackGuru (talk) 04:55, 26 September 2014 (UTC)
I'm sorry but I don't see it in any of these cases. I saw it in a few other cases and I didn't post those here, but with these, no new sources were added in. If I'm wrong, you are more than welcome to show me the diffs where old sourcing I'm claiming was removed for being too old, and show that it was actually replaced by new sourcing and we can talk from there. LesVegas (talk) 05:07, 26 September 2014 (UTC)
The older sources were removed for various reasons. The main reason was that new sources were found. We don't need to continue to talk about this. These are old issues there were resolved a long time ago. QuackGuru (talk) 05:17, 26 September 2014 (UTC)
What were the various reasons? All I see in the edit summaries were that they were "old" or "dated". From what I see there are no other reasons they were removed. Now that we have come to a new consensus, I see no reason they shouldn't be added back in. That is, unless you can show me the diffs that show justification beyond just "dated" or "old" sources. LesVegas (talk) 05:26, 26 September 2014 (UTC)
I think this is a good start for a new discussion. I am not sure which "consensus" we are talking about here now, but I think MrBill3 gave a pretty good summary earlier about the MEDDATE one.
When it comes to sources that have been removed already but still could be use in the article, I see no obstacles for those (providing that they are MEDRS or RS depending on the case). Jayaguru-Shishya (talk) 19:07, 28 September 2014 (UTC)
There is no new consensus and there is no reason to continue to explain every little thing. This is old news. QuackGuru (talk) 05:30, 26 September 2014 (UTC)
QuackGuru, I'm sorry but you did not explain these and show where new reviews have supplanted them. Therefore, according to MEDDATE's statement regarding review cycles, I see no reason why they shouldn't be in the article. I'm going to add these back in one at a time, as long as they're pertinent. Cheers! LesVegas (talk) 02:48, 2 October 2014 (UTC)
There may be a new consensus if we look into the new sources, if something's come in that isn't dated or old. I wanted to comment on the creation of tags. Considering that Acupuncture is a form of 'alternative medecine,' it's very possible that some of the sources might be reaching out of credibility. I read somewhere above that there is a strong belief that there are new sources being produced currently, and when regarding MEDDATE vs MEDRS, it seems appropriate to just represent the interests of both. — Preceding unsigned comment added by Chewbakadog (talk • contribs) 05:57, 26 September 2014 (UTC)

New paper

Integrative oncology: really the best of both worlds?, David H. Gorski, Nature Reviews Cancer (2014) doi:10.1038/nrc3822, Published online 18 September 2014 - paywall though. The main relevant passage: "When acupuncture is tested in the clinic, overall, with possibly one exception (for example, to treat nausea123), recent evidence strongly suggests that its effects are nonspecific and indistinguishable from placebo effects124, 125, 126, 127, 128 that are highly dependent on practitioner–patient interaction129, 130. Moreover, meta-analyses almost always conclude that there is insufficient clinical evidence to make a determination of efficacy123, 131, 132, 133 and include studies with a high risk of bias134, 135, 136. Also, contrary to the claimed mechanism of redirecting the flow of qi through meridians, researchers usually find that it generally does not matter where the needles are inserted, how often (that is, no dose-response effect is observed)137, or even if needles are actually inserted138. In other words, 'sham' or 'placebo' acupuncture generally produces the same effects as 'real' acupuncture138, 139, 140, 141, 142 and, in some cases, does better143. Even what is arguably the most persuasive meta-analysis144 concluding that acupuncture has some efficacy against chronic pain included studies without sham acupuncture controls, and the reported difference due to acupuncture was still less than the minimal clinically important difference in pain for osteoarthritis145, 146, strongly suggesting that acupuncture effects are probably not clinically relevant. The most parsimonious explanation for this body of evidence is that acupuncture almost certainly has no specific effects greater than placebo for any condition19, with the possible exception of nausea123."

Refs in this:
122.Hurt, J. K. & Zylka, M. J. PAPupuncture has localized and long-lasting antinociceptive effects in mouse models of acute and chronic pain. Mol. Pain 8, 28 (2012). CAS
123.Garcia, M. K. et al. Systematic review of acupuncture in cancer care: a synthesis of the evidence. J. Clin. Oncol. 31, 952–960 (2013). PubMed
124.Cho, S. H., Lee, H. & Ernst, E. Acupuncture for pain relief in labour: a systematic review and meta-analysis. BJOG 117, 907–920 (2010). PubMed
125.Ernst, E. Are the effects of acupuncture specific or nonspecific? Pain 152, 952 (2011). CAS
126.Ernst, E., Lee, M. S. & Choi, T. Y. Acupuncture: does it alleviate pain and are there serious risks? A review of reviews. Pain 152, 755–764 (2011). CAS
127.Gilby, A. Y., Ernst, E. & Tani, K. A systematic review of reviews of systematic reviews of acupuncture. FACT 18, 8–18 (2013). Show context
128.Posadzki, P. et al. Acupuncture for cancer-related fatigue: a systematic review of randomized clinical trials. Support Care Cancer, 21, 2067–2073 (2013). PubMed
129.Street, R. L. Jr., Cox, V., Kallen, M. A. & Suarez-Almazor, M. E. Exploring communication pathways to better health: clinician communication of expectations for acupuncture effectiveness. Patient Educ. Couns. 89, 245–251 (2012). PubMed
130.White, P. et al. Practice, practitioner, or placebo? A multifactorial, mixed-methods randomized controlled trial of acupuncture. Pain 153, 455–462 (2012). PubMed
131.Dodin, S. et al. Acupuncture for menopausal hot flushes. Cochrane Database Syst. Rev. 7, CD007410 (2013). PubMed
132.Franconi, G., Manni, L., Schroder, S., Marchetti, P. & Robinson, N. A systematic review of experimental and clinical acupuncture in chemotherapy-induced peripheral neuropathy. Evid. Based Complement Alternat. Med. 2013, 516916 (2013).
133.O'Sullivan, E. M. & Higginson, I. J. Clinical effectiveness and safety of acupuncture in the treatment of irradiation-induced xerostomia in patients with head and neck cancer: a systematic review. Acupunct Med. 28, 191–199 (2010). CAS
134.Cheuk, D. K. & Wong, V. Acupuncture for epilepsy. Cochrane Database Syst. Rev. 5, CD005062 (2014). PubMed
135.Kim, T. H. et al. Acupuncture for treating acute ankle sprains in adults. Cochrane Database Syst. Rev. 6, CD009065 (2014). PubMed
136.White, A. R., Rampes, H., Liu, J. P., Stead, L. F. & Campbell, J. Acupuncture and related interventions for smoking cessation. Cochrane Database Syst. Rev. 1, CD000009 (2014). PubMed
137.Chiu, H. Y., Pan, C. H., Shyu, Y. K., Han, B. C. & Tsai, P. S. Effects of acupuncture on menopause-related symptoms and quality of life in women on natural menopause: a meta-analysis of randomized controlled trials. Menopause http://dx.doi.org/10.1097/GME.0000000000000260 (2014). Show context
138.Cherkin, D. C. et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch. Intern. Med. 169, 858–866 (2009). PubMed
139.Linde, K. et al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA 293, 2118–2125 (2005). CAS
140.Pastore, L. M., Williams, C. D., Jenkins, J. & Patrie, J. T. True and sham acupuncture produced similar frequency of ovulation and improved LH to FSH ratios in women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 96, 3143–3150 (2011). CAS
141.Manheimer, E. et al. The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis. Hum. Reprod. Update 19, 696–713 (2013). PubMed
142.Bao, T. et al. Patient-reported outcomes in women with breast cancer enrolled in a dual-center, double-blind, randomized controlled trial assessing the effect of acupuncture in reducing aromatase inhibitor-induced musculoskeletal symptoms. Cancer 120, 381–389 (2014). PubMed
143.Goldman, R. H. et al. Acupuncture for treatment of persistent arm pain due to repetitive use: a randomized controlled clinical trial. Clin. J. Pain 24, 211–218 (2008). PubMed
144.Vickers, A. J. et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch. Intern. Med. 172, 1444–1453 (2012). PubMed

Wiki CRUK John (talk) 13:20, 22 September 2014 (UTC)

As of 2012, the impact factor was 35. I added a little something to Acupuncture#Ethics. QuackGuru (talk) 23:09, 22 September 2014 (UTC)

Possible original research and not a conclusion

The following sentence is in the article: The mechanism of action for acupuncture is still unclear. Evidence suggests that acupuncture generates a sequence of events that include the release of endogenous opioid-like substances that modulate pain signals within the central nervous system. See Acupuncture#Scientific view on TCM theory.

A dated 2007 was restored to the article against consensus. Here is the article. I could not verify the claim and there are newer sources for osteoarthritis of the knee. See Acupuncture#Extremity conditions. QuackGuru (talk) 03:22, 2 October 2014 (UTC)

Duplication

There is similar information in the same section and general agreement was original research. For example, Acupuncture is generally safe when administered using clean technique and sterile single use needles. QuackGuru (talk) 03:26, 2 October 2014 (UTC)

This is even more duplication. What is the point? QuackGuru (talk) 03:42, 2 October 2014 (UTC)

Hello QuackGuru, the review found that results from pediatric acupuncture AE's mirrored those of AE's in general, and that's relevant to that section. But I will modify it to only include information on AE's in general. I appreciate your input in this instance. LesVegas (talk) 03:51, 2 October 2014 (UTC)
The information is similar with text in another section using the same source. The text is also misleading according to the conclusions of full text. QuackGuru (talk) 04:00, 2 October 2014 (UTC)

The first sentence for Acupuncture#Adverse events says "Acupuncture is generally safe when administered by an experienced, appropriately trained practitioner using clean technique and sterile single use needles." QuackGuru (talk) 01:06, 7 October 2014 (UTC)

Statement: Exhaust financial resources by pursuing ineffective treatment

I could not verify the statement, "As with other alternative medicines, unethical or naïve practitioners may induce patients to exhaust financial resources by pursuing ineffective treatment." with this reference. Quackwatch is also a source, but Quackwatch does not meet MEDRS compliance. LesVegas (talk) 04:03, 2 October 2014 (UTC)

"Final Report, Report into Traditional Chinese Medicine" (PDF). Parliament of New South Wales. 9 November 2005. Retrieved 3 November 2010. The link works.
QW is reliable for the claim. QuackGuru (talk) 04:04, 2 October 2014 (UTC)
I'm sorry to have to be disagreeable in this instance, but QW is not reliable for this claim. In fact, here is what MEDRS says about it

Press releases, blogs, newsletters, advocacy and self-help publications, and other sources contain a wide range of biomedical information ranging from factual to fraudulent, with a high percentage being of low quality. Conference abstracts present incomplete and unpublished data and undergo varying levels of review; they are often unreviewed and their initial conclusions may have changed dramatically if and when the data are finally ready for publication. Consequently, they are usually poor sources and should always be used with caution, never used to support surprising claims, and carefully identified in the text as preliminary work. Peer reviewed medical information resources such as WebMD, UpToDate, Mayo Clinic, and eMedicine are usually acceptable sources in themselves, and can be useful guides about the relevant medical literature and how much weight to give different sources; however, as much as possible Misplaced Pages articles should cite the more established literature directly.

LesVegas (talk) 04:14, 2 October 2014 (UTC)
The words "never to support surprising claims is most pertinent. We need to be quoting direct from peer-reviewed secondary sources only, as it tells us to do in the MEDRS passage above. LesVegas (talk) 04:19, 2 October 2014 (UTC)
There were previous discussions about QW as a source. The result was QW is reliable. QuackGuru (talk) 04:21, 2 October 2014 (UTC)
Can you show me this? Did they bring up the passage I quoted? I was not part of this discussion then, but I'd be glad to be part of it now. LesVegas (talk) 04:24, 2 October 2014 (UTC)
Here is one example: Talk:Acupuncture/Archive_14#Appropiateness_use_of_QuackWatch. QuackGuru (talk) 04:29, 2 October 2014 (UTC)
Thanks for providing that, I read it but see no consensus whatsoever. I see that another editor brought up my argument, but it wasn't addressed. Would you care to do so? Seriously, Misplaced Pages seems quite clear on this topic. You wouldn't want a pro-acupuncture website to be used as a source. That's why there's a policy on this. QuackWatch's citations are original research, and QW is a blog, not a peer-reviewed journal, and "should never be used to support surprising claims". It violates MEDRS on multiple counts. We should "cite established literature directly" not through QW. I see no policy that allows us to include it for claims like this, not by a long shot. LesVegas (talk) 04:52, 2 October 2014 (UTC)

As I recall, the article wording is paraphrased from the Australian PDF -- but I can't recall which statement/part exactly. QuackWatch -- is it being used as a MEDRS here? I wouldn't really say so.... and FWIW, exhaustion of resources on ineffective treatment is a genuine ethical concern and risk (both with alt-meds and experimental or off-label use of mainstream meds). --Middle 8 (contribs • COI) 13:26, 2 October 2014 (UTC)

There was an extensive discussion about the use of QuackWatch as as source here: Talk:Acupuncture#Quackwatch is a reliable source. I start to agree more and more with position of Bullrangifer and Middle 8: QuackWatch can be used as an RS (not MEDRS) on a case-by-case basis. Aside from that view, there was a strong opposition against using QuackWatch at all, and the other extreme basically labeled everyone objecting QuackWatch as "POV-pushers" or "advocates". I find Bullrangifer's and Middle 8's position the most constructive for consensus building though. Jayaguru-Shishya (talk) 13:54, 2 October 2014 (UTC)

This isn't a medical claim, so WP:MEDRS is irrelevant. I'm actually not sure whether QW should be considered reliable for this statement, but there are certainly adequate sources. — Arthur Rubin (talk) 18:38, 2 October 2014 (UTC)

Thanks everyone! You're all right, it's not a medical claim, and much thanks for pointing that out. Peace! LesVegas (talk) 00:10, 3 October 2014 (UTC)

Theatrical placebo

More research confirming that acupuncture is a theatrical placebo: JAMA. 2014 Oct 1;312(13):1313-22. doi: 10.1001/jama.2014.12660. Commentary here: More evidence to show that acupuncture is a ‘theatrical placebo’ Guy (Help!) 08:47, 4 October 2014 (UTC)

Adenosine and a good overall summary

From Integrative oncology: really the best of both worlds?, Nature Reviews Cancer (2014) doi:10.1038/nrc3822:

It has been proposed on the basis of mouse studies that acupuncture relieves pain through the local release of adenosine, which then activates nearby A1 receptors. Unfortunately, the key studies that made this conclusion suffered from the awkward grafting of concepts of ‘qi’ and meridians onto what would other-wise have been straightforward interesting neuroscience studies of the role of the A1 receptor in pain modulation. Instead, needles were inserted into an ‘acupuncture point’ on the mouse that, relative to the mouse leg, was far larger and far closer to a major nerve than in the human. In essence, because this caused more tissue damage and inflammation relative to the size of the animal in mice than in humans, such studies unnecessarily muddled a finding that local inflammation can result in the local release of adenosine with analgesic effect, and they still fail to demonstrate a sufficiently biologically plausible mechanism to justify clinical?trials.

This phenomenon goes beyond basic science. When acupuncture is tested in the clinic, overall, with possibly one exception (for example, to treat nausea), recent evidence strongly suggests that its effects are nonspecific and indistinguishable from placebo effects that are highly dependent on practitioner–patient inter action. Moreover, meta-analyses almost always conclude that there is insufficient clinical evidence to make a determination of efficacy and include studies with a high risk of bias. Also, contrary to the claimed mechanism of redirecting the flow of qi through meridians, researchers usually find that it generally does not matter where the needles are inserted, how often (that is, no dose-response effect is observed), or even if needles are actually inserted. In other words, ‘sham’ or ‘placebo’ acupuncture generally produces the same effects as ‘real’ acupuncture and, in some cases, does better. Even what is argu-ably the most persuasive meta-analysis concluding that acupuncture has some efficacy against chronic pain included studies without sham acupuncture controls, and the reported difference due to acupuncture was still less than the minimal clinically important difference in pain for osteoarthritis, strongly suggesting that acupuncture effects are probably not clinically relevant. The most parsimonious explanation for this body of evidence is that acupuncture almost certainly has no specific effects greater than placebo for any condition, with the possible exception of nausea.

Refs for above:

19. Colquhoun, D. & Novella, S. P. Acupuncture is theatrical placebo. Anesth. Analg. 116, 1360–1363 (2013).
121. Goldman, N. et al. Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nature Neurosci. 13, 883–888 (2010).
122. Hurt, J. K. & Zylka, M. J. PAPupuncture has localized and long-lasting antinociceptive effects in mouse models of acute and chronic pain. Mol. Pain 8, 28 (2012).
123. Garcia, M. K. et al. Systematic review of acupuncture in cancer care: a synthesis of the evidence. J. Clin. Oncol. 31, 952–960 (2013).
124. Cho, S. H., Lee, H. & Ernst, E. Acupuncture for pain relief in labour: a systematic review and meta-analysis. BJOG 117, 907–920 (2010).
125. Ernst, E. Are the effects of acupuncture specific or nonspecific Pain 152, 952 (2011).
126. Ernst, E., Lee, M. S. & Choi, T. Y. Acupuncture: does it alleviate pain and are there serious risks A review of reviews. Pain 152, 755–764 (2011).
127. Gilby, A. Y., Ernst, E. & Tani, K. A systematic review of reviews of systematic reviews of acupuncture. FACT 18, 8–18 (2013).
128. Posadzki, P. et al. Acupuncture for cancer-related fatigue: a systematic review of randomized clinical trials. Support Care Cancer, 21, 2067–2073 (2013).
129. Street, R. L. Jr., Cox, V., Kallen, M. A. & Suarez-Almazor, M. E. Exploring communication pathways to better health: clinician communication of expectations for acupuncture effectiveness. Patient Educ. Couns. 89, 245–251 (2012).
130. White, P. et al. Practice, practitioner, or placebo A multifactorial, mixed-methods randomized controlled trial of acupuncture. Pain 153, 455–462 (2012).
131. Dodin, S. et al. Acupuncture for menopausal hot flushes. Cochrane Database Syst. Rev. 7, CD007410 (2013).
132. Franconi, G., Manni, L., Schroder, S., Marchetti, P. & Robinson, N. A systematic review of experimental and clinical acupuncture in chemotherapy-induced peripheral neuropathy. Evid. Based Complement Alternat. Med. 2013, 516916 (2013).
133. O’Sullivan, E. M. & Higginson, I. J. Clinical effectiveness and safety of acupuncture in the treatment of irradiation-induced xerostomia in patients with head and neck cancer: a systematic review. Acupunct Med. 28, 191–199 (2010).
134. Cheuk, D. K. & Wong, V. Acupuncture for epilepsy. Cochrane Database Syst. Rev. 5, CD005062 (2014).
135. Kim, T. H. et al. Acupuncture for treating acute ankle sprains in adults. Cochrane Database Syst. Rev. 6, CD009065 (2014).
136. White, A. R., Rampes, H., Liu, J. P., Stead, L. F. & Campbell, J. Acupuncture and related interventions for smoking cessation. Cochrane Database Syst. Rev. 1, CD000009 (2014).
137. Chiu, H. Y., Pan, C. H., Shyu, Y. K., Han, B. C. & Tsai, P. S. Effects of acupuncture on menopause-related symptoms and quality of life in women on natural menopause: a meta-analysis of randomized controlled trials. Menopause http://dx.doi.org/10.1097/GME.0000000000000260 (2014).
138. Cherkin, D. C. et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch. Intern. Med. 169, 858–866 (2009).
139. Linde, K. et al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA 293, 2118–2125 (2005).
140. Pastore, L. M., Williams, C. D., Jenkins, J. & Patrie, J. T. True and sham acupuncture produced similar frequency of ovulation and improved LH to FSH ratios in women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 96, 3143–3150 (2011).
141. Manheimer, E. et al. The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis. Hum. Reprod. Update 19, 696–713 (2013).
142. Bao, T. et al. Patient-reported outcomes in women with breast cancer enrolled in a dual-center, double-blind, randomized controlled trial assessing the effect of acupuncture in reducing aromatase inhibitor-induced musculoskeletal symptoms. Cancer 120, 381–389 (2014).
143. Goldman, R. H. et al. Acupuncture for treatment of persistent arm pain due to repetitive use: a randomized controlled clinical trial. Clin. J. Pain 24, 211–218 (2008).
144. Vickers, A. J. et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch. Intern. Med. 172, 1444–1453 (2012).
145. Stauffer, M. E., Taylor, S. D., Watson, D. J., Peloso, P. M. & Morrison, A. Definition of nonresponse to analgesic treatment of arthritic pain: an analytical literature review of the smallest detectable difference, the minimal detectable change, and the minimal clinically important difference on the pain visual analog scale. Int. J. Inflam. 2011 , 231926 (2011).
146. Tubach, F. et al. Minimum clinically important improvement and patient acceptable symptom state in pain and function in rheumatoid arthritis, ankylosing spondylitis, chronic back pain, hand osteoarthritis, and hip and knee osteoarthritis: Results from a prospective multinational study. Arthritis Care Res. 64, 1699–1707 (2012).


A decent summary, I think, and current (September 2014) and in an extremely reliable source. Guy (Help!) 12:26, 6 October 2014 (UTC)


Given the above, is it now time to take a slash and burn approach to the article as it currently stands? We have been pandering to quacks for far too long, so I suggest the wholesale removal of Section 2 Effectiveness, to be replaced with a quote - perhaps the following, "acupuncture almost certainly has no specific effects greater than placebo for any condition, with the possible exception of nausea."
just delete section 3.2 Cost effectiveness as it obviously isn't.
The Ethics section must now make clear what a bunch of self serving quacks acupuncturists are.
This is just an off the cuff response to Guy's post above, but something needs to be done to clear up article cruft.
best wishes. -Roxy the dog™ (resonate) 19:12, 6 October 2014 (UTC)

Careful of WP:UNDUE before going after the article with pliers and a blowtorch .... acu's use in mainstream settings shows the existence of sig views diverging from Gorski's, cf. Talk:Acupuncture#Serious_dispute. The disagreement is (as far as I can see) over whether to use/refer. Some believe that if it enhances a patient's sense of well-being and is low-risk, then it's justified, even if the effects are mostly/fully non-specific. This "logic" understandably drives people like Gorski nuts, but it is what it is. --Middle 8 (contribs • COI) 10:53, 9 October 2014 (UTC)

Removed material

Greetings. Why this material was removed?

Based on growing literature, regarding acupuncture's physiological effects, a 2014 review proposed a model combining both connective tissue plasticity and peripheral sensory modulation as a needle response.

One review cited considerable development regarding neural mechanisms of both manual (hand stimulated) acupuncture and electrical acupuncture, stating manual acupuncture activates all types of afferent fibers, while electrical acupuncture can produce an analgesic effect by exciting Abeta and part of Adelta fibers. The same review found that acupuncture signals ascend mainly through the spinal ventrolateral funiculus to the brain.

Several brain nuclei are involved in processing acupuncture analgesia. In addition to opioid peptides, glutamate, 5-hydroxytryptamine, and cholecystokinin octapeptide contribute to mediating acupuncture analgesia. In electroacupuncture, the release of opioid peptides is frequency dependent. Brain regions responsible for acupuncture analgesia in animal studies have been confirmed in humans via functional imaging.?

Were the sources unreliable or what? I can't find any "strong disagreement with using these sources" either, as it was stated in some deletion summaries.

I can't see any reason why not to add these sources, but please do correct me if there's something I have missed. Cheers! Jayaguru-Shishya (talk) 15:32, 7 October 2014 (UTC)

This was explained in another section. See Talk:Acupuncture#Acupuncture_and_the_brain. QuackGuru (talk) 20:38, 7 October 2014 (UTC)
There is zero consensus QuackGuru. KWW wasn't even contending the sources I added. These were in a different section, and they had to do with much more than just the brain. These are reliable sources and belong in the article somewhere. If you still think they don't belong in 'Scientific Reception', then perhaps we should create a new section, 'Mechanism of Action'? LesVegas (talk) 20:12, 13 October 2014 (UTC)

RSN: Sourcing medical centers' use of acu

There's been debate above over whether the websites of medical centers are RS's for the fact that they use acupuncture. Several editors have agreed this such use is fine; despite this one editor (QuackGuru) who disagrees has twice removed such sources, arguing that as "primary sources" they don't meet RS. I think they're fine per WP:SELFSOURCE, as well as WP:SENSE. I've posted about this at WP:RSN#Websites_of_medical_centers_as_sources_for_services_they_perform. --Middle 8 (contribs • COI) 05:28, 13 October 2014 (UTC)

You are making a series of controversial edits that were previously resolved. For example, the in-text attribution was removed by User:Jmh649 but you restored it to the article again. Better sources were found and editors have moved on. User:RexxS deleted the unnecessary primary sources too. He also commented on the talk page and the matter was resolved. QuackGuru (talk) 06:58, 13 October 2014 (UTC)
@QuackGuru - Unfortunately your comments and ES's address fail to address my arguments. I'll reply in order with specific requests:
  • Your first sentence relates to the section below, which please see.
  • As far as sourcing medical centers, we will see what RSN says. (1) But you're ignoring my argument that their sites are fine per WP:SELFSOURCE, as well as WP:SENSE; please address that.
  • (2) You're also ignoring the UNDUE argument for this pair of edits:. Medical centers at Harvard, Stanford etc etc all vastly outweigh Gorski and Novella, and my 2nd edit explains their position consisely -- which is more than enough. Please address.
  • Your revert has a very misleading RS ("reorder"); please don't do that.
We've had difficulty communicating in the past, and I've accused you of IDHT, but now I'm going to AGF and assume we've just had difficulty communicating. Therefore I'm being as specific as possible. Please be equally specific in your responses to my questions (1) and (2) above. It will help me and probably others as well. Thanks! --Middle 8 (contribs • COI) 08:44, 13 October 2014 (UTC)

Restoring consensus wording re Ernst review

Self-explanatory ES, and left a note on Doc James' page (section here) since I was reverting him. My edit restores the latest consensus wording which was a bold edit by User:Vzaak that accords with the source Ernst 2009. QuackGuru among others accepted this edit as we see in archived talk. That was a broad consensus; there were a lot of editors involved spanning more than one talk page, and those who didn't comment implicitly accepted Vzaak's edit per WP:SILENCE.

That said, I think that when it comes to efficacy we can do better than Ernst's 2009 review of reviews whose dataset spans 2000-2009. But for safety that source remains fine. --Middle 8 (contribs • COI) 07:37, 13 October 2014 (UTC)

QuackGuru: You reverted my edits to the lede and body , saying "violation of consensus". WHAT???
As stated, my edit restored the broad consensus reached at archived talk supporting Vzaak's edit. In fact, as stated, you supported that consensus. (1) Please justify your edit in light of consensus, and show evidence for any supposedly more recent broad consensus. (Note that in e.g. this recent version, the wording in the body reflects Vzaak's consensus wording. Is there any discussion of what that later changed?) (2) Please explain why you changed your mind .
Also, above, you said: "Better sources were found and editors have moved on." (3) Which "better sources"?
Again, I'm being very specific. I sometimes have a hard time understanding your writing. So if you indicate which question you're replying to, it will help me with WP:DR a great deal. Thanks, Middle 8 (contribs • COI) 08:50, 13 October 2014 (UTC) revised 09:05, 13 October 2014 (UTC)
I do not see the justification for
"A systematic review of systematic reviews highlighted recent high-quality randomized controlled trials which found that for reducing pain..."
When this can be summarized as
"A systematic review of systematic reviews..."
Why exactly is "highlighted recent high-quality randomized controlled trials"? A proper systematic review for an intervention of course only includes high quality RCTs. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:27, 13 October 2014 (UTC)
(e/c) Because it was a review of reviews and the RCT was cited as an exception. The dataset was reviews of efficacy for pain, a majority of which were actually positive. But Ernst considered those results dubious, because of the low quality of many RCT's that the reviews looked at. (The reviews spanned 2000-2009, so the RCT's they looked at go back even further.) As part of his explanation of why he thought the positive reviews dubious, he pointed to some high-quality RCT's, including one from 2010, Suarez-Almazor, to which the phrase "real acupuncture was no more effective than sham" (on the last page of the review) refers. Then he went on to predict (correctly) that in the future, as RCT's got better, results would be likely to show small efficacy or none.
So we need to get both the spirit and the letter right while doing violence to neither. To do that we need to stick with the precise, consensus wording as long as we're citing Ernst 2009 in the lede for efficacy. And better, use more up-to-date reviews that actually find lack of efficacy.
Also see my comment on your talk page. And feel free, Doc James and all editors, to email me if you'd like a copy of the review. --Middle 8 (contribs • COI) 13:50, 13 October 2014 (UTC)
Addendum: So why not just cite more up-to-date reviews? The answer so far seems to be that QuackGuru is hot to see the phrase "real acupuncture is no better than sham" in the article (see above, where he proposes using a weak source for the claim, and archived talk, where he wanted to use Moffet, another weak source that actually failed MEDRS, per Alexbrn , and was finally deleted by Doc James ). But that wording, "real acu is no more effective than sham", is of course synonymous with saying "acu isn't effective", which we already say for most conditions anyway. We should just (a) report the most recent results on efficacy and (b) explain to the reader what sham/placebo acu is: real acu at fake points, or fake acu at real points. I've tried this -- see above -- and QuackGuru escalated the drama and went to User:Kww, begging to let him take me to AN for "editing against consensus", which is pretty fucking ironic since my edits then and now actually uphold consensus, i.e. Vzaak's edit. --Middle 8 (contribs • COI) 13:50, 13 October 2014 (UTC) edited 14:10, 13 October 2014 (UTC)
I likewise find Middle 8's proposed rewording greatly weakens the conclusion of the systematic review, and amounts to little more than whitewashing. Dominus Vobisdu (talk) 13:35, 13 October 2014 (UTC)
Have you read the review -- not just the abstract? I doubt it, or else you'd know that the phrase "real acupuncture was no more effective than sham" (on the final page) refers to the RCT by Suarez-Almazor (2009), with which Ernst was contrasting the dataset (which was reviews from 2000-2009 that found for efficacy, albeit with contradictions, hence Ernst's citation of newer, better stuff like Suarez-Almazor).
And please explain this edit summary -- where you revert my restoring Vzaak's consensus wording and repeat QuackGuru's ES "violation of consensus". Oh really? Show us that contrary, more recent consensus? I doubt you can point to that either, since it doesn't exist.
Neither the source nor the edit history backs you up. I think -- and I think it's obvious -- that you're just trying to wing it, making broadly "anti-acupuncture" edits that you figure must be correct. Dude! Way to edit an encyclopedia! --Middle 8 (contribs • COI) 14:06, 13 October 2014 (UTC)

Restoration of verifiable material

I removed material that failed verification per source and replaced it with an earlier, verifiable piece of text. I got reverted, however, by Dominus Vobisdu per "Fringe whitewashing". Taking that no explanation for such revert was given, @Dominus Vobisdu:, what was your reason for such a revert? Instead of editing collaboratively, your edit without any reason seems like a personal attack making accusations of "fringe" and "whitewashing", and such behavior cannot be tolerated at an encyclopedia. Jayaguru-Shishya (talk) 15:28, 13 October 2014 (UTC)

See my comments just above; same issue. Dominus Vobisdu is as wrong as can be on this, both on the history (both you, J-S, and I indeed restored consensus wording) and the source (per above). After the dust settles here, I will escalate the issue to a noticeboard unless D.V. changes course. --Middle 8 (contribs • COI) 15:37, 13 October 2014 (UTC)

(Personal attack removed) (Personal attack removed)

It's embarrassing, the way you guys are doubling down and not engaging on substance. Epitome of 2nd sentence of WP:NPA.
Re COI: I've seen no evidence J-S has one, and I've plainly declared mine. --Middle 8 (contribs • COI) 18:51, 13 October 2014 (UTC)
Personally, I see your being an acupuncturist as an asset because you can offer your expertise to edits. You're not editing an article on "Middle 8 the Acupuncturist". LesVegas (talk) 20:18, 13 October 2014 (UTC)
Thanks! A lot of editors don't really understand WP:COI. Sometimes subject-matter experts find that "no good deed goes unpunished" around here.  :-/ --Middle 8 (contribs • COI) 05:52, 14 October 2014 (UTC)

Put simply: The reason Ernst's review-of-reviews doesn't find unambiguously for lack of efficacy is because the dataset is old-ish reviews (spanning 2000-09) based upon still-older RCT's, which weren't designed very well. With newer and better RCT's we started seeing more and more convergence toward the null result (no efficacy vs. placebo). Ernst '09 predicts this... and cites one such RCT as an example of real being no better than sham. Hence consensus language : A systematic review of systematic reviews highlighted recent high-quality randomized controlled trials which found that for reducing pain real acupuncture was no better than sham acupuncture. But we'd be better off using a newer, less ambiguous review, rather than a superseded one that requires clarification. --Middle 8 (contribs • COI) 08:36, 14 October 2014 (UTC)

OK, here is a full copy of Ernst '11 at researchgate.com. correction: it's Ernst '11 not Ernst '09 (thanks to User:ImperfectlyInformed, whose diff is also informative.) It's about two broad topics, efficacy and risks, and we're concerned with the former. Especially look at the Intro, Discussion and Conclusions. Which literature is Ernst talking about when he mentions real vs. sham, on p. 762? --Middle 8 (contribs • COI) 09:59, 14 October 2014 (UTC) <small.edited 09:43, 21 October 2014 (UTC): corrected name; it's Ernst '11

Thanks for the PDF, Middle 8, I'll try to have a look. When it comes to the achieved consensus, I think it withstands some random removals. After all, Misplaced Pages is not a democracy (WP:DEMOCRACY). Jayaguru-Shishya (talk) 14:56, 17 October 2014 (UTC)

You claimed the text failed verification and now you will "try to have a look"? https://en.wikipedia.org/Acupuncture#cite_note-Ernst_2011-8 Click on the Ernst 2011 source and you will see a little symbol of a PDF file. The PDF file has been in the article for quite some time. I read the source gain. Actually the high-quality randomized controlled trials did not find that for reducing pain real acupuncture was no better than sham acupuncture. That would be a misinterpretation of the source and the conclusion of an editor. It was the 2011 source that came to that conclusion. We do not need to say or mention it was referenced to the high-quality randomized controlled trials, anyhow. If we did something like that for every sentence this article would be ridiculously written. QuackGuru (talk) 06:02, 19 October 2014 (UTC)
It was the RCT Suarez-Almazor to which the text about real being no better than sham refers, and this should be obvious to editors who are applying scientific literacy in reading the source (and not being disingenuous). --Middle 8 (contribs • COI) 09:47, 21 October 2014 (UTC)
The part "highlighted recent high-quality randomized controlled trials which found" claims the RCTs came to that conclusion. That is a OR. I explained it was the 2011 source that made that conclusion.
It may be the RCT Suarez-Almazor is what the text refers to but that was not what was added to the article and it is unnecessary to explain where the text was sourced to. QuackGuru (talk) 10:03, 21 October 2014 (UTC)
Perhaps you meant it just the other way around, QuackGuru? The source still fails to verify the claim; it does, however, find that in reducing pain real acupuncture was no better than sham. In my earlier edit, I removed that piece of text that failed verification and replaced it with the previous verifiable one.
Perhaps you could advise me which part exactly supports that conclusion? Jayaguru-Shishya (talk) 18:34, 20 October 2014 (UTC)
Your edit fails V and I already explained why. There is no justification for it. QuackGuru (talk) 18:48, 20 October 2014 (UTC)
@ QuackGuru No, it doesn't fail VER; we have consensus to that effect. You say there's no justification for the edit, and that was a good question Doc James asked -- but since you follow talk pages closely, I think you may have seen that I explained the situation already and he didn't respond. Indeed, nobody else who reverted my consenus-restoring edit has responded to my explanations, so WP:SILENCE can be assumed. It's obvious we had a broad consensus in July that hasn't changed, and is substantively sound according to that consensus discussion. Time to move on. --Middle 8 (contribs • COI) 11:29, 22 October 2014 (UTC)

@ QuackGuru, continuing from your comments at 10:03, 21 October 2014: Glad to see you back; you went silent shortly after my replies to you above. I know we all want to keep WP:DR moving forward, so please respond to my questions 1, 2 and 3 there. Brief recap: after some discussion, I recently remembered that we actually had a broad consensus (including discussion at WT:MED, in which lots of editors participated) to use Vzaak's edit, which said "A systematic review of systematic reviews highlighted recent high-quality randomized controlled trials which found that for reducing pain real acupuncture was no better than sham acupuncture". And you supported that wording, enthusiastically, with a big "thumbs up" in your ES. It was great to see us all on the same page with what you called a "good compromise". Given your support and the breadth of consensus, it seems to me we should just respect that consensus and move on, shouldn't we? I look forward to your responses. Again, since we sometimes have trouble communicating, please indicate specifically which questions you're replying to -- that will help me, and I suspect others here, a great deal. Thanks! --Middle 8 (contribs • COI) 10:24, 21 October 2014 (UTC) edited 13:37, 22 October 2014 (UTC)

I explained it was OR over and over again. The newer discussion showed editors support using the text for a conclusion. QuackGuru (talk) 16:58, 21 October 2014 (UTC)
I agree with Middle 8 restoring the firm and sound wording of the text, it has been discussed already to a great extent. Since nobody is responding to the discussion, the established consensus can be assumed. Jayaguru-Shishya (talk) 20:17, 21 October 2014 (UTC)
I did respond to the discussion. Read my previous comment. No editor has been able to provide a rational argument to including the unnecessary wording. QuackGuru (talk) 20:27, 21 October 2014 (UTC)
@QuackGuru Yes, I saw your comment (starting with "I explained it was OR...."). The diffs you linked to were not explanations, but simply assertions that the consensus text (from Vzaak) was OR. No, it is not OR to quote a source correctly. Additionally, you cited two diffs from a September discussion at WT:MEDRS that opposed consensus wording; however, we both know that there were also editors favoring it (and with more detailed analysis based on the source's grammar) -- just read that discussion and see comments from Peter Coxhead (08:40, 3 September 2014 UTC) and 2/0 (15:12, 4 September 2014 UTC). More importantly, that discussion, having fewer participants and no consensus, does not supersede the July discussions (on this page and at WT:MED, cf. Vzaak's discussion-closing edit), which had more participants and did reach a consensus.
So with respect to the three questions I asked, you did offer an answer to (1), but you still haven't shown evidence for any supposedly more recent broad consensus than in July (for Vzaak's edit). You have not explained (2) at all, i.e. why you changed your mind -- not that you have too, but it is odd. Nor (3) have you explained your statement that "Better sources were found and editors have moved on" (3) Which "better sources" -- but we can let that one go since you're not pressing it. Still, that leaves (1), which is fundamental to consensus.
And most importantly, you are totally overlooking the context of Ernst's statement about real vs. sham. So I would ask some new questions: (4), are you suggesting that any statement X made in a review article, no matter what the context, can be cited as "the review found X"? If so, that's prima facie unsound; and if not, then (5) why do you think context doesn't matter in this case? Maybe English isn't your first language (and that's OK, obviously), but I assure you, grammatically, that the antecedent for Ernst's statement re real vs. sham is indeed Suarez-Alamazor. (6) Do you see that the dataset is reviews, and that they're old and based on poor quality RCT's? (7) In light of (6), do you see that Ernst is contrasting his dataset with Suarez-Almazor's RCT?
Additionally, we don't say that Ernst '11 found real to be no better than sham just because Ernst found that to be true in later papers. Which is why I've been saying we should cite later papers instead.... and I hope that that point makes it clear that I am not trying to "whitewash" anything; I just think content errors hurt the project.
And in light of our difficulty communicating in the past, I wish you would answer my queries specifically, e.g. "My answer to Middle 8's question 1 is (...); my answer to his question 2 is (...)? That would help me a lot, and it's not an unreasonable demand. So, work with me on this, OK? Thanks! --Middle 8 (contribs • COI) 11:21, 22 October 2014 (UTC) edited 13:34, 22 October 2014 (UTC), 22:28, 22 October 2014 (UTC)
But I did explain the problems with the current wording. It is reasonable to ask you to follow WP:COIADVICE. You did declare you have a COI, right? QuackGuru (talk) 19:09, 23 October 2014 (UTC)
Your diff simply says you changed your mind about how to read Ernst '11, which sort of answers my #2, but still leaves 4,5,6 and 7 unaddressed. I'm giving you every opportunity to move discussion forward and you aren't being helpful. Sounds like you don't intend to answer my questions. That's up to you, but remember, each time you choose not to answer, you're (a) not collaborating, and (b) creating a clear, specific record that you are refusing to collaborate. Re COI, etc., see long reply below (or you could just read the link in my signature, which anticipates your question). --Middle 8 (contribs • COI) 15:02, 24 October 2014 (UTC)


Continued controversial changes

  • Revision as of 05:45, 31 August 2014 Middle 8 replaced sourced text with original research in the lede. His edit was also a violation of lede because it did not summarise the body.

Let's review: "These findings should be seen in the light of recent results from high-quality randomized controlled trials. Cherkin et al. have shown that, for chronic low back pain, individualized acupuncture is not better in reducing symptoms than formula acupuncture or sham acupuncture with a toothpick that does not penetrate the skin." Reference number 14.

"This view was further strengthened by a recent randomized controlled trial in patients with osteoarthritis examining the effects of acupuncturists’ communication style ." Reference number 128.

The part "highlighted recent high-quality randomized controlled trials" refers to it should be seen in the light of recent results from high-quality randomized controlled trials. The source does not indicate it was the conclusion of the recent high-quality randomized controlled trials. and this is not how to summarise sources. No other text (specially in the lede) needs to explain what sources a review may or might have referred to.

"Real and sham acupuncture were both more effective in reducing pain than no acupuncture at all, but real acupuncture was no better than sham." This was an independent sentence that did not specifically refer to any randomized controlled trials. It is you opinion (educated guess) that you think the source refers to RCTs for that specific sentence. It is unencyclopedic writing to have this extreme level of detail, anyhow.

See WP:COI: "If the article you want to edit has few involved editors, consider asking someone at the talk page of a related Wikiproject for someone to make the change.

If another editor objects for any reason, then it's a controversial edit. Such edits should be discussed on the article's talk page."

Did Middle 8 violate WP:COIADVICE by knowingly making a controversial disputed edit? Middle 8, do you agree to follow WP:COIADVICE and revert your controversial edit and wait for consensus? QuackGuru (talk) 19:09, 23 October 2014 (UTC)

Hmm, many diffs loose from their context, and only accompanied by your personal commentaries. So have these issues been subjects of conversation before, and what are you suggesting exactly? Perhaps links to the original discussion would give a better picture than individual diffs alone? Especially when you are bringing up diffs from as early as last June, some clarification would be more than welcome! Cheers! Jayaguru-Shishya (talk) 13:17, 24 October 2014 (UTC)


@QuackGuru -- First, re my COI, it doesn't sound like you've read my declaration (see here or in my signature line) carefully. I have a COI (like any party with an interest in an outcome), but it doesn't make me ineligible to write a Cochrane review, for example. Nor does it reach Misplaced Pages's threshold, where COIADVICE kicks in. WP:COI has said, for years, that simply having a profession doesn't create a COI. Which makes sense: since I could write a Cochrane review on acupuncture, it would be pretty stupid for Misplaced Pages to restrict my editing simply on professional grounds. I know that some of the most ardent skeptic-warriors would love nothing more than to see acupuncturists constrained by COIADVICE, but less partisan editors have observed, repeatedly, that doing so would be a kind of WP:GAME.
Second, re Ernst' 11, I don't know why you're re-litigating this. We reached a broad consensus in July, and it still applies, even though you changed your mind. And July's broad consensus got it right. Your analysis above misreads context. Here's the full paragraph from the top of p.762 of Erbst '11, color-coded for clarity. My clarifications are in :
These findings should be seen in the light of recent results from high-quality randomized controlled trials. Cherkin et al. have shown that, for chronic low back pain, individualized acupuncture is not better in reducing symptoms than formula acupuncture or sham acupuncture with a toothpick that does not penetrate the skin. All 3 forms of acupuncture, however, were more effective than usual care. The authors consider, therefore, that the benefits of acupuncture ‘‘resulted from nonspecific effects such as therapist conviction, patient enthusiasm, or receiving a treatment believed to be helpful’’ . This view was further strengthened by a recent randomized controlled trial in patients with osteoarthritis examining the effects of acupuncturists’ communication style . Real and sham acupuncture were both more effective in reducing pain than no acupuncture at all, but real acupuncture was no better than sham. Moreover, a communication style generating high expectations in patients resulted in improved outcomes compared to a normal style, regardless of the type of acupuncture administered. In the primary studies included in the systematic reviews evaluated above, the risk of bias was often considerable. Adequately controlling for nonspecific effects in future is likely to demonstrate that acupuncture has no or few specific effects on pain .
Remember, this is a review of reviews spanning 2000-2009, and those reviews are based on RCT's that are even older. A LOT has changed since then, and that's why this paragraph exists: so that Ernst can contrast those reviews with newer, better RCT's. The text in brown pertains to Cherkin and the text in purple pertains to Suarez-Almazor . Your assertion to the contrary is incorrect. We can't just pick a sentence from, e.g., the brown or purple text above and say "this was a finding of Ernst" -- that's absurd! Context matters. To find out what the findings of Ernst '11 are, look at the abstract, or the last two sentences of the paragraph above, where he is actually discussing his dataset.
The only way in which "real acupuncture was no better than sham" is a "finding" of Ernst '11 is in a very hazy "spirit of the law" sense, insofar as he predicts the trend of future research as methods improve. But our job is to get both the spirit and the letter right without screwing up either. To do that, all we have to do is use more recent sources that are less ambiguous than Ernst '11. That's a better use of your energy and mine.
Third, re your complaints about my edits: If I were you, I'd be careful about throwing around perfectly reasonable edits, because they may well boomerang back at you. You've already tried that multiple times at Kww's user talk, but he's been silent. You're attempting to imply that by making an edit more than once, I must be fighting consensus, but in fact I'm restoring July's consensus, which you've been edit-warring against: a classic boomerang situation. I'll respond below only to show how meritless your objections are, for the record.
  • 1. Revision as of 13:16, 8 July 2014 Middle 8 deleted sourced text but claimed the source doesn't support the general statement.
    • And I was right (See also #3 below). This was resolved with a consensus-forming bold edit by Vzaak in July. (Discussion here & links therein, and sections preceding)
  • 2. Revision as of 05:45, 31 August 2014 Middle 8 replaced sourced text with original research in the lede. His edit was also a violation of lede because it did not summarise the body.
    • Perfectly good edit -- very simple explanation of controls -- but you (QuackGuru) define OR as any sort of paraphrasing or summarizing of sources.
  • 4. Revision as of 12:52, 7 September 2014. Middle 8 replaced sourced text with SYN and OR. For example, the part "that indicates a lack of effectiveness" was original research.
    • Similar to #2. Any editor who knows the topic area and understands SYN/OR will recognize this as a good summary of study design. I can't help it if you keep reverting good edits.
All in all, it's time for you to stop fighting a broad consensus that was factually correct, and to stop accusing others of violating consensus when you're actually the one doing that. That kind of conduct is very likely to boomerang.
A better idea: let's use more recent sources. Ernst '11, as I said, relies on reviews from 2000-2009, which are based on RCT's probably going back to the early 1990's. The Streitberger needle didn't even come along until ca. 1998! Ernst '11 is full of outdated information, which is why he made a prediction in the last sentence of the excerpt above. Better, less ambiguous sources now exist. --14:51, 24 October 2014 (UTC) copy-edit and format, 15:16, 24 October 2014 (UTC)

POV

I have just added a POV tag to this article. This article falls foul of the overly enthusiastic MEDRS-guys who refuse to allow any other sources into the article. Effect is that the article is rather negative. The Banner talk 10:01, 14 October 2014 (UTC)

I'm about to remove it because you haven't made a single suggestion for improvements to the article. -Roxy the dog™ (resonate) 10:44, 14 October 2014 (UTC)
Yup agree explanation / suggestions are required. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:15, 14 October 2014 (UTC)
@Jmh649/Doc James - note e.g. Talk:Acupuncture#Removed_material. I see no good reason to remove that. --Middle 8 (contribs • COI) 19:23, 14 October 2014 (UTC)
The suggestion is there refuse to allow any other sources into the article. So add more relevant sources. There is no need to dismiss every claim and/or source because it does not suit your opinion about medical sources. This is not a mainstream medical subject, so applying mainstream medical sources is not useful. The Banner talk 11:55, 14 October 2014 (UTC)
and now you are edit warring, and if I knew how to template you, I would. Nowhere in the article have reliable sources been refused, your objection is unsupportable, and I will again remove the tag, unless another editor beats me to it. You have to make real suggestions, not generalised observations. -Roxy the dog™ (resonate) 12:00, 14 October 2014 (UTC)
With your edit warring and template removal, you make loud and clear what the POV-problem is: refusal to see the unbalance. But take a look at the recent history and you will see several sources being removed with no or dubious motivation. The Banner talk 12:29, 14 October 2014 (UTC)
Yes, The Banner is right, reliably sourced material was not only removed, but one user even broke the 3RR with 6 reverts removing it. That was both a 3RR violation and disruptive, and I didn't know where I should file it, so I just filed a report here but it was pending for several days and is now archived. I'm curious why nobody ever ruled on this? Anywho, the user claimed "consensus" for removing the material, but never showed where consensus was reached when asked about it. I think this removal alone justified the tag, but as we can all see, there were several other instances where reliably sourced material was removed and makes the article unbalanced.
Anyway, let's focus on the material removed. In my opinion, it all needs to go back in and I don't see why not. Is anyone still opposed to the material being in the article? LesVegas (talk) 16:56, 14 October 2014 (UTC)
Of course. -Roxy the dog™ (resonate) 18:16, 14 October 2014 (UTC)
And here would be a great place to explain why. In the section above where this was also recently discussed, Talk:Acupuncture#Acupuncture_and_the_brain, you added nothing about content, just more stuff about contributors that had nothing to do with the content being discussed. . --Middle 8 (contribs • COI) 18:58, 14 October 2014 (UTC)
Most of our articles on pseudoscientific subjects, and many on scientific subjects more generally (evolutionary biology, climate change and so on) are despised by those with strong beliefs opposed to the scientific consensus view. We understand this, but it does not amount to justification for a POV tag. Misplaced Pages has a systemic bias towards scientific rationalism, this is pretty much by design. If you don't like how we cover subjects you're free to fork, as Conservapedia did. Over the long term our model seems ot be more successful than theirs, but whatever. Guy (Help!) 19:20, 23 October 2014 (UTC)

Protected, again

I saw the recent flurry of reverts about an article improvement tag. A protection is nicer than blocks but make no mistake there may have to be blocks if some of this battleground behaviour continues. I don't care what this article ends up saying about acupuncture but we are not going to have edit warring or people attacking each other. I hope that's clear. Meantime you have one week to resolve what the POV problem may or may not be on the article. Please be nice as well. --John (talk) 12:11, 14 October 2014 (UTC)

I support this action, but I am very interested to know why you don't care what this article ends up saying about acupuncture ;) -Roxy the dog™ (resonate) 12:14, 14 October 2014 (UTC)
That's easy. It's a subject on which I am disinterested. --John (talk) 12:22, 14 October 2014 (UTC)
That explains a great deal. Thanks. -Roxy the dog™ (resonate) 12:43, 14 October 2014 (UTC)
Sounds like John is saying "I'm going to make sure you play nice (WP:DR), now you guys work it out within that framework". Makes sense to me. --Middle 8 (contribs • COI) 19:08, 14 October 2014 (UTC)

Protected edit request on 20 October 2014

This edit request has been answered. Set the |answered= or |ans= parameter to no to reactivate your request.

http://www.naturalnews.com/025057_acupuncture_placebo_changes.html 24.249.35.198 (talk) 17:14, 20 October 2014 (UTC)

It isn't very clear at all what you want to do with that source, but the answer is no, the source is one of the most unreliable in the whole multiverse. -Roxy the dog™ (resonate) 17:22, 20 October 2014 (UTC)
Do you have proof for that, Roxy? The Banner talk 20:59, 21 October 2014 (UTC)
It's making a medical claim, but doesn't meet WP:MEDRS (which see), and not by a long shot.... trust me, this is not something you want to push. --Middle 8 (contribs • COI) 10:44, 22 October 2014 (UTC)
So, the Harvard study is not reliable due to place where this is published? The Banner talk 11:12, 22 October 2014 (UTC)
@ Banner - I'm sorry, I admit I wasn't paying attention to the content, just the source. Sure, the study itself is entirely legit, but it's a primary source, and on WP we strongly prefer secondary sources (again, MEDRS and WP:SOURCES). And it's so small -- just 12 patients! Studies that small are not uncommonly outliers, cf. reversion to the mean. Since it's from 2008, reviews that we cite -- that take into account studies totaling to hundreds of patients -- will have taken this study into account. And those reviews say... well, what the article says they do, more or less. That said, I agree there is other stuff that should go in, e.g. at Talk:Acupuncture#Removed_material. --Middle 8 (contribs • COI) 15:11, 22 October 2014 (UTC)
I think it is very fair to say that if Middle8 agrees with me on anything then it is a slam dunk certainty. -Roxy the dog™ (resonate) 13:30, 22 October 2014 (UTC)
Yep. :-) Then again, the set of things on which I and most people agree, and that are slam-dunk true (like MEDRS being a good idea), is pretty big, cf. the thing about how we get to share opinions but not facts. And I'm a reality-based kinda guy... remember, I studied acu before we knew what we know now about its evidence base. The qi/meridian stuff never bothered me, since the map isn't the territory... ancient astrologer/astronomers, who thought that a serpent periodically ate the sun or moon and made them disappear, could correctly predict eclipses. --Middle 8 (contribs • COI) 15:11, 22 October 2014 (UTC)
My irony meter just asploded again. -Roxy the dog™ (resonate) 23:09, 22 October 2014 (UTC)
Tragic, that... assplosions can happen when one's diet includes too much hot air. ;-) --Middle 8 (contribs • COI) 07:39, 23 October 2014 (UTC)
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