Talk:Acupuncture

• /archive1: December 2002 - February 2006
• /archive2: February 2006 - August 2006
• /archive3: August 2006 - January 2008

Changing the introductory paragraphs

I have just submitted a change to the introductory paragraphs. The original sentence relating to needling "acupuncture points" did not take into account the treating of Ashi points. My clarification, although quite lengthy, added this element. This is my first post so I hope that I have not transgressed in any way. Llj444 (talk) 16:44, 18 January 2008 (UTC)

Welcome aboard. I appreciate the spirit of your edit. If "ashi points" are not defined as "acupuncture points", they are certainly part of TCM theory... and researchers claiming to do "sham" acupuncture by needling "non-acupuncture-points" may be doing verum treatment if the "sham" points are also "ashi" points. That's an actively debated topic and should be mentioned. However, I'm not sure the lead section is the place to jump right into the specific meridians. Will think it over. Welcome! Jim Butler^(talk) 21:42, 18 January 2008 (UTC)

For McCready: you asserted "bulk of scientists saying ac is crap." Source please? Also: "page needs to be 50kb max." Yes, your attempts at WP:GAME are duly noted[1][2]. (Assume good faith isn't a suicide pact.) You've been blocked in the past for such behavior. Suggest you disengage a bit. --Jim Butler^(talk) 10:20, 27 January 2008 (UTC)

Good the talk begins. But you are wrong in your allegation that I have been blocked for gaming. Pls apologise and pls answer for the third time, should the article be 30-50kb? Mccready (talk) 10:27, 27 January 2008 (UTC)

(1) Pls answer my question: "bulk of scientists saying ac is crap." Source please?

(2) You were blocked for tendentious editing. You're doing it again, and you ought to be blocked again for it, IMO. You're the one who owes an apology to the various editors whom you've stressed out.

(3) No, I don't see any reason to be rigid about article size, per other comments at Wikipedia talk:Article size. Also, I think the best way to go about reducing article size is discussion and splitting, not chopping out well-sourced material that you don't happen to like. --Jim Butler^(talk) 10:41, 27 January 2008 (UTC)

1) Don't be silly. I suppose you'd want a cite that most scientists don't think the moon is made of blue cheese. 2) Not gaming. Don't be silly again. Editors are responsible for their own emotional state, not me. 3) Pls answer question. Do you agree or not that the article should be limited to 30-50kb? I'm quite happy for you to split away. A lot of the material is repeated elsewhere as I have said. Mccready (talk) 08:10, 28 January 2008 (UTC)

On (1), we've been over this before: see WP:NPOVFAQ#Pseudoscience and WP:RS#Claims_of_consensus. Prove your claim. The moon being made of blue cheese not a serious claim. Acu's effifacy for various things is, and is studied as such. On (3), what part of "no" didn't you understand? --Jim Butler^(talk) 09:00, 28 January 2008 (UTC)

I return after a long break to comment on this article (which I was editing back in 2006). First let me make it clear that I have no interest in engaging into debate with McCready over the same content that was argued about 2 years ago, and seems to be still argued about now. It is interesting to see how the page has developed, but I must admit it is a shame to see how skewed the article is towards discussion of the scientific validation of acupuncture, at the expense of giving readers an understanding of what acupuncture actually is. Also unfortunate to note is that McCready seems to still not make the distinction between what acupuncture is and what it claims to be able to achieve). He has successfully wasted many people's time and effort on argument over a sub-topic, at the expense of the same time and effort being spent on making the article more complete with information about all subtopics of acupuncture.

I am giving my opinion based on a break of 18months from editing this page, and the fresh perspective this gives. Summarised below:

1. Of the four paragraphs in the lead, only one describes what acupuncture is, and it does so poorly. I'm not sure that people know what filiform needles are, and the link to wiktionary doesn't enlighten the reader any further. I think it is important to disambiguate this, also I'm not sure how you would achieve this. I am happy to give you some further ideas on this Jim (or others) if you require.

2. The other 3 paragraphs are centred on the topic of the efficacy of acupuncture. Such a series of paragraphs would be better suited to an article entitled "the efficacy of acupuncture". For an article titled "acupuncture" one paragraph is enough. McCready, be concise and fair in what you wish to say about the efficacy of/debate surrounding acupuncture and summarise it into one paragraph. There is no need to repeat yourself for theatrical purposes, especially in the lead paragraph. Leave it in the section that it belongs to, and summarise appropriately in the lead. (I am only naming you McCready because I see you as the primary spokesperson for this subtopic and main person responsible for such a series of paragraphs being in the lead in the first place).

3. Suggestions for other subtopics that I think could suitably replace the space left by removing 2 of 3 paragraphs would be:

   a. use of the words qi and meridian, as any discussion on acupuncture is kinda pointless 
      without referencing key ideas behind its use by acupuncturists etc.
   b. reference to "gate theory" and other medical references to the western medical ideas 
      behind the use of acupuncture by doctors etc.
   c. acupuncture points are located all over the body, and are chosen according to a number 
      of theories: TCM, Japanese acupuncture, ashi points, scientific reasons etc.

These are just suggestions, however I think it is VITAL to give more of an idea about what acupuncture actually is in the lead section of an article entitled acupuncture- before launching into debate about scientifically verifiable efficacy.

4. McCready, please go ahead and create a page for your pet topic of efficacy of acupuncture and put yours and others well researched content in there. Be sure to link to it at the head of the section titled "Scientific Research into Efficacy" and summarise appropriately. I think that you have spent a lot of time and effort putting this view across that your efforts should be displayed in an article of their own. There is certainly more than enough material. Your strong command of written english will allow you to effectively summarise such material into two paragraphs or so on the main acupuncture page, whilst leaving an entire page for the full extent of yours and jim butler's previous posts on the subject. Note, this is not an attempt at "muddying the waters" as you commonly cite, simply a pragmatic way of keeping the article on topic. At the moment, if I were marking a paper titled "Acupuncture" that contained what is written on the acupuncture page, it would receive an E at best due to a lack of information about the topic and a seemingly strong bias to one of the many sub-topics. Other sub-topics don't receive nearly as much weighting and space on this page, which I think is very unfortunate. I'm sure both yourself and Jim Butler would agree with me on this.

I'll pop back in a month or so to see how things are going, and to see if either McCready, Jim Butler or others have responded to my suggestions and comments. Who knows, I may even dare to edit again. Until then... Happy editing! Piekarnia (talk) 01:45, 9 March 2008 (UTC)

Hi Piekarnia, long time no see. Generally agree about reworking the lead, and since another editor (DavidRuben) has suggested something similar, I think we should go ahead. BTW, I would not favor a separate article on efficacy as that could be seen as a POV fork (or at least, I would favor retaining a significant amount of stuff about efficacy in this article, just not so much in the lead).

I've kind of given up on this article though. WP's fundamental assumptions (that lack of peer review can result in a decent article) are too flawed. So forgive me if I keep an eye on it so it doesn't get worse, while not putting in hours to make it better. Rather like bailing a leaky boat. regards, Jim Butler (t) 02:31, 14 March 2008 (UTC)

Piekarnia, your personal attacks on me do you no credit. Please desist. The culture of wikipedia has changed since you were last here. Try to address yourself to the issues not the person. Such bad behaviour on your part is clampled down on much more rigorously now. Please check civility and assume good faith. I agree with Jim that a fork would be inappropriate. I agree with you on filiform. I agree with you that the top is too long and some of the history stuff could be addressed below. I think we need to say much more strongly up top what science says on acupuncture's efficacy on the various diseases acupuncturists treat. The statement "according to a review by Edzard Ernst and colleagues in 2007, which found that the body of evidence was growing, research is active, and that the "emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions". is a wishy washy unscientific one (seems???,imply???) that acupuncturists would love. ie the subtext is "we know it works, just give us time and research money and we'll prove it." There are plenty of more punch statements on efficacy. Who cares, for the purposes of the lead, if the research is growing. The "body of evidence" growing phrase can be read as "evidence that acupuncture works is mounting". It can also be read strictly that this is not the case. In either case the phrase should go because it allows ambiguity, does it not? Acupuncture points are hotly debated by various schools of acupuncture - undermines the whole claim. So I don't agree with where you are coming from in this.

The WHO and NCCAM stuff need not be in the lead. They there serve the purpose of puffery. They've reported on it. So what was the outcome? And once again we have the altmed cry for more reseach.

Yes the article is a long long dog's breakfast. Mccready (talk) 13:42, 17 March 2008 (UTC)

We already have a list of diseases. We simply need to present them in a table with a column for the efficacy of acupuncture.

UNDUE Weight

Acupuncture Jim wants to cherry pick the slight amount of dodgy evidence that may exist for efficacy of acu and put it at the top. This is unacceptable. We all know that acupuncture has no demonstrated effect for the huge range of conditions for which it is used. Shouldn't we put that at the top if this is the route you want to travel? Mccready (talk) 08:23, 28 January 2008 (UTC)

Cochrane Collaboration is dodgy, eh? Sounds like an opinion straight out of the fringes of anti-science. It looks like more editors agree the lead is well-weighted in the version you dislike. The sources are impeccable, like Ernst, and the wording is clear about where there is and isn't efficacy per EBM. --Jim Butler^(talk) 09:03, 28 January 2008 (UTC)

Are you being deliberately obtuse? It's not about Cochrane, which has its share of altmed nuts infiltrated anyway. You, Acupuncture Jim, gather every bit of evidence in support and want it in the top but have none which says for heaps of conditions it's crap. POV or not? For chrissakes why do you insist on filiform???Mccready (talk) 09:28, 28 January 2008 (UTC)

Ah, I think I see what happened; a sentence I'd thought was there dropped out along the way. Restored. Better approach than just deleting good V RS's, I think. Filiform? Of course, to distinguish them from other needles the reader might know of in a medical context, like hypodermic needles. I think that's called accuracy, not undue weight. --Jim Butler^(talk) 10:45, 28 January 2008 (UTC)

Fair enough. Accepted. Now we have to address undue weight. The top needs to ack that science shows the bulk of conditions acu purports to treat are not amenable to acu. Mccready (talk) 01:38, 30 January 2008 (UTC)

Hehe, hey I just had this same statement made on the Talk:Chiropractic page. Mccready, are you trolling? I agree the article is long, especially the lead, but any shortening needs to be NPOV. More likely, the article could be split up, but don't delete hard work from other editors, make a new page and move it. Also, you can't just cut out one POV and expect it to stick. See if you can shorten it and still be saying the same thing... and it needs to be reliably sourced. ---- Dēmatt (chat) 02:35, 30 January 2008 (UTC)

Well, I removed the unsourced POV statement that remained. ---- Dēmatt (chat) 14:51, 30 January 2008 (UTC)

Thanks Dematt; agree entirely that what you removed was OR. I went even further and reverted, since the earlier wording remains the most accurate depiction of the sources cited (Ernst 2007, and the rest of the EBM reviews). As Ernst explains, the body of evidence is growing, and that evidence is showing efficacy for some conditions and a lack of efficacy for others. For many more conditions, there is not enough evidence to determine efficacy. That's what the sources say. A good example is their review of acupuncture for depression. cheers, Jim Butler^(talk) 20:14, 30 January 2008 (UTC)

Are you guys deliberately ignoring the topic. The topic is UNDUE weight. It's a wiki policy. Pls address the issue.Mccready (talk) 01:55, 31 January 2008 (UTC)

"Undue weight", "article length" -- anything to justify your pruning particular views from the lead. It's called "wikilawyering". Your edits speak louder than your talk-page rationalizations. Happy editing and hope you have a great day, but don't think others haven't seen through your approach. I agree there is some accumulated cruft in the article, but I don't think you possess the objectivity to identify it. --Jim Butler^(talk) 03:24, 31 January 2008 (UTC)

Temper, tempers please :-) I've not delved into the recent edit history, but this is generally a well written and informative article. I would though tend to feel that description of what acupuncture claims to be should come before critisms etc. Hence should last paragraph of leadin ("Traditional Chinese medicine's acupuncture theory predates... ") come as the second paragraph of the leader? David Ruben ^Talk 03:36, 31 January 2008 (UTC)

Hi David - we could, although that paragraph (fourth one in the lead, this version) actually contains criticism, unlike the neutral evidence in the second. Maybe can rearrange somehow. I think it does have good article potential. (Mea culpa on temper, but do check the edit history for certain editors' deletionism.  :-) cheers, Jim Butler^(talk) 05:19, 31 January 2008 (UTC)

Acupuncture Jim, Your abuse doesn't hide the fact the you refuse to engage in sensible discussion. We both know that for a huge range of conditions that acus treat there is no evidence of effectiveness. Does this or not need to be referenced in the top. Mccready (talk) 09:03, 1 February 2008 (UTC)

The reason for my revert is that we already talk about evidence in the lead, and specifically say "For most other conditions[12] reviewers have found either a lack of efficacy (e.g., help in quitting smoking[13]) or have concluded that there is insufficient evidence to determine if acupuncture is effective (e.g., treating shoulder pain[14])." It's redundant then to list a bunch of conditions where evidence for efficacy is lacking or uncertain.

Of cource acu is used clinically for conditions where EBM support is lacking, but that is also true for some biomedical modalities, including most surgical techniques. The Institute of Medicine, one of the four Academies of Sciences in the US, also makes this point (see last paragraph here). If you edited the lead sections of arthroplasty, etc., to add a list like you want to here, how far would you get? Be realistic. If your edits aren't judicious and supported by other editors (it's not just me objecting), they aren't going to stick. regards, Jim Butler^(talk) 21:16, 1 February 2008 (UTC)

If we aren't going to mention specific conditions in the lead where acu is ineffective, then pls explain, Acupuncture Jim, why we should mention specific conditions were it is claimed to be effective. If you want to edit an article on surgical techniques go right ahead. Your point is irrelevant here. Mccready (talk) 11:27, 2 February 2008 (UTC)

The list of conditions that a particular compound or technique cannot treat is endless. I don't believe we apply your logic to other articles on WP, and surgical techniques are a good comparison because similar blinding issues apply to RCT's. Use common sense, please. --Jim Butler (t) 07:35, 3 February 2008 (UTC)

We're getting closer now. Of course the list is endless, but as you have it now you present one person's view that acu relevance is expanding. What are we to do about this UNDUE weight? I reiterate, your comments on other articles are irrelevant. We are talking here about the acu article. Mccready (talk) 03:07, 5 February 2008 (UTC)

Read more carefully, please. Ernst doesn't say acu relevance is expanding; he says the evidence base is, which is a simple statement of fact: more RCT's are being done every year. Your attempt to add a list to the lead is tendentious, redundant and stylistically inappropriate. It's good in the article but ridiculous in the lead. The lead is a summary; we already say that evidence is equivocal or lacking for "most other conditions" in the lead, and I hold firm to my view that enumerating them in the lead is plain silly. And comparisons to other articles are entirely relevant: your edits would never stick in any other article either. How many things does aspirin not treat? Please, common sense applies. You've been blocked before for disruptive editing and I wouldn't be at all surprised to see it happen again. --Jim Butler (t) 05:34, 5 February 2008 (UTC)

Stuff to add

This is interesting, re mechanism. --Jim Butler^(talk) 05:19, 31 January 2008 (UTC)

And here is a link that (currently) provides free full access to the text and PDF version: Acupuncture Anesthesia and Analgesia for Clinical Acute Pain in Japan. MeekMark (talk) 11:36, 31 January 2008 (UTC)

I would hardly consider that journal to be reliable. And basically, they're saying that acupuncture treats every pain ever known. I would be opposed to using it. I'm not at all a supporter of junk science, so I've added some very reliable references to this article. I intend to be as neutral as I can to balance both sides of this story. But this article doesn't even entice me to look beyond it. Unsupported claims always makes me yawn. OrangeMarlin ^{Talk• Contributions} 03:19, 2 February 2008 (UTC)

Agree it is fairly underwhelming as a review, but as for the journal itself, Ernst and Kaptchuk are pretty studly and are on the review board. Not sure though about the general quality of articles or publication bias. --Jim Butler (t) 06:47, 2 February 2008 (UTC)

• Good one re sham acu and placebo effects: Kaptchuk et. al., BMJ 2006;332:391-397. Article about it in Science News. --Jim Butler (t) 06:47, 2 February 2008 (UTC)

Added. --Jim Butler (t) 07:58, 3 February 2008 (UTC)

Maybe more stuff

This research was published yesterday in the British Medical Journal. It includes meta analysis, which is something that never gives me any feeling of confidence. However, the paper suggests a NNT of 17:1 so it is note worthy from that point of view. Manheimer, Eric; et al. (7 February 2008 ).Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ. doi:10.1136/bmj.39471.430451.BE.--Aspro (talk) 16:55, 8 February 2008 (UTC)

I saw that reported too, yes, agree. cheers, Jim Butler (t) 06:27, 9 February 2008 (UTC)

Williams

Good; undue weight to cite that guy in lead anyway. --Jim Butler (t) 04:15, 2 February 2008 (UTC)

Cleanup

If all goes well, I'm hoping to clean up the article and prune/merge some stuff into Traditional Chinese medicine, Channel (Chinese medicine), Zang Fu, etc. --Jim Butler (t) 04:18, 2 February 2008 (UTC)

It may take awhile, since edits like this are nontrivial and I haven't edited a couple of the above articles before. But the result will be a shorter, tighter article. --Jim Butler (t) 05:29, 2 February 2008 (UTC)

I made a small but significant change to the lead, in accordance with the sources we have in the article (AAMA etc), which list mainly pain and other symptoms. --Jim Butler (t) 07:57, 3 February 2008 (UTC)

Lead-in discussion on verification

Clearly Mccready's steady drastic reduction of the lead-in's discussion of the research and verification basis for acupuncture is not agreed with by several editors who have reverted it back (warning issued re risk being seen as edit warring). However I do have issues with the lead-in concentration on this:

• The leadin should really explain what something is and its historical & social background before getting too heavily into criticism & proofs.
  • The leadin current is sparse on history and even less mention of social/society issues. The first date mentioned in the leadin is not some estimate of when the practice first started (or a referrence to first written record to at least give a minimum timeframe) but "2007" for an American Journal publication.
  • The leadin needs give a little more description of history and uses. NB this should be noncontentious to indicate what it has been/is used for, which is quite distinct from an assertion of effectiveness - cf antibiotics often given for sore throat in the UK (true) but this not the same as whether blanket prescribing helps (contentious and certainly less clear-cut than the previous generation of doctors thought, and I certainly prescribe in well under half of cases as most are clearly self-resolving viral infections). Some mention also should be made of spread of practice into Western World (we surely all agree that acupuncture more prevalently available and practised in UK & US than say 100 years ago, but precisely what was this process (NB needs citing of course)
• Given I do not dispute that acupuncture is widely practised in the Far East, acupuncture is clearly not a trivial-minority opinion. Therefore the leadin should at least make some better mention of TCM viewpoint on disease and how acupuncture is thought to aid health. Likewise, given there are some positive scientific studies, how modern science (which does not see evidence for Qi) suspects acupuncture might exhibit its effects (ie pain-gate model, neuro-immunological effects or whatever).
• Of course given the alternative/complimentary aspect of how acupuncture is perceived, the leadin needs cover the evidence supporting or refuting claims of effectiveness, but this should not I think form the largest part of the leadin (relocate details to the "Scientific research into efficacy" section).

So, IMHO, the material Mccready has removed and paraphrased was overly harsh with the scythe, but I agree currently unduely long and needs some triming with expansion of other more straight forward encyclopaedic description aspects. David Ruben ^Talk 12:02, 7 February 2008 (UTC)

Thanks David. Good finally to get the discussion started properly. The diehard defend acu at all costs acus who inhabit this page have refused to discuss properly despite an outward appearance. The points you made are valid on the whole. But the overwhelming evidence is that acu is BS. Even the one metastudy on P6 that AcuJim likes to tout has been criticised by scientists. AJ operates, as do most altmeders, by 1) muddy the waters by saying it's controversial and scientists can't agree (we've seen it classically in the tiny minority of global warming deniers among scientists) 2) suggesting their fav altmed as soln, 3) crying that they are cut off from research fund which would soon prove the moon is green cheese (thus AcuJim likes to quote any source he can that concludes more research is needed) 4) wikilawyering to prevent any sensible analysis or presentation of facts unsullied by UNDUE weight (thus a sensible conclusion is labelled OR and out of court, or a syllogistically correct statement is also thus labelled.

The facts are 1) most of the "science community" pays no attention to altmed because they've got b better things to do. Therefore statements about what the community thinks are fraught and need to be carefully verified. 2) the huge bulk of papers conclude acu is BS 3) this article's LEAD gives UNDUE weight to the minority of studies finding acu may have a point. The current statement in the lead "For most conditions acupuncture has no effect." is a huge compromise as it is. But AcuJim doesn't even accept that compromise. He can name no condition for which acu has unequivocally, to the satisfaction of the science community, been shown to have effect. There are even editors here who claim to be skeptics but have stated on their pages that they think acu has a demonstrated analgesic effect. Show me the studies proving that I say. Looking forward to sensible discussion. Mccready (talk) 00:53, 8 February 2008 (UTC)

(Further repeated blanking of section being discussed was disruptive and your block warranted). Whilst above indeed probably the views of majority established "conservative" conventional medical doctors, your points are merely items that the acupuncture criticism section might cover. Rather what I am trying to generate is discussion that the lead-in should have more information describing what acupuncture is, its historical context and views of claimed modality of effect, rather than be so heavily dominated by just the modern scientific verification/justification. The problem, I see, is over balance of spread of covered aspects, not a POV desire to downplay the veracity of the technique (of which I am an intrigued sceptic), so could some pro-acupuncture editors help here by suggesting how the verification discussion in the lead-in might be summarised down just a little and the other items I mention be more fully covered. The article's tone as set in the lead-in should really be a positive affirmation of what acupuncture is, and not what might be seen as an apologetic justification piece. David Ruben ^Talk 01:02, 9 February 2008 (UTC)

David - I think your idea on moving forward with the lead is great, and the only reason I haven't responded sooner is I am time-poor and was asked to resolve a BLP problem elsewhere. Will work on this as soon as I can, certainly this weekend.

BTW, for Mccready, I'd appreciate being referred to by my handle here, and not nicks like "Acupuncture Jim" and the like. This isn't a political campaign, and as I mention on my user page, I prefer not to label people based on a single attribute, and in the spirit of the Golden Rule ask that others refrain from doing so with me. Also, WP:NPA comes into play.

As for Mccready's other comments... I feel that acu should be held to the same standards as anything else in medicine, and there is plenty already cited in the article (just go to Pubmed and read the studies cited in the reviews from Cochrane, Ernst etc.). However, Mccready seems to have a double standard for acupuncture, doubting any result and questioning the motives of the researchers. Not unlike his approach to wikiquette[3][4], interestingly. So, I'm not sure if there's anything else I can say to address his concerns. regards, Jim Butler (t) 06:27, 9 February 2008 (UTC)

Jim Butler, I have noted you prefer me not to use a nickname for you. For brevity I'll address you as JB and hope that is OK. Please stop your slurs on me. Other editors have agreed the article has UNDUE weight and length problems. The UNDUE weight in the lead is by mentioning a purported condition that acu is useful for but not mentioning the huge bulk of conditions it is useless for. You have already ack'd this and therefore I have edited accordingly. How then do you propose we address the remainder of the issues of undue weight and length? I have to disagree with DR about criticism in the lead. One persons crit is another's fact. If the bulk of people believe acu may be useful, it might be good to point out up front that it largely isn't. Mccready (talk) 08:13, 10 February 2008 (UTC)

(1) I'm sorry if you believe I've slurred you. Please show me where. I believe it's calling a a spade a spade to cite your edit and block history. (2) Per WP:DR, please take care not to misrepresent my views. I don't recall ever there were undue weight problems such that therefore you should go ahead and edit as you have. I do agree with DavidR that we should refocus the lead on historical use and devote a shorter section to scientific research, but not in the biased way you suggest. (3) Your edit conflates the jury being out with outright dismissal of acu by the sci community. A great many of of our Cochrane reviews say "not enough evidence to determine efficacy". Some do say "no evidence of efficacy", but based on what we have, you're going too far. That's why I (and a bunch of other editors) think the original stable version is preferable. More work on lead to come. --Jim Butler (t) 09:51, 10 February 2008 (UTC)

P.S. My ES here should have read (emphasis added on omitted matl'l): "(rv- "most conditions no effect" not supported by sources, which frequently cite a need for more/better studies - conflates positions of agnostic and disbelief - and reword to attrib Ernst)" --Jim Butler (t) 09:56, 10 February 2008 (UTC)

For Davidruben et. al. - well, I wanted to work on the lead this weekend, but other stuff came up, both on and off wiki. Still a priority. Am also interested in improving the history section, and have some good books (including Unschuld, one of the best) at hand. regards, Jim Butler (t) 20:41, 11 February 2008 (UTC)

Fact or Crit

I have copied this from my talkpage to here. Mccready (talk) 05:48, 11 February 2008 (UTC)

In regards to my Acupuncture revert, it was done to restore the introduction. The article simply didn't make sense starting out with a criticism of acupuncture without first defining the term.Asher196 (talk) 05:43, 11 February 2008 (UTC)

Asher, the fact it that the material you removed was factual. Whether you personally regard it as critical is not the point. Even if I concede your point, please show me the wikipedia policy which says we cannot have such material in the lead. Mccready (talk) 05:48, 11 February 2008 (UTC)

I want to Wikipedia to be encyclopedic, and your version of the lead-in is confusing. Simple as that.Asher196 (talk) 05:56, 11 February 2008 (UTC)

You have now changed your story. Now you need to explain why you are confused. Otherwise will you please replace my version? Thanks. Mccready (talk) 06:18, 11 February 2008 (UTC)

I'm not saying your material shouldn't be in the article, I'm saying your material shouldn't be the lead. I came to the article by clicking the "Random article" button. The first thing I read was "Many Cochrane reviews of acupuncture say there is not enough evidence to determine its efficacy. Others say there is no evidence of efficacy. A review by Edzard Ernst and colleagues in 2007 said that the "emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions." Well, that's fine, but what is acupuncture? Look at it from the perspective of someone with no knowledge of the subject and maybe you will see my point.Asher196 (talk) 06:41, 11 February 2008 (UTC)

Fine.Yes I concede your point. But as it now stands it conveys the idea that there is controversy. This a classic altmed tactic. In fact the overwhelming bulk of evidence is that it has no effect. I'm happy to edit to take out the possibly confusing reference to Cochrane in the lead. Mccready (talk) 07:37, 11 February 2008 (UTC)

Lead

I really am getting sick of the fact that bold editing is regarded as disruptive. And it needs to be seriously noted that edit warring alone is an impossibility. I am also getting sick of the fact that some editors refuse to conduct discussion properly despite numerous attempts on my behalf. So let's try again. Could you please address three points one by one.

1. Jim Butler has acknowledged multiple times that for the great bulk of conditions acupuncture has no effect. His words are "A great many of of our Cochrane reviews say "not enough evidence to determine efficacy". Some do say "no evidence of efficacy"" He believes then that my preferred formulation goes too far. My latest formulation, reverted by him without adequate discussion, despite his edut summary, was "Many scientific reviews of acupuncture say there is not enough evidence to determine its efficacy or that there is no evidence of efficacy. However, a review by Edzard Ernst and colleagues in 2007 said that the "emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions"." On 30 January Butler said "For many more conditions, there is not enough evidence to determine efficacy. That's what the sources say." Then on 10 February he writes, after he reverts me again (and remember he doesn't edit war - only me) in contradiction to his earlier claims "rv- "most conditions no effect" not supported by sources". He also says "Of cource acu is used clinically for conditions where EBM support is lacking" then he tries to excuse this by saying "but that is also true for some biomedical modalities, including most surgical techniques." Why don't we just stick to the facts and let other article handle issues the way they will? On 3 February Butler says "The list of conditions that a particular compound or technique cannot treat is endless." Then he refuses to list any of them in the lead (a position I'm comfortable with) while listing nausea in the lead because this throws a possible positive light on acu.

So point 1. Why cannot the lead say "Many scientific reviews of acupuncture say there is not enough evidence to determine its efficacy or that there is no evidence of efficacy. However, one review by Edzard Ernst and colleagues in 2007 said that the "emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions".

2. UNDUE weight. A typical altmed tactic is to muddy the waters. Altmeders love to say science doesn't know or scientists are divided etc. Thus Butler's preferred formulation of the lead says there is scientific controversy. And Butler stoutly defends (but I edit war apparently) his preferred formulation that "Scientists are studying the mechanisms and efficacy of acupuncture." Again a typical altmed tactic to gain legitimacy - scientists are studying it so it must be worthwhile. It's a bit like the global warming "controversy" - only existing in the minds of a tiny minority of outliers. In fact most scientists, if they bother to look at CAM or acu at all, conclude it is utter rubbish. To drum up a supposed controversy is Original Research and UNDUE weight. Likewise to use the term "scientific community" which Butler also defends. Despite being asked, Butler has refused to name even one condition for which acu has unequivocally, to the satisfaction of the science community, been shown to have effect. Likewise, it's a typical altmed tactic to say further research needs to be done. So whenever Butler gets the chance he likes to quote any source he can that says so. This is undue weight.

So point 2. Why do we not delete reference in the lead to scientific controversy and scientific community.

3. Nausea. Given the above can we please delete reference to nausea in the lead. It is one of the tiny shreds of research that acupuncturists can still hold onto to give them faith that there must be something to acu after all. Needless to say there is strong disagreement by other researchers about the validity of the nausea study Butler stoutly defends in the lead (but I only edit war, remember?). By all means discuss it, for and against, but why in the lead? And for the record, my personal view is that yes there may be something in it, but so far it certainly doesn't look like it.

So point 3. Can we delete nausea in the lead?

Finally I might add that Butler's clever attempt to sideline me, while consistently refusing to discuss properly, does indeed appear self-serving. It's about time the wikipedia community looked beyond my bold comments in edit summaries and on talk pages and looked at the facts of my editing and my consistent attempts to get sensible discussion. And before even the self-styled skeptics start another attack, let me assure you I have learnt a lesson from my recently block and that my edit style and gosh yes to some extent my wiki personality have undergone a change for the better. Over to you :-) Mccready (talk) 23:59, 11 February 2008 (UTC)

Hi Mccready -- I'd like to applaud your recently taking to heart criticism that was meant as constructive. I think Fyslee, a self-identified chiro-skeptic, had it right when he said (paraphrasing) that there's not much point in revert warring, because if others agree with one's edits, they'll make sure the edits stick. If not, why bother? Even if one doesn't think others are making sensible arguments, all one can do is keep a cool head, discuss, and accept that sometimes others may disagree. That's WP, for better or worse. If you want expert oversight, Citizendium is the place for that (and of course, some will feel that those experts are probably all biased too.... e.g., only Joseph Mercola, or Stephen Barrett, has it right...can't please everyone.)

I acknowledge that I've reverted a number of your edits, but the thing to remember is that at least four other editors have agreed (and reverted along) with me, whereas you've been the only one arguing for and rv-ing to your edits. IOW, while bold editing is good, repeated bold editing against consensus is bad. See WP:BRD. But, that's the past. Looking ahead, we should be pragmatic and try to collaborate.

The other thing that's important to keep in mind is that all CAM's are not the same. Some are taken more seriously than others as shown by the volume of peer-reviewed studies. Acupuncture is in the top tier of that class, and perhaps has the greatest number of RCT's of any so-called CAM therapy. Comparing it to global warming skepticism, or saying that the moon is made of green cheese, is fallacious. Scientists have spoken en masse against the former, and do not take the latter seriously enough to submit it, time and time again, to peer review.

I would also, once again, gently request that you not misrepresent my views, as you did when saying that I have "acknowledged multiple times that for the great bulk of conditions acupuncture has no effect." False. Not so. In a field with active research, I don't read absence of evidence as evidence of absence. This is a case where the jury is out, and is actively deliberating. Ernst is no alt-med sympathizer; he's very EBM about everything, and if anything is an acu-skeptic, but even he acknowledges research is active and the issue is controversial. (I'd add that in my view, and per several V RS's, the issue of proper study design is critical and not well-settled.)

I disagree re omitting nausea and other positive findings from the lead. The idea that it's "undue weight" to cite it, if we talk about evidence or lack thereof for other things in the lead, makes no sense to me. Am I the only one who feels this way? Chime right in, ya'll.

And BTW, you can keep on repeating your demand for RCT's all you like, but I already replied above, and to clarify, double-blind is never gonna happen properly for a procedure as opposed to a compound, so if anything the meta-analyses are too conservative. Start with Pubmed, search terms "acupuncture pain", limits "Clinical Trial, Randomized Controlled Trial, Review, Core clinical journals." Or ask OrangeMarlin, who reputedly is able to decipher such things ;-)

Regarding your last edit, I have some issues with it:

• The statement that "the exact location of acupuncture points (is) not agreed by acupuncturists" is not supported by the source, which instead says "the definition and characterization of these points remain controversial". I've read lots and lots of point location texts, and compared them, and there is little disagreement over the location of the major channel and extra points on the body (Liv-8 is about the only one I can think of); only in subsystems like hand and ear acupuncture (which often involve mapping a homunculus onto those respective body parts; TCM loves systematic correspondence) can one find significant variance.
• The second and second-to-last sentences are virtually identical.

Anyway, I would prefer to move forward from here with DavidR's suggestion and reorient the lead, and generally improve the article as I've talked about above. I'd really rather write than argue, especially if I'm in the minority and arguing is fruitless. Does that seem like a sensible approach? Pouring you a cold beer now (if that's your thing ... substitute recreational beverage of choice). regards, Jim Butler (t) 10:27, 14 February 2008 (UTC)

Partially reverted, for reasons above: (a) source didn't meet the claim re point location. (b) it's redundant to say Many studies say there is not enough evidence to determine its efficacy while others say there is no evidence of efficacy ... For most other conditions reviewers have found either a lack of efficacy ...or have concluded that there is insufficient evidence to determine if acupuncture is effective". Apart from removing the claim re (a), my edit doesn't change the meaning of the lead at all, just yet (pondering how to do that re history, migration to the West etc.). Also, I'm not sure whyquit.com is a V RS, and in any case, I'd like to suggest a guideline for new stuff like that: first edit the article, then synthesize the lead from that. That's per WP:LEAD. regards, Jim Butler (t) 10:27, 14 February 2008 (UTC)

---

(sorry been busy in real world last couple days) OK, above looks more promising being a discussion on how to approach further editing. I'll make a few observations (ignore as you see fit)

• "contentious" or similarly implied phrase needs including: western medicine has obviously not (yet) wholeheartedly included this into its own practice and does not accept the traditional proposed underlying mechanism of action of Qi, conversely (until recently) the Chinese would have relied exclusively upon TCM. So what is common experience & approaches taken in health care are very different for large fractions of the world's population, there is a discrepancy and therefore some degree of tension between the viewpoints. As Wikipedia should not be US/UK centric, the practice of approx 1/4 of the worlds population is highly notable.
• Jim Butler and Mccready are clearly more familiar with literature on acupuncture than most wikipedians, so I'll refrain from commenting on any single paper or how firmly various viewpoints identify with that paper.
• Point about lack of evidence for efficacy is not the same as evidence that lacks efficacy is a good one and all too often forgotten. However given that studies generally can only confirm a positive rather than a negative, not unreasonable that an extensive practice acquires a body of supportive evidence - and conventional medicine is also guilty of this. Example: one might suppose that use of bath oil emollients for patients with dry skin and eczema is a good thing, but a surprising lack of evidence for this (vs. just apply full-on creams after a bath) - and a recent Cochrane review was highly critical of the practice not so much that this of disproved effectiveness, but rather that such a common and expensive practice lacked support and so needed to be questioned.

But might I suggest you take a step back from concentrating on these few sentences of the lead-in. As you two are exploring ways to work better together, can I suggest a few wikidiversions (aka some lateral thinking):

1. Firstly put on the back burner current discussion on that paragraph, and find some parallel parts of the article that need improving. Select a dull, dry, most matter-of-fact points you can find and see if it can be better written (i.e. good English rather than necessarily great expansion or clarification) and better sourced. There must be some points you can happily agree with (how about representation in Chinese art, or role of acupuncture as forming part of Chinese self-identity). If you can work together on such aspects this will help regain trust and AFG.
2. Be really brave and rather than trying to edit in a style that is shifted from your personally held viewpoint to that of NPOV, instead agree to edit only as if from your opposing view point trying to approach the NPOV. I promise you it is much harder than you might think, but does wonders from being a good encyclopaedic copywriter, rather than a participant in a discussion forum arguing out a case. Consider what makes a good competitive Debater: being given an unprepared bizarre untenable proposition to have to earnestly debate and defend :-)
   Hence (following points of course would need references to cite) Jim Butler try adding something about how western medicine has traditionally rejected or felt threatened by acupuncture (perhaps seen as vanguard opening the way for all other CAMs diverting limited resources/spending to what is/was seen as "unproven" treatments) and Mccready add something on scope of acupuncture use in China (NB factual usage, not whether proven effectiveness). Likewise Jim Butler on perhaps unrealistic claims made for acupuncture (surely some less scrupulous practitioners may make wild claims for treating conditions for which wider acupuncture/TCM community would view as unjustified) and Mccready on the "professionalisation" of practitioners in the west, from just a few practicing enthusiasts to voluntary organisations to official legislated bodies - I'm guessing here but presumably: addressing clinic sterilisation protocols, continuous training and reaccredidation, financial propriety, personal propriety such as move here in UK to have everyone who works intimately with members of the public to be required to have undergone a police criminal check (i.e. not on a Sex Offenders register).

There is only one thing better than a good edit, and that is a good edit that makes one feel virtuous and gains one kudos :-) I'm not going to suggest that you two become each other's best friend, but if you could agree to flip roles and form a team, then as such knowledgeable people on the subject, that would be an incredibly strong team to move this article forward from B-class to Featured Article status. Hence Jim Butler be the proactive one to (disappointingly) add a major study that fails to confirm acupuncture effect in a condition (rather than Mccready gleefully adding this and risk being seen to push the conventional medicine POV) and conversely where a good paper finds some positive effect a (somewhat surprised) Mccready adds this (rather than Jim needing to fly the flag). Before anyone argues impossibility of this as acupuncture does/does not work, reflect that we all know that it is a statistical certainty that in research with multiple studies at least some will report positive findings and some negative so there will opportunities on both sides (irrespective of where one personally thinks the balance of papers will prove to be).

So foster exemplary super-civility, scrupulous AFG thanking each other for valid points, time & effort in contributing and going out of you way to ensure your personal counter-viewpoint is fairly described (I’ll coin the terms "wikihiatus", "wikiparallel", "wikireciprocate"). This is an article/topic that should easily warrant Feature Article status and eventual inclusion as article of the day on the Main Page, work to that goal, not whether can be resolved as absolute proof/disproof. If you can move the article forward (and bring a fresh spring clean to this talk page), then consider seeking Wikipedia:Peer review (a copyediting, not expert academic, process), to gain some outside views on what this artcle lacks and what, as leading contributors to this article, you can help do. David Ruben ^Talk 15:40, 14 February 2008 (UTC)

Excellent general advice. Re "writing for the enemy", note that I was doing that 18 months ago,[5][6] as well as recently[7]. --Jim Butler (t) 19:07, 19 February 2008 (UTC)

Pain

I noticed that on 3 Feb Jim Butler inserted the reference to pain in the LEAD. The reference is unsourced. The use of acupuncture for pain relief is also highly controversial. For these two reasons the statement on pain in the LEAD implying perhaps some efficacy should be removed. Please comment. Mccready (talk) 02:09, 15 February 2008 (UTC)

The wording ("with the aim of") is already adequately NPOV, but I added a ref nonetheless. --Jim Butler (t) 05:30, 15 February 2008 (UTC)

Hi Mccready. Why are you trying to add Quackwatch to the lead again when you've already tried twice [8][9] and have been reverted by two different editors[10][11]? The second rv was very clear in the ES as to why, and I also discussed the reasons in archived talk. So, I've reverted, both because QW is not a good source here and also because the definition uses aforementioned "aims to..." language that invokes no scientific evidence (which we go on to cover in detail anyway).

It's really good that you're trying to turn over a new leaf in terms of wikiquette, but repeated bold editing with which most or all other editors disagree is still disruptive, even if it stays within 1RR, cf. feedback from admins here. thanks, Jim Butler (t) 21:38, 15 February 2008 (UTC)

My tuppence worth: I personally find Quackwatch useful for some of the more bizare internet claims one sees - often commented by QW already. However it has been debated previously at wikipedia how much of an individual blog vs open peer-reviewed process it is (this is not the place to rehash that debate), but consensus was that did not form a reliable source as per our (wikipedia) guidelines (WP:RS) or that it constituted more of a tertiary source (which is not allowed). So whilst I personally might find QW articles interesting (if sometimes a little over-the-top), they should not generally be used as a citation to support material here in wikipedia. Whilst I have sympathy with the idea that if a majority-opinion body decides not to comment on a minority's views, that may leave an absence of sources to cite from, there is merit in WP's assessment of QW usefulness; instead more direct primary or secondary sources need be found. David Ruben ^Talk 22:00, 15 February 2008 (UTC)

I agree; I think where can be good is as a counter to vanity claims in fringe topics. But for well-known areas that have attracted plenty of V RS commentary, it's gratuitous. best, Jim Butler (t) 22:08, 15 February 2008 (UTC)

paring lede

As an unlooked for side effect of trying to prettify and and properly integrate User:Mccready's recent edits, I reorganized and significantly rewrote the introduction. On inspection, this is far too drastic a change to introduce without discussion, so I am bringing it here; also, I do not have time tonight properly to place the content that it seems to me has no place in the new order. The major motivation for rewriting the lead section is that it swiftly devolves into verbose argumentation without first adequately explaining what the practice entails. Criticism and acceptance from the scientific community are crucial (lay opinions might also be nice), but I think that citing individual studies and conditions clutters the section and invites WP:SYN without allowing proper depth of treatment. This aggressive flensing leaves the second paragraph far too dependent on Ernst, and will definitely need to be fleshed out with a few recent high-quality unimpeachable systematic reviews. I have tried to err on the side of credulity, please comment and revise. - Eldereft ~(s)talk~ 10:47, 8 April 2008 (UTC)

Acupuncture (from Lat. acus, "needle", and pungere, "prick") or in Standard Mandarin, zhe-n bia-n (a related word zhe-n jiu( refers to acupuncture together with moxibustion) is a technique of inserting and manipulating fine filiform needles into specific points on the body with the aim of relieving pain and for therapeutic purposes. These acupuncture points lie along meridians along which qi, a kind of spiritual energy, is said to flow. There is no generally-accepted anatomical or histological basis for these concepts, and modern acupuncturists tend to view them in functional rather than structural terms, (viz. as a useful metaphor in guiding evaluation and care of patients). Acupuncture is thought to have originated in China and is most commonly associated with Traditional Chinese Medicine (TCM). Different types of acupuncture (Classical Chinese, Japanese, Tibetan, and Korean acupuncture) are practiced and taught throughout the world.

The practice of acupuncture predates the scientific method, and the Western scientific community initially reacted to the idea with skepticism and assignment of a low prior probability. Despite numerous clinical trials designed according to the precepts of evidence based medicine, the objective effectiveness of acupuncture beyond non-specific placebo effects has not been convincingly demonstrated, and remains controversial among researchers and clinicians. Further, several reviews have reported cultural, geographical, or other bias in published outcomes of scientific studies of acupuncture. The body of evidence remains inconclusive but is active and growing, and a 2007 review by Edzard Ernst and colleagues finds that the "emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions".

The WHO, the National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (NIH), the American Medical Association (AMA) and various government reports have all studied and commented on the efficacy of acupuncture. There is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles, and that further research is warranted.

Hi Eldereft, how goes it? Just the other day, as I was marveling at what a remarkable 6,000-year-old, non-climate-changing earth we're living on, I had a psychic premonition that you were editing this page. And I was right!!  ;-)

Great you and Orangemarlin and Davidruben are editing here. Wish I had more faith in WP or I'd be editing this one more actively. Anyway, I appreciate your efforts, including the above attempts at distillation, although there are a couple things I'd argue for changing. In general, I think Mccready's edits here tend to be highly biased and point-y, and that there is little of merit -- substantively or aesthetically -- in his recent attempts at re-writing the lead.

The "convincingly demonstrated beyond placebo" business is something of a red herring, IMO, because acupuncture is a procedure and not a pill, so one can't run double-blinded trials. So Mccready's list is true in a sense, but it is far from the whole truth. I'd be interested in Orangemarlin's view on whether every article on WP on any procedure should contain such a list, because it is equally true that there is no gold-standard EBM evidence for coronary bypass surgery, hip replacement, and on and on. Of course, that's a rhetorical question; it would be ridiculous to include such lists, both for aesthetic and undue weight reasons.

And of course the statement that Mccready keeps wanting to add, that a minority of scientists accept acu, is something that he's unable to support in any way except the most tenuous of original syntheses.

What I think might be better is to say something to the effect that for the last few decades the efficacy and mechanisms of acu has been studied, and remains controversial, and that the most promising areas are in pain control, and treating stress and nausea, and then keep fleshing that out further in the article. That seems consistent with what reviews say, as well as the studies themselves. A good way to weed out the chaff at Pubmed is to use the limits: (a) Type of Article: Clinical Trial, Meta-Analysis, Randomized Controlled Trial, Review; (b) Subsets: Core clinical journals, Dental journals. Can't link to the search directly.

Gotta go; will suggest some prose later. cheers, Jim Butler (t) 02:30, 9 April 2008 (UTC)

I would say that I am doing great, but the secret government agents that I am watching are preparing for imminent alien activity and I need to hide before Elvis gets involved.

I would disagree that conducting properly blinded RCTs and demonstrating action beyond placebo is impossible. There have been designed some apparently quite clever retractable needles, and a really interesting study was published last week (Components of placebo effect) on splitting out different aspects of care to study individually their influence on the placebo effect. On the other hand, that is just a details issue that can be ironed out once we can all agree on a structural framework. Placebo response figures pretty prominently in the literature, but I am open on how precisely that is presented in the lead.

I would expect that "only a minority of scientists accept acupuncture" is true, but only in the trivial sense - I also have no particular opinion on whether post-surgical outpatient visits should routinely include a scan with a handheld ultrasound for thromboembolism. This statement requires a source, and unless major scientific bodies have start naming it anathema while I was not paying attention, I am not sure that one will be forthcoming.

I would like to avoid cluttering the limited introductory real estate, but characterizing the areas of suggested or demonstrated (lack of)/efficacy should be possible and worthwhile. This might need to be qualified be mentioning the range of use in TCM, which sacrifices a little in the way of paragraph focus.

Thanks for your reply, I look forward to more. - Eldereft ~(s)talk~ 06:33, 9 April 2008 (UTC)

It's easier to approximate the "gold standards" of double-blinding and placebo controls for acupuncture than it is for, say, coronary bypass surgery. It's still far more complicated than doing so with pills, though. So whatever we say about placebo here, as for any therapeutic procedure, should somehow factor in the caveats involved in proper study design. One sentence will do and I'm sure that in an inspired moment I'll come up with one. cheers, Jim Butler (t) 07:47, 12 April 2008 (UTC)

Just to add, Eldereft, I haven't forgotten about this. Have been busy IRL, but still taking an occasional moment to swat away some disruption from this page's perennial disruptor. Thanks for your patience. At the moment, I think your version is a move sideways, better and worse in some respects. Sorry for slo-mo editing, but we'll get there. cheers, Jim Butler (t) 09:29, 20 April 2008 (UTC)

(de-indent) - OK, how about this? cheers, Jim Butler (t) 21:19, 27 April 2008 (UTC)

Explanation: I think my second para is more appropriate since the "prior probability" stuff needs a cite and is jargon-y. As I mentioned above, discussions of efficacy w/r/t placebo are are knotty ones for procedures (e.g. surgery) as opposed to pills, and invoke arguments about study design that I thought were better discussed in the article. Thus, it seemed that a more general statement was better. On the sentence about cultural biases in studies, that's an artifact of a Mccready drive-by where he inappropriately inserts any and all new material into lead sections; I've placed it in the appropriate section, but its weight in the article does not demand lead inclusion. cheers, Jim Butler (t) 00:37, 28 April 2008 (UTC)

This page should be beneficial in getting down firm operation definitions of acupuncture, scope, etc.. as well as guidelines on the topic. It would be wise to consider these sources in the reformation of the article. CorticoSpinal (talk) 21:55, 27 April 2008 (UTC)

Dynasty of Origin

Does anyone know the dynasty of origin of acupunture??? I DO!! It originated i the Han dyansaty under the rule of Emperor Wudi. htey also created paper, the seismograph, sundial, and made many new achivements in art. this was a very sucsesful dynasty. 76.102.128.126 (talk) 03:00, 10 April 2008 (UTC)--

Mccready and lead, part 19 in a continuing series

For McCready, re this string of attempts [12][13][14][15] to add undue weight, make a point and generally violate the letter and spirit of WP:LEAD... echoing Dematt above, are you trolling? We don't need to use the lead to list all the areas where acu's efficacy is unproven, or even some of them. We cover the topic (i.e., efficacy) more than sufficiently in the lead, and quite a bit more under Acupuncture#Scientific_research_into_efficacy, where we also offlink to Cochrane's list of acu reviews as well. --Jim Butler (t) 07:50, 12 April 2008 (UTC)

Effectiveness

For the following conditions, the Cochrane Collaboration concluded there is insufficient evidence that acupuncture is beneficial, often because of the paucity and poor quality of the research and that further research would be needed to support claims for efficacy: Giving up smoking,[16] chronic asthma,[17] bell's palsy,[18] shoulder pain,[19] lateral elbow pain,[20] acute stroke,[21] rheumatoid arthritis,[22] depression,[23] and induction of labour.[24]

please delete all duplication below and merge with above summary (thanks)

Acupuncture for depression - There is insufficient evidence that acupuncture may be helpful with the management of depression[25]

Acupuncture and related interventions for smoking cessation - Acupuncture and related therapies do not appear to help smokers who are trying to quit.[26]

Acupuncture for Bell's palsy - inadequate to allow any conclusion about the efficacy of acupuncture.[27]

Acupuncture for schizophrenia - We found insufficient evidence to recommend the use of acupuncture for people with schizophrenia.[28]

Acupuncture for epilepsy - No strong evidence for acupuncture as a treatment for epilepsy[29]

Auricular acupuncture for cocaine dependence - The authors conclude that there is no evidence that any form of auricular acupuncture is effective for treating cocaine dependence.[30]

Acupuncture for insomnia - there is a lack of high quality clinical evidence supporting the treatment of people with insomnia using acupuncture[31]

Acupuncture for glaucoma - At this point, the effectiveness of acupuncture as a therapeutic modality for glaucoma could not be established[32]

Acupuncture for chronic asthma - Current evidence has not shown an effect in favour of acupuncture compared with control treatment for asthma[33]

Acupuncture for acute stroke - No clear evidence of benefit from acupuncture in acute stroke [34]

Acupuncture for vascular dementia - There is no evidence from randomized controlled trials to determine whether acupuncture provides any effect when treating people with vascular dementia[35]

Acupuncture for treatment of irritable bowel syndrome - There is no evidence to support the use of acupuncture for the treatment of irritable bowel syndrome.[36]

Acupuncture for stroke rehabilitation - No clear evidence of the effects of acupuncture on stroke rehabilitation[37]

Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis - From the little evidence that there is, acupuncture does not appear to improve the symptoms of rheumatoid arthritis.[38]

Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea - there is not enough evidence to assess the effect of acupuncture[39]

Acupuncture for induction of labour - There is insufficient evidence describing the efficacy of acupuncture to induce labour[40]

Commentary on Effectiveness

There may be a place somewhere in this article for this info. Yes or no? QuackGuru (talk) 15:13, 12 April 2008 (UTC)

Yes equivocally. That place, however, is under Section 5: Scientific research into efficacy, ideally as a properly formatted wikitable. The article is already 81 kb long, so it might be preferable to summarize the information and provide a link to a separate Efficacy of acupuncture article. - Eldereft ~(s)talk~ 16:06, 12 April 2008 (UTC)

Under the section Scientific research into efficacy is the place to add this info. A brief summary is preferable. QuackGuru (talk) 16:11, 12 April 2008 (UTC)

Wow, I actually agree with QuackGuru -- now that's a promising omen. I will consult the I Ching and we can take it from there, assuming the goat entrails don't suggest otherwise. ;-)

Actually, what Quackguru says is a pretty good description of how the efficacy section reads now, give or take a condition. That's why the ugly list in the lead is superfluous.

I've expressed concerns in the past that an Efficacy of acupuncture-type article could become a POV fork, but perhaps we could overcome that by keeping this article and an efficacy article adequately harmonized with each other. Certainly there is a lot of material here on efficacy, so it's a logical candidate for splitting, as I did with Regulation of acupuncture, which turned out OK. There is another article, Scientific theories regarding acupuncture, that is basically a lot of WP:OR and WP:WEIGHT "bathwater" with just enough "baby" to retain, perhaps, some value. That's the kind of article I would not want an efficacy article to become. --Jim Butler (t) 00:57, 13 April 2008 (UTC)

This article is a lot more peaceful to discuss things unlike the chiropractic article. There is an Effectiveness section that has been repeatedly deleted from the chiropractic article. I have learned from that content dispute. It is better to discuss on the talk page and then edit the article. I hope this article will improve from this discussion and information. QuackGuru (talk) 01:21, 13 April 2008 (UTC)

As a point, the we cannot call the section effectiveness of chiropractic because we cannot study the effectiveness of a profession. Rather, it should state acupuncture vs. SMT which is more factual and appropriate. CorticoSpinal (talk) 07:32, 13 April 2008 (UTC)

Where is acu vs chiro discussed? Not in this article, right? --Jim Butler (t) 09:30, 20 April 2008 (UTC)

OK, I added the additional conditions to the efficacy section. I trust that suffices. --Jim Butler (t) 20:38, 27 April 2008 (UTC)

Sourcing

Parts of this article lack references, which is particularly troublesome when making quotes and summarising specific named studies, as the material becomes very hard to verify. Shoemaker's Holiday (talk) 06:39, 22 April 2008 (UTC)

Hi SH -- which parts that cite quotes/studies are unsourced? I'm not aware of any, but maybe I'm overlooking something. I know there is some unsourced stuff in there but it's mostly about the history of acupuncture, not research or quoted opinion. regards, Jim Butler (t) 23:00, 23 April 2008 (UTC)

Please, by all means fact tag them. I semi-regularly run through various pages searching for the text "citation needed", but am less likely to notice otherwise. - Eldereft ~(s)talk~ 23:47, 23 April 2008 (UTC)

Butler bulk revert

The silly bulk revert of my hour's work by Butler a few minutes ago cannot be allowed to go unchallenged. This is the last straw. He deleted uncontroversial and good edits and claimed they were addressed on talk. I'm not going to wade through thousands of words of talk to see what he means on this occasion. This new thread will allow him to say why he removed well sourced well edited material which other editors had suggested.Mccready (talk) 01:54, 28 April 2008 (UTC)

First, I reverted because your edit was redundant and sloppy, and ignored discussion on this page.

If it took you an hour to do two cut and pastes -- the second paragraph from Eldereft's draft above, and the material you've been edit warring about, then my heart goes out to you: you must have a very slow internet connection indeed.

Sorry you were puzzled as to where my discussion of my edit might be. Hint: a logical place for it would be at the bottom of Talk:Acupuncture#paring_lede, from which you cut and pasted your hour-long edit. Another good way to find out when editors may have recently edited a page is to use the history, which shows this: 00:37, 28 April 2008 Jim Butler (Talk | contribs) (82,370 bytes) (→paring lede: explanation). Lo and behold, there are my comments.

Another thing the edit history shows is that the last time you edited this page, apart from your comment above, was 13:42, 17 March 2008. All this time you've been revert warring on the article, and you haven't discussed till now. You have it backwards: you need to be discussing a lot more and reverting a whole lot less.

As for our respective edits: you may not have noticed that I made a number of edits to the article today, including working in the material over which you've been revert warring. Your edit completely ignored that, and redundantly re-added list of conditions, and with poor formatting as well. As for my changes to the lead, those were based on Eldereft's draft above and our ensuing discussion (more below).

Since your edit adds redundant material and doesn't take into account the discussion following Eldereft's draft, I'm mostly reverting. Please feel free to continue the discussion. Why is "spiritual energy" preferable to "vital energy" given that most TCM-er's wouldn't call qi spiritual? Where is a reliable source on "prior probability", and why does a jargon-ish term like that belong in the lead? And most importantly, what is the threshold for objective efficacy beyond placebo, and how is that reached with acupuncture and other procedures (as opposed to compounds)? Has any surgical technique ever objectively been proven via double-blinded studies to be effective beyond placebo, and if not, isn't that the wrong question to be answering, cf. undue weight? I'd argue yes, and that a more general presentation, with further unpacking in the article, is preferable. --Jim Butler (t) 02:24, 28 April 2008 (UTC)

I think the problem we have here is that some kinds of treatment with acupuncture DO seem to survive reasonably serious scientific scrutiny - whilst others are no better than quackery. This is unfortunate because many of us (I have to confess to being one) are very much against the promotion of quackery to the status of science. However, when science shows that something works, it's vital to put away the skepticism and to start seeking an understanding of how the darned thing works. But here we have both...some things that you see all over the place (such as helping people quit smoking using acupuncture) are undoubtedly quackery of the worst kind - whilst others do indeed seem to work against all reasonable predictions. It is therefore ESSENTIAL that those of us on either side of the pseudo-science wars get together on this one subject where we ought to be able to put together something useful. We need to clearly separate out the things that we have good evidence that they work from the things that we have equally strong evidence do not. We can then proceed to write usefully about the areas of medicine where it's useful - including the occasional side-effect...and also to clearly state the areas where it does not work and fraudsters and charlatans need to be exposed for what they are - with appropriate language about the efficacy of placebo-effect "cures". May I suggest first separating out the material we have into two sections and proceeding from there with the detailed wording. SteveBaker (talk) 03:09, 29 April 2008 (UTC)

Hi Steve, and welcome -- your thoughtful comments are most welcome, especially given that the temperature has run a bit high lately. I agreed with almost everything you said except the very last part about splitting things into two sections. It's absolutely important to present the state of the art of scientific knowledge, but we have mostly shades of grey here, and I'd hate to see needless disputation over the somewhat arbitrary demarcation of what is proved vs unproved, as opposed to proved vs disproved. The section Acupuncture#Scientific_research_into_efficacy attempts to simply give evidence regarding different conditions, roughly descending in order of demonstrated efficacy. I'm sure that can be improved upon, but I have serious reservations about putting everything into two baskets... regards, Jim "Bulk Revert" Butler ;-) 03:24, 29 April 2008 (UTC)

Full protection

I have fully protected this article for a three day period due to apparent edit warring and disagreement. Please sort the issue out using this forum before these three days are up. -- Anonymous Dissident^Talk 04:17, 28 April 2008 (UTC)

Thanks; the principal disruptor generally eschews talk and has been blocked for 7 days, so I think this can be safely removed. cheers, Jim Butler (t) 03:26, 29 April 2008 (UTC)

Relationship of acupuncture points and meridians to connective tissue planes

This paper by Langevin and Yandow presents a fascinating (or fascia-nating) hypothesis regarding an anatomical basis for acupoints. Probably the most plausible I've seen. --Jim Butler (t) 00:45, 11 May 2008 (UTC)

Changing the introductory paragraphs (2)

Regarding the specific quote by Ernst, how about replacing it by one from his (and Simon Singh's) new book:

"acupuncture is very likely to be acting as nothing more than a placebo"

(Trick or Treatment, p 87)? That sounds to me a fairer summary of Ernst's, at least, position? RandomP (talk) 20:07, 10 May 2008 (UTC)

They are both relevant experts, and I have heard good things about that book. It does not come out until August, but if you have an advance copy identical to the retail version it can probably be quoted (cited to both of them unless the organization of the book indicates otherwise). It is verifiable in principle, though you will need to be especially careful not to misrepresent the source in any way. You might want to take it up at Wikipedia:Reliable sources/Noticeboard, though. - Eldereft ~(s)talk~ 20:52, 10 May 2008 (UTC)

It's out in the UK, and I believe you can order it for shipment to the US.

RandomP (talk) 17:27, 11 May 2008 (UTC)

Whoops, time to get a {{globalize}} sticker for my forehead. Thanks. - Eldereft ~(s)talk~ 16:56, 13 May 2008 (UTC)

@RandomP: Except that what we're doing in the lead is attempting to summarize the evidence as presented in the article, not summarize the opinions of Ernst per se. I think we went with the quote that in the present version because we agreed that it squared well with the Cochrane reviews below. We don't have to rely on his quote if another summary (citing different or multiple sources) works better.

Ernst is unquestionably notable, but there are many notable commentators on acu, with a spectrum of opinion. And in any case, the whole point of EBM is that peer-reviewed meta-analyses are more reliable than the opinions of experts. --Jim Butler (t) 21:45, 10 May 2008 (UTC)

Currently, the lead represents someone from the "acupuncture is placebo"-camp, which appears to me to include everyone who's seriously studied it in the West, as being from the "acupuncture works sometimes, but not in concordance with the "theory" behind it" camp. That's unacceptable.

I think the scientific consensus on acupuncture is recently quite clear, though before about 2000 there was actual controversy, not least because of the WHO statement. If you want to portray that as a spectrum, I think it's important to point out that there's also a clear temporal trend: the more we know about acupuncture, the less it appears to work.

RandomP (talk) 17:27, 11 May 2008 (UTC)

Hi RandomP -- Ernst may well have changed his view on acu with the publication of his book with Singh. Prior to that, his commentary on acupuncture has been far more nuanced, e.g. "Compelling evidence now suggests that real acupuncture is better than sham acupuncture for a range of pain-related syndromes, e.g. back pain" (2005), as well as the two reviews currently cited in the lead (2006, 2007). The one from 2007 is the source of the quote: "The emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions". So there has been no negligent misrepresentation of Ernst (although, as your quote suggests, he may well have changed his mind very recently). Indeed, Ernst's 2007 review reaches a conclusion that contradicts your last sentence regarding a temporal trend: "For 7 indications it has become more positive (i.e. favoring acupuncture) and for 6 it had changed in the opposite direction." [41]

In any case, I hope you agree that per WP:LEAD, our first priority in the lead section is to summarize the most salient points in the article.

As for your perspective on scientific consensus, I'm wondering what sources you base that on? I'm sure you can find some sources saying that acu is likely placebo, but if we're going to assert consensus exists, we'd better be sure our sources can meet the claim. Please see WP:RS#Claims_of_consensus. Who is saying that consensus exists? regards, Jim Butler (t) 19:02, 11 May 2008 (UTC)

Concurred - now that the lead is finally pared down to a manageable size, it would be nice to keep it that way. I got distracted by hoping that the new book was out, and was commenting solely on that point. Somewhere under Scientific research into efficacy might be good for the article, though. You might also work it in to (desperately needed) improvements to Scientific theories regarding acupuncture or Medical acupuncture. If you find a reliable source indicating that this placebo opinion is held by a significant portion of relevant researchers, that could be citeable in the lead as such, though.

As a side note, would we be interested in getting one of those nifty series templates for navigation between all the acupuncture articles? There are several. - Eldereft ~(s)talk~ 23:50, 10 May 2008 (UTC)

I too look forward to reading Ernst's book. I don't always agree with his interpretations of evidence, but I agree with his basic approach and believe he's honest. For sure the book will be a good source here and in other acu and CAM articles. Also, contrary to Mccready's fuming, I have no problem citing placebo anywhere here, including lead, but for the lead I agree it would have to be appropriately sourced and presented (since it's kind of complicated).

Thumbs-up on the series box idea (only caveat being formatting, i.e., space at the top). On the other two acu articles you cited, they are kind of a mess... both are very fork-ish and heavy on original research and weight problems. Probably each could be AfD's, salvaging maybe a paragraph's worth of good stuff that could be plopped in here. (And since this article is already long, other stuff, like a more general sci/efficacy article, could be spun off). But a few editors seem to have been really into keeping them, so I haven't pressed that issue.... cheers, Jim Butler (t) 00:43, 11 May 2008 (UTC)

Also, although Ernst's forthcoming book will certainly be a reliable source, it won't be quite at the level of a peer-reviewed systematic review, per WP:RS#Scholarship. Books are a good opportunity for scientists to state their opinions; there, they don't have to be quite as conservative as in peer-reviewed journals. Just a small caveat, not a big deal. --Jim Butler (t) 04:36, 12 May 2008 (UTC)

(undent) @RandomP - find a funnel plot supporting an inverse relationship between quality of study and likelihood of finding a significant effect. We already have a little bit about the geographic bias and the generally poor (though stellar compared to some alternative medicines) state of the evidence base. While I maintain that this must inform the weight given various studies and positions, I fail to see how it would not be original research to draw such a conclusion based solely on the sources currently cited. Ioannidis 2005 has some interesting ideas on how to interpret a weak evidence base, though applying their criteria directly to the situation at hand would of course run afoul of WP:NOR. - Eldereft ~(s)talk~ 16:56, 13 May 2008 (UTC)

Navbox

I have placed a proposed Navigational template at Talk:Acupuncture/Navbox. I would like to move it to template-space and add it to the bottom of the articles in a week or so if there is consensus on its utility. Particularly welcome are any articles I missed, comments on the organizational scheme, and (dis)advantages compared to Category:Acupuncture. - Eldereft ~(s)talk~ 00:31, 28 May 2008 (UTC)

Circular argument

I don't want to be too rigorous, but this phrase here: "There is scientific agreement that an evidence-based medicine (EBM) framework should be used to assess health outcomes and that systematic reviews with strict protocols are essential" is a circular argument. An "evidence-based" medicine is a scientific medicine. It is just a way of saying there is scientific agreement that medicine should be practiced scientifically. If anybody that was not convinced that science was the best way for medicine becomes convinced because of the phrase, it would be because he was tricked. I will remove it because of that. —Preceding unsigned comment added by 189.10.1.162 (talk) 13:39, 16 June 2008 (UTC)

I think there are other ways that scientists could seek to understand this. Evidence-based implies that we're going to do a lot of clinical trials and measure the results. Instead, they could have said "Theory-based" - suggesting that we should seek to understand HOW it works from basic biological principles regardless of whether it seems to work or not. This was never a "circular argument" - but (if we take your view) a "tautology". However, I believe it to be neither of those things - so on reflection, I'm reverting your change. SteveBaker (talk) 14:02, 16 June 2008 (UTC)

Indications and WHO

The Indications according to acupuncturists in the West section discusses WHO having endorsed the effectiveness of acupuncture for the asterisked conditions. Is this ultimately cited to the 1979 Viewpoint? A great deal has occurred acupuncture research since then, both in terms of elucidating the publication bias in the field and in terms of rigorous investigation. I am not finding a more recent comparable document, but regardless it seems reasonable to at the very least note the historical nature of the opinion if not striking it outright. The closest I have found to the WHO's current stance is the Traditional Medicine factsheet:

Acupuncture has been proven effective in relieving postoperative pain, nausea during pregnancy, nausea and vomiting resulting from chemotherapy, and dental pain with extremely low side effects. It can also alleviate anxiety, panic disorders and insomnia.

It would be nice if the factsheet cited a full report, but sadly it is not that sort of document. Can anyone else find a better resource? - Eldereft (cont.) 04:14, 21 June 2008 (UTC)

References

Please put new sections above this one.

NIH advises against using the consensus statement

The NIH consensus statement now starts off

This statement is more than five years old and is provided solely for historical purposes. Due to the cumulative nature of medical research, new knowledge has inevitably accumulated in this subject area in the time since the statement was initially prepared. Thus some of the material is likely to be out of date, and at worst simply wrong. For reliable, current information on this and other health topics, we recommend consulting the National Institutes of Health's MedlinePlus

http://consensus.nih.gov/1997/1997Acupuncture107html.htm

I think that this probably needs to be noted. 68.57.206.49 (talk) 21:08, 26 June 2008 (UTC)