Talk:Acupuncture

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)

• True Believers? Enough said.(Littleolive oil (talk) 23:36, 23 August 2015 (UTC))

Again, think about what you are saying specifically when you say "Chinese research". Editors here are using a tiny piece of evidence (one CHINESE systematic review cited by Ernst) to make very broad assumptions, going so far as to say that articles in mainstream medical journals authored by people with Chinese names are unreliable. Advocacy creates certain types of problems, but when advocates are clear and transparent about their reasoning, at least you can have an intelligent debate about quality of sources. This debate does not seem intelligent to me, it seems to too easily generalize, and borders on racism, and I think its outrageous. You want to exclude a journal published in China because it is weak and uncritical? Fine. But if you want to label all Chinese researchers as compromised and unreliable, that's unacceptable.Herbxue (talk) 00:18, 24 August 2015 (UTC)

• • As I've said before I agree. These are the issues as I understand them.

Research coming out of China may be poor.

Can we discount all research where the researcher/s have a Chinese name.

Can we ever discount per WP: RS any research en masse when our policies state that sources are reliable only and specifically per the content they support or should each source be scrutinized per the content it is purported to support.

Is a single voice, Ernst's, enough to discount both Chinese research and research where names of the researchers are Chinese.

Is using Ernst to discount all Chinese research and research where names of the researchers are Chinese, undue weight per Ernst's position.

And finally, can we add a section, and is such content significant, which describes China's research on its traditonial medicine, while also noting western response to that research. (Littleolive oil (talk) 00:51, 24 August 2015 (UTC))

Badge of shame

The recent re-add of the NPOV tag[1] 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)

are you looking for WP:BESTSOURCES? -- TRPoD aka The Red Pen of Doom 03:00, 6 September 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 [2]. 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 [3] 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. [4] 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 [5]. 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)

AD

Medications work poorly in AD per this high quality secondary source.[6] Stating that acupuncture may work in AD as well as medications, stating how well meds work is important. Doc James (talk · contribs · email) 23:26, 5 September 2015 (UTC)

Hum. Discussion is here. Doc James (talk · contribs · email) 01:11, 6 September 2015 (UTC)

Yes, it sometimes takes a minute to respond. This isn't an article about medications. If it were to become one, where would we stop? Given the many applications of acupuncture, it would be one enormous article. Furthermore, there are many claims of how well meds work for varying conditions. Choosing only one of those becomes problematic and is best left to the article on the med or the condition itself. LesVegas (talk) 01:13, 6 September 2015 (UTC)

This is similar to the issue of codeine as a cough medicine. Codeine is the "gold standard" cough medicine. Evidence states it works similar to placebo. This is important when a review states that dextromethorphan is as good as codeine. One needs to define how well codeine than works. Doc James (talk · contribs · email) 01:16, 6 September 2015 (UTC)

Doc James, do we compare every medication to every other medication when claims are made about comparative efficacy on their respective Wikipedia pages? Furthermore, some sources disagree on how effective meds are in certain instances. For instance, some sources show overwhelmingly positive results for SSRI's for depression. Others show them to be no more effective than placebo for most cases of depression. Comparisons on efficacy can thus be cherry-picked, which is a violation of our policies. LesVegas (talk) 01:23, 6 September 2015 (UTC)

That is not the case here however. Doc James (talk · contribs · email) 01:28, 6 September 2015 (UTC)

Sure, the benefits are low in this case. But that's according to one source. Are you sure there aren't other sources that state different results? LesVegas (talk) 02:17, 6 September 2015 (UTC)

All good sources may or less say the benefit is small. Doc James (talk · contribs · email) 04:31, 6 September 2015 (UTC)

Context matters for statement like this. You really don't want to write things like "Lying down in the middle of the road is just as safe as eating arsenic", because it's misleading. However, depending on the source, it might not be necessary to write a direct comparison. You could instead write "Acupuncture works poorly for Alzheimers" and leave out the "just like everything else" part. WhatamIdoing (talk) 02:33, 6 September 2015 (UTC)

Much as I admire Doc James's editing in general, and however correct his comment is, we really don't need, here, a comment on the uselessness of a not-acupuncture intervention. Richard Keatinge (talk) 09:12, 6 September 2015 (UTC)

• In my view, per Talk:Acupuncture#Proposal:_truce_conditions, we shouldn't even discuss AD in this article, just like we shouldn't discuss infertility. as there is no reasonable basis to assume that it even could work. I do wish the editors here would agree to limiting the scope of this article to mainstream uses of acupuncture as an adjuvant in some pain conditions and some side effects of cancer treatment. Jytdog (talk) 16:01, 6 September 2015 (UTC)

There was not any acceptance of your proposal because it was too sweeping and made presumptions that amount to original research. That said, I support the basic idea of limiting the scope, especially if it is limited to descriptive content the way most medical articles are. Unfortunately ,the proposal that acupuncture cannot possibly be effective for any specific condition is, despite what passes as common sense, an assumption rather than something proved by reliable sources. Studies that show acupuncture as effective or more effective than standard of care are indeed notable.Herbxue (talk) 23:38, 6 September 2015 (UTC)

Today in 2015, there is no plausible mechanism by which sticking needles in your skin could do something as extremely specific within the body as affecting any step where fertility goes awry (sperm count or the viability of sperm, or the ability of a fertilized egg to implant in the uterus or stay there or any other step). Likewise the notion that acupuncture could actually be disease-modifying in AD. Maybe acu could be useful for dealing with anxiety or something else messy (like pain and cancer side effects) in AD where placebo effect is huge, but not for actually treating AD. Efforts to add content about these kinds of things are lead balloons and just lead to endless turmoil. Until the basic science establishes actually plausible mechanisms for that kind of stuff (if ever - doing that would be a miraculous Nobel-prize winning kind of thing), they are going to be rejected. You really should be willing to walk away from them. More importantly, there is no way the crap state of this article can improve until both sides agree to limit the scope. Everybody wins some that way, and everybody loses some that way (the skeptics will not like acknowledging that pain/alleviating cancer treatment effects, is mainstream. That would be a huge win for you Herbxue. But you have to give up this other stuff and agree to actually enforce keeping it out, and actually do that.) Jytdog (talk) 00:01, 7 September 2015 (UTC)

I will reject untrue claims like "acupuncture cures cancer" any day, but if a reliable review says "acupuncture reduces chemotherapy-induced leukopenia" I don't see why a lack of knowledge about the mechanism of that phenomenon is relevant. We can't reject whole categories of conditions because we don't see how its possible that it might work (if it has been shown to work). I'd be interested to see a skeleton draft of what you are proposing, I do see the value of simplifying the article. Until we can agree on what neutral really means though, I support inclusiveness and attribution of claims in order to responsibly represent the mixed messages that actually exist in the literature. Herbxue (talk) 14:35, 7 September 2015 (UTC)

• • Yes if we remove the content completely my concerns are addressed. Doc James (talk · contribs · email) 22:37, 6 September 2015 (UTC)

Chinese authors again

"A 2015 systematic review and meta-analysis found that acupuncture may be more effective than medications for Alzheimer's disease, and that it may also enhance the effect of donepezil for this condition." See Acupuncture#Alzheimer.27s disease.

Zhou, J; Peng, W; Xu, M; Li, W; Liu, Z (June 2015). "The effectiveness and safety of acupuncture for patients with Alzheimer disease: a systematic review and meta-analysis of randomized controlled trials". Medicine. 94 (22): e933. doi:10.1097/MD.0000000000000933. PMID 26039131.

The benefit of medication for Alzheimer's disease is low,[7] yet the pseudo-review does not mention this. I recommend deleting the misleading review. QuackGuru (talk) 03:49, 6 September 2015 (UTC)

We at least need to put it into context. Doc James (talk · contribs · email) 04:08, 6 September 2015 (UTC)

The Zhou meta analysis appears to have purposefully included Chinese Acupuncture Journals. A meta analysis that is based on bad source materials would seem to be inherently not the best research and source.-- TRPoD aka The Red Pen of Doom 04:18, 6 September 2015 (UTC)

Likely why they say "may be" which equally means "may not be" Doc James (talk · contribs · email) 04:30, 6 September 2015 (UTC)

agree --Ozzie10aaaa (talk) 11:00, 6 September 2015 (UTC)

• According to the review, most of the included studies did not require the outcome assessors to be blinded. That's a very serious weakness. Looie496 (talk) 16:34, 6 September 2015 (UTC)

The methods of the review itself seem decent, so I think its findings should be included, but with the caveats mentioned above, particularly inclusion of trials that were not double blinded (not sure that some trials were "Chinese" is a caveat per se, but we could mention it without insisting that reader interpret that info one way or the other). Herbxue (talk) 23:27, 6 September 2015 (UTC)

With respect to mechanisms, there is a recent review addressing how acupuncture could be effective for Alzheimer's based on animal models. According to the review, "It is suggested that acupuncture improves cognitive function of Alzheimer's disease by regulating glucose metabolism, enhancing neurotransmission as well as reducing oxidative stress, A protein deposition, and neuronal apoptosis." [8] Everymorning (talk) 16:33, 7 September 2015 (UTC)

Do many animals get Alzheimers? (dogs, for instance?) -Roxy the dog™ (Resonate) 16:35, 7 September 2015 (UTC)

Many dogs do experience, in old age, Alzheimer-like issues. (Littleolive oil (talk) 18:17, 7 September 2015 (UTC))

Thank you Olive, that explains a few things for me. ;) -Roxy the dog™ (Resonate) 18:58, 7 September 2015 (UTC)

Alzheimer's section

This page is under discretionary sanctions, and is controversial. Therefore, please be bold but not reckless. If you want to add something you know is going to be controversial, please work it out on talk first. I have cut the new AD section from the article and am pasting it here for discussion. I see that discussion is ongoing above. Please work out acceptable language so that the article isn't destabilized. Jytdog (talk) 15:55, 6 September 2015 (UTC)

A 2009 systematic review found only a small number of studies looking at acupuncture for Alzheimer's disease (AD), and concluded that "the existing evidence does not demonstrate the effectiveness of acupuncture for AD." A 2015 systematic review and meta-analysis found that acupuncture may be more effective than medications for Alzheimer's disease, and that it may also enhance the effect of donepezil for this condition.

References

Why was this section removed? What is so controversial about it?LesVegas (talk) 04:31, 8 September 2015 (UTC)

The second paper should go due to the well documented bias in favour of acupuncture among Chinese authors. The first states the obvious: there is no remotely plausible reason to suppose acupuncture would work for Alzheimer's. We really don't need a separate section for every single condition where Chinese authors claim a marginally significant effect and the reality-based community either ignores them or finds the opposite. Guy (Help!) 13:41, 8 September 2015 (UTC)

Possible restructure in sandbox

Bearing in mind Jytdog's comment at 15:55, 6 September 2015 above (that editing has to be cautious per the discretionary sanctions), I put a copy of the article at 15:53, 6 September 2015 in Talk:Acupuncture/sandbox. I have been inactive on this topic but have watched proceedings, and the recent country of origin RfC highlights the divergent views on the article. I'm wondering if people would like to try reworking the current page. Any such work could then be considered for use in the article. Johnuniq (talk) 03:14, 7 September 2015 (UTC)

You mean reworking it in the sandbox, right?Herbxue (talk) 14:40, 7 September 2015 (UTC)

Yes, reworking in the sandbox would allow trying more massive rearrangements whereas bold editing on a contentious article would be unsuccessful. Johnuniq (talk) 21:06, 7 September 2015 (UTC)