Talk:Acupuncture

MASS violation of MEDRS and LEDE

This change deleted a rare overview of Cochrane reviews and replaced it with a poor source that is not even a review in the lede. The change did not improve the lede. QuackGuru (talk) 00:35, 6 July 2015 (UTC)

There is duplication in the lede. See "but there is some evidence that it may have a beneficial effect for chronic lower back pain, tension-type headaches, migraines, nausea and vomiting, osteoarthritis, neck pain, irritable bowel syndrome.[13] as well as several other conditions where there is not enough evidence to draw any clear conclusions over its relative effectiveness compared with other treatments.[14]" The following is sourced to a better source" An overview of high-quality Cochrane reviews suggests that acupuncture may alleviate certain kinds of pain.[15]" We should delete ref 13 and 14 and keep the overview of high-quality Cochrane reviews. QuackGuru (talk) 00:45, 6 July 2015 (UTC)

This change is obviously original research. QuackGuru (talk) 00:57, 6 July 2015 (UTC)

I've made a couple of adjustments without removing (at least not yet). I also have concerns about about source quality - this is a MEDRS but is the lowest level of acceptable source (e.g. see Peer-reviewed medical information resources...are usually acceptable sources for uncontroversial information; however, as much as possible Wikipedia articles should cite the more established literature directly.) As written, it also currently appears to be used to rebut the higher-quality source that precedes it, which needs to be avoided. Sunrise (talk) 05:45, 6 July 2015 (UTC)

Greetings Sunrise! I am not totally sure if I could catch the intention behind these edits[1] (ex. ref work), but now the text says (emphasis added): "Cochrane Reviews found acupuncture is not effective for a wide range of conditions, but there is some evidence that it may have a beneficial effect for several conditions, and there are other conditions where there is not enough high-quality evidence to draw any clear conclusions about efficacy."

So conditions, conditions, conditions ... Any suggestions how to rephrase the text in order to avoid the repetition? :-P Jayaguru-Shishya (talk) 14:35, 6 July 2015 (UTC)

Yes this makes sense to me Jayaguru. Regarding source quality, the NHS is different. MEDRS considers statements by bodies such as the NHS to be very high quality. What is actually considered unreliable are outdated statements and given that the Ernst statement is now 6 years old, it falls outside MEDDATE's window since some new (and wider) conditions have been favorably reviewed by Cochrane in that period of time and since the evidence overall has shifted in the positive direction. Not positive yet, but what I'm saying is that some reviews have stayed negative, some have gone from negative to null and some from null to positive. So I suppose the outdated statement can stay for now until we can find an updated source. I will put a tag on it. LesVegas (talk) 18:33, 6 July 2015 (UTC)

I also agree with Jayaguru's revert, listing the individual conditions because it avoids synthesis. LesVegas (talk) 18:36, 6 July 2015 (UTC)

I tried explaining this before. We have much higher quality sources available. If editors want more details in the lede we should use the higher quality sources. QuackGuru (talk) 18:38, 6 July 2015 (UTC)

I don't understand why you claim it is low quality because per MEDRS, the NHS is very high quality. It isn't about having more details in the lede, it's about having accurate, updated statements that are non-synthesized. Regarding the Ernst statement, it was high quality in 2009 but since we have new reviews to contend with it is no longer even reliable. Yes, I added an update tag to the old source as we should. You're very good at finding new sources, QuackGuru, so please helps us find an updated source that backs up the statement. LesVegas (talk) 18:50, 6 July 2015 (UTC)

NHS is not a review and it is a lower quality source than an overview of Cochrane reviews. We are using the best available research except for the NHS source. QuackGuru (talk) 18:57, 6 July 2015 (UTC)

LesVegas: I quoted the relevant part of MEDRS in my previous comment. The source is an information page, not a position statement, so it should only be used for uncontroversial information. Also, summarizing a list of six as "several" is not WP:SYNTH; you need two sources for synthesis to be possible. Either way, on second glance, specifying the exact number is probably better.

Jayaguru-Shishya: Greetings. :-) I've made a different edit which removes one of the "conditions" much more easily: "other conditions" -> "others." How does that look? This maintains the version without the undue weight issue as well as the other changes for concision etc. (Please don't revert several changes if you're only providing objections to one of them. Was anything unclear from the edit summaries and/or do you have objections to the other parts? Also, either of the remaining "conditions" could be replaced by "uses," "circumstances," or a number of other terms if you prefer.) Keep in mind that the source is still being contested so it's not worth much to discuss the wording in detail yet. The reference change was just to make two identical references appear as the same number in the page's rendered text. Sunrise (talk) 02:50, 7 July 2015 (UTC)

Hello there, Sunrise! Looks a lot better now. Cheers! Jayaguru-Shishya (talk) 16:04, 7 July 2015 (UTC)

A tag was added to the review again. The edit summary claims it was an update? QuackGuru (talk) 18:42, 6 July 2015 (UTC)

A good tag, well-described in the "reason" section. We should definitely urge editors to seek for a better source to replace this one. Jayaguru-Shishya (talk) 18:55, 6 July 2015 (UTC)

It should not be tagged when it is an extremely high-quality source. QuackGuru (talk) 18:57, 6 July 2015 (UTC)

QuackGuru, please don't IDHT. I said it was a high quality source in 2009, but now that some of the Cochrane reviews are different it's not even reliable for such a statement. If you have an objection to the tag, please try to find us an updated source. You can post it here to the talk page and I will add it in. LesVegas (talk) 19:12, 6 July 2015 (UTC)

You have not presented a better source than the overview of Cochrane reviews. Therefore, there is no need to tag. QuackGuru (talk) 19:37, 6 July 2015 (UTC)

LesVegas, you have never managed to demonstrate any meaningful shift in the results of the Cochrane reviews, and there isn't any support for tagging it. Remember what John said about not reverting to troublesome behaviour? Edit-warring a tag into place when you know that other editors virulently and violently object is troublesome behaviour.—Kww(talk) 19:47, 6 July 2015 (UTC)

I did demonstrate a shift. I and several others believed it was meaningful enough to remove the source, but obviously you did not. After all, we had multiple new positive reviews in a wide range that a 6 year old source hadn't seen. It would be a different story if all the reviews had stayed the same over 6 years with no change in the data at all, but clearly that was not the case. LesVegas (talk) 22:56, 6 July 2015 (UTC)

Yes, from 28/32 to 27/32 or 27/33, depending on how one counts. Your definition of "meaningful" is a bit stretched, LesVegas. Not certain who you thought agreed with you, either.—Kww(talk) 04:22, 7 July 2015 (UTC)

We should go back to this version before the poor source was added to the lede. QuackGuru (talk) 19:37, 6 July 2015 (UTC)

Those diffs are the same. What's the point? Jayaguru-Shishya (talk) 20:14, 6 July 2015 (UTC)

Why did you restore the tag to one of the highest quality sources. This is the best available evidence. QuackGuru (talk) 20:27, 6 July 2015 (UTC)

Jayaguru-Shishya, please self-revert. You know the tag is controversial, and you should also know that LesVegas has been edit-warring for weeks over that particular cite ([2][3][4][5]). Constantly replacing and tagging the same text is just a form of edit-warring. Once tagging that reference was rejected by multiple editors, a tag shouldn't have been reinserted until there was consensus.—Kww(talk) 20:40, 6 July 2015 (UTC)

In my opinion, it would help if editors understood Wikipedia policies and guidelines better such as NPOV, MEDRS and BLP and we would see less edit warring all over the encyclopedia. I don't mind listing the relevant policy here if editors are confused or simply are unaware. Tags are necessary in some cases and our guidelines say that outdated sources need tags. I assumed it would be welcomed to tag an obviously outdated source rather than simply removing it again. LesVegas (talk) 22:49, 6 July 2015 (UTC)

Your opinion is your opinion, LesVegas. You do, however, know as certain fact that multiple other editors object to the tag, and, in fact, you are well aware that the material presented by the source has not changed in any significant fashion since its publication. That means that you are intentionally changing material without consensus and are edit-warring in relation to that particular source.—Kww(talk) 23:42, 6 July 2015 (UTC)

Actually I know as a certain fact that only you and QuackGuru object to the reasonable tag. I see no other editors thus far who are willing to stick their neck out to combat guidelines and reasonable editing standards by objecting to a date tag for an outdated claim. But QuackGuru objects to anything that doesn't denigrate acupuncture, and I am surprised that you are objecting so strongly given the fact that you have an Arbcom case against you at the moment, part of which called into question your understanding of policies. But let the record show that, unlike you, I haven't reverted material so I'm not so sure I understand the edit warring accusation either. LesVegas (talk) 03:04, 7 July 2015 (UTC)

"Haven't reverted material" is pure sophistry, LesVegas, and, unfortunately, this edit shows that it isn't simply sophistry, it's blatantly false. You've attacked the exact same link with multiple tags and removals ([6][7][8][9]), and have been unwilling to acknowledge that you actively misrepresented material in your last effort to remove it. Oh, and by the way, remember Arthur Rubin and this edit? It wouldn't be so painful arguing with you if you would maintain a consistent story that had some semblance of reality. I don't think Arthur is either QG or myself, and you obviously have been engaged in edit-warring over that citation. —Kww(talk) 03:45, 7 July 2015 (UTC)

An inaccurate statement from Les. "Actually I know as a certain fact that only you and QuackGuru object to the reasonable tag." Worth noting. -Roxy the non edible dog™ (resonate) 04:20, 7 July 2015 (UTC)

If the "pro-acupuncture" editors had been paying attention, they would know that Roxy and I were opposed to the tag the last time it was added. My smartphone has an aggressive autocorrect. I'm not going to try to name names. — Arthur Rubin (talk) 04:47, 7 July 2015 (UTC)

Actually, there wasn't a tag added last time. I decided to tag the source instead of removing it per MEDDATE since we found a new one. Arthur, you were only opposed to that update because it was synthesis and I agreed, which is why I modified it. Please take a look and if you feel unsure about what I'm saying, I'm more than happy to provide some diffs. LesVegas (talk) 17:44, 7 July 2015 (UTC)

Interesting: the six conditions in that NHS source compared to the actual Cochrane reviews:

1. Irritable Bowel syndrome: Sham-controlled RCTs have found no benefits of acupuncture relative to a credible sham acupuncture control for IBS symptom severity or IBS-related quality of life.
2. Migraine: There is no evidence for an effect of 'true' acupuncture over sham interventions
3. Osteoarthrities: benefits were small, did not meet pre-defined thresholds for clinical relevance, and were probably due at least partially to placebo effects from incomplete blinding

Looks like someone has been doing some cherry-picking of the words from these reviews again.—Kww(talk) 06:05, 7 July 2015 (UTC)

Kww, I already pointed out on John's talk page that you trying to bust me as a cherry picker has been to pick the cherries first and claim I did it. Here's just one example, migraines, where you left out a slew of material: In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of 'true' acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment. LesVegas (talk) 17:40, 7 July 2015 (UTC)

It's the NHS that cherry-picked, not you, LesVegas. That's the problem with using a political body as a source in a scientific article.—Kww(talk) 22:20, 7 July 2015 (UTC)

Well, I'm not opposed to quoting in more detail directly from Cochrane. If there is a way to summarize caveats in the lede to your liking, which I see is part of your objection, would you then compromise with me and delete the dated Ernst citation? In other words, we'll apply MEDDATE to Ernst and find something that gives greater parity to the NHS summary. I'll look and see if I can find something that works for you and get back to you, if you're on board with this. My purpose in making this change was to summarize the most recent evidence and if we need another source to summarize all the more recent evidence more fully, that's what we need to be doing anyway. And thank you for your explanation above, I appreciate it. LesVegas (talk) 23:22, 7 July 2015 (UTC)

My first step is going to be to look up all 32 areas that Ernst reviews and doublecheck that there has been no shift in the results. If there has been no shift in the results, there's no reason to consider the source outdated. There's nothing about a statement that says "it isn't effective for a wide range of conditions"(Ernst) that actually contradicts "there's evidence of effectiveness for these other conditions" (NHS), which seems to be the root of your logic. The only reason to remove the Ernst citation would be if it truly is outdated: a source that found contradictory results to Ernst. The NHS source says what it says, and I am primarily concerned that it is a source that knowingly recommends placebo treatments. Review of the 32 conditions will take a few days.—Kww(talk) 23:35, 7 July 2015 (UTC)

Lede has been updated

Current wording: "An overview of Cochrane reviews found that acupuncture is not effective for a wide range of conditions, and they suggest it may be effective for only chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache.[12]"

Now that the lede has been updated we can delete the followed (including the tag): "[needs update] but there is some evidence that it may have a beneficial effect for six conditions,[13] and there are others where there is not enough high-quality evidence to draw any clear conclusions about efficacy.[13] Similar text was deleted before. We can do the same again. QuackGuru (talk) 05:13, 7 July 2015 (UTC)

That was a clear-cut violation of your editing restrictions, which were to not make controversial edits. Since Cochrane reviews have now been updated to include more than just those few conditions, it is misleading to expand an outdated source like this, as I have pointed out. Anywho, I removed this expansion. LesVegas (talk) 17:30, 7 July 2015 (UTC)

This was not a controversial edit in any way. The overview of Cochrane reviews is an update to date source and MEDRS compliant. QuackGuru (talk) 17:48, 7 July 2015 (UTC)

Why was this source given additional weight[10], even it's outdated per WP:MEDDATE and we already have a newer source? We should use the more recent source instead. Cheers! Jayaguru-Shishya (talk) 21:01, 7 July 2015 (UTC)

Have you actually read both sources, Jayaguru-Shishya? Ernst evaluates 32 separate topics and finds that for 28 of them, there's no evidence of effectiveness. The "newer" NHS source does not provide any information that contradicts Ernst on 27 of those 28 conditions.—Kww(talk) 22:18, 7 July 2015 (UTC)

One of the points that I have been trying to make is that we have more conditions overall, now, with 7 conditions that have enough evidence to support effectiveness, compared with only 4 back in 2009. Additionally, the range has grown, with Cochrane reviews now showing evidence for other types of headaches, fibromyalgia, and even anti-psychotic effects. That's a wide range of conditions. Based on that, I don't know if Ernst would be able to publish the same statement in 2015 as he did in 2009, or if he would have to temper it some. There's been other changes too, with summaries of the evidence shifting from negative to null and two shifting from null to positive. I really have a larger point I'm trying to make other than the number of flipped studies, which, on their own should suffice to remove a quote that looks at broad data and makes a conclusion about it. When one of those pieces of underlying data change, a conclusion might also change. When several pieces of underlying data change, and the data set of conditions widens, and it's beyond MEDDATE's expiration date, what are we supposed to do? Wait until 10 conditions are positive? If 10 is too low then what about 15? 20? 28? Really, as editors we have to respect MEDDATE's 5 year window because otherwise there's no hard and set rules about when to discard a source and we'll have citations decaying and rotting all over the encyclopedia. LesVegas (talk) 23:47, 7 July 2015 (UTC)

But you are trying to treat WP:MEDDATE as if it is some bright-line rule. It's not, as it includes such caveats as "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." What you need to find is a source that reviews similar things and makes a differing conclusion. Your NHS report is close, but not really the same, as they did not report the items they evaluated and found negative results: they reported only positive and inconclusive results.—Kww(talk) 00:07, 8 July 2015 (UTC)

If MEDDATE isn't a bright line rule whenever it's past 5 years and we have a change in the overall evidence compared to 2009, where do we stop? The World Health Organization conducted a review back in the early 2000's and found evidence for 40 conditions! Should we quote that? Absolutely not, for several reasons, one being that it's past the threshold and we have different studies sometimes showing more robust evidence for many of those conditions. This is why we have cutoffs on MEDRS once new evidence is reviewed. Anywho, I am glad that despite our differences in how we see this, you are at least open to compromising on this. LesVegas (talk) 00:26, 8 July 2015 (UTC)

That study was widely denounced, so it wouldn't matter how recent it was. I wouldn't describe any of the evidence in favor of acupuncture as "robust". That's why all of the Cochrane reviews have so many qualifiers and hedges.—Kww(talk) 01:25, 8 July 2015 (UTC)

The NHS source is not a high quality source. It does not measure up to the other high quality sources. An overview of Cochrane reviews is very clearly a much higher quality source. QuackGuru (talk) 19:32, 8 July 2015 (UTC)

I think LesVegas is making a point here. We should use the most up-to-date sources that best reflect the current state of medical literature. Besides, we should be very careful not to be conducting a second peer-review of our own: "Editors should not perform a detailed academic peer review. Do not reject a high-quality type of study due to personal objections to the study's inclusion criteria, references, funding sources, or conclusions." as per WP:MEDASSESS. Cheers! Jayaguru-Shishya (talk) 19:09, 8 July 2015 (UTC)

I'm not arguing to remove the NHS source, simply that it doesn't refute or replace Ernst. Both "it doesn't work for a lot of things" and "there's evidence that it does work for this handful of things" can be simultaneously true and represent the latest state of research. They don't contradict each other.—Kww(talk) 20:24, 8 July 2015 (UTC)

Text should be restored to the lede

An overview of Cochrane reviews found that acupuncture is not effective for a wide range of conditions, and they suggest it may be effective for only chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache.<ref name=Ernst2009/> The part and they suggest it may be effective for only chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache is sourced to a very high-quality source. QuackGuru (talk) 19:30, 15 July 2015 (UTC)

The tag in the lede has no consensus

The tag that says "[needs update]" is not appropriate. It does not need updating. We are using a very high-quality source. QuackGuru (talk) 19:30, 15 July 2015 (UTC)

The tag added to the high-quality source against consensus has not been removed. QuackGuru (talk) 03:42, 3 August 2015 (UTC)

No consensus for using a lower quality source in lede to argue against a higher quality source

"but there is some evidence that it may have a beneficial effect for six conditions,[13] and there are others where there is not enough high-quality evidence to draw any clear conclusions about efficacy.[13]" This text has no consensus to keep. QuackGuru (talk) 19:31, 15 July 2015 (UTC)

Weight violation

See diff. QuackGuru (talk) 01:53, 19 July 2015 (UTC)

Why is that a weight violation?Herbxue (talk) 19:45, 22 July 2015 (UTC)

Well, the journal in question, Neural Regeneration Research, has one of the lowest impact factors I've ever seen (.180). Perhaps that could be the problem. Everymorning talk 12:15, 23 July 2015 (UTC)

Kinda off topic but could someone point out the WP guideline that discusses impact factor?Herbxue (talk) 16:02, 23 July 2015 (UTC)

I assume that you're not suggesting that we can (or should) only ever consider factors specifically enumerated in Wikipedia's (ever-evolving, deliberately flexible) guidelines in evaluating the quality or reliability of a publication—nor that we should stick our fingers in our ears and shout "la la la I can't hear you!" if anyone mentions a relevant red flag that didn't happen to appear in a guideline document....

Ultimately, it doesn't matter if a particular criterion appears on a guideline page—it matters if the criterion is relevant. TenOfAllTrades(talk) 04:29, 24 July 2015 (UTC)

Another problem is that the sentence is unreadable. "A 2015 systematic review analyzing a particular needling method found that it elicited a better effect than control treatment in reducing disability rate in ischemic stroke patients and that the long-term effects were better than that of control groups." The sentence makes no sense. QuackGuru (talk) 01:19, 24 July 2015 (UTC)

That source should not be included. We have many better sources that essentially contradict its basic claims. Guy (Help!) 08:07, 24 July 2015 (UTC)

TenOfAllTrades, I appreciate the flexibility of WP guidelines, but in many cases sources are excluded here because we have "better" sources, or because an editor labels them as "fringe journals" with no objective or even verifiable way to determine that. I certainly understand that a review in the Lancet or BMJ is more notable than a review in the World Journal of Gastroenterology, but the latter is a peer reviewed journal with a robust editorial structure and is absolutely MEDRS compliant, but I guarantee you if I cite a review from that journal it will get shot down. We need to decide do we really follow MEDRS or do we just include what we like and disregard what we don't like? Impact factor is not directly a measure of the quality control of a journal, so I don't see that as a justifiable reason to include or exclude a source.Herbxue (talk) 18:49, 24 July 2015 (UTC)

That is a good point, Herbxue. What editors at MEDRS talk have agreed on in the past is that we don't delete sources because of impact factor, but what we might want to do is consider impact factor in where we place a source. For instance, we wouldn't put a low impact factor source in the lede. This source was from a good journal and publisher that Jeffrey Beall went out of his way to say was reputable. LesVegas (talk) 18:59, 24 July 2015 (UTC)

This is not about the impact factor or MEDRS. The content itself is not about acupuncture in general. It is about a specific technique. The current wording is poor writing. QuackGuru (talk) 19:21, 24 July 2015 (UTC)

It's a specific acupuncture technique, so it is appropriate for the acupuncture page. If you feel the current wording is poor writing, would you mind suggesting an alternative here for us to discuss? LesVegas (talk) 20:19, 24 July 2015 (UTC)

It is a specific acupuncture technique but the text does not say what is the technique or how the technique differs from a regular acupuncture technique. The specific section you added it is about acupuncture in general. It does not belong in that section. QuackGuru (talk) 21:55, 25 July 2015 (UTC)

It is a specific technique, a distal technique that stimulates the brain, that doesn't merit having its own Wikipedia page. We shouldn't create pages for individual acupuncture techniques, although I think it might be a good idea to consider creating a section for individual acupuncture techniques. Still, since this is an assessment of the evidence for stroke, it belongs in that section. LesVegas (talk) 12:45, 26 July 2015 (UTC)

The text is not a description of a specific technique. The writing is very poor and it is still not about acupuncture in general. QuackGuru (talk) 03:44, 3 August 2015 (UTC)

Tags

I placed an NPOV tag as well as a systemic bias tag, whilst removing the relevance tag per discussion in the section above.

Regarding the NPOV tag, I feel that while there are many issues lending undue weight and non neutral POV throughout the page, what can likely remedy it is for us to come up with a working rule on which sources are reliable and which ones are not. In the past, we have had issues with adding seemingly reliable sources from peer-reviewed publications which seem to meet every aspect of MEDRS, yet these are sometimes rejected as "fringe sources"almost arbitrarily. At the same time, sources such as Quackwatch which may not be reliable at all per WP:SPS are given great prominence and weight throughout the article and lede and this seems to be a source of constant dispute. So if we are able to come up with some clearer criteria for what sources, specific to this topic, are allowed according to our guidelines and which ones are not, it would help all editors working here.

Regarding the systemic bias tag, we have had much discussion about Chinese and Asian sources in the past. I have even seen US published sources rejected because the authors have Chinese names. While it can be healthy to be suspicious of some Chinese sources, given the possibility of publication bias, an outright rejection of them does our readers a disservice. So maybe what we need to work out here is a checklist of sorts, where if a source shows certain qualities (determined by us) then we can use it. If not, it's either rejected or subject to further scrutinization.

I think that if we are able to resolve issues regarding source reliability, most of the other issues here will probably resolve themselves in due time. LesVegas (talk) 17:41, 2 August 2015 (UTC)

As per the previous discussion, Chinese publications and authors have published as close to zero percent negative or inconclusive results as makes no difference, it's as bad as Indian studies of homeopathy - it's a giant red flag and it's not going to change until we have reliable evidence from the real world to show that the scientific community has noted a meaningful improvement in this.

Quackwatch is one of the most widely cited sources for critical analysis of quackery. For this reason, believers in unverifiable health claims, be it qi, therapeutic touch, chiropractic subluxations or homeopathy, have consistently tried to exclude it from Wikipedia. It is a reliable source for the content in which it specialises, and if you find that Quackwatch says things you don't want to hear then the problem is almost certainly your end.

I'm fine with an NPOV tag as I think it's way to supportive of the quackery in acupuncture, but a "systemic bias" towards "Western scientific sources"? Bullshit. There is no "Western science"< there's just science, and Wikipedia is absolutely intentional in having a bias towards scientific sources in areas of medicine and science. If you want to rewrite the article to make it clear that acupuncture is a religion, then fine, you can dispute the relevance of science, but not until. Guy (Help!) 20:24, 2 August 2015 (UTC)

Guy, please understand that we don't require consensus to add the tag, but once reasons are listed here on talk and a case is made, we require consensus to remove it. Part of the reason for the tag in the first place is your continual removal of all-sources-China, including non-Chinese publications that merely have Chinese authors. Instead of complaining, why don't you engage in discourse on the criteria for inclusion and exclusion of Chinese sources. Certainly you don't think all Chinese sources are unreliable? Or maybe you do. Ok, maybe we should start with something else. How about, surely you don't find non-Chinese publications whose authors are Chinese automatically unreliable, do you? LesVegas (talk) 22:55, 2 August 2015 (UTC)

Most of the sources are Western and they are of high-quality. That is not the issue. The issue is clearly the Chinese bias sources in this article. QuackGuru (talk) 03:40, 3 August 2015 (UTC)

Les, please understand that one person not understanding the relevance of WP:MEDRS, WP:RS and WP:FRINGE does not excuse adding a fatuous tag to an article. There is no such thing as Western science, there is just science. If you want to admit that acupuncture is a religion then you can argue about the inclusion of scientific sources, but you're arguing that it's a form of medicine, and as such Wikipedia policy and practice means that scientific sources are where we source the majority of content. We already addressed this issue when talking about the bias in Chinese sources (and yes, they are the ones that are biased, not "Western" scientific sources). Guy (Help!) 06:37, 3 August 2015 (UTC)

e/c The "western science" tag is pure pointy bullshit, and should be removed. I would not object to the tag if instead of western science it said "real science". - -Roxy the dog™ (Talk to the dog who doesn't know when her owner is coming home) 06:40, 3 August 2015 (UTC)

Exactly. We don't do 'fair and balanced' we do things using proper sources. There really isn't a problem here. Dbrodbeck (talk) 12:34, 3 August 2015 (UTC)

Please establish that there is a problem before attempting to tag the article. Why does it need tags? If there is an insufficient number of editors available here to discuss the matter, mention it at a noticeboard. Articles are bound by WP:RS, not by a desire to balance science sources with the views of practitioners. What text in the article suggests there is a NPOV problem? Why? What source supports the claimed NPOV problem? Johnuniq (talk) 07:03, 3 August 2015 (UTC)

I support the NPOV tag on the basis that we have a hard time agreeing on the validity of certain sources and the weight given to other sources. When we have people rejecting sources because of Chinese authorship, we have a problem. Now, I do understand the issue with SOME Chinese research, I saw first hand students in a Chengdu hospital working on master's theses that were basically designed to prove their teacher's hypotheses, but I have no idea how widespread these practices are. In Shanghai Shuguang hospital I saw the opposite, they were very proud of their review processes and their outcomes were less unbelievably positive. So, how do we know which research was properly conducted? How do we know that in ANY field? Right now we have people believing "science from America or UK is good, science from Asia is bad" but we do not have a reliable policy or guideline on this. As a workaround people have proposed impact factor as a gauge, which also is not a reliable metric for the quality of a journal. Unless we can all agree to acceptable inclusion / exclusion criteria, we will see editors rejecting sources that don't agree with their preconceived notions, which is an NPOV issue.Herbxue (talk) 21:35, 3 August 2015 (UTC)

Articles should not be used to express vague feelings via tags. The first step is to demonstrate that there is an NPOV problem in the current text, then tag the article if discussion with available editors is unable to resolve the issue. What text is a problem? Why? Trotting out complaints about Quackwatch is not going to fly because hundreds of discussions on a range of topics have established that WP:REDFLAG applies and gold-plated scientific studies are not required to refute unproven claims that contradict mainstream medical views. Johnuniq (talk) 23:06, 3 August 2015 (UTC)

Agree there is only science, not Western science. That said, Chinese research is caveated but still part of science, and some examples weigh more than others, e.g. stuff in adequate journals. Even outside of China, the jury is still out for some, re efficacy. NPOV tag: We don't need editorial consensus to have one, but we do need specific issues, specific passages of concern, not vague or poorly-founded objections. --Middle 8 (t • c | privacy • COI) 00:43, 4 August 2015 (UTC)

OK, I pulled up a short list of diffs to illustrate the problem I'm talking about, where it seems like its a free-for-all when it comes to denying sources.

• Here is one and another where a journal from an excellent publisher, Elsevier, is removed because it happens to be about "acupuncture", and therefore promotes acupuncture, as if we have the same standard for journals that study "knee surgery".
• Here is one where a citation from the prestigious BMJ is removed for being a "fringe journal".
• Here is an example where, yes, a misleading edit summary is used. However, the publication is Elsevier and we clearly use sources much worse than that in the same paragraph, so I think we should discuss what the problem, specifically, with the source is. And if there is a problem, perhaps we should remove sources not up to par with it, found elsewhere in the article?
• Removal of reliable sources goes on both sides of "party lines", if you will, as seen in this edit. While it's a historical claim and the most reliable source for that would be a historical source, I don't think it's a tertiary source, since it comes from the prestigious Lancet. This is an example of removing sources because of what it "says" rather than who says it. We cannot question highly reliable sources, no matter what they say, so long as they are appropriate for the article.
• In this revert, we have a study from eCAM reverted, and it highlights a double standard here. We use eCAM in the article, elsewhere, yet new updated reviews and meta-analyses are constantly reverted. Specifically regarding this journal, we should discuss if it's allowable or not and be consistent with our application of it.
• Here is an example where we all seem to have confusion about sources like Quackwatch, which applied to Acupuncture, seem to make it a Wikipedia:SPS. While Quackwatch is recognized as an expert source on quackery, it is not an expert source on acupuncture Acupuncture is not within the field of it's editor's expertise, and it's really a slippery slope if we say that anything a self-published source gets general credit for we can apply to specific subjects on Wikipedia. If a blogger gets recognized as an expert on Hollywood celebrities by some mainstream publication, then writes on his blog "Tom Cruise is gay" can you imagine how long it would be up on Cruise's page? I know, BLP requires an even higher threshold, but it doesn't even meet reliability standards to make ANY claim, contentious or not, about Tom Cruise. It's a SPS. In essence, per SPS, Quackwatch could be used on the quackery page, but not every page it calls quackery because it's not expert in all those fields.

Anywho, those are a few of the examples I'm talking about to suffice in illustrating the problem that we don't follow clear guidelines for what constitutes a reliable journal versus an unreliable one, and since journals are being left off the article for various reasons, and low quality SPS's are given a prominent position throughout, the article is not neutral. My hope is that this dialogue can help to resolve the issue, and that the tag can attract new perspectives. LesVegas (talk) 22:09, 4 August 2015 (UTC)

The most reliable source for a historical claim is the most current research on that historical period, not outdated historical perspectives. -- TRPoD aka The Red Pen of Doom 22:22, 4 August 2015 (UTC)

OK, how about we re-start the discussion with talk about the BMJ? Is it indeed a fringe journal, as it was stated to be in the diff above? LesVegas (talk) 13:53, 10 August 2015 (UTC)

• I looked at the diff to which you are referring, LesVegas, and it appears the journal that you are talking about was not the BMJ but Acupuncture in Medicine, which is a different journal published by the same publisher (BMJ Publishing Group). Its impact factor, FWIW, is 1.5 [11]. Everymorning talk 13:59, 10 August 2015 (UTC)

Thank you, Everymorning. So it's an acupuncture specific journal published by the BMJ then, an excellent publisher, and it's peer-reviewed and should be an excellent source. Is there anyone who disagrees with that statement? LesVegas (talk) 17:07, 10 August 2015 (UTC)

Chinese Source Idea

I'll leave the systemic bias tag off the article for now, because I have an idea that might be acceptable to all parties involving Chinese research. We know publication bias exists everywhere and it may be worse in China. The extent of the problem can't be known, but we can't say that all publications from China are disallowed because we know that some good research gets done there. And if we were to make it a "hard rule" that a particular country-of-origin's research isn't allowed on the article, it would have to come from the policy or guideline level because the issue of publication bias goes beyond China and certainly beyond acupuncture. If we are to exclude Chinese studies, it can't be decided here. And I'm not aware of a single analysis that states publication bias is the definite issue anyway, only a possible issue. But since it is a possible issue, just one that we don't know how widespread, we need to deal with it in some way. So my proposal is this: as long as Chinese authored or published research meets every other requirement of MEDRS, such as peer-review, we can use the sources where appropriate but they must be attributed. So, for instance, we begin it by saying something like "In a 2014 Chinese meta-analysis," and we do that with the studies. I think this is the only way we can do this. After all, MEDRS states, "editors should not perform a detailed academic peer review. Do not reject a high-quality type of study due to personal objections to the study's inclusion criteria, references, funding sources, or conclusions." Anywho, for now, let's try to work this out amongst ourselves. I will leave the systemic bias tag off right now because I think this is a compromise we can all agree on, and my guess is that we won't need to bring more editors to help us out here on this. LesVegas (talk) 22:09, 4 August 2015 (UTC)

We do know that it is worse in China, at least in respect of acupuncture, because we have reliable independent sources that have analysed that specific question and found that, to all intents and purposes, Chinese research on acupuncture is uncritical and therefore unscientific. Yes, we can decide here that Chinese studies can be excluded, because we have much better sources that are not Chinese. And the reason we should exclude Chinese sources is precisely because of that quote you ined: we are not qualified to judge which are good and which bad, so we look at the WP:RS that say Chinese research exhibits systemic bias and we can exclude all of it with no detriment to the article because we have non-Chinese sources that provide all significant facts. Guy (Help!) 23:28, 4 August 2015 (UTC)

You said reliable independent sources have analyzed it. Since this is the basis for your objection, would you mind providing these so we can discuss this more in-depth?

Also, I'm curious if we question sources on other medical articles such as industry-funded studies versus government studies where industry-funded studies show overwhelmingly positive results compared to government studies? By the way, WP:MEDRS says we shouldn't conduct a second peer review. It also says we shouldn't exclude a source based on a second peer review, not refuse to include it, as you suggest. Big difference. We simply analyze if a source meets MEDRS requirements, and if so we add it if it adds new info to the article. A month or two ago, some editors tried amending MEDRS to exclude Chinese studies and they overwhelmingly failed at their attempt. As I see it, we don't even need to attribute studies or sources and say they are Chinese. I'm simply suggesting it to all editors here as a compromise, hoping to resolve the constant edit warring on this article anytime editors add a Chinese source. LesVegas (talk) 17:01, 5 August 2015 (UTC)

It is really as simple as this: you want to include Chinese sources, because they are always positive and you are a believer. I want to exclude them because they are always positive and I am not a believer. We can both cite MEDRS until we're blue in the face, the fact remains that reliable independent sources have pointed out an acute systemic bias towards acupuncture in Chinese-authored papers, and we have an abundance of non-Chinese papers, some of which are disgracefully credulous, so there is no need to even argue about it. Guy (Help!) 17:24, 5 August 2015 (UTC)

But Guy, I can cite MEDRS till I'm blue in the face, but you can't, I'm afraid, unless you want to pretend words like exclude actually mean include. Anywho, I asked you for these sources before. Again would you please mind providing them so that we can have a more in-depth discussion? LesVegas (talk) 18:43, 5 August 2015 (UTC)

Las vegas you are all alone in that tagging. it is malarky. Jytdog (talk) 01:27, 10 August 2015 (UTC)

The tagging being "malarky" is not a reason for removing the tag until consensus is obtained. Unfortunately. — Arthur Rubin (talk) 03:40, 10 August 2015 (UTC)

I don't think its malarky. We need a serious discussion about standards for journal inclusion/exclusion - and I am open to reasonable standards that are consistent, but I am not open to "Chinese authors means its suspect" or "the study supports acupuncture therefore it is a fringe journal". Until that nonsense stops, we have an NPOV issue. Still waiting for an actual source about the problems with some Chinese research (which again, I've seen firsthand, but cannot generalize to all "Chinese research"). Saying "Chinese research" is biased is like saying Jews are overly concerned with money. Yes, it is racist in the same way. Herbxue (talk) 06:57, 10 August 2015 (UTC)

Thanks Herbxue. I formatted the talk page discussion into two parts, one being all about having a better standard for regular sources, and this one about Chinese sources, even though I had taken the systemic bias tag off for now. This is an example of a source that was removed and highly contested and argued all because of the fact that it's Chinese. This is a big problem with some editors even arguing that authors being Chinese make a source unreliable (and in this case it was a Cochrane Review with Chinese authors!) Here was another example where Guy argued the source was primary (which it wasn't) then argued it was speculative (and the statement was framed as such, not as something definitive, so it's okay), then came here to the talk page and argued it's invalid because the authors are Chinese, an argument he has repeated in this thread. While I didn't re-add the systemic bias tag, going forward it would benefit us to establish a consensus about the use of these sources so as to avoid edit wars. MEDRS is clear that we can't deny sources based on things like funding sources, so that makes Chinese sources the same. But, out of the spirit of compromise, we should allow all Chinese research as long as it is peer-reviewed and the journals aren't on Beall's list, and the like, but we should attribute, i.e., "A 2013 Chinese review of the literature, stated X". We should not attribute in the case of publications outside China that happen to have Chinese authors. So, for instance, the Cochrane review with Chinese authors should just state that it was a Cochrane review. Can you imagine how racist it would sound if we attributed that? "A 2015 Cochrane review with authors who were Chinese stated X". Wow, that wouldn't fly with the Wikipedia community at all. LesVegas (talk) 13:21, 10 August 2015 (UTC)

While we're on the topic and we have plenty of editors here, this source, which was contested on the grounds of having Chinese authors, looks like an excellent source. Is there anyone who objects? LesVegas (talk) 17:18, 10 August 2015 (UTC)

Safety

This is what I mean when I say that the assumption of safety is based on an idealised model that does not necessarily match actual practice.

The problem of course is that some US states have licensed acupuncture, so safety is assessed by co-religionists and may not conform tot he standards required by reality-based practice. Guy (Help!) 10:11, 3 August 2015 (UTC)

An anecdote is your evidence for your assumption that acceptable safety standards are not widely upheld by acupuncturists, despite the excellent safety data we have? How about this - name any medical procedure in the "reality based" world and then see if we can find any anecdotal evidence that someone is doing it wrong. Would that indicate a trend or a norm to you? If so we should probably include a paragraph on the rape threat of seeing a dentist at the dentistry article. Here's another anecdote for you - my malpractice insurance is $600 USD per YEAR - do you think people in the insurance business take chances? No, to them its easy low-risk money because the percentage of people experiencing adverse events with acupuncture is ridiculously low compared to other invasive medical procedures. Until you get "reality based" and provide us with a real study of acupuncturists adherence to CNT, your posts about this belong more on Facebook than they do here. Herbxue (talk) 12:58, 3 August 2015 (UTC)

No, it's not an anecdote, it's an example. As a long time watcher of anecdote-based medicine (especially homeopathy, chiropractic and TCM) I do know the difference.

And here's another example: bee sting therapy.

My issue is, as I've stated before, that while I accept there are practitioners who understand the germ theory of disease and appreciate the importance of proper hygiene and so on, the entire field of TCM seems to me to be infested with people who have no concept of reality-based medicine, infection control, anatomy and other really rather important fields of knowledge (especially important if you're going to start sticking needles into people).

I do see it as a positive sign that acupuncturists in Ottawa are actually part of the process of shutting down the sub-standard shop.

The thing is, the world of acupuncture is only really taking its first steps into the whole evidence thing. I don't see any evidence of adverse event reporting, albeit that unlike chiropractors the acupuncturists are at least not in denial about them. And systematic reporting of adverse events is a necessary first step to being able to claim that an invasive procedure is actually safe.

Insurance rates are not relevant in a community that is normally treating the worried well. There will be rare cases where there is a delay in reality-based treatment, but people rarely admit that their bad judgment in seeing someone who has nothing to say about a disease, is a component of their bad outcome. We know that users of alt med who get cancer, present later, with more advanced disease, and fare worse, even allowing for that. Guy (Help!) 13:40, 3 August 2015 (UTC)

e/cAlternatively, Herb, you could name any practise in the Magical acu based world, and show us some convincing evidence that Acu works in the reality based world. The insurers know a good thing when they see it, obviously. The only risks they have are that practitioners injure people, or infect them, or advise them badly. We know that nothing can happen from the "treatment" -Roxy the dog™ (Talk to the dog who doesn't know when her owner is coming home) 13:42, 3 August 2015 (UTC)

Guy, you're still speculating based on your limited experience. Please try to get more informed. Look at the curricula taught at acupuncture schools. Look at the outline for the Biomedicine portion of the NCCAOM board exam. People in any profession present with a wide range of skill and competence, but I assure you things like universal precautions, safe needle handling and disposal, signs indicating the need for referral to a physician or red flags indicating emergency, and appropriately stating the benefits, limitations, and risks of acupuncture are all essential parts of acupuncture training. But don't take my word for it, investigate some reliable sources. Herbxue (talk) 16:36, 3 August 2015 (UTC)

There are definitely acupuncturists who are performing medical malpractice. This is made more complicated by the fact that the entire industry may be based on malpractice. But there are cases which are uncontroversially malpractices such as the instance from Ottawa. I'd be interested to see if the percentages of acupuncture clinics closed due to malpractice in various locations is the same as medical clinics. The statistics on this are somewhat hard to come by. jps (talk) 17:23, 3 August 2015 (UTC)

As with Guy, you are speculating, but yes, there are definitely incompetent or lazy acupuncturists out there, as there are in any profession. I've seen nurses do blood draws that looked like a scene from the Saw movies. See my comment above on the risk of getting groped by a dentist - its probably higher than the risk of having a serious side effect of acupuncture. But like you, I am speculating, so it is meaningless in terms of editing WP. I too would be interested in seeing real data comparing acupuncturists to other healthcare professionals in terms of safety, malpractice allegations, and cost of care. Herbxue (talk) 17:56, 3 August 2015 (UTC)

None of what I wrote was speculation. jps (talk) 18:06, 3 August 2015 (UTC)

Except this: "This is made more complicated by the fact that the entire industry may be based on malpractice." --Middle 8 (t • c | privacy • COI) 00:22, 4 August 2015 (UTC)

That's not speculation either. That's just pointing out that since acupuncture lacks an evidence basis, it can be considered malpractice. jps (talk) 12:24, 4 August 2015 (UTC)

Yes -- malpractice exists. It is bad. Regulation and training undoubtedly figure. And unless we can get some kind of RS with an incidence rate, I don't see what we can use these examples for.

I do think the analogy with chiropractic is flawed: the "idealized form" of chiropractic is, IIRC, based on one or more chiropractor's attempts to establish an EBM-congruent form of practice. That sets the bar pretty high relative to how students are actually trained, since they keep learning the same old vert-sub stuff. With acupuncture, we're talking about using alcohol swabs and not needling the wrong places, really basic stuff that is taught everywhere there is regulation. The rate of SAE's from acu is of course very low [12] to the best of our knowledge, arguments from ignorance notwithstanding. At any rate I don't see what chiropractors' adherence to certain EBM standards has to do with acupuncturists' safety and hygiene.

some FWIW comments about that story [13]

It's actually hard to tell from this story what dangers existed to patients. Proper disposal of needles: Throwing them out with the trash, or just the wrong colored (but otherwise OK) container? Improper hand hygiene: Not washing hands? Or not using gloves, which per the WHO [14] you don't need to do when giving someone a shot? Expired products: old alcohol swabs have been known to dry up, but expired alcohol hand gel (which they cited) is about as problematic as expired table salt, if properly stored. Just saying -- even as anecdotes go, this one is vague and "proves" little.

Idiots exist; what we need are RS indicating how common they are, not RS that furnish only examples or speculation. --Middle 8 (t • c | privacy • COI) 05:50, 4 August 2015 (UTC)

Better source needed

This information: De qi is more important in Chinese acupuncture, while Western and Japanese patients may not consider it a necessary part of the treatment. uses Complementary Medicine for Dummies as the source. Could a better source be provided? Thanks. Gandydancer (talk) 11:20, 5 August 2015 (UTC)

That would be good, although the source isn't very bad. The statement is, FWIW, accurate per all the sources I've read (and inevitably can't remember at the moment). --Middle 8 (t • c | privacy • COI) 10:17, 7 August 2015 (UTC)

References

Conceptual Basis

I'm working my way up to the "Conceptual basis" section and am getting to a point where I'll have to spend some focused time doing research before I can make further thoughtful contributions to the section. That may take a while before I have a spare block of time that big available. I see that under the "Traditional" header we have a lot of sub-articles devoted to specific concepts, allowing us to just summarize them here, but I was wondering if anyone knew of relevant sub-articles for the "Modern" sub-section.

In other words, are there any Wikipedia articles devoted to concepts related to the modern scientific rationalization of acupuncture? CorporateM (Talk) 15:34, 6 August 2015 (UTC)

The German acupuncture trials are the only ones that come immediately to mind. I haven't looked at that article for a while, but I know that the set of trials had some particularly onerous flaws in claims of outcomes according to Edzard Ernst. jps (talk) 16:39, 8 August 2015 (UTC)

The fact that no clear benefit over sham acupuncture was established for any condition, is the telling point. Commercial providers don't accept that it works, but the public sphere, where politics and letter-writing campaigns often trump evidence, is a different matter. That's why there is still a small (albeit shrinking) residue of homeopathy in the NHS: the minister does not want to have to field all the green-ink letters. Guy (Help!) 13:06, 10 August 2015 (UTC)

Guy, would you mind staying on topic? This thread wasn't about the benefits of acupuncture, this was asking about Wikipedia articles that talked about modern acupuncture research. For some reason, it seems you enjoy trolling on the talk pages, and while it's amusing to see how angry you get, it's distracting. But back to Corporate M's question. We used to have an article called the Primo Vascular System, but several editors had it deleted (Guy one of them) so all that remains is an article on that scientist, Kim Bong Han. LesVegas (talk) 13:39, 10 August 2015 (UTC)

Interesting recent review

• What is the Acupoint? A preliminary review of Acupoints

I don't have access to the full text, so I don't know to what extent the authors believe acupuncture points really exist or not. Perhaps someone with a subscription could add content from this review to the article. Everymorning talk 16:29, 7 August 2015 (UTC)

I'm not sure they know themselves. They say that there is "no persuasive evidence" for the existence of acupoints, but they also use language that apparently assumes they exist, like "[s]ufficient evidence exists to suggest that acupoints may have distinct physical properties." Sunrise (talk) 18:26, 7 August 2015 (UTC)

Didn't we previously look at another source that was also funded by the "National Natural Science Foundation for Excellent Young Scholars of China"? Or am I just losing my mind? (both are a very strong possibility, especially at 2 a.m.) At the time it sounded kosher to have a government funded study, but since then I wrote the History section and found out that China is known for supporting or attacking acupuncture/TCM based on the political climate (and China is known for information manipulation in general anyway), so now I'm not quite so sure how to look at it. CorporateM (Talk) 06:00, 8 August 2015 (UTC)

I really don't think it's relevant. We have ample evidence already that acupoints don't exist, there's no need to add a questionable source. Guy (Help!) 13:45, 8 August 2015 (UTC)

Looks quite relevant and is also very recent. Guy, do you have a source that concludes that acupoints "don't exist"?Herbxue (talk) 19:43, 10 August 2015 (UTC)

Proposal: truce conditions

I've thought for a long time, that if everybody working here could:

• a) agree to limit discussion in the article to uses of acu that are accepted in the mainstream (adjuvant care for pain/nausea relief in cancer and a few chronic pain conditions) (in other words, declare a zone in the middle) These are uses taught in medical textbooks and practiced at major medical centers
  
  • a1) agree to a minimal and reasonable discussion of the underlying theory as being based on pre-scientific traditional medicine and having no basis in science (not belabored, just simple)
    
  • a2) agree to a minimal and reasonable discussion of the difficulties of obtaining good evidence (problems with placebo arm; lack of funding for big trials) (not belabored, just simple)
    
• b) agree to self-police - if an acu-proponent shows up and adds some woo content positive about acu outside of that, pro-acu editors here would agree to remove that themselves (and not contest it if an acu-skeptic gets there first) and if some acu-skeptic shows up and adds skeptical/negative content, acu-skeptics would agree to themselves remove it (and not argue if an acu-proponent beats them to it). This is really essential to building up trust that the zone will be honored. A lot of the arguments on this page are about taking long-term stances against relentless pushing from the other side.
  
• c) Enlarging or shrinking the zone -- in other words - adding new content or removing existing content, positive or negative, stays out, unless there is significant consensus
  

It is .. silly and somewhat embarrassing, that the article actually talks about things like using acu to improve sperm motility. All that kind of garbage should be taken out of the article. I understand why it is here - everybody here is following source/evidence-based editing and there is indeed a systematic review on that. But the junk-pile of an article that we currently have is the result of that process. A higher-agreement could produce a more useful article.

What do you all say? Jytdog (talk) 13:14, 10 August 2015 (UTC) (added breaks to make structure more clear Jytdog (talk) 13:14, 12 August 2015 (UTC))

We follow sources and policies. While I have witnessed acupuncture work for conditions other than pain or nausea in China, if all the sources said otherwise, I would have to respect them. Wikipedia:NOTTRUTH is a good read on this. LesVegas (talk) 13:43, 10 August 2015 (UTC)

Oh JD. You are an idealist, and its a great but doomed idea. You only have to read Les' response to see why. -Roxy the dog™ (Resonate) 13:53, 10 August 2015 (UTC)

I think Jytdog should be commended for attempting to create a collaborative situation. I do believe though, that we have no business judging whether editors are pro or con anything. Unfortunately many incivilities on Wikipedia, and I mean the real incivilities come out of the tendency to pigeon hole people, to assume they hold positions which they may or may or not and then to assume those positions gives us the right to condemn . Look at the edits not the editor and use the policies seems useful. When we start to talk about sides we are in territory that judges. Simplify don't judge. Deal with the content, discuss the content. If you have to discuss a long time so be it. There are no right answers here, no right content in my opinion. We are trying to describe a traditional health care system that has made its way into the 21st century. From beginning to end that must be described whether we like the system or not. I may sound preachy. If so I apologize, but frankly I myself have been the subject to the most astounding lies on and off Wikipedia created buy some of our in- appearance, most respected editors. Les has a point, too. Follow the sources whatever we may think. (Littleolive oil (talk) 15:49, 10 August 2015 (UTC))

I see all that Olive, and we don't really disagree on the substantive point you make, that we should AGF. Also, I've been looking at the edits not the editors here for a reasonable time. My comments are based on watching Les and others edit here. I am judging his edits - not him.

I note with some dismay that you missed a bit in the following sentence, to my mind the most important bit ... "We are trying to describe a traditional health care system that has made its way into the 21st century" This should have been what (I think) you meant ... We are trying to describe a traditional health care system that doesn't work, that has made its way into the 21st century" That is very important. -Roxy the dog™ (Resonate) 16:35, 10 August 2015 (UTC)

No. Not my business or yours, that is, to declare or deal with what works or doesn't. Just write the dang article as if you don't know or care... and then maybe the article would be neutral. I do note that you do have a good sense of humour though.(Littleolive oil (talk) 16:42, 10 August 2015 (UTC))

• I've noticed a trend, here and in altmed articles generally, of adding text and source(s) with little consideration of weight, proportion, and overall context. I would welcome an informal agreement that such additions (or deletions) should gain consensus first. Just because a review exists doesn't necessarily mean that it should be mentioned in the Wikipedia article. I recently created the WP:BESTSOURCES shortcut because I think that part of NPOV is often overlooked. We should be seeking the best sources and prefer those. Quibbling over lots of lesser sources not only wastes time but can lead to contradictory conclusions, causing more quibbling. Contradictions can usually be resolved by preferring higher quality sources. Manul ~ talk 20:58, 10 August 2015 (UTC)

Especially since the article is contentious, consensus is a good step. However, this way of dealing with content additions has to be adhered to by all. I'd note that weight, proportion, context are subjectively identified so there is no objectively right content. I'd also suggest that consensus is not gained by numbers but by the logic of the arguments. Otherwise, the page could be flooded with editors called in to support positions. (Littleolive oil (talk) 23:20, 10 August 2015 (UTC))

What I proposed above is an agreement on the scope of the article, which is something set by consensus of the editors working on it. It is unusual to have an informal agreement that would limit the scope in this way, but the long term BATTLEGROUND around this topic is something that calls for creative solutions. Jytdog (talk) 13:17, 12 August 2015 (UTC)

• Again, I ask you all editing here to consider the proposal above. The drama today was entirely un-necessary - there is no way in hell that this edit would ever stick and it is terrible to me that the more acu-proponent folks have not been saying so. That is so far outside the medical mainstream. So far. Jytdog (talk) 20:54, 22 August 2015 (UTC)

Jytdog. Please consider your position. You have appeared in three different threads attacking editors both who commented there and editors who do not agree with your position while crying for Les Vegas to be sanctioned. Why do you think your proposal here should be trusted? Why not let Doc and LesVegas work this out in a more peaceful way between them. The drama is truly unnecessary. (Littleolive oil (talk) 21:13, 22 August 2015 (UTC))

Littleolive oil. I stand in the middle. I tried hard to get LesVegas to back away from the cliff edge and come to the middle - you did nothing. Now he is blocked. In any case, the invitation remains open. In my view the acu-proponents have way more to gain from my proposal than the acu-skeptics, who hate it that acu has become mainstream in certain uses. You are spiting yourself. But whatever. I ado also want to point out that this article is under discretionary sanctions. Aggressive editing is not welcome. There is a box at the top of this Talk page notifiying editors of the DS (already a warning to edit cautiously) and yet another box warning editors explicitly ~not~ to be too bold. Jytdog (talk) 01:27, 23 August 2015 (UTC)

Jytdog. We all do what we can as best we can. There was no cliff edge until it was created. You stood in the perceived middle as did I. We have different "middles": the error is in thinking one middle is better than another (and I didn't say neutral). I actually have no position on acupuncture. What I care about is the procession of editors, hurt, damaged, and going out the door. I have seen this sanctioning process multiple times, same process, same ending, and often with good admins as Drmies is. I was not in the least surprised, only sorry. I'm also sorry you see fit to blame me for not helping in the way you think is appropriate. I sincerely wish you the best; I think you are a well-meaning person.(Littleolive oil (talk) 03:37, 23 August 2015 (UTC))

I see it slightly differently to Olive, but having seen this sanctioning process multiple times, same process, same ending, same disruptive intent from true believers. To me this is an indication that DS, when used properly, can be useful in keeping such editors within PAG. -Roxy the dog™ (Resonate) 07:30, 23 August 2015 (UTC)

The Chinese question

I think we have a real dilemma with the Chinese research. One one hand there seems to be a lot of it and I don't see how we can ignore it. On the other, comments have been made about the integrity of the researchers and the research. I wonder if a solution might be to have a section on Chinese research which first describes concerns with the research per sources which discuss this problem, then second, research is added in this section. Acupuncture comes out of a Chinese tradition so it makes sense to add research from the tradition which created the modality. Just a suggestion and thought in attempts to reach a compromise.(Littleolive oil (talk) 23:26, 10 August 2015 (UTC))

That's an interesting idea, Littleolive oil. We know there was once a problem documented many years ago where Chinese studies were more positive than others on acupuncture, and that publication bias may have been an issue, although other possibilities (like conducting experiments very differently than other countries) may have acted as a confounding factor. We don't know how extensive the problem was, is, or even if it exists today, so how do we proceed? Or do we proceed with anything? Your idea is an interesting one worth us thinking about, and I also like my idea of attribution. Surely there's a way to make this work. And perhaps there is still yet another option already being used on Wikipedia that we're not even aware of yet. There have been issues within the pharmaceutical industry where "industry funded" studies are also overwhelmingly positive (almost never negative, that is) compared to government-funded studies. Since that is a problem that dwarfs the Chinese one substantially, surely a precedent has been set somewhere on Wikipedia about how to source industry funded pharmaceutical studies? Perhaps we could just pattern the way we cite our sources after however that's done? At least it could give us ideas. Are you or anyone else aware of what we do with how we're supposed to present industry funded studies on pharmaceutical articles? LesVegas (talk) 04:51, 11 August 2015 (UTC)

We don't base any content on PRIMARY sources describing pharma-funded clincial trials. You don't understand MEDRS after all this time.

In any case, there is no way the community will agree to lower source quality on a controversial article. Per the very useful essay on controversial articles. we need to raise source quality. Not lower it. The effort to add content based on low quality sources that was never going to be accepted, and then tag-bombing the article because that edit was reverted, was transparent and doomed to fail and to bring trouble on the one who executed that strategy. That is what this and the subsequent tag-bombing were all about. It is not going to happen. That is advocating for a FRINGE position instead of aiming for the middle - for what is supported by high quality sources that everyone can accept. Jytdog (talk) 01:33, 23 August 2015 (UTC)

Jytdog please let this go. At some point the fact that you bring up a sanction again and again becomes tedious. Second, perhaps you don't understand what I was suggesting. I am not suggesting or talking about the sourcing for MEDRS content. I am suggesting actually adding content. There is a vast difference between using sources to support content and or claims, and for example noting what the history of the research in a field is, as content for an article. For example, in such a section, the concerns about Chinese research could be noted as long as we source it, as well as what some of the research was and is again R sourced. This is Chinese traditional medicine and as I said before how the Chinese deal with their traditional medicine and how they research it is significant. However, this is only a suggestion for dealing with contention, for dealing with content we don't seem to know what to do with. (Littleolive oil (talk) 21:22, 23 August 2015 (UTC))

LesVegas just got blocked for a week for tendentious editing, and if he keeps it up it will be a topic ban. As to "how the Chinese deal with their traditional medicine", we already know: they are uncritical. China has a strong cultural reluctance to challenging orthodoxy, and thanks to Mao, acupuncture is part of Chinese orthodoxy. Guy (Help!) 21:55, 23 August 2015 (UTC)

China has pro-TCM bias enshrined in its Constitution and there dissent isn't handled lightly. Tgeorgescu (talk) 22:06, 23 August 2015 (UT

And so we see why Wikipedia cannot hold on to its newer editors. My point about the research was that if this is how China deals with research that should be in the article RSourced. But hey, just an idea to deal with contention. (Littleolive oil (talk) 22:53, 23 August 2015 (UTC))

True believers do not last long in WP, and that is their problem, not WP's. We have policies against advocacy. In any case, when the institutions that support science in China become independent and mature, their journals will become valuable sources. They are not there yet. Jytdog (talk) 23:24, 23 August 2015 (UTC)

Recently added review

As if foretold by my comment in the above thread, this review was just added to the article. The paper makes clear that it is assessing what happens in response to "inserting needles into the body" without regard to specific acupoints. Indeed it says there isn't evidence to support the hypothesis that acupoint specificity matters, and taken as a whole the paper may be disaffirming acupuncture more than affirming it. (After all, the brain responds to anything that happens to the body, with needling being one such thing.) Thus it doesn't seem appropriate to enlist this review as showing a "purported scientific basis" of acupuncture. One might try to save it by including a bunch of caveats, but it would be difficult to avoid being misleading. Manul ~ talk 00:04, 11 August 2015 (UTC)

Yeah, you're right, the whole analysis was even designed around the fact they were more concerned with needling response rather than acupuncture point needling response. Scientifically, it is useful to explain how sham acupuncture might not be all that inert after all, since the brain still elicits some sort of response. Wikipedially, it is a good source and contains interesting information, so I'm for salvaging it with caveats, but we would need to be specific about how it measured brain changes in response to needling anywhere rather than on acupuncture points, specifically. Everymorning, since you added this meta-analysis, do you have any ideas on how we should caveat it, or if we should even have it on the article at all? LesVegas (talk) 05:01, 11 August 2015 (UTC)

Perhaps I was being too subtle, but my comment about adding caveats was proscriptive, not prescriptive. A paper that denies a fundamental tenet of acupuncture should not be used to show the "scientific basis" of acupuncture. Let's not turn the article into a kettle defense, please.

It doesn't appear the paper is saying that needling is therapeutic, so that can't be implied in the article. The paper is looking at brain responses, and as I said, the brain responds to all kinds of stimuli, needling included. One can find a specific and measurable brain response to the forehead being slapped. That doesn't mean that slapping is therapeutic, or that a mechanism for Slapping Therapy has been discovered. Manul ~ talk 12:37, 11 August 2015 (UTC)

Badge of shame

The recent re-add of the NPOV tag[15] directs us to Template:POV, where it says, "The editor who adds the tag should discuss concerns on the talk page, pointing to specific issues that are actionable within the content policies."

Looking at this talk page, the tag is apparently present because "what we need to work out here is a checklist of sorts", and other vagueness. There are complaints about the removal of fringe journals, which would seem to be an attempt to form a local consensus that is contrary to the established consensus and common practices with respect to WP:FRINGE and WP:MEDRS.

The article history shows over three months of either the POV or CONTENT tag being present. There is no clear end here; no specific, practical issues that have been identified. Template:POV warns that the tag should not be used as a badge of shame, much less a permanent one with conditions of removal that nobody can figure out. Manul ~ talk 19:21, 11 August 2015 (UTC)

Agreed. The editor who keeps tagging seems to have an issue with the policy, which they should bring to WT:MEDRS not here. VQuakr (talk) 19:30, 11 August 2015 (UTC)

Yup, no need for the tag. Dbrodbeck (talk) 19:45, 11 August 2015 (UTC)

Neither WP:FRINGE nor WP:MEDRS use the term "fringe journal" and yet some editors frequently invoke that term to reject content from sources that are acceptable according to MEDRS. I have repeatedly asked those editors to identify a guideline or policy that excludes a source due to Chinese authorship, or the fact that the journal has the word "complementary" in its title. It is not the person placing the tag that has a problem with MEDRS, it is a culture of authors rejecting evidence they BELIEVE is erroneous, and that's why we have a POV issue.Herbxue (talk) 21:58, 11 August 2015 (UTC)

It's more basic than that, see WP:QUESTIONABLE. Tgeorgescu (talk) 22:05, 11 August 2015 (UTC)

That's because they are fringe. MEDRS is primarily concerned with medicine, whereas fringe journals are primarily concerned with pseudomedicine. There are fringe journals for physics, too, where they discuss free energy devices and the like. The problem with Chinese studies is not something dreamed up by Wikipedia, it is a real world problem discussed by a real-world expert here. Guy (Help!) 22:06, 11 August 2015 (UTC)

Agree, the tag is being replaced POINTedly, and hasn't been justified here. -Roxy the dog™ (Resonate) 23:21, 11 August 2015 (UTC)

Guy, just repeatedly saying "fringe journals" does not make that a real thing. Science is either carried out appropriately or it isn't, and if its vetted by a peer review process by reputable editors then who are you to question it? It is not appropriate to say all Chinese authors practice faulty science because Ernst wrote an editorial about it. And you don't get to decide on the fly what journals are real and which are fringe. How about BMJ? Is that a fringe journal to you? They publish plenty of favorable acupuncture studies. And btw, look at some more conventional medical articles and you are bound to see papers authored by Chinese researchers. Do you have enough knowledge about them or their institutions to decide which ones are doing legit science? I highly doubt it. Herbxue (talk) 00:14, 12 August 2015 (UTC)

You don't believe that fringe journals exist? Anyways, WP:MEDRS explicitly instructs us to look at the source's content to evaluate the methodology used; merely stating that a journal is "peer reviewed" is not enough to comply with the policy. WP:MEDSCI also requires us to look at the wider picture to determine the level of acceptance of a viewpoint. VQuakr (talk) 00:39, 12 August 2015 (UTC)

You are right, but we rarely get to discuss methodology of individual reviews because they get rejected for reasons not outlined in MEDRS. MEDRS does caution us against journals that are not indexed in Medline, or journals that publish on topics outside of their scope. MEDRS does not say Chinese authors are unreliable, or that lesser known journals are necessarily unreliable. We do not have clear enough criteria to decide when a lesser known journal is reliable or not.Herbxue (talk) 01:09, 12 August 2015 (UTC)

If you dont have evidence that it is reliable, then when the journal is making claims counter to what actual reliable sources state and present, then obviously we treat it as not reliable. WP:REDFLAG. -- TRPoD aka The Red Pen of Doom 02:15, 12 August 2015 (UTC)

Ok, fine, but you're still not addressing the issue I'm talking about. Obviously, if a lesser known journal publishes a review or editorial that says "acupuncture is effective and cost effective care for TMJD" but the Lancet or JAMA has a recent systematic review of RCT's that concludes "acupuncture is no better than sham or standard of care for TMJD" - I'm not gonna argue over which is the more reliable source. If World Journal of Gastroenterology or Pain Medicine or Journal of Complementary and Alternative Medicine publishes a review of trials of acupuncture for abdominal pain, written by faculty at the Beijing University of TCM, and there's no conflicting evidence from a more well-known journal in the last 5 years, then that source should be fair game. MEDRS identifies a few journals as generally reliable, but it does not require that lesser known journals must prove their reliability like you suggest - I mean, how would you even do that? How do you prove beyond a shadow of a doubt that articles in the Lancet are reliable? Herbxue (talk) 06:57, 12 August 2015 (UTC)

"Reliable source" does not mean "true". But Edzard Ernst's article is a fairly definitive, referenced comment from a notable researcher. In this field, as in others, "researchers" who are prepared only to confirm prior beliefs may be ignored. Unless we want a section on the quality of "science" in acupuncture, which actually might be a better option than the present tag. Richard Keatinge (talk) 12:54, 12 August 2015 (UTC)

The review Ernst cites is certainly damning and there is definitely a real problem there (I've seen it firsthand), but Ernst's conclusion is somewhat lazy (can't be bothered to even read the methodology of papers to evaluate quality, just discard all) and self-contradictory: the systematic review he cites is from Beijing University of Chinese Medicine! So… Chinese research is ok when it is critical but not ok when its positive? That's a form of bias too. China is an ENORMOUS country with a wide range of quality in terms of educational institutions. To say ALL Chinese research is unreliable because Ernst says so it not adequate. Herbxue (talk) 16:31, 12 August 2015 (UTC)

There is a problem with "researchers" who are prepared only to confirm prior beliefs. That's not a problem limited by nationality. But it is widespread in fringe science and in this case Ernst's point is one that we should use. Richard Keatinge (talk) 16:41, 12 August 2015 (UTC)

I agree about the nature of the problem, but not Ernst's conclusion. We should evaluate journals and articles on a case by case basis, not reject them because the authors are Chinese. Herbxue (talk) 17:20, 12 August 2015 (UTC)

In general, that's certainly arguable. In the particular case of acupuncture we can save ourselves a very great deal of time and trouble by using Ernst's conclusion. Richard Keatinge (talk) 08:28, 13 August 2015 (UTC)

That would be a convenient way to push a POV by omission, ignoring a large body of potentially valuable research because of one expert's opinion (which is based on the findings of a Chinese review). I'd be willing to go along with something more specific - like using reviews published in a reputable Chinese journal only with caution and attribution when they appear to use appropriate methodology. But if a systematic review is authored by Chinese researchers and published in a Western journal like BMJ, NEJM, Medical Acupuncture, or Integrative Cancer Therapies, I do not see justification for excluding it as it has passed through an appropriate peer review and editorial process. Herbxue (talk) 14:51, 13 August 2015 (UTC)

The point is that while appropriate methods may "appear" to have been used, we have a notable commentator telling us that in this large body of work appropriate methods have generally not been used; the work is invalid and if we use it at all it should be described as claims based on pseudoscience. (That word again, but fully justifiable here, this is work that has the appearance of science but is not actually testing hypotheses.) Richard Keatinge (talk) 15:13, 13 August 2015 (UTC)

Richard, there is no way I can take such a sweeping generalization seriously. Please get a little more into the weeds on this. People here Iincluding you) are seriously proposing that all research into acupuncture, written by people with Chinese names, is unreliable, EVEN if it s published in a mainstream journal. Just pause for a moment and consider how absolutely absurd and racist that is.Herbxue (talk) 16:23, 13 August 2015 (UTC)

I am confused? A blog post from Edward Ernst is being used to suggest that articles with Chinese authors cannot be used here?75.152.109.249 (talk) 16:41, 13 August 2015 (UTC) I guess that the review mentioned in Ernst's blog post (from 199 and done by Chinese authors), and not his blog post itself, is the source actually being used to suggest that Chinese sources are unreliable?75.152.109.249 (talk) 17:14, 13 August 2015 (UTC)

Both. I paste a large chunk of Ernst's post:

"In this case, you might perhaps believe Chinese researchers. In [this systematic review http://online.liebertpub.com/doi/pdfplus/10.1089/acm.2014.5346.abstract], all randomized controlled trials (RCTs) of acupuncture published in Chinese journals were identified by a team of Chinese scientists. A total of 840 RCTs were found, including 727 RCTs comparing acupuncture with conventional treatment, 51 RCTs with no treatment controls, and 62 RCTs with sham-acupuncture controls. Among theses 840 RCTs, 838 studies (99.8%) reported positive results from primary outcomes and two trials (0.2%) reported negative results. The percentages of RCTs concealment of the information on withdraws or sample size calculations were 43.7%, 5.9%, 4.9%, 9.9%, and 1.7% respectively.

The authors concluded that publication bias might be major issue in RCTs on acupuncture published in Chinese journals reported, which is related to high risk of bias. We suggest that all trials should be prospectively registered in international trial registry in future.

I applaud the authors’ courageous efforts to conduct this analysis, but I do not agree with their conclusion. The question why all Chinese acupuncture trials are positive has puzzled me since many years, and I have quizzed numerous Chinese colleagues why this might be so. The answer I received was uniformly that it would be very offensive for Chinese researchers to conceive a study that does not confirm the views held by their peers. In other words, acupuncture research in China is conducted to confirm the prior assumption that this treatment is effective. It seems obvious that this is an abuse of science which must cause confusion.

Whatever the reasons for the phenomenon, and we can only speculate about them, the fact has been independently confirmed several times and is now quite undeniable: acupuncture trials from China – and these constitute the majority of the evidence-base in this area – cannot be trusted."

I'll drop the matter here, but, just to repeat the point, this is a reference and comment from a very notable commentator, and we should use it. Richard Keatinge (talk) 17:27, 13 August 2015 (UTC)

It might be fine to use the comment. However, using a single cmt to disallow multiple sources is a violation of Weight. RS are determined per the content they support and underpin and should be scrutinized as such. As an example of how an overarching, general statement can abuse; I noticed at one point an editor here mistook Japanese names for Chinese ones and on that rational decided the source was no good. It is necessary I think to keep Ernst's comment in mind as it provides insights but the comment is not a carte blanche permission to exclude studies. In every instance individual sources must be scrutinized for their reliability per the content they are purported to support.(Littleolive oil (talk) 17:10, 19 August 2015 (UTC))

We should definitely exclude pseudoscience (in the strict sense) and Ernst's comment is an evaluation that helps us to do so. I suppose you could repeat all the work he's done; without that, we should exclude the sources that he condemns. I agree it's important not to confuse Japanese names with Chinese, or, say, English ones with Basque. Richard Keatinge (talk) 17:22, 19 August 2015 (UTC)

I disagree. We can't exclude sources on Ernst's comments. He's not editing here; we are. We can use his insights to help us determine what is useful to us, but again his word is not a carte blanche to exclude. And thanks this is the first time I see someone use pseudoscience, in my opinion, its accurate sense.(Littleolive oil (talk) 17:49, 19 August 2015 (UTC))

It looks like the Ernst post is being misinterpreted and/or overblown here. Ernst is saying that acupuncture trials from China cannot be trusted, not random papers that have Chinese names attached. The post doesn't seem particularly relevant to us anyway since we shouldn't be citing specific RCTs in the first place. Following WP:MEDRS and WP:BESTSOURCES should naturally, on its own, have the effect of incorporating Ernst's advice.

Also, Ernst's conclusion is being profoundly misunderstood as "can't be bothered to even read the methodology of papers to evaluate quality, just discard all". Scrutinizing methodologies has no power to thwart the file drawer effect, for example, even if the methodologies are found to be impeccable. If we receive reports that someone is consistently rolling 6s on a six-sided die, and if upon examination we find that the die is fair and method of rolling is fair, that doesn't imply that the reports are to be trusted. If the reason for that isn't immediately clear then see the wikilink in this paragraph. Manul ~ talk 03:02, 20 August 2015 (UTC)

Thanks Manul and Littleolive oil. Indeed, Ernst's comments aren't carte blanche to exclude the studies he mentions from the article. They exist and are notable in themselves. Ernst's comments do, however, exclude this body of work from consideration as serious testing of the efficacy of acupuncture. Any mention of them should be brief and should be framed by some version of Ernst's comments. Richard Keatinge (talk) 10:02, 20 August 2015 (UTC)

I hate to sound like an extremist here, but can somebody show in our policies or guidelines where that position would be appropriate? I would love to say that studies or reviews that don't use CONSORT reporting standards should be weighed less heavily than sources that do. And it makes great sense to do that since we should give preference to the sources with the most robust evidence as possible. But I don't see where in our policies this would be allowed. Similarly here. Anywho, if somebody can show the policy where we should weigh sources form one country less heavily than other countries' based on commentary by a retired professor, I would love to see it. LesVegas (talk) 19:38, 20 August 2015 (UTC)

WP:PSCI is probably your best guide. Richard Keatinge (talk) 20:34, 20 August 2015 (UTC)

Can you show me the specific statement there that applies to this case? LesVegas (talk) 21:09, 20 August 2015 (UTC)

History section in lead

I am concerned that most of the part of the lead dedicated to history is not sourced. While this seems to be OK at first due to WP:CITELEAD it really seems like a no-no to me because the rest of the lead is sourced like you would expect the body of an article to be. I think the second paragraph of the lead should have references at the end of each sentence. Everymorning (talk) 14:46, 19 August 2015 (UTC)

I agree that we need some consistency in the lede. Ledes on Wikipedia are either sourced or unsourced and I prefer unsourced ledes myself because it greatly improves readability. It's much better for the body to have the sources. If readers want to look into something deeply, they can there. LesVegas (talk) 17:48, 20 August 2015 (UTC)

Removed this content

This journal has an impact factor of zero [16]. This indicates that they do not have a history of publishing high quality content. By the way anyway can start a journal. Our in house journal is here [17] and is not suitable as a Wikipedia reference either. Doc James (talk · contribs · email) 05:10, 22 August 2015 (UTC)

• I recently asked Randykitty about whether Researchgate is a reliable source for impact factors of journals here. His response was that "Apparently, that's not reliable info, because that particular journal (according to the TR master journal list) is not even in any of their databases, so it has no IF." So it's not in any Thomson Reuters databases, but is is in Medline. [18] Everymorning (talk) 11:56, 22 August 2015 (UTC)

Exactly. It's a Chinese language journal that's MEDLINE indexed, peer-reviewed, and has been around for 35 years. There's a reason IF has no bearing on whether we can use a source or not, and this shows yet another reason: because the TR rating system is naturally biased against foreign language journals specifying in non-traditional medical techniques. LesVegas (talk) 16:09, 22 August 2015 (UTC)

Being around for a long time does not make something necessarily reliable. Its SJR is also very low [19]. Basically I am see no indications that this is a reputable source. Doc James (talk · contribs · email) 16:36, 22 August 2015 (UTC)

Is there anything in MEDRS that disqualifies it? Please show me something in MEDRS and I'll change my mind. LesVegas (talk) 17:26, 22 August 2015 (UTC)

I quoted it to you. It is not a realiable source and that disqualifies it. Doc James (talk · contribs · email) 22:22, 22 August 2015 (UTC)

No IF and being Chinese is two red flags. That's enough for me. We already know that Chinese journals are essentially uncritical of acupuncture claims, and that may be why this journal has a low IF, but we don't need to speculate because the low IF in and of itself indicates that we should not include it for anything that it remotely controversial. Their belief is touching but not to be taken at face value. Guy (Help!) 22:38, 22 August 2015 (UTC)

Multiple Tags

In order to gain an outside point of view by more neutral, third-party Wikipedians, I have added tags outlining multiple issues on the article. Since there are multiple issues, you might choose to highlight each tag when commenting on it instead of, say, individual sources, because it's much easier to follow.

• POV tag

Throughout the article there are many issues with undue weight given to contentious sources. For instance, this source by Edzard Ernst is given placement 9 times in the article, whereas an NIH consensus statement is only mentioned twice. Another review on safety is mentioned 16 times. Compounding the issue is that numerous editors feel it is an unreliable source when it shows positive findings on acupuncture, yet when it has a negative finding it can be used excessively. Additionally, there are unresolved disputes regarding reliability of sources. Often sources with no reliability issues according to our policies and guidelines are removed, and this creates WP:BALANCE and WP:IMPARTIAL issues. Here are a few of the incidents:

• Here is one and another where a journal from an excellent publisher, Elsevier, is removed because it happens to be about "acupuncture", and therefore promotes acupuncture, as if we have the same standard for journals that study "knee surgery".
• Here is one where a citation from the prestigious BMJ is removed for being a "fringe journal".
• Here is an example where, yes, a misleading edit summary is used. However, the publication is Elsevier and we clearly use sources much worse than that in the same paragraph, so I think we should discuss what the problem, specifically, with the source is. And if there is a problem, perhaps we should remove sources not up to par with it, found elsewhere in the article?
• Removal of reliable sources goes on both sides of "party lines", if you will, as seen in this edit. While it's a historical claim and the most reliable source for that would be a historical source, I don't think it's a tertiary source, since it comes from the prestigious Lancet. This is an example of removing sources because of what it "says" rather than who says it. We cannot question highly reliable sources, no matter what they say, so long as they are appropriate for the article.
• In this revert, we have a study from eCAM reverted, and, again, this highlights a double standard here. We use eCAM in the article, elsewhere, yet new updated reviews and meta-analyses are constantly reverted. Specifically regarding this journal, we should discuss if it's allowable or not and be consistent with our application of it.
• POV Lede:

TCM theory and practice are not based upon scientific knowledge, and acupuncture is described by some as a type of pseudoscience. This statement has many problems. First, we are using a self-published source, Quackwatch, a website that has never been deemed an expert in acupuncture or TCM. By including it in the lede, we are giving a self-published source that is not a reliable source for statements on acupuncture and the like, massive WP: UNDUE weight. The statement, "acupuncture is described by some as a type of pseudoscience" is also contentious. While true, because some do describe it this way, it only shows one side of the issue. We should add a source that provides this parity. An edit like this one would fix this problem.

The statement, "Scientific investigation has not found any histological or physiological evidence for traditional Chinese concepts such as qi, meridians, and acupuncture points" is problematic because it's only one side of the issue. The research that supports this statement never reviewed literature that shows evidence that fascial planes and some blood vessels closely corresponding to the “meridian lines”, for instance. To remedy this, I think it would be an excellent idea to either state: “However, evidence has been proposed that meridians could be X, Y or Z.”

Third paragraph of lede: Cochrane reviews are higher level evidence so these are good to show here, but when we get into systematic reviews it becomes far too one sided. We overuse Ernst’s systematic reviews and leave out plenty of others that have equal weight. Ideally, for NPOV, we should use several other systematic reviews here. If not, then we should delete all systematic reviews and use the highest level evidence such as consensus statements and Cochrane Reviews.

In the lede, there is a statement, "Some research results suggest acupuncture can alleviate pain, though other research suggests that acupuncture's effects are mainly due to placebo.” The source for the statement was a 2006 publication, and since then we have had research that shows a contradictory result, such as [this one here]. To use a 2006 source in 2015 is a violation of MEDDATE. To use it prominently in the lede, is a violation of weight.

"A 2013 review stated that the reports of infection transmission increased significantly in the prior decade” is wrong. The source looked at data between 2001 and 2011, which was last decade’s decade, not the prior decade which would be 2005 to 2015. This should be amended, stating "A 2013 review stated that the reports of infection transmission increased significantly between 2001 and 2011.” But then is it prominent enough for the lede?

• Weasel

We have several issues with weasel words throughout the article. Upon quick scan, here are two I attempted to fix:

Some research results suggest acupuncture can alleviate pain but others consistently suggest that acupuncture's effects are mainly due to placebo. The source never uses the word consistently, so this not only is a problem with misrepresenting a source, but is a rather unnecessary addition of a weasel word.

Under the section Conceptual Basis we have two subsections, Traditional and Purported Scientific Basis The title is a weasel phrase since Modern as in Modern Conceptual Basis is the idea which contrasts Traditional Conceptual Basis and I attempted to fix this before being reverted.

• Self Published Source

We have several violations, namely Quackwatch and Acuwatch, which are self-published sources in violation of our policy on it. The fact that these are given undue weight creates not only unreliability, but non-neutral POV. Additionally, these are violations of WP:BIASED so it's a gross and egregious violation of multiple policies for these sources to exist on the article, much less be given prominence (see POV lede). LesVegas (talk) 06:35, 22 August 2015 (UTC)

• Systemic Bias

These Chinese sources, amongst many others in the past, were removed. In this instance, the argument was that they lacked impact factor. Nowhere in MEDRS is impact factor mentioned as having any bearing on reliability, and for good reason. Impact factor would naturally be low to nonexistent for acupuncture articles written in Chinese, since these would need to be read and translated first by Western publishers before receiving an IF. The journal in question is in its 35th year and is MEDLINE indexed, peer-reviewed and has no reason according to our guidelines to be excluded. Classic case of systemic bias. LesVegas (talk) 06:11, 22 August 2015 (UTC)

Some details have been omitted from the above. Taking "Systemic Bias" for example, the removed sources were used to support a section titled "Cardiovascular Conditions" with text referring to "statistically significant outcomes" regarding the medical treatment of angina. That is standard WP:MEDRS which requires known-good sources for such claims. The meme about Quackwatch has been rebutted on WP:RSN many times, starting with WP:REDFLAG. Johnuniq (talk) 06:44, 22 August 2015 (UTC)

The source, having been in publication for 35 years is a known good source. On the RSN, Quackwatch was argued to be reliable for claims about pseudoscience, not acupuncture. LesVegas (talk) 06:49, 22 August 2015 (UTC)

Your tagging of the article is pointy User:LesVegas. That you see nothing wrong with the use of a source with an impact factor of zero / 0 raising concerns for me. This is one strong indication that a source is not a "reputable medical journal" Doc James (talk · contribs · email) 16:34, 22 August 2015 (UTC)

Sorry to be so disagreeable here, but where in our policies or guidelines is IF a factor on reliability? Frankly, your inability to see anything wrong with IF ratings when journals are peer-reviewed, Medline-indexed and 35 years old concerns me. LesVegas (talk) 17:12, 22 August 2015 (UTC)

Sure you are welcome to request further opinions. Doc James (talk · contribs · email) 17:18, 22 August 2015 (UTC)

Well, I thought POV was justified until you wrote all this, but basically you just said that the article is written in accordance with WP:FRINGE so, I now withdraw my support for an NPOV tag. Guy (Help!) 22:39, 22 August 2015 (UTC)