Talk:Acupuncture

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• /archive1: December 2002 - February 2006

Cochrane Collaboration

Hi Jim

Thanks for your work on the article. I would like you to consider putting back some of the material you removed. I didn't cherry pick, and it was a list of criticisms. If you google acupunture on cochrane you will see what I mean. I also reported accurately that Cochrane had some support for P6 in the wrist. Looking forward to some good collaboration on this one. Mccready 23:23, 16 February 2006 (UTC)

Hi Mccready, yes, I think it's fine to list some of Cochrane's conclusions as long as it's a balanced list and includes some of the stuff for which they thought acupuncture was valid (unless P6 was the only one!). There are a lot of hits on Cochrane for acupuncture and I'm not sure how to sort through it all efficiently. Cochrane does seem to be a pretty good EBM site and not biased against CAM in the way NCAHF/Quackwatch/Barrett are. I appreciate the spirit of collaboration too; it's a real strength of this site. Best regards, -Jim Butler 06:59, 17 February 2006 (UTC)

Hi McCready, I see that you simply reverted, but did you understand and address the concerns I expressed just above? Thanks; more on your other edits later; have a great weekend. -Jim Butler

Hi Jim and Mccready

I have read some Cochrane articles. No, I am not a scientist, but I think I am intelligent enough to know that the Cochrane folks could be more straightforward with their reviews of studies. I mean, they must state if in terms of morally possible certainty, a study has already proven or not, beyond reasonable doubt, that a cure has been effected by acupuncture. You see, according to what I learned in law 101, if we insist on absolute certainty then nothing can be certain because in human affairs that is impossible; but in terms of moral certitude, then it is possible to arrive at such a certainty, namely, that which excludes all reasonable doubts. Maybe I am mistaken, that Cochrane also seeks moral certitude, not absolute certitude or scientific certitude when science is open-ended (what is scientifically certain today can be not and will not be so in the future, as science expands and grows more elaborate in its grasp of life and the universe). For example in one article I read, in the conclusion the authors of the review article say about the worth of the study they reviewed, worth=silver (meaning not gold); I might be more exact but they did use the word silver, and the mood is one of ridicule -- considering that these are supposedly academically scientific people. What about with drugs and medical procedures of conventional scientific medicine, do they also require that every drug and every medical procedure should be 100% certain to be successful? I don't think so, as a matter of fact, I know it is not so. They always tell you what probability of success you can expect from a drug or a treatment. My father was operated on for a heart bypass, and the surgeon who did the operation told my father before the operaton that he had an 80% probability of successful surgery -- but he did not tell him that his life would be as good or better than before the bypass (now he is not as good as before, whereas a neighbor who resisted bypass but insisted on medication and at most an angioplasty is better all around than my father). I can continue on and on, but I am addressing myself to Jim and Mccready: if you both are into acupuncture and into scientific examinations of acupuncture, why not invest some time and labor to pick out those cases where acupuncture is really successful, and reasonable critics are satisfied, but with moral certainty; not with absolute certitude which I think is not applied either to conventional scientific medicine. Pachomius2000 06:19, 24 February 2006 (UTC)Pachomius2000

Hi Pachomius In order to try to discuss Cochrane I'd need to know what article you find problematic. In terms of medical treatment its worth understanding that different humans respond in different ways so 100% certainty is highly unlikely. It's worth spending time understanding the concepts at [Bandolier at Oxford University]. Mccready 07:16, 24 February 2006 (UTC)

Hi Pachomius - Remember, scientists are people too, and they will have different subjective standards (and sometimes double-standards) for what constitutes "proof". Even if acupuncture ONLY treated pain (a mere "subjective symptom", as some say), it would still be highly valuable. For evidence of acupuncture (actually a related technique, moxibustion) treating a condition other than pain, see this study for treatment of breech presentation of the fetus [1].

For Cochrane's analysis of that and other studies, see this [2]. Basically, Cochrane is saying that in this case there aren't yet enough randomized controlled trials to support the technique unequivocally, but there is preliminary evidence. That seems to be a perfectly reasonable conclusion (as long as Cochrane's editors understand that procedures cannot be double-blinded in the same way pills can, and apply the same exacting standards to biomedical interventions: I have no reason to doubt their integrity on the latter point, but am not sure they have sufficiently considered the former).

What I object to is the use of double-standards: as the NIH concensus statement notes,

Assessing the usefulness of a medical intervention in practice differs from assessing formal efficacy. In conventional practice, clinicians make decisions based on the characteristics of the patient, clinical experience, potential for harm, and information from colleagues and the medical literature. In addition, when more than one treatment is possible, the clinician may make the choice taking into account the patient's preferences. While it is often thought that there is substantial research evidence to support conventional medical practices, this is frequently not the case. This does not mean that these treatments are ineffective. The data in support of acupuncture are as strong as those for many accepted Western medical therapies.

Thus, it needs to be kept in mind that in biomedicine, a number of practices are routinely used that don't rise to Cochrane's standards of proof either. Critics who highlight the lack of proof for some therapies in alternative medicine, while ignoring the similar lack of proof for some therapies in biomedicine, are biased and/or disingenuous. I think the article, as it stands, implicitly makes this clear enough, but keep in mind that many critics of acupuncture ignore this point. I hope this discussion addresses some of your concerns. -Jim Butler 21:52, 24 February 2006 (UTC)

Pachomius here -- but first: I really don't know how this discussion works in respect of contributing here; so just anyone in charge, please put my contribution in the proper place and also proper layout.

Jim says "What I object to is the use of double-standards: as the NIH concensus statement notes..."

Addressing Jim: Do you know of any Cochrane reviews about any treatments in conventional scientific medicine that obtained the same less than 100% positive rating or grading from Conchrane, as acupuncture in respect of the same medical complaint, say, low back pain or some other medical complaints; but critics of acupuncture do not object to their employment whereas they do with acupuncture? And how can this inconsistency of double-standards be pointed out convincingly to such critics? Pachomius2000 04:09, 4 March 2006 (UTC)Pachomius2000

fda

An FDA Guide to Choosing Medical Treatments by Isadora B. Stehlin FDA Consumer June 1995 http://www.fda.gov/oashi/aids/fdaguide.html said re acupuncture "at this time their safety and effectiveness are still unproven." so until another updated FDA source is provided I'll remove the claim from the article Mccready 01:40, 21 February 2006 (UTC)

Actually, in 1996 the FDA did change acupuncture needles from Type 3 devices (experimental) to Type 2 (safe and effective when used according to certain standards, i.e. sterilized, etc.). Google for "fda acupuncture safe effective" and you'll find it. I'll fix it later. -Jim Butler 21:55, 24 February 2006 (UTC)

victorian board

I haven't been able to substantiate the claim that the Australian Victorian system has been used elsewhere. In fact the system is a mess as any examination of the law or their website will show. After six years they are still working on a FAQ for the general public, their findings that some practioners were lying in the statment of claim as to English competency have not been properly pursued, the board is aware (see decisions) that practioners are achieving registration by fraud but ..... Mccready 02:21, 21 February 2006 (UTC)

NIH Consensus Statement

McCready, I took out your edit that the Consensus Statement is "outdated". Just because 1997 was nine years ago doesn't make it outdated. For it to be outdated there would have to have been some fundamentally new information. Studies since 1997 have shed new light on acupuncture's physiological effects, supported its use in some areas (e.g. osteoarthritic pain) and not supported its use in others (cocaine addicion). I don't see in any way that in sum, the studies since 1997 change the overall conclusions of the Consensus Statement. In the absence of credible arguments or evidence for a contrary claim, my revert should stand. - Jim Butler 22:04, 24 February 2006 (UTC)

Fair enough Jim, good call. Could you let me know any study to Cochrane stds on osteoarthritis. Cochrane, from my research, doesn't support it. Mccready 06:25, 25 February 2006 (UTC)

This one is pretty good; don't know if Cochrane has reviewed it or not - Berman et. al. Ann Intern Med. 2004 Dec 21;141(12):901-10 -Jim Butler 11:33, 25 February 2006 (UTC)

Example of Acupuncture Practice

Why is it necessary to say anything in the example of practice section about Cochrane, or anything else? This is why I took out all of the statements about efficacy, pro or con. As far as I can tell, this section is meant more to describe what a visit to an acupuncturist is like. The article is clear enough elsewhere on claimed and proven efficacy, standards of proof, study design etc. -Jim Butler 11:41, 25 February 2006 (UTC)

Hi Jim, I think it useful for each section to be balanced and as comprehensive/encyclopediac as possible. If a section, standing alone, can be read as one sided then we have failed WP duty. Why not draw the readers' attention to all areas of controversy so that the reader can form their judgement? Mccready 04:58, 26 February 2006 (UTC)

Yes, that is a good principle to keep in mind. I would say that we need to balance it with another principle, namely: avoiding redundancy across sections, on the assumption that the reader is intelligent enough to read the whole article. However, on this edit, since the section in question does mention the treatment of a specific condition, I can see the value of mentioning observations of efficacy. I'll leave the EBM cite in there and restore the stuff I deleted about clinical observation of tenderness to palpation and so on. Actually, I just noticed that Cochrane's conclusions were more nuanced than the one-line summary you inserted, so I'll clarify that as well. Thanks! I'm enjoying the collaboration here, and I think the article is improving quite a bit as a result. -Jim Butler 04:30, 27 February 2006 (UTC)

Berman et al

thanks jim for the link to [berman] I couldn't get the full text so almost impossible to judge its worth. I noticed that the editors said there was 25% drop out rate and results should therefore be treated with caution. Sample sizes after the drop out were small. Given that, and given the meta-analysis of Cochrane do you think we're on solid ground to conclude there is insufficient evidence that acupuncture has therapeutic value for osteoarthritis? I also found a good warning on [RCTs]. On your earlier comments re cochrane, I did understand your point, and try as i might I could only find one instance (P6 in wrist) where it might be of value. Mccready 06:01, 26 February 2006 (UTC)

Hi Mccready; Cochrane's treatment of acupuncture for osteoarthritis is in progress, so Berman et. al. will be incorporated there. Yes, drop-out rate is a confounding factor (how small is a "small" sample size, btw? relative to what?), so I'm not sure whether this study would rise to their "gold standard". On your question as to whether or not we can "conclude there is insufficient evidence that acupuncture has therapeutic value for osteoarthritis", that of course depends on what standards one chooses. One of the things I like about Cochrane is that they offer more nuanced conclusions than simply saying whether evidence is "sufficient or insufficient". I think that approach more closely corresponds to scientific and clinical reality (as opposed to, say, political reality). Knowledge is not the same as certainty, and the search for the latter can actually impede the acquisition of the former.

For example, regarding Cochrane's conclusions on idiopathic headache, your edit originally stated that "the Cochrane Collaboration found there is insufficient evidence that acupuncture is beneficial for treating idiopathic headache." However, that is in fact a rather gross oversimplification, if not outright distortion, of what they actually stated in their conclusion: Overall, the existing evidence supports the value of acupuncture for the treatment of idiopathic headaches. However, the quality and amount of evidence are not fully convincing. There is an urgent need for well-planned, large-scale studies to assess the effectiveness and cost-effectiveness of acupuncture under real-life conditions." I presume you simply erred in haste here, and have amended the article accordingly; I will also do so if and where the article's other citations of Cochrane so warrant. I think that approach is consistent with the spirit of your suggestion above to err on the side of being comprehensive, and letting readers decide. I'm really glad you brought Cochrane in, btw; fantastic resource.

Finally, thanks for the article caveating the design of RCT's. A good explanation of the virtually insurmountable with applying EBM's "gold standards" of double-blinding to surgical procedures (and by extension any procedure, such as acupuncture, that isn't readily amenable to placebo controls) is given here:

Evidence-based medicine is defined by Sackett et al. as the integration of the best available research evidence with clinical expertise and patient values. The best research evidence is clinically relevant research---both basic science and patient centered clinical research. In the ideal situation, the best clinical evidence is arrived at by a randomized, prospective, double-blind study. With diverse surgical procedures, including spinal fusion research, these designs are difficult at best and the ideal of EBM is virtually too problematic to achieve, given the unethical nature of employing a sham surgical procedure. Purely scientific evidence does not exist in spine fusion research. The best that can be achieved is a prospective randomized clinical trial. Patient acceptance of randomization in virtually any type of surgical procedure has proven problematic, albeit less so in socialized countries where patients may have less choice. Therefore, clinical decisions must be based, as Sackett states, on the best evidence available including the clinical experience of the surgeon. With this limitation in mind, it is also crucial to appreciate that the absence of ideal EBM evidence is not equivalent to the absence of truth, the absence of benefit or the absence of positive clinical effect.

cheers,-Jim Butler 07:38, 27 February 2006 (UTC)

EMB and FDA

Thanks again Jim yes I edited a bit quickly, trying to get the "cochrane doubts list" under one rubric. I'm not sure sufficient effort has gone into blinding in acupuncture research. Single blind with assessment not being made by practioner is simple and even blinding the practioner inserting needles to patient identity is feasible. In other words the EMB problem is not as tough in acupuncture as it is in fusion treatment of lower back pain.

On your FDA edit, I'm concerned that as it stands it implies FDA approval of acupuncture when in fact they were looking at whether inserting needles per se was dangerous. Would you like to consider a rewording? Kevin Mccready 08:46, 27 February 2006 (UTC)

I think we should report exactly what the FDA said/did and what it meant. What they did was reclassify acupuncture needles from Class III to Class II medical devices, which means exactly what the article says (cf. refs; like the NIH consensus statement, this caused a lot of consternation in some quarters [3], but nonetheless that's what they said). I do think it's appropriate to add a statement re the reclassification thing; it should probably also be mentioned under "Potential Risks". -Jim Butler 04:46, 28 February 2006 (UTC)

sounds good, will you go ahead and do it? Mccready 05:46, 28 February 2006 (UTC)

I sure will - within a day. Cheers! -Jim Butler 06:30, 28 February 2006 (UTC)

further note on ebm

According to the Centre for Evidence-Based Medicine, "Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." Do we really want to accept the Sackett forumulation about patient values? Sure there's a role for patient values in treatment, but not in EMB. Mccready 08:49, 27 February 2006 (UTC)

Interesting question. Patient values clearly matter in care. If EBM excludes them, does that mean that EBM alone is insufficient as a basis for providing care? -Jim Butler 01:43, 28 February 2006 (UTC)

Further thoughts: it may be that Sackett's inclusion of patient values in the definition of EBM is intended, in effect, to create a form "EBM" that one could say IS completely sufficient for patient care. But Cochrane's meta-analyses of RCT's say nothing about patient values, so all that's going on when a doctor claims to practice "Sackett EBM" is that s/he's lending the imprimatur of empirical validation to non-empirically-validated clinical decisions that doctors make all the time, based on anecdote, experience, intuition and so on.

I would prefer to just call a spade a spade and have docs be clear about what aspects of their practice are informed by EBM and what aren't. Some stuff docs do may never be able to be based on strict EBM, and that's OK, and in some situations even desirable. Things like bedside manner, trust and so on are important factors in the patient's healing response, even if they do fall (in whole or part) outside EBM, and even if they are regarded as "mere placebo effects". I seek out docs with whom I have good chemistry and whom I trust, intellectually and emotionally. When I'm sick, I want everything working in my favor, placebo as well as EBM! :-) - Jim Butler 07:41, 1 March 2006 (UTC)

reversions March 1 2006

Mccready, no offense, but your last batch of edits are without merit.

• Bandolier is 1998, which is way out of date for obvious enough reasons: since then there have been 23 RCT's on acupuncture and headache. Cochrane (2006) supersedes.
• On Empire, it's insane for the article to start listing the views of every insurance company on acupuncture. It would be pages long if we did so. There are some in the US that cover it for anything, and some that cover it for nothing. The reasons for such coverage vary.
• On the Huang Di Nei Jing, give me a break, the entire second section of that text (Ling Shu) is about acupuncture. Googling or checking any basic introduction to acupuncture and TCM shows this.

Sorry if I seem testy here, but I'm getting a little tired (cf. your distortion of what Cochrane said about headache) of editors shooting first and asking questions later. Thanks. -Jim Butler 22:56, 1 March 2006 (UTC)

History section

The history section has a few minor problems. I'd fix them but I don't know enough about the subject to correctly edit. The section seems a mixture of facts about its history, some conjecture and edits to discredit acup. Could someone knowledgeable editor help me resolve these issues:

1. What does (Ma-wang-tui graves 68 BC)' mean?
2. Later in Chinese history, 365 points along the meridians were spoken of, not because they were anatomically identified, but because there are 365 days in a year. Could we get a cite for works that talk about 365 points? Is it an old idea that is no longer accepted? Is the points=days thing accepted or one user's POV?
3. Some hieroglyphics... Which hieroglyphics? Where were they found? What are they called?
4. Bian stones...not directly related to acupuncture Is it accepted that they aren't related to acupuncture or is this, again, one editor's POV? If they aren't related to acupuncture, they shouldn't be in the article

Regards,Ashmoo 04:38, 3 March 2006 (UTC)

Hi Ashmoo: (1) Ma-Wang-Tui refers to ancient medical texts; see Unschuld's Medicine In China. (2) I deleted this; it's not a central theory in acupuncture. (3) No idea. (4) I fixed this; there is some debate. BTW good idea to add the new section on accreditation and controls. regards, -Jim Butler 07:55, 5 March 2006 (UTC)

Jim Bulter reverts

Hi Jim, it's not like you to revert in this manner so I'm a bit surprised. My edits were factual on the health insurance company. I also have found no mention of zhenjiu (針灸) in Huangdi Neijing (皇帝內徑) - if I am wrong please let me know. On the bian stones, these are not acupunture despite acupuncturists attempt to claim the lineage - they are for blood letting. I've foreborne to revert until we discuss here. Thanks and looking forward to your cooperation. If I've attributed edits to you which you didn't do, please forgive me, I don't have time to track each edit at the moment. Kevin Mccready 06:57, 3 March 2006 (UTC)

Jim, you have not assumed good faith. In fact I have discovered a problem in windows search which was why HuangDiNeiJing came up with a negative result. I have rechecked and yes you are right. As to the health insurance question, the fact that such a large organisation follows what they believe is good science is in fact a significant criticsm of acupunture which belong in the criticsm section. On the issue of "out of date". If we agreed that the NIH guidelines had not been updated and belonged, then likewise the bandolier. Lots of RCT don't make a summer (see the bias section of Bandolier). Mccready 11:10, 4 March 2006 (UTC)

Hi Kevin. On the Huang Di Nei Jing, I did assume good faith on your part in that I figured you'd made a well-intentioned error; nor have I ever doubted that your motivations are to improve the article. My objection was simply that this is a very basic issue that could easily have been double-checked elsewhere. And I must admit I was a little irritated at the time because similar things had happened a couple of times before, not just with Cochrane/headache, but also with an earlier deletion you made citing tattoos on the "Tyrolian Iceman" Ötzi (01:48, 21 February 2006); you said a source was needed, but of the two included only one was a dead link and the other was fine. Easily fixed, but I'm busy too, and I'd rather not have to feel like I need to double-check your edits for accuracy. So all I would ask is that you try to refrain from editing in haste and relying on others to clean up. This is a minor complaint relative to all the good stuff you've added, and I hope I've expressed it in the friendly spirit I intend.

On Bandolier, their goals are considerably different than those of the NIH Consensus Statement, so it's not just about the date of publication. Amusingly though, as it turns out, Bandolier later trashes Cochrane's treatment of idiopathic headache (2002, undated), and predictably completely overlook the problems with double-blinding (e.g., there is disagreement over the validity of sham acupuncture). This shows that both the criteria for EBM and its application (cf discussion above) are more subjective than its proponents would like to think. Anyway I think it's fine to have the more recent Bandolier things I found in the article; I'll put them in later.

On Empire, I don't think it or any specific insurance plan belongs there. Just how many insurance companies would you propose listing in the article? Empire's one of many. Is it appropriate to list them all? What criteria should we use for which ones to list? What criteria are the insurance companies using for their coverage, and do they make this clear? I think it's fine to mention insurance, and that coverage varies, but listing a bunch of individual insurance plans is not appropriate for an encyclopedic article. Plus I think there are more credible scientific critics than bottom-line driven businesses.

Someone else brought up Bian stones. Yes, they're for bloodletting, but that's actually still used in certain situations today in acupuncture (e.g. traumatic injury or fever), and some scholars believe bloodletting presages certain acupuncture techniques [4]. I added that. I also deleted the 365 thing as it's not a central part of acupuncture theory (see Unschuld on Ma Wang Tui etc). regards, -Jim Butler 08:47, 5 March 2006 (UTC)

jim, I've never edited Otzi, but having checked it out and the simple error is that of correlation ([pirates have disappeared while global warming has increased says the Flying Spaghetti Monster]). Anyone tatooed like him will have a tatoo on or near an acupuncture point. The Bandolier stuff was good and confirms my discovery that there is variability in quality across Cochrane groups - all the more benefit in having many sources of analysis evaluated. Your second Bandolier article was dated 1998-9 from memory. Do you have any sources on the problems sham acupuncture as a blind. In that case, how can you test the claims? What is a testable hypothesis for an acupuncture treatment? On empire I think but am happy to listen to alteratives that it definitely belongs. It is a large firm covering millions of people and says it bases its opinions on acupuncture on science. Naturally if other equally large companies have a view then that should be considered for the article, including their reasons for forming that view (I'd assume that the commercial motivation would be strong in either case). I think we should replace the 365 - it's an undeniable part of the history. The source you gave for bian stones didn't seem strong and I don't have access to the book. Mccready 12:04, 7 March 2006 (UTC)

Hi Kevin, I think it was you who deleted Otzi (see history), but no matter. I don't know whether or not it's BS, but the issue isn't having a tattoo near just any acupuncture point, but rather ones specific for conditions Otzi was suspected to have. It's past my bedtime and no time to add Bandolier now, but I'll try to tomorrow, or please feel free to stick it in. On issues with sham acupuncture, see NIH Consensus Statement:

"A commonly used control group is sham acupuncture, using techniques that are not intended to stimulate known acupuncture points. However, there is disagreement on correct needle placement. Also, particularly in the studies on pain, sham acupuncture often seems to have either intermediate effects between the placebo and 'real' acupuncture points or effects similar to those of the 'real' acupuncture points. Placement of a needle in any position elicits a biological response that complicates the interpretation of studies involving sham acupuncture. Thus, there is substantial controversy over the use of sham acupuncture in control groups. This may be less of a problem in studies not involving pain."

What does one test? Same sort of hypothesis as one tests in any procedure where a sham isn't accessible, right? As in most surgical procedures. Compare the intervention with some other intervention, preferably one that does have a placebo baseline.

On Empire, I continue to have serious reservations about the article listing specific insurance companies, because there are so many, and their reasons for coverage vary widely. They may say "science", but what does that really mean? Does another company's covering it for anything the patient wants really mean anything? Also, isn't it POV to list Empire's coverabe under "Criticisms" when the stuff it does cover could just as easily be considered an endorsement of acupuncture's efficacy? I'd rather see Empire in a different section if at all. One 365, have you got a reference giving its importance in historical context? I'll check Unschuld for that; he's one of the top guys in the field. There is scholarly debate on Bian stones; they are mentioned in the Chinese-published standard English-language text on which Americn national certification is a based, so I think that should count. Will get to this and other stuff later; it's nearly 3 AM over here! Ciao, -Jim Butler 07:44, 8 March 2006 (UTC)

Please excuse my lack of medical knowledge, but I'm sure there are a couple of people out there with the same questions. What is wrong with the following double-blind protocols. Either teach a non-practitioner to properly insert the needles, but not which points relate to which diseases, then tell him to insert the needles in points which are right for some patients and wrong for others. Or, just tell the practitioner that the patient has a different disease to the one which they actually have? 203.4.250.227 13:29, 7 March 2006 (UTC)JeremyG

Jeremy, the double-blinding problem is not as severe, but in the same ballpark, as the problem with double-blinding a surgical procedure. Technique matters and you can't so readily blind the person giving the treatment if that person is sufficiently trained so as to have good technique. A surgeon would usually know whether or not he's taking out an appendix, right? Sure any dummy can shove needles into a spot, but then you're studying something different than TCM acupuncture in which technique is said (and in clinical practice, often observed) to matter. But of course you can blind the evaluator, etc. -Jim Butler 07:44, 8 March 2006 (UTC)

Simple Error? What ever the truth about Otzi and his tattoos, the article in the medical journal the Lancet, one can not dismiss the hypothesis as being the result of a simple error (ie. the tattoos are 'grouped' rather than spread out randomly etc). The article also suggests that Otzi is not the only example.

[| 'The Lancet 1999;' A medical report from the stone age? 354:1023-1025; DOI:10.1016/S0140-6736(98)12242-0]

One of the problems with acupuncture seems to lie in the observation that it is often effective as a palliative treatment for self limiting conditions. As such it doesn't lend its self to trials originally developed for testing would be cures. Using a western example: diazepam does not cure dislocated joints, but a large dose of said drug, can so relax muscles -that were tense from the pain- that the joint will then sometime slip back of its own accord.

The body is a complex negative feed back system and so it is possible that acupuncture provides an opportunity for the body to re-balance (regain full homeostasis) by temporally blocking an over active response in part of the feed back system. We will have to await more studies, as recently done using a fMRI scanner. Although made in conjunction with the Open University and the results this study were broadcast on UK BBC television, no paper has yet been published[[5]].

As for testable hypothesis, I take it you mean is it possible to design a trail or study that can answer the question once and for all. If so, then part of the answer to that problem is in comments above, plus the limitations of resources available (doing a study costs a lot of money; not even drugs get 'thoroughly' tested but just enough to get them over the hurdles of the regulators.) So, I think it is possible to prise out the truth - we just don't know how yet, and those that think they do are quite likely deluded (well 50% must be wrong!).

The British medical journal has recently accepted an article for publication on the effectiveness of acupuncture for low back pain. and here the researchers had to make do with what opportunities the real world provided -rather than the ideal. How good the trial design was I don't know as I am fed up at the moment with reading papers, but some have already commented on it, so you can read theirs and the whole pre-pub article in PDF form.[BMJ.com]

As for double bind trials: it might not matter were the needle is inserted or whether the patient gets no treatment at all, the recover time can be the same (as makes no difference) for self limiting conditions -even with western treatment. What is important here is whether the acupuncture treatment relived the patients symptoms more so than the placebo effect. (then there is the question of the treatment effect plus the placebo effect of having the treatment, but lets keep things simple). There is no objective way yet, of measuring perceived (subjectively experienced) relief brought on by treatment, although scanning looks promising. With rats it would be easier; as one could time how long they could tolerate keeping their paws on a hot plate. This is a procedure that is sometimes used for testing the effect of drugs.--Aspro 16:28, 7 March 2006 (UTC)

But the page states that there is NO way of performing double-blind trials, not that there is no way to test them in 'self limiting conditions' 203.23.158.24 00:46, 8 March 2006 (UTC) JeremyG

Please see my comments above on this. Also I added a link to NIH Consensus on sham, mentioned above to Mccready. -Jim Butler 07:44, 8 March 2006 (UTC)

Placebo effect

Hi, here's an article (sorry don't have the full text or a link, just an abstract) comparing a sham acupuncture needle has more of an effect than a sham pill

Kaptchuk TJ. Stason WB. Davis RB. Legedza AR. Schnyer RN. Kerr CE. Stone DA. Nam BH. Kirsch I. Goldman RH.

Institution Osher Institute, Harvard Medical School, Boston, MA, 02215 USA. ted_kaptchuk@hms.harvard.edu

Title Sham device v inert pill: randomised controlled trial of two placebo treatments.

Source BMJ. 332(7538):391-7, 2006 Feb 18.

Abstract OBJECTIVE: To investigate whether a sham device (a validated sham acupuncture needle) has a greater placebo effect than an inert pill in patients with persistent arm pain. DESIGN: A single blind randomised controlled trial created from the two week placebo run-in periods for two nested trials that compared acupuncture and amitriptyline with their respective placebo controls. Comparison of participants who remained on placebo continued beyond the run-in period to the end of the study. SETTING: Academic medical centre. PARTICIPANTS: 270 adults with arm pain due to repetitive use that had lasted at least three months despite treatment and who scored > or =3 on a 10 point pain scale. INTERVENTIONS: Acupuncture with sham device twice a week for six weeks or placebo pill once a day for eight weeks. MAIN OUTCOME MEASURES: Arm pain measured on a 10 point pain scale. Secondary outcomes were symptoms measured by the Levine symptom severity scale, function measured by Pransky's upper extremity function scale, and grip strength. RESULTS: Pain decreased during the two week placebo run-in period in both the sham device and placebo pill groups, but changes were not different between the groups (-0.14, 95% confidence interval -0.52 to 0.25, P = 0.49). Changes in severity scores for arm symptoms and grip strength were similar between groups, but arm function improved more in the placebo pill group (2.0, 0.06 to 3.92, P = 0.04). Longitudinal regression analyses that followed participants throughout the treatment period showed significantly greater downward slopes per week on the 10 point arm pain scale in the sham device group than in the placebo pill group (-0.33 (-0.40 to -0.26) v -0.15 (-0.21 to -0.09), P = 0.0001) and on the symptom severity scale (-0.07 (-0.09 to -0.05) v -0.05 (-0.06 to -0.03), P = 0.02). Differences were not significant, however, on the function scale or for grip strength. Reported adverse effects were different in the two groups. CONCLUSIONS: The sham device had greater effects than the placebo pill on self reported pain and severity of symptoms over the entire course of treatment but not during the two week placebo run in. Placebo effects seem to be malleable and depend on the behaviours embedded in medical rituals.

Publication Type Journal Article. Randomized Controlled Trial.

Conclusion is that there may be a difference, but it is not scientifically significant. Mar 13 2006

If taking a phony aspirin pill produces some benefit in the reduction of, e.g., headache pain, then taking an aspirin pill also produces some benefit in the reduction of pain due to whatever factors are active in the case of the inert pill. We do not know exactly how the placebo effect works. There are also therapies that involve the deliberate mobilization of the bodies own resources without the trickery or manipulation involved in the use of placebos. One of the differences between placebo pills and placebo needles is the specificity of the mental stimulus provided. If a phony aspirin pill is administered, the psychological message implied is, "feel less pain." Expectation of the relief of pain may facilitate the relaxation of muscles constricting the blood vessels or otherwise causing head pain, but it also may facilitate the release of endorphins out of the same sense of relief because "someting is being done." Theories abound, but nobody really knows why the use of needles, heat, and accupressure are efficacious, but each of these methodologies can cause the mind of a conscious patient to focus very sharply on one point in the body. To an extent, the more powerful the stimulus, i.e., the greater the pain or the greater the felt pressure, the more strongly one's attention may be focused on these points. But the applicaiton of a phony needle, especially to a naive subject, may be equally productive in causing intense attention to be directed to those points.P0M 01:07, 17 March 2006 (UTC)

With regard to the abstract above, I don't have the full text either, but it does state that there were significant differences between the sham needle and placebo pill groups on certain measures during the study's full course (i.e., greater than a 2-week period). Those observations, and the conclusions given by the authors in the abstract, are not the same as the editor's comment: "Conclusion is that there may be a difference, but it is not scientifically significant". Patrick, I agree the issues are complicated and not fully understood. I also think the article (as of this moment, with the references to double-blinding issues and NIH on sham) summarizes and caveats the issues adequately. Thanks. -Jim Butler 08:05, 17 March 2006 (UTC)

It occurred to me earlier today that if we really want to know whether something like aspirin works the best way to find out would be to administer it without the experimental subjects being aware of it. It's easy to vary the input into an intravenous drip without alerting a patient. But it would be much more difficult to stimulate acupuncture points without letting the patient know what is going on. Maybe low voltage, low amperage currents to be delibered to probes attached at various points on patients' bodies without letting them be aware that they were being zapped. That might be a plan in the case of hospital patients suffering conditions that force them to remain bedridden and relatively immobile anyway. Maybe with miniaturized controls other patients could serve as test subjects without their having to be immobilized.P0M 02:12, 20 March 2006 (UTC)

I just noticed your reply here; sorry for delay. Yes, I agree, that would be an interesting experiment. Quite creative. -Jim Butler 23:22, 25 March 2006 (UTC)

Science section

jim, you can't prove a negative - article already too long - my rewrite of the intro in science section should meet your concerns - pls disucss otherwise. readers can look up refs (that's what they are for. On stroke the issue here is not safety. I'm happy to delete ideopathic headache ref becuase it doesn't fit intro and I've moved p6 to make it clear Mccready 08:51, 21 March 2006 (UTC)

Hi Kevin. Yes, readers can look up references, but (without accusing you of bad faith) I still think your summaries oversimplify and err on the negative side. Cochrane is more nuanced than that; they don't set a threshold and just ignore possibly interesting trends under it. So I will fix that somehow without being too wordy. Simply removing their summary on headache is hardly a solution either; it's pure POV to list only negative conclusions for acupuncture under "science" (as if by implication the preceding section is unscientific). I think the whole section needs to be merged with indications and research under an EBM subsection, and lists summarized more carefully.

If article length is a concern, then Empire is surely on the chopping block; I doubt there is any other respected encyclopedia whose entry on acupuncture mentions the plans of specific insurance companies. Linking to something like that is fine, however. thanks, Jim Butler 01:16, 22 March 2006 (UTC)

Hi Jim and other editors Yes I'm open to some sort of merge and acknowledge that removing headache could be POV. Though you will be aware of criticisms of bias creeping into cochrane reviews. As for "interesting trends", how do we measure them, and where would we put them? Lots of stats can be manipulated to give trends. What we want to tease out is real effects and causation. The implications though of the Indications and research are that all the things listed can somehow be helped by acupuncture - I get the feeling you would ack that all these have not been demonstrated susceptible to acu. Yes the implication is that the preceding section is unscientific. I think this needs to be handled. Further work we could agree on would be to move the licensing stuff in modern medicine to the licensing section, clean up history section, rationalise NIH consensus which is repeated everywhere (perhaps shorter quotes and refs would be appropriate), use of sources should be to make the point then ref (in order to cut length), risks are risks potential is tautological. Apart from the last point, I'll try to avoid editing until you respond, but please go ahead if you think I'll accept. Cheers. Kevin Mccready 07:22, 23 March 2006 (UTC)

Hi Kevin. Generally agree that the article still needs work. It's improved a lot, in no small part thanks to our collaborating, but still has a way to go! -- e.g. the links section is a mess.

On what we call "scientific": I am not comfortable with the equation "verified by EBM standards" = "scientifically proven", or "not EBM-gold-standard" = "not scientific(ally relevant)". As we know, not all scientists, let alone clinicians, agree that EBM criteria are the appropriate ones to use to tease out real effects and causation in every case. That objection obviously includes modalities like acupuncture that are based on procedures (cf. blinding issues) and, often, individualized treatment (other controls). It's a scientifically plausible objection, FWIW, and not "merely" a clash of paradigms based on competing religious vs. naturalistic worldviews or some such thing. If one is going to study something, one can't just look "where the light is good" (like the drunk guy in search of his car keys) and imagine that is sufficient. Nor does this objection reflect some sort of extreme minority view among scientists. It's part of a legitimate debate about how data are interpreted. So, let's not spin all that is non-EBM as inherently non-scientific.

On the overall presentation: obviously, we're not after "objective truth" here but rather verifiability and NPOV. Therefore, in terms of claims for indications or efficacy, I think it's better to be clear on who says what and why, rather than (implicitly or explicitly) presume EBM or anything else to be the objective-truth standard. Does that make sense? And that's more or less what the article does as it stands now, IMO. I think that at this point it mostly needs pruning and editing so that claims, objections, lists, etc., aren't subtly spun one way or another. What do you think?

In terms of specific edits, please go ahead, but with regard to NIH citations I'd appreciate discussing changes first as I feel most of those reflect important issues (blinding, safety, many biomedical techniques not EBM-gold-standard either). I'd like to prune redundancy but keep that stuff. I'm entering a busy stretch and will be somewhat hit-and-miss for the next two weeks, so if I'm absent just go for it and I'll have a look later. Cheers, Jim Butler 09:22, 25 March 2006 (UTC)

Like democracy, EMB, is imperfect but is the best system we have. It also includes (and this is not yet reflected in WP article, the Number Needed To Treat concept. We must also consider the weight given to minority views - you are probably aware of this in WP guidelines. The question remains, how many large RCTs are necessary to conclude with reasonable firmness that acupuncture is not useful for certain conditions? To my mind we are reaching that point in a great many areas, though I agree that the equations you are concerned about at the beginning of your post are inadequate and inaccurate. Mccready 13:06, 25 March 2006 (UTC)

I wouldn't agree with the EBM-democracy analogy. (On reflection, I'd probably agree with the proposition that science is like democracy [in the sense of being flawed, but the best thing we've got], but I think EBM is sort of like America's Electoral College: not the best means to the end, slanted and prone to conceal meaningful information!) Your question regarding RCT's and efficacy is meaningful primarily to those who accept the applicability of EBM's parameters. If one rejects them, the question is irrelevant. If (as I do) one accepts them provisionally, as part of the picture, one might say "it depends". If one accepts them fully? -- I suppose one might say "six" if one is a Bandolierian, or "eight" if one is a Cochraneian. You aren't suggesting that our job as Wikipedians is to settle on some integer as an answer and edit accordingly, are you? Our task is instead to present adequately the POV(s) of those who do believe it is an important question to ask and answer, along with other relevant POV's. Also, majority vs. minority is a function of which community one is talking about. For example, see poll. - best, Jim Butler 00:58, 26 March 2006 (UTC)

If we are going to use the term science we must understand that it can be no more than a set of probability statements and therefore, yes, you need to put numbers on it. It's 99.9999999% likely the sun will rise tomorrow. It's 80% likely (to pluck a figure at random for the purposes of demonstration) that acu is no more than placebo. It's 95% likely that homeopathy is no more than placebo. It's 99% likely that astrology is crap. As to how you can accept emb for some purposes and not for others .... :-) Mccready 03:51, 26 March 2006 (UTC)

You're putting the prediction-cart in front of the observation-horse. Science predicts only after observing systematically. It is EBM's criteria for the latter process that is questioned by critics. EBM does tend to "look where the light is better" in its systematic reviews of RCT's (double-blinding problem) and thereby favors pills over procedures. (Good graphic of EBM's hierachy here in context of TCM discussion.)

From what I've read, both Bandolier's and Cochrane's reviews tend to exclude non-double-blinded RCT's for acupuncture without comment, but they aren't so blithe when concerning surgical procedures. Here, the problem doesn't seem to lie so much in EBM's principles per se but rather in how the EBM reviewers have been approaching the subject.

There are some who argue that CAM can never be evidence-based [6]; I'm not sure I'd go that far, depending on how EBM's decision analysis is applied. EBM does (in theory) include "lower-tier" material in its decision analysis [7], and that point is worth mentioning along with findings regarding the "top tier" (i.e., systematic reviews of RCT's).

Thus far, as well, no EBM reviewer distinguishes among acupuncture treatment styles; other problems have been noted [8]. -Jim Butler 07:41, 27 March 2006 (UTC)

HELP

I have still not gotten my answer for the (Question not answered) thing! Please answer...I am very curious!

Imagine you asked a similar question about how Asperin worked back in the 5th century BC. You won't get an answer until a couple thousands years later. Back then the willow bark would have been called pseudoscience because no body could explain how it worked. Many discoveries were by accident and people made up a model to explain them. Most of the time, the model was inaccurate and only explained some cases but not all cases. I remember sometimes ago, "scientists" believed atoms look like swiss cheese, but the model changed overtime. Back then, they called that science though we would call it cheesy science now. :-) Nowadays, scientists believes atoms are made up of subatomic particles, waves etc., who can be sure the current model would be the same 200 years from now? I'll bet my lunch it will change, though you won't want to eat my lunch 200 years from now. There was a guy called Li Shizhen (李時珍) who chewed all kind of herbs and see if he would die from it. He survived and wrote a book about the medicinal properties of all kind of herbs based on his body's reaction to them. Many Chinese herbal doctors still base their prescriptions on this guy's book. Is that book 100% accurate? Probably not. One person's reaction can never be reliable. Is it totally worthless? Not so either. Asperin was discovered in similar way too. Many well known Chinese medicinal receipes had gone through clinical tests. The Chinese University of Hong Kong had done many scientific researches with Chinese medicines. I don't know how acupuncture was invented. However, I guess someone was kneading his own body and found that certain points had different sensation when pressed. When he squeezed those points very hard, his body had some reactions. If surface pressure caused a reaction, then what would happen if you poke it with a needle? Millions of trial and errors later, someone documented and classified the effect of each response. Someone drew a conclusion and formed a model trying to explain what was going on. The model is as good as the swiss cheese atoms model. It works in some cases, but not in others. In current state, acupuncture is an art, it is not science until some scientists found a good model to explain what is going on.

If you are interested in acupunture, sequeeze around your own body. Take note of all the places that give you a special sensation when squeezed. Then buy a book on acupuncture and read about what the Chinese found out about those spots through experiments in the past thousand years. You don't have to believe those emperical results because they are only as good as what conclusion is drawn from them, but you will be amazed that those acupressure points are not random locations, they were found based on your body reactions to pressure. There are several famous acupressure points: try sequeezing the flesh between your thumb and index finger, there is a spot near where the two bones join which give you a numbing feeling when squeezed. How about rubbing your temples, the base of your skull etc.? There are many spots on your body that are different from the rest. Experiment with them and report the result here. Kowloonese 08:31, 24 March 2006 (UTC)

Sorry, I agree this is an interesting subject, but what does it have to do with how we edit the article? It still has to present all relevant POV's in a balanced way, whatever anyone feels from the exercise you suggest. -Jim Butler 08:57, 25 March 2006 (UTC)

jim's reorg

In the science section you've gone beyond what we've agreed here Jim.

• your opening statement implies acupuncture works - the jury is still out on this - the P6 stuff is the best you have and even the conclusion "seems" is controversial
• i don't agree there is a better framework than emb.
• I don't agree the NIH consensus statement should be top of the science section (and it is far too long - better to make the point then leave the link)
• I don't agree that a study on endorphins belong at the top either and the site you give for this is appalling as I hope you will acknowledge.
• the NCAHF points to a Wp source which doesn't site source of crits
• I'm not happy if you say that emb is unscientific
• I'm not happy with non-peer reviewed televsion programs being put in

I've removed insurance stuff as you requested. I've removed the list of tradtional indicators because of the implication that acu is effective in relation to them - a point you didn't demur on.

next time, and I will try to do the same, can you please put drafts on the talk page if you are considering such wholesale contentious changes. thanks Mccready

Hi Kevin. If you look carefully you'll see that virtually all I did was rearrange content. That was my only goal for the edit; there is of course plenty yet to be done. I didn't add or delete material except for a couple redundant things on licensure and an intro statement on research that was as innocuous as I could come up with.

Show me where I said or implied in the article that EBM is unscientific.

I'm restoring the traditional indications. Please re-read the policy on NPOV and understand that it's not our job as a Wiki editors to decide whether acupuncture "works". An article on acupuncture that doesn't include the POV of what acupuncturists say about it would be laughably POV. Clinical experience of practitioners is highly prized in classical TCM as a standard of "truth", which isn't entirely irreconciliable with EBM, but still reflects a different hierarchy [9]. -Jim Butler 19:08, 27 March 2006 (UTC)

P.S. You disregarded my request above: "In terms of specific edits, please go ahead, but with regard to NIH citations I'd appreciate discussing changes first as I feel most of those reflect important issues (blinding, safety, many biomedical techniques not EBM-gold-standard either)." Rving it all for now pending further discussion. - Jim Butler 20:17, 27 March 2006 (UTC)

Jim, the article is too long. The US NIH stuff has been superceded. It repeats stuff already in the risk section. The smoking stuff is already in too. You have eliminated the electro stufff. The comparison with other forms of medicine is irrelevant IMO. The statment's uyse of MAY, REASONABLE SINGLE CASE, PROBABLY and PROMISING have now been superceded by scientific research, just as they urged, and should go in the history section if anywhere. The post op nausea appears twice in the NIH stuff too. The bias of the NIH statement must be clear to you. They pre-empted scientific findings - not a good look. I've edited accordingly and urge you again to try to cut down the WHO puff. They themselves said it was a PROVISIONAL list. Again it belongs to the history section if anywhere. If you want to put a statement that clinical experience is valued above scientific research you'll need to provide a source. Mccready 00:55, 28 March 2006 (UTC)

I'll reply more later. But one question. We discussed NIH being superseded earlier, and at that time you agreed that it was not. What has changed since then? Presumably a bunch of new RCT's have been published in the intervening month, right? That must be it. Obviously, it's not possible that you, let alone the NIH panel vs. Cochrane's reviewers, are interpreting the same data differently. Because that would be unscientific, or biased, or something less than rational. Right? Looking forward to your rational reply to this. -Jim Butler 04:16, 28 March 2006 (UTC)

yes my view has changed because i've reconsidered the evidence like a good scientist should. Mccready 06:55, 28 March 2006 (UTC)

And you are entitled to your view personally, but in your capacity as a Wikipedian you don't get to discount the NIH consensus statement or say it is outdated without sourcing that claim. Let me be clear: you, Kevin, are not a reliable source for making recommendations about efficacy based on meta-analyses of RCT's. The NCCAM (among other groups) is, and abides by the consensus statement. For that reason I'm reverting, and you can put your opinion about it back in when you find a source for it.

I don't think you fully understand the nature of scientific debate and the fact that legitimate and defensible differences exist over the interpretation of data. You seem to think that science is about certainty rather than knowledge. Perhaps my view of you is mistaken, but in any case: The NCCAM's view on acupuncture research differs from that of Cochrane et. al., but is clearly a relevant one in the biomedical community if the poll of doctors I cited above is any indication. Therefore, it can be included along with other POV's. You may realize that it is nothing new that clinicians and scientists sometimes diverge on matters of clinical efficacy. The reader can conclude for himself (as you have, with access to evidence) whether NCCAM's view is bad science or a difference of opinion in interpreting the data. You will notice that I've explained some reasons for those differences already, and will add some of the above-sourced stuff to the article. Thanks. -Jim Butler 07:35, 28 March 2006 (UTC)

Kevin, I would also ask that when editing you keep in mind Wikipedia's NPOV policy on fairness and sympathetic tone. It is not necessary or appropriate to undercut other POV's by criticizing as you go along, as your edit (and others in the past) did. I value your contributions and in no way question your good faith. Just a constructive criticism, and of course I'm open to such as well. Update: On NCCAM, I put in a reference for their continuted endorsement of the Consensus Statement, which is plainly evident on their acupuncture page which does cite stuff from 2004 and therefore has been updated. In accordance with guidelines on tone, I also added a qualifying statement there about putative putdatedness, so all you have to do is find a verifiable and reliable source for that claim. -Jim Butler 18:06, 28 March 2006 (UTC)

More on science and EBM

Since we may have an edit war brewing over this NIH/EBM business, I think we should try to isolate which issue(s) are contentious. The discussion will benefit from third parties as well.

I understand that some editors, like Kevin, feel that acupuncture is pseudoscientific and/or that scientific consensus is that it is not more than a placebo. These are issues that potentially affect the very structure of the article itself owing to NPOV guidelines regarding pseudoscience and undue weight.

On pseudoscience, it is important to distinguish between acupuncture theory and practice. Ironically, even though TCM theory is arguably pseudoscientific, its predictions still guide modern research and have predicted positive results in RCT's [10], [11]. The value of TCM theory in a vacuum (with its bodily humors and medieval sounding-stuff) is quite a different matter from TCM's value (even if informed by that theory) in practice. In other words, modern, scientifically-literate TCM clinicians believe that there is some valuable information encoded in the culturally-determined models used by the old doctors. (Where do you think the researchers got the idea to use P6 for nausea?) As one EBM advocate points out, evidence is more important than power (i.e., the political legitimacy of a modality of healing).

The question of evidence naturally arises, and leads to the issue of majority POV and undue weight. Scientific consensus is indeed that EBM is the "gold standard", but it is wrong to infer from EBM's lack of support for acupuncture that the scientific consensus is that acupuncture is a placebo. I can't cite any definitive source for the scientific consensus on acupuncture's efficacy (and challenge others to find something explicit), but to my view what actually follows from EBM is that acupuncture's efficacy is for the most part unproven. EBM's support (or lack thereof) for acupuncture is a function of at least two things: (1) the criteria for top-tier evidence, and (2) the application of the decision tree for lower-tier evidence (cf. evidence is more important than power above). There is substantive debate over the former (double-blinding issue), and the application of the latter is a matter for the individual clinician and therefore (as Kevin seems loathe to consider) is something that depends on the individual doctor and patient. Thus, when Cochrane summarizes its top-tier evidence, they are careful to say whether there is pretty much no evidence (e.g. for smoking), or that evidence is mixed but inconclusive (low back pain), etc. They are also careful to note varying results among RCT's. This is so that doctors can make their own calls, rather than just blindly follow some one-size-fits-all EBM "bottom line".

The issue of individual judgement among clinicians may be a factor in the finding that a polled majority of doctors state that acupuncture is (in general) at least somewhat effective [12]. This is a significant divergence from what Kevin presumes (reasoning only from top-tier EBM data and ignoring the rest) must be a skeptical scientific consensus on acupuncture. I suspect that Kevin's view is really a straw man. Let's remember that we haven't really established what is the consensus of scientists on acupuncture: Kevin is assuming that absence of evidence = evidence of absence = most scientists think it's bogus, but we don't know that's true. However, if we were to assume that it were true, then we'd have an interesting situation wherein the majority POV would be a function of the community polled, and surely the weight of doctors' views on such a matter has some bearing. Of course, if you poll doctors a majority will say they believe in a Judeo-Christian God too, but it would be difficult to argue that their belief in acupuncture reflects Judeo-Christian cultural conditioning.  :-) And of course clinical decision-making is a somewhat different matter than belief in a deity.

Anyway, enough said, but I hope I've added something to the debate here. Bottom line, there is no obvious majority POV on acupuncture's efficacy among scientists, and among doctors, the evidence presented so far sways towards favoring efficacy. The inferences in terms of our edits (sympathetic tone, weight, NIH) should be clear enough. -Jim Butler 09:11, 28 March 2006 (UTC)

mccready reasons for revert

Dear Jim Yes you are wrong about my understanding of science. I do not assume lack of evidence means it’s not effective. I simply ask that the alternative with lots of weasel words not take its place. And yes the issue is what is the majority science view. Clearly, very limited possible exceptions aside, scientists in large majority say acu is has no more demonstrated effect than placebo.

You have got to be kidding to link this NCCAM stuff and call it science. I find the implication that acu might be useful for fibromyalgia disgusting. This is a simple con with no reliable evidence to support it (happy to eat my words if I’m wrong). The getout weasel word “MAY” for this condition and the others is intellectually pathetic, particularly given the amount of data now in. You cannot seriously use this source to paint a legitimate scientific dispute.

In Australia you would be prosecuted and found guilty for false and misleading advertising for stuff like this. Our legislation specifically says even to imply efficacy will get you into trouble – happy to provide further evidence if you wish. The other logical flaw in using the quote is that it is self referencing back to the prevaricating NIH consensus statement. Just as an exercise for yourself you may like to count the number of weasel words in the statement. Once again let me tell you why it is outdated – research work since its publication answers questions it posed. You have failed to address the points in my earlier post in relation to this ie all the weasel words.

Your link to a study of 39 people for pain and oral surgery was, quite frankly, pathetic. This is the sort of stuff which was used in my stats classes to illustrate how people misused stats. You just cannot draw conclusions from numbers like this. That is why LARGE trials are needed. I leave you to draw your own conclusions about a P value of 0.001 in the moxibustion paper!!

I’m not loathe to consider doctor patient relations Jim. But the type of doctor that tells a patient the doctor knows best from his/her own experience and therefore scientific findings can be ignored would rightly get struck off the register. The fact that some doctors believe mumbo jumbo from pharmaceutical companies, conventional medicine or anywhere else does not count a fig in whether or not the mumbo jumbo is scientific.

A disagree fundamentally with your conclusions that there is no majority scientific view on acu. And by your logic on EBM, anyone making any unfalsifiable claim could push it arguing there is no proof against it because it fits in the framework as level three or four or whatever. Science and EMB is perverted by such arguments. As I’ve said before the request to prove a negative is clearly absurd.

As to your insistence on the WHO provisional list. Please explain. The implication remains that it MIGHT be useful and once again this is offensive to reason. The statement, like the NIH, is almost 30 years old and it outdated by NEW evidence. Your insistence as an acupuncturist in keeping it in, despite the evidence is POV. Your insistence on removing the statement that the NIH stuff has been superceded by scientific work looks like POV too. Would you prefer to reword the sentence?

Once again you have reverted the statement. “Science does not support the use of electrical acupuncture.” I’m happy to reword or even remove if you can prove otherwise.

Your reverts appear to have taken no notice of my point that the article says TWICE that acu has no demonstrated effect on smoking cessation. Surely once is enough. Mccready 02:01, 29 March 2006 (UTC)

Hi Kevin:

>Yes you are wrong about my understanding of science. I do not assume lack of evidence means it’s not effective. I simply ask that the alternative with lots of weasel words not take its place.

I'm not using weasel words as an editor, but citing a fact about an opinion. If that opinion uses weasel words (and scientists use "may" all the time; cf. climate change debates etc.), then that is fine per Wikipedia as long as it is a verifiable and reliable source for a relevant POV. Nor am I saying that the POV expressed by NCCAM (which as I've shown is echoed by a majority of of American docs, per poll) must replace another POV. I'm just saying let's include them both. Read NPOV guidelines. NPOV is not the same as "scientific POV".

That above pretty much sums up all that follows. Please consider it carefully.

> And yes the issue is what is the majority science view. Clearly, very limited possible exceptions aside, scientists in large majority say acu is has no more demonstrated effect than placebo.

If that's so clear then you should be able to find a reliable and verifiable source stating such, and even then that would be no excuse not to include other relevant POV's.

>You have got to be kidding to link this NCCAM stuff and call it science. I find the implication that acu might be useful for fibromyalgia disgusting. This is a simple con with no reliable evidence to support it (happy to eat my words if I’m wrong). The getout weasel word “MAY” for this condition and the others is intellectually pathetic, particularly given the amount of data now in. You cannot seriously use this source to paint a legitimate scientific dispute.

Others reserve the right to interpret extant data differently. You are free to disagree. You are not free, as a Wikipedian, to delete that POV because you disagree with it.

>In Australia you would be prosecuted and found guilty for false and misleading advertising for stuff like this. Our legislation specifically says even to imply efficacy will get you into trouble – happy to provide further evidence if you wish.

Fine, but I'd like to remind you that this is Wikipedia, not Australia.

>The other logical flaw in using the quote is that it is self referencing back to the prevaricating NIH consensus statement. Just as an exercise for yourself you may like to count the number of weasel words in the statement. Once again let me tell you why it is outdated – research work since its publication answers questions it posed. You have failed to address the points in my earlier post in relation to this ie all the weasel words.

I addressed it above. Some people's POV's include what you might call "weasel words". Editors are supposed to avoid using weasel words themselves, but facts about opinions are not constrained by this guideline. See any number of articles citing people who say "may" about something.

>Your link to a study of 39 people for pain and oral surgery was, quite frankly, pathetic. This is the sort of stuff which was used in my stats classes to illustrate how people misused stats. You just cannot draw conclusions from numbers like this. That is why LARGE trials are needed. I leave you to draw your own conclusions about a P value of 0.001 in the moxibustion paper!!

As I said, others reserve the right to interpret extant data differently. Not all doctors follow EBM, and even with regard to those who do, you have not addressed my point above about EBM's decision tree and its inclusion of data below the "top tier".

>I’m not loathe to consider doctor patient relations Jim. But the type of doctor that tells a patient the doctor knows best from his/her own experience and therefore scientific findings can be ignored would rightly get struck off the register. The fact that some doctors believe mumbo jumbo from pharmaceutical companies, conventional medicine or anywhere else does not count a fig in whether or not the mumbo jumbo is scientific.

First, recommending acupuncture in the absence of top-tier EBM data is not necessarily unscientific if the doctor feels that lower-tier data support doing so. Second, again: NPOV is not the same as "scientific POV"

>A disagree fundamentally with your conclusions that there is no majority scientific view on acu.

I understand that. If you're right, surely you can source your claim. As I said, it sounds like you're just inferring that it reflects scientific consensus.

>And by your logic on EBM, anyone making any unfalsifiable claim could push it arguing there is no proof against it because it fits in the framework as level three or four or whatever. Science and EMB is perverted by such arguments. As I’ve said before the request to prove a negative is clearly absurd.

For purposes of the article the issue isn't your or my analysis of what is logical or scientific. The issue is representing different POV's fairly. If NCCAM is really a tiny minority POV, why do ca. 60% of American doctors in the poll I cited say acupuncture is at least "somewhat effective"? You need to source your claim.

>As to your insistence on the WHO provisional list. Please explain. The implication remains that it MIGHT be useful and once again this is offensive to reason. The statement, like the NIH, is almost 30 years old and it outdated by NEW evidence. Your insistence as an acupuncturist in keeping it in, despite the evidence is POV. Your insistence on removing the statement that the NIH stuff has been superceded by scientific work looks like POV too. Would you prefer to reword the sentence?

On NIH, please note: I already proposed a reword along with an opportunity for you to source your "outdated" claim. Rather than provide such a source you reverted.

On WHO, of course I have POV, as do you and most editors, but our job is to ensure NPOV in the article. Unless you can show that your POV really is a large majority and everything else a much smaller minority -- and that 60% of doctors statistic shows you almost certainly cannot -- then we have to give reasonable space to other POV's even if you say they aren't scientific.

In fact, the WHO list still guides instruction and practice today, as any TCM textbook or curriculum (at least in the US) would show. Recall the "traditional" in TCM and that it relies on clinical experience, including that recorded in the old texts. Loathesome as it may seem to you, it is part of the TCM paradigm in which clinical experience is valued more than RCT's (I'll add that source to the article, but have cited it above, and here it is again.) So the point of my citing WHO was just to represent the POV of TCM practitioners regarding what acupuncture treats, and that does need to be represented somehow in the article no matter how much you dislike it. I'm happy to cite something more up-to-date, e.g. Wiseman and Ellis's translation of a Chinese TCM textbook. Again, some people rely on different evidence than RCT's (or additional evidence), a/o interpret evidence differently. Clinical experience and RCT's sometimes diverge. The article can note this point and its implications fairly and sympathetically along with the obvious objection about placebo.

>Once again you have reverted the statement. “Science does not support the use of electrical acupuncture.” I’m happy to reword or even remove if you can prove otherwise.

Friend Kevin, you are really out on a limb here. Surely you realise that it is not my burden of proof to justify removing an unreferenced assertion. I deleted the sentence (as I said when I did so) because it is unreferenced, and it was left over from Empire. YOU are the one who needs to source it.

Your reverts appear to have taken no notice of my point that the article says TWICE that acu has no demonstrated effect on smoking cessation. Surely once is enough.

No problem with that at all. That's easy to fix and I will if/when I revert. But this point is hardly the crux of this debate.

Overall, you are pretty plainly disregarding the need to source your claims, mistaking NPOV for scientific POV, and disregarding fairness and tone. Any response before I revert and we call in third-party moderation? -Jim Butler 04:33, 29 March 2006 (UTC)

burden of proof

Jim, I accept I need to provide source for electoacu. I do not accept I need to provide source that 30 year old material has been superceded by modern research. I do not accept that a survey of doctors represents scientific opinion (in any case survey questions, as you know, can be framed to get the result desired). Your source on EBM/TCM states "acupuncture treatment is typically highly-individualized and based on philosophical constructs, and subjective and intuitive impressions." This is not science. As for accepting the traditions of TCM based on this kind of logic, that is akin to accepting voodoo practices in medicine. Even the source your quote states "Convincing published data for acupuncture efficacy are minimal or lacking for most conditions, especially under the standards for EBM." It is up to you, not me, to prove your claim that scientists generally support efficacy of acu.

I do not accept that it is legitimate scientifically in any way shape or form to rely on the P values in the studies you cite or the number in a trial (39). You cannot fudge the issue by trying to say it is a legitimate dispute between scientists examining the data - that is like saying creationism is a legitimate science. It is not. We are talking Stats 101 here.

• Mccready 06:47, 29 March 2006 (UTC)

Jim, you said "I'm happy to cite something more up-to-date, e.g. Wiseman and Ellis's translation of a Chinese TCM textbook." yes please in which case we agree to delete WHO stuff unless you want to link it in history section. Mccready 06:55, 29 March 2006 (UTC)

Hi Kevin,

I'm not arguing that scientists generally support efficacy. I am arguing that you go too far if you imply that the consensis is it DOESN'T work, as opposed to that consensus is that efficacy is unproven but still an open question. If the consensus were that it doesn't work, why all the research?

The article needs to take into account and adequately cover at least three relevant POV's: (1) Classical TCM. (2) Modern clinical practice of doctors. (3) Scientific consensus.

(1) I didn't say you had to prove that WHO's claims are superseded by RCT's. I said that those claims represent the clinical experience of TCM practitioners, and thus are part of the TCM paradigm which (as I referenced) values such experience more highly than RCT's. Let me be clear: that who list being superseded by RCT's IS IRRELEVANT within the classical TCM paradigm, because TCM DOESN'T VALUE RCT's as highly as clinical experience. I know very well that the quote above re TCM isn't science. It's still part of acupuncture, even if it is pseudoscience. The article can be explicit about that, but it has to be included somehow (I'm fine with replacing it w/ a similar list from Wiseman later, but till then I want to leave it as an e.g. of what TCM says since by TCM's own evidential criteria it's not outdated). You are want to exclude because it doesn't fit scientific POV, but Wikipedia explicitly is about NPOV and not a scientific POV.

(2) On American MD's and NCCAM, again you confuse NPOV and scientific POV. I didn't say that the doctor survey represented a scientific view. It does shows a majority view within the community of Dr's and is thus relevant to the article, as is the NCCAM view which parallels it. If doctors don't always practice medicine per EBM gold standards, fine, say so, but you can't pretend it doesn't exist. Nor can you say that their reliance on non-gold-standard EBM evidence is unscientific or even un-EBM. You don't have to believe me on that (I'll put this in the article as well):

EBM as often presented by CAM advocates is a caricature unrecognizable from EBM as usually understood. CAM advocates seems to suggest that the only thing that matters in EBM is scientific evidence, that the only scientific evidence that counts is large randomized trials and that the results of these trials should be followed blindly with no place for clinical judgment and assessment of individual patient needs. Accordingly, a typical argument is that EBM constitutes a 'contrasting rhetoric' to the clinical art, intuition and the idiosyncratic nature of the consultation [1]. It is difficult to credit that anyone who has made an attempt to learn about EBM could believe such a claim. For example, the first paper found by the search "What is evidence based medicine?" on the worldwide web is an editorial by Sackett et al [2]. The very first sentence states that EBM is "about integrating individual clinical expertise and the best external evidence." Later in the article, Sackett claims that "clinicians who fear top down cookbook [medicine] will find the advocates of evidence based medicine joining them at the barricades". Similarly, the claim that EBM pushes doctors to use only those treatments "research has proven [to] work" [1] bears no relation to anything found in the EBM literature. Quite the opposite, by incorporating decision analysis (see page 138 of Sackett et al's introductory book [3]), EBM provides an explicit framework for incorporation of therapies where evidence is incomplete.[13]

(3) On scientific consensus, please pay attention: I am not claiming that scientists generally support the efficacy of acu. You are claiming that they believe it is not more than placebo -- that they think it doesn't work. That is different from saying that its efficacy is unproven and still being studied. There is a difference between not believing it is raining outside and believing it is not raining outside. This may seem semantic but it is a highly relevant distinction, and impacts the weight given to other POV's. If the consensus were indeed that acupuncture was just a placebo, then it would be getting about as much research these days as phlogiston does. Instead it is vigorously researched. Does that suggest a consensus that it's no more than a placebo? No, it says scientists are curious about it.

Regarding NCCAM's citation and statistics, you are still confused about NPOV vs. scientific POV, and you also seem to believe that you are the arbiter of what acceptable scientific POV's are. NCCAM and many doctors see the data (and analysis thereof) differently than you or Cochrane. As an editor you may cite criticisms of other POV's but you may not omit them, especially when they are held by large numbers of people, as they indisputably are in this case.

This is going to go to third-party moderation without a doubt, which will be good, because it will clarify some important issues for Wikipedia: (a) how to correctly identify and describe a scientific consensus POV, and (b) how to reconcile treatment of scientific consensus with other POV's that are held by a majority outside science but by a minority within it. IMO, (a) needs to be done with care to avoid your error of conflating absence of evidence with evidence of absence, and (b) needs to be handled by giving greater weight and more respectful treatment of non-scientific-consensus than you seem willing to. So, Rving, and we'll take it from there. -Jim Butler 07:50, 29 March 2006 (UTC) (+ some edits -Jim Butler 21:08, 29 March 2006 (UTC))

BTW, Kevin, note that your objection about the NIH consensus statement being outdated/superseded is at the end of that section, and awaits a citation. If it's as egregious a problem as you say I'm sure you can find a good one. Scientists spoke out very convincingly and vocally on the "Intelligent Design" issue. If they also disagree with NCCAM's position, surely they will have made their voices heard somehow. If scientific consensus is anywhere near as unified and strongly-opposed to NCCAM as it is to ID, then it will be VERY obvious. And it's not. Some scientists disagree with NCCAM, maybe even most, but that needs to be sourced rather than inferred. To my view, NCCAM's position is on the optimistic end of "the jury is out" and within the mainstream. In any case, cf. 60% of docs, it's a significant enough POV to merit more than cursory coverage. -Jim Butler 23:09, 29 March 2006 (UTC)

Reorganization to address differing paradigms

I just did a reorg that's intended as a step toward adequately covering the spheres I mentioned above: (1) Classical TCM. (2) Modern clinical practice of doctors (and other practioners?). (3) Scientific consensus. The article has to be clear on the difference between principle and practice, which is a bit challenging because doctors may practice with an eye both toward EBM and TCM/CAM criteria.

One purpose of this reorg is to address the concerns Kevin mentioned above re inclusion of the WHO list of traditional indications. It should go under its own umbrella rather than the article taking a stance on its "working" because -- this needs to be understood -- different paradigms rely on different evidence sets and ways of evaluating them. I tried to be as clear as possible that the list is TCM-based and not science-based. I experimented with several reorgs to day and finally placed it under the theory section and renamed it "TCM Perspective on Treatment of Biomedical Disease".

On the science section, I think the article should avoid the POV that the NIH statement isn't "scientific", because that's a bit like saying who is really a Christian. Better again to cite facts about opinions along with data (and summaries thereof). On that basis, readers can decide for themselves whether NIH is "prevaricating" as some believe, or whether Bandolier shows bias against acupuncture by selectively glossing the double-blind issue etc. -Jim Butler 22:29, 29 March 2006 (UTC)

P.S. That said, I still intend to replace WHO with a list derived from a standard TCM textbook like Bensky & O'Connor or the Cheng Xinnong text. I am cool with pruning this section and other stuff as long as it's done evenly and not at the expense of any POV. Some of the theory can perhaps be pruned a/o merged with TCM; I'll have a closer look at the latter. 36K isn't over the top but of course we should shoot for the guidline of 32. Also, Kevin, I think your earlier point about FDA belonging under risks is correct and I moved it. -Jim Butler 06:49, 30 March 2006 (UTC)

Added "matter of active scientific research and debate" to lead section so readers understand it's taken seriously in scientific community as a subject for research, unlike astrology or something. -Jim Butler 22:56, 31 March 2006 (UTC)

On the WHO list, I'd hoped to find a list that was more up-to-date in terms of reflecting clinical practice in the West. What I'm finding so far is that if such a source exists, it probably isn't going to be in translations of introductory TCM texts from China. Both Cheng Xinnong and O'Connor & Bensky, the two standard teaching texts in the US, include lists of conditions that don't differ appreciably from the WHO list: that is, they include stuff like infectious disease and pediatric conditions, which in Western settings aren't treated nearly as often as chronic and acute pain in adults.

However, the ubiquity of the WHO list (or stuff very much like it) in Asian texts argues for its inclusion in the article as a reflection of the POV of TCM clinical experience (cf. Npov#Anglo-American_focus). We can add a note about Western applications as well.

And the article does need to be pruned, and I think this is best done collaboratively. But that shouldn't be at the expense of any POV currently included, because (as I've argued above) no one has been able to substantiate a single POV as the majority one (cf. WP:NPOV#Undue weight). thx, Jim Butler 04:35, 12 April 2006 (UTC)

Another possibility is splitting the article. That could be done without creating a POV fork. There is some stuff that could be trimmed, but it might be hard to get it to 32K. Since Wikipedia isn't paper, we're not obliged to eliminate material that seems valuable. -Jim Butler 02:01, 13 April 2006 (UTC)

Journal of the American Medical Assocation Study: May 2005

I think this article should describe the recent findings of a the JAMA double blind study involving sham accupuncture. As reported in the following Scientific American article: [14] The JAMA issue May 4, 2005

"Klaus Linde and his colleagues at the University of Technology in Munich compared the experiences of 302 people suffering from migraines who received either acupuncture, sham acupuncture (needles inserted at nonacupuncture points) or no acupuncture. During the study, the patients kept headache diaries. Subjects were "blind" to which experimental group they were in; the evaluators also did not know whose diary they were reading. Professional acupuncturists administered the treatments. The results were dramatic: "The proportion of responders (reduction in headache days by at least 50%) was 51% in the acupuncture group, 53% in the sham acupuncture group, and 15% in the waiting list group." The authors concluded that this effect "may be due to nonspecific physiological effects of needling, to a powerful placebo effect, or to a combination of both."

I think this is research speaks for itself. I am new to Wikipedia so I did not feel right diving in to make the addition myself.

Patniemeyer 19:40, 31 March 2006 (UTC) Pat Niemeyer

Hi Pat, good study; there is a citation to a Cochrane mata-analysis that looked at 26 RCT's on headache and it may or may not have included this one. No objection in principle but in the interest of keeping article size down we should make sure that links to individual studies are notable. Sham has been looked at in other studies with varying results. thanks, -Jim Butler 22:54, 31 March 2006 (UTC)

I am not sure what could be more definitive than a double blind study sponsored by JAMA. I think the current article, in attempting to represent many sources is muddled and leads to the conclusion that there is no scientific concensus on the topic. I think that is misleading.

I will wait until I have time to make a thoughtful review of the entire article and make an attempt at a fair revision. -Pat Niemeyer (signature added by other user)

Hi Pat - before editing, please also read the Talk page where we've covered similar ground, along with Wikipedia's NPOV policies, and keep in mind that

• JAMA didn't sponsor the study, they published it
• The article's study design seemed good, but the authors didn't list the specific methods used for sham points; those were in another paper that as I recall isn't an English-language source, which makes it difficult for commentators to address the issue
• Dozens, perhaps hundreds, of randomized controlled studies exist for acupuncture
• Scientists generally agree that no single RCT is definitive; results need to be replicable and multiple RCT's need to be meta-analyzed. Google for "Evidence-based medicine" aka EBM
• The results of the study speak to the points studied and techniques used in that study, and generalizing them to all of acupuncture is unwarranted
• If any single majority view on acupuncture existed (scientific consensus, or otherwise) that consensus should be easily citable in a commonly accepted reference text. The burdon of proof is on the person asserting that a view is a majority view, so you if you believe consesus exists you need to show this, not simply infer it from what you think is sufficient evidence
• If there does exist scientific consensus, why do they keep investigating basic questions about acupuncture?
• Even if a majority scientific view could be proven to exist, NPOV is not the same as scientific POV, and requires the treatment of all significant views on a topic. See the cited poll in the article on American MD's, and the stuff about TCM being a different paradigm.

edit: obviously, it's cool to put stuff like this in the article, esp. if we're not worried about space and it's eventually going to be split, but please be careful of overgeneralizing from its results to some sort of general "consensus" unless you can demonstrate that such exists among a majority of scientists. Also, you might want to check and see if Cochrane already covered it in their meta-analysis. What criteria do you think that this article, or a daughter article, should use in choosing which individual studies to discuss? thx, Jim Butler 19:01, 20 April 2006 (UTC)

Pruning

hi Jim thanks for your message. what do you mean by no POV viewpoint in the ascendency? please go ahead and begin pruning - let's do it bit by bit so we can check on progress. Mccready 09:17, 14 April 2006 (UTC)

HI Kevin - no POV in the ascendency = NPOV approach when no majority view. As mentioned above, some splitting a/o consolidating possible; theory could be moved to TCM article. thx, Jim Butler 18:20, 14 April 2006 (UTC)

Hi all Might I suggest that we create a new page titled "Science and TCM" (or similar) to relocate all the information from this page and the chinese medicine page regarding scientific evidence, NIH, NCCAM, "questions of efficacy" etc. These sections take a lot of space on both pages and have similar content, a lot of which is repeated. I think a paragraph summarising the main issues (plus a link of course) would suffice to highlight the contention that exists and direct interested readers. I think it is inappropriate to dedicate such a large amount of space on these pages to contentious argument. So many studies I have read on acupuncture and chinese herbal medicine (and I'm talking over 1,000 articles) have concluded that more research needs to be conducted into the area - regardless of positive or negative research findings. Study into TCM is still a work in progress and it seems futile to continue with the "he said" "she said" stuff on the main page because it's not representative in terms of describing what acupuncture is, the flow of the article is disrupted and contains little bits from here and there. Every month new studies emerge that contradict previous ones, and I think that a separate page would allow a better focus and more attention to be paid to this particular "subset" in the TCM/acupuncture story. It is a big subset afterall, and is only going to continue to grow. I would have created the new page today already, but with all the b@?tch-slapping on this page, I'm afraid of getting dragged into this crazy debate, or worse still, a thoughtless revert imposed upon my changes. If there are any objections to this suggestion of creating a "Science and TCM" page, please state them clearly and sanely in response to this post.Piekarnia 02:57, 19 April 2006 (UTC)

Hi Piekarnia. It seems to me that creating such a page would arguably be an example of a POV Fork.

Also, until or if such a page is created, I think that the stuff you just deleted should stay. The last paragraph from the NIH Consensus Statement, about TCM theory's value lying in its clinical efficacy rather than its correspondence with biomedical theory, is intelligent and nuanced stuff, neither skeptical nor "believing". Shouldn't Wikipedia present a range of POV's? I agree that some of this stuff can be folded into the TCM article, and linked accordingly, but I'd be happier if it could stay until we have a chance to integrate the two. I haven't had much time to edit lately, but apart from the fact that the article is (at 37K) too long, there is nothing urgent here; the TCM, EBM and "pragmatic clinical" (NCCAM; also majority of American MD's, cf poll) POV's are all adequately represented and well-balanced with respect to one another (none of them being demonstrably majority POV's). thx, Jim Butler 05:05, 19 April 2006 (UTC)

Hi Jim. Sorry to step on your toes. The reason I removed the content is that I felt it was already covered in other areas, and at the very least had no place under the heading of "Traditional Theory". The two paragraphs are not representative of Traditional Theory, but rather of contemporary interpretation - science/pseudoscience whatever. Perhaps it should be in a different category. We are meant to be discussing Acupuncture and TCM, not dedicating every section to a different fragment of the science vs tcm argument. See also the final paragraph in the "example of acupuncture treatment" section - it doesn't fit. I feel that including the scientific justification or argument is important, but it should be dedicated to a separate section - without comments all the way through. The subject headings and content itself doesn't lend itself well to having scientific discourse littered throughout. If you refer to the article on POV and criticism, they say that criticism shouldn't be put into a separate section - unless it affects the flow and readability. I strongly feel that due to the nature of the subject, a separate section is warranted in order to maintain readability. But if you truly believe that the scientific discourse belongs in each subsection, I'm not going to start a revert war.

Also, I don't believe that the separation of the two sections is contrary to Wikipedia guidelines. I refer you to the final paragraph in the first section on POV Fork:

In line with Wikipedia's semi-policy of assuming good faith, the creator of the new article is probably sincerely convinced that there is so much information about a certain aspect of a subject that it justifies a separate article. There is no consensus whether a "Criticism of .... " article is always a POV fork. At least the "Criticism of ... " article should contain rebuttals if available. And the original article should contain a summary of the "Criticism of ... " article. See also Wikipedia:Criticism

Further in the same article under the subject heading "Article spinouts"

Even if the subject of the new article is controversial, this does not automatically make the new article a POV fork. Provided that all POVs are represented fairly in the new article, it is perfectly legitimate to isolate a controversial aspect as much as possible to its own article, in order to keep editing of the main article fairly harmonious.

A separate science page SHOULD NOT constitute a criticism page because there would be data presented from both sides. Properly conducted scientific investigation will only strengthen the basis of TCM and acupuncture, it will tell us where the strengths and weaknesses truly lie - which doesn't necessarily constitute a negative opinion. Unfortunately, if the general practice of TCM involves "individualising" treatments according to symptom differentiation and/or accompanying factors, the ol' double blind RCT is not going to be able to take that into consideration and serve as an accurate testing protocol. We need to have research comparing real TCM treatments with other therapies (pragmatic trials) and we need research that is representative of the therapy. If people are reporting that they are getting success from a particular modality of treatment, but the studies are saying otherwise - perhaps we should be doing the studies differently before we call healed patients "loco" and dismiss their experiences. As a TCM practitioner, I am appalled at how ridiculous studies can be - they do not represent anywhere near what would happen in clinic, yet we are trying to use them to argue for our point of view, and the critics are trying to use them against us by saying they're poorly designed. I agree! Most of them are crap, but I think so for different reasons. Yes, there are aspects of the subject of science and TCM that are definitely POV, but surely they should be more completely represented in a separate, unbiased section. At the moment, both sides are needing to sell themselves short in terms of telling their story in order to conserve space on the page. Piekarnia 06:35, 19 April 2006 (UTC)

Whilst we're talking about pruning the page, are there any plans to include more complete information about acupuncture, such as the different "flavours" of acupuncture = five element acupuncture, japanese acupuncture, microsystems other than auriculotherapy (which has its own page I believe)? What about discussion about the different types of needles used, and a reference to the ling shu? It is the earliest text on acupuncture, and quite comprehensive. What about the classification of points == jing-well points, he-sea points, luo and yuan points etc. Musculotendino meridians, eight extra meridians, luo channels etc. This page could contain so much more useful information about what acupuncture is and its theory, rather than contesting and justifying whether or not it can be explained by science.Piekarnia 06:58, 19 April 2006 (UTC)

This is a good discussion to be having. Aren't there some acupuncturists who accept that EMB is the way to go? In which case the prominence in the article given to traditional pre-science stuff needs to be balanced. At the same time we may need to say that different practitioners and styles don't agree on where the points are and what they may do (if my understanding is correct). The long list from 1979 WHO needs to be pruned down and perhaps even moved to the history section because some items on the list are no longer accepted by a significant number of practitioners as being amenable to acupuncture (again I could be wrong abou this). If there is consensus I would like to try to edit down the NIH stuff with links to the NIH site. Mccready 07:31, 19 April 2006 (UTC)

Good stuff to consider. Piekarnia, you are right that there is MUCH more that could be put in (I say this as a fellow TCM practitioner, btw). China has a "three roads" policy (cf article). Maybe we should emulate that, and do as you suggest. As Kaptchuk pointed out, TCM is founded on basic axioms from which everything unfolds, whereas biomedicine is ever-changing and based on the scientific method. They are arguably different entities, not just different POV's on the same entity. So there could be articles on TCM, traditional acuppuncture (possibly branching into different articles on different styles) and science and acupuncture. (I also agree that in the interest of fairness and tone, every paragraph about TCM theory or practice need not be followed by a "but science says this is BS" type statement.)

Kevin, the problem with "undue weight" is that there isn't good evidence as to the proportions of people holding different views (or doing different things), and the question also arises, among whom? Scientists? Doctors in the West? Doctors worldwide? We shouldn't feel constrained to keep this stuff, including different scientific views on acu, to just 32 K. I'd rather have more information than less, since this isn't a paper encyclopedia. On different point locations, AFAIK for body points they are very consistent with rare exceptions; there is some debate over auricular points. Can you reference that? thx, -Jim Butler 21:06, 19 April 2006 (UTC)

P.S. Forgot to add: as I mentioned above, the WHO list includes basically the same stuff as current, standard English-language teaching texts. This is basically the TCM piece of Chinese medical education (which can be anywhere from 10-50% of a Chinese doc's training depending on the school). This is important enough to merit inclusion, even if most Western graduates don't devote much of their practice to treating, e.g., infectious disease. However, "TCM-ized" acupuncture (TCM in the sense of the PRC's official version of it) isn't the only acupuncture taught or practiced in the West, although it's the most prevalent one (and the basis for most of the national board certification exams) in the US. There is Japanese, French, Worsleyan 5-Element, emerging American styles, etc. Those should be mentioned too. I think we should focus on spinning off a new article or two before deleting stuff from this one.

As for science and undue weight, again, NCCAM is a significant player representing a POV that should be covered (cf. 60-75% of American MD's). thx, Jim Butler 22:47, 19 April 2006 (UTC)

Pruning NIH; more on NIH consensus (NCCAM) and EBM

Kevin, if the above wasn't clear, there ISN'T consensus on pruning NIH, so I'm reverting and am going to keep doing so unless or until you adequately address my reasons (stated above several times) for leaving it in. Please quit taking out stuff that doesn't jibe with your POV. You need to cite assertions that it's outdated or biased. Even that doesn't justify removing it. And if we're gonna split the article anyway, there is no need to prune. Thanks, Jim Butler 05:15, 20 April 2006 (UTC)

P.S. I've left that tagged statement on "outdated" in there for well over a week. As you know, uncited statements can be removed at any time, but I've heard that a week is customary for tagged things. I'll leave it awhile longer so you can dig something up, if you like. -Jim Butler 05:21, 20 April 2006 (UTC)

Due to an edit conflict my ealier post didn't make it. Here is is again:

Keep cool Jim and assume good faith. Looks like we don't agree on leaving it all in. To help us along could you ennumerate why the bits I removed should stay? In particular, you need to say why the comparison with other forms of medicine should remain. At the moment it reads like an advertisement for acupuncture, which is not the point of the article. The bias is a simple statement of fact and doesn't need a source, but I'll rephrase it and hope you agree. On outdated, I've also said before that plenty of stuff has been done in the quarter of a century since the biased statement was published - and that stuff, we both agree, has improved our knowledge to a point well beyond what was available in 1977. Once again, its heavily qualified use of what we also both acknowledge as weasel words, make it a problematic, not necessarily authoritive source, from one particular agency in one particular country. It would be similar perhaps to inserting critical material from [15]. I've therefore moved it to the history section, which I hope is OK? I don't agree the article should be split at this stage when there is still discussion about pruning. Mccready 06:47, 20 April 2006 (UTC)

I do assume good faith, Kevin, but I've stopped assuming that you understand that NPOV isn't the same as scientific POV, or that you are careful in your edits.

• First of all, NCCAM is 1997, not 1977. Oops. They stand by what the 1997 report said, and that alone suffices whether or not you think it's outdated. Putting it under history is absurd, and saying it's not scientific is just your POV (TCM is obviously not the same as science, but NCCAM's panel was mostly composed of PhD's). Your qualification "although much research has since been published" still has some POV, suggesting their position is unreasonable. Why not just find a source who says so? If you can't, then it shouldn't be in the article.
• Second, their purported bias is obviously an opinion, not a fact.
• Third, weasel words are something we want to avoid as editors, but if a source uses them that does not mean that the source isn't reliable (by any Wikipedia standard that I'm aware of; please correct me if I'm wrong). Life is full of uncertainties and probabilities and possibilities, you know? So is clinical practice.
• Fourth, you say it sounds like an "advertisement" for acupuncture on the basis that it gives qualified endorsement of acupuncture for certain conditions; this is circular logic based on your reading of the studies as showing lack of efficacy (as opposed to Cochrane, which more often than not says that studies are insufficient to show efficacy, which isn't the same thing; NCCAM interprets the studies still more liberally, and it's not our place as Wikipedians to exclude a significant POV we don't agree with).
• Fifth, you wish to delete material on its safety relative to Western therapies when in fact safety is an essential factor, along with efficacy, in clinical decision-making.

Please feel free to include the critical material you refer to. I see no justification for your deletions, and am rving. Why err on the side of shutting down other POV's? Clarify the ones you think are important, and try writing for the enemy once in awhile. - Jim Butler 07:47, 20 April 2006 (UTC)

Thanks Jim, sorry about the error 1977/1977 and I do in fact understand NPOV and science. Yes, given my error it is not appropriate yet in the history section. Regarding your safety arguments, wouldn't it be better then to put it in the safet section? I would like you to consider how, as editors we can include the fact that the statement, to the extent it prejudges research, is IMHO biased. Unless your argument, if I understand you correctly, is that they, not accepting science, somehow imagine some other type of research. Are you also suggesting they reject EMB? In either case, the case for bias is made out in logic. Regarding your fourth point there is no circular logic - as I've said before you cannot prove a negative. Rhetorically for the moment, how many studies and how much money spent would it take for you to allow the conclusion that enough is enough? What we are seeing here, not necesssarily from you, is a religious belief (ie science doesn't matter, we have a diferent framework, my personal experience says etc etc). If that is the case we need to work that into the article. Thanks for the go ahead on the NSW material, I think it will make a useful addition for why regulation takes place. Many practitioners believe that regulation = approval. It does not and we need to cover this also. Mccready 08:50, 20 April 2006 (UTC)

Hi Kevin, good call on moving the appropriate comments to the safety section. On NCCAM's putative bias, I don't think they prejudge research. I think their view is that given that acupuncture is relatively safe, it doesn't hurt to try it in some cases where the data is suggestive, and by doing this we will accumulate clinical observations that will be helpful. Such qualified endorsement may sound to you like an advertisement, but in Wikipedia terms it has to be allowed as a difference of opinion. All I can say, as before, it please feel free to flesh out other POV's/criticisms for which you have reliable sources, but you don't get to infer "bias" as "fact" within NPOV.

Your rhetorical question on "when enough is enough" is a leading question. My response is that it will answer itself when scientific consensus is reached. This isn't like flat-earthism; there is active research on acupuncture worldwide. If consensus existed that it was ineffective, shouldn't you have been able to find it by now? One might be tempted to ask: at what point do we say enough is enough, and stop trying to exclude significant POV's because they don't correspond to an imaginary, unproven majority view?

Finally, I think the article is pretty clear on the differences between classical TCM and science/EBM. edit: meant to add -- in what ways do you think it's not? I did try in recent edits to make clear that classical TCM isn't based on the scientific method, etc. thx, Jim Butler 22:17, 20 April 2006 (UTC)

P.S. On proving a negative, note that there is a difference between the meta-analyses of RCT's for smoking (essentially no evidence of efficacy) and headachce (mixed). Giving unproven-by-top-tier-criteria stuff a try isn't antithetical to EBM, at least according to this source (already in the article at end of EBM section). Consider NCCAM (NIH Consensus recommendations) in that light. If something is very unlikely to cause harm (certainly true of acu in trained hands: my malpractice insurance is really cheap relative to what MD's pay), it's not unethical (or unscientific) to try it in practice, especially if doing so is suggested by clinical experience, consistent with patient values and has the potential to generate information that can guide further research. That's how good stuff is sometimes discovered, or re-discovered. thx, Jim Butler 07:07, 22 April 2006 (UTC)

New South Wales report; AMA and NIH

Hi Kevin, I just read the New South Wales report you mentioned[16]. It's a good example of a well-considered regulatory proposal, and notably has useful summaries of regulation of acu worldwide.

Above you said "Many practitioners believe that regulation = approval. It does not and we need to cover this also." I don't read regulation as endorsement, but as ensuring both freedom of consumer choice and safety. These issues arise with any modality or practice that has the potential to harm. In any case we should stick close to sources and use fair tone.

The safety issues raised that were acu-specific had to do with unsterilized needles, linguistic competency of practitioners, and patients' potentially not seeing warranted biomedical intervention. (Issues of toxicity were mentioned with regard to herbal TCM.) These are issues frequently raised in regulating acu and CAM; they are covered somewhat in the Safety & Risks section (to which the Legal and Political Status section should refer). Were those the things you wanted to add? thx, Jim Butler 19:13, 21 April 2006 (UTC)

hi Jim, yes they were the issues. I moved the NIH stuff to safety. On the bias question we'll have to agree to disagree. They did, after all, say the research would prove them right or words to that effect. I'm not going to have time to work on acu much for a little while, but pls feel free to put the NSW stuff in. Mccready 12:23, 22 April 2006 (UTC)

Hi Kevin; thx for adding AMA. On NIH, perhaps you hadn't noticed that I'd already moved the safety-specific stuff to that section? The rest was about research, efficacy and suggestions for clinical use, and is better left under the Research section. It is too POV to edit the article such that positive statements by scientists are left out of the Science section and thereby subtly spun as unscientific. (I don't know whether that was your intention or not; just commenting on the way it reads.) edit: On bias, I don't think that any of the quoted commentators (Bandolier, NIH Consensus Comittee, AMA) are without some degree of bias, though none of it appears extreme; readers can infer a/o sources can be cited on this issue. (If no one finds a source, I'll remove tagged statement on NIH being outdated in a few days). Have a good weekend, and thanks, -Jim Butler 01:14, 23 April 2006 (UTC)

About the AMA reference, don't mean to be picky, but it's a pretty dodgy reference. It's a report that was commissioned a number of years ago that contains two references to acupuncture: 1) a digest article from AMA from 1992 2) an article written by our friend S Barrett (recognised biased writer). There are no primary sources stated, no direct references to any trials. Are these the only two things they read before writing the report? Other material available from the AMA website shows that the opinion stated in the 1997 article is outdated. In fact, in a 50 page report on pain management from 2005 [17], they discuss the role of acupuncture and quote real research. They state that many benefits are based on empirical observations with only a few studies done to back up. On their site they quote NIH 1997 and their link to acupuncture tells a very different story [18] to the one currently listed on wiki. Can we please remove the statement and replace it with something more current and representative? Cheers Piekarnia 05:58, 26 April 2006 (UTC)

Agree that the AMA report is pretty underwhelming; they have some boilerplate citations and don't even purport to analyze RCT's. But AMA is a relevant POV, and I'd tend to err on the side of inclusion. Googling, I couldn't find anything better from them. thx,Jim Butler 06:08, 27 April 2006 (UTC)

Not sure if everyone is aware, but the page on Medical acupuncture discusses some of the issues that we're talking about here. Perhaps some of the scientific discourse would fit on that page? The page is lacking somewhat in references and some of it is relevant to what we're discussing here.Piekarnia 06:07, 26 April 2006 (UTC)

Hi Piekarnia. "Medical acupuncture" is basically Joseph Helms' synthesis of various schools. I think it should probably be treated in the same way as Japanese, Korean, Worsley, TCM, etc. -- either merged or having its own page, but being clear on what it is and isn't (it is valuable, but it's not more "scientific" or "rigorous" just because docs are doing it). I like your original idea of having a "science and acu" page that covers emerging scientific research in more detail, and would naturally be updated more frequently than a TCM page. I think we also should try and distinguish between China's "offical" TCM and the larger body of material that's sometimes called "traditional Oriental medicine". Lot of work to do. Wish I had more time, but I'm happy to help incrementally. best, Jim Butler 06:04, 27 April 2006 (UTC)

AMA Statement

I disagree with the views expressed above re the AMA statement. The medem.com site is not the AMA, though it is true that acupuncture received a signficant boost in the west as a result of chinese businessmen fleeing communist china during and after the cultural revolution - some of them had been trained in Mao barefootdoctorism (the doctor you get when you don't get a doctor because the communists were exterminating the intelligentsia).

The AMA pain link stated:

"efficacy of acupuncture may have more to do with the therapeutic relationship between the patient and the acupuncturist than the direct physiological effects."

I think you may have misread other parts as support for acupuncture. My own view is that the human mind is one of the most powerful but least understood parts of the health equation. I look forward to a day when we can harness the placebo effect reliably and repeatedly - unfortunately western medicine moved away from this, for example when it pooh-poohed hypnosis or meditation and turned instead to a one size fits all type of medicine that failed to account for individual differences. This is not to say that EMB should be abandoned - it's just that your EMB must take individuals into account. So I'd be reluctant to alter the science section as suggested. There is still no scientific proof that acupuncture is anything more than placebo for any condition whatsover. Even the metastudy on P6 for nausea is hotly contested. Mccready 11:27, 26 April 2006 (UTC)

You forgot to quote from the same sentence:

"Anecdotal evidence suggests acupuncture can produce some significant physiological changes, some of which have a pain-mitigating effect"

Later in the article they mention the use of acupuncture as a non-pharmacological intervention for pain management in conditions such as myofascial pain and fibromyalgia. Whilst I'm not saying that we should quote this article, and I am very aware that there are no "blanket" statements that acupuncture is the holy grail, what I was trying to highlight was two main points.

1. Firstly, the sentence that is quoted from the AMA is from 1997 (the best part of a decade ago). The actual article that it comes from was a very general article that discussed everything from homeopathy, herbal medicine, acupuncture etc - so it more accurately describes their view of complimentary medicine in general rather than acupuncture. The article itself is very poorly referenced, they have not actually referenced any primary sources - rather they get their information on the effectiveness of acupuncture from secondary sources. One of these sources was S Barrett, who is a known biased writer on the topic. The other was a digest article from a 1992 issue and can hardly be considered a "solid" reference. So my first argument is that it's a poor quality piece of writing and it shouldn't be used. I'm not sure if you have a university degree, but this quality of report writing is unacceptable for a university student to produce and it's definitely unacceptable for a body such as the AMA to be producing. Why are we quoting it? Was it the first thing that you found that had a negative skew toward acupuncture? It seems to me that you enjoy fishing for negative viewpoints instead of trying to find actual viewpoints here.

2. Secondly, I find that there is a great difference between the two statements

"There is little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies."

"Anecdotal evidence suggests acupuncture can produce some significant physiological changes, some of which have a pain-mitigating effect, still, the efficacy of acupuncture may have more to do with the therapeutic relationship between the patient and the acupuncturist than the direct physiological effects"

and I am certainly not delusional about their views on acupuncture with regard to their pain article. I do however see a large difference between the two statements and I think there is a better sentence that we could quote the AMA on.

Yes, the medem.com site is not the AMA, but it does represent two things. Firstly, and less importantly, it represents a wider medical community opinion. Secondly, and more importantly, organisations like the AMA must be quite prudent in websites that they link to, and should not link to websites like that if they do not support the views presented there. Whilst it is obviously not their website, it does show that they appreciate the information held there moreso than they do the quackwatch site for example - which is not linked to.

You've really gotta cut us some slack here, Kevin, it's quite tiring having to deal with your constant provocation here. I stated that the article that you quoted was of poor quality and suggested that it doesn't represent their current point of view. I suggested that we find a better quality article written by the AMA and referenced an example of something they have produced that is properly researched. You jump from that statement to questioning my insight - pointing out that their pain article wasn't an advertisement for acupuncture. I was actually aware of this, and did read the article myself. Did you? (Did you find the reference to fibromyalgia on page 25 disgusting?). I'm really quite insulted by this entire process, here we are trying to have intelligent discourse on this topic and you continually manipulate our words, refuse to see the difference between NPOV and scientific POV and constantly indulge your own POV. What right do you have to come onto this forum and continually bash your own point of view around, and insult others for not having NPOV? You are the only person on this discussion page who clearly has no idea what NPOV means. I would really like to know what your actual problem is.

I'm going to concentrate more on getting some content done for the other topics listed earlier that aren't covered on the page. Should I post them here first? Put them straight on - or hold off until the page has been "revamped"?Piekarnia 00:02, 27 April 2006 (UTC)

My two cents is that you should go for it. We all get a little hot under the collar sometimes, but overall I think the article has improved significantly due to Kevin's presence here (esp. bringing in EBM). Valid criticism does everyone a favor. If we keep erring on the side of inclusion, fair tone and balance, the article will imo keep getting better (and naturally spin off other articles). best, Jim Butler 06:42, 27 April 2006 (UTC)

Thanks Jim, I think that Piekarnia has misunderstood my position. I suspect that we all actually agree. ie the mind is a powerful thing. The psychological point is well made and one I agree with - I didn't forget to quote it because it was clear in what I said. I will repeat though that what we are talking about could be due to psychology/placebo/power of human mind in and of itself, not due to acu. Mccready 08:43, 27 April 2006 (UTC)

I think acu, like anything that makes a person feel good, does harness placebo aka the self-healing mechanism. I think that some acupoints (e.g. the best-known, most-used ones like LI 4 and St 36) will be found to do that more effectively than others. I also think that some acupoints will be found to have specific effects (on nociception regionally, neuroendocrine activity, etc.). But that will require careful study design that takes into account its traditional use rather than "looking where the light is better". cheers, Jim Butler 05:06, 2 May 2006 (UTC)

Ok, so I have just added some brief theory about point categories. This is pure acupuncture theory, so anyone who wishes to improve its accuracy or add to what I have written (according to TCM framework) is welcome to do so.Piekarnia 10:36, 30 April 2006 (UTC)

Small edit

I can't edit for technical reasons, but all of the references to "yin" and "yang" need to be changed to reference the page "Yin_and_yang", as the two concepts do not have individual pages. Please delete this note after the edit has been made.

Lead section

I removed the statement about cochrane collaboration from the lead section. Wiki guidelines state that the use of specialised terminology should be avoided in lead sections, that we should ease our readers into the topic without dropping them into the middle straight off. Knowing about the cochrane collaboration is not an essential component to one's knowledge of acupuncture: simply stating that there is scientific debate is an adequate introduction. The general reader is "eased into" the topic (see Wikipedia:Lead Section), interested readers can easily find the scientific debate section. I also expanded the information on the cochrane stuff so that it made more sense, previously the reference to P6 did not state what it was tested for. The adverse opinion to the cochrane findings is not made by cochrane themselves, now this is clear to the reader. Cochrane have stated their P6 findings, there is no need to state that it is not valid according to their system just because another group said so. It is good to quote SRAM, but their findings do not change the Cochrane findings. If Cochrane do change their stance, then it will be appropriate to quote that "None of the findings of acupuncture have been proved....etc". But not before.Piekarnia 12:02, 30 April 2006 (UTC)

Hmmmm. "None" goes too far, but "most" may have been OK. Even so, it does need to be made clear that debate extends into the EBM realm as well (P6, headache). And you make a valid point about the technical nature of the definition of EBM and its scientific standards. (1) The reader may not know what EBM is, or what its standards for efficacy are. (2) Scientific standards include not only efficacy, which is debated, but also safety, which is generally accepted (or at the very least much more widely accepted than efficacy is). (3) Finally, EBM also includes non-scientific standards, such as clinical experience, so a doc doing EBM could therefore do acu without transgressing EBM standards. Would the reader understand these issues from the single statement about EBM in the lead? Doubtful, so it becomes a POV statement, an oversimplification of a nuanced issue that needs to be "eased into". Will have to sleep on this, but I think I agree with your point here. thx, Jim Butler 05:06, 2 May 2006 (UTC)

The other thing I forgot to mention is that wiki guidelines also state that longer articles can afford to have longer lead sections. So whilst removing the detail about EBM may suffice for the meantime, I think it's worthwhile considering fleshing the lead section somewhat so that we can summarise a little more of the article's contents, perhaps rephrasing the EBM sentence to be more of a layman's version and less technical whilst still representing the issue and providing adequate introduction. We should probably also put in a sentence or two to summarise the other sections as well to provide a more complete overview of the article. Your thoughts, Jim? Piekarnia 06:21, 2 May 2006 (UTC)

Excellent idea, Piekarnia -- go for it & I'll ponder too (short on time just now). cheers, Jim Butler 17:51, 2 May 2006 (UTC)

Kevin (User:Mccready) suggests that A in the lead section should be substituted with B:

• A) The mechanism of acupuncture and its effectiveness are a matter of active scientific research and debate.

• B) Whether acupuncture is truly efficacious or a placebo is subject to scientific research.

I suggest C:

• C) "The nature of acupuncture's effects, and the degree to which it is truly efficacious or a placebo, are a matter of active scientific research and debate."

This, however, definitely doesn't belong in the lead section:

None of the claims for acupuncture have been proved to the scientific standards of evidence-based medicine (cf. Cochrane Collaboration).

Please see my comments just above (currently the second entry in this section, beginning with "Hmmmm...") for why. The sentence is misleading for several reasons. Even EBM types, when discussing top-tier evidence for efficacy, disagree on headache and nausea. You're trying to advance one view based on your intrepretation of studies. As with your ideas about the existence of a purported majority consensus view that acu is no more than a placebo, Kevin, I think you're venturing into original research here. thx, -Jim Butler 23:39, 3 May 2006 (UTC)

Thanks for discussing Jim and Piekarnia. Pls see WP:LEAD - anything that's in the article is ideally summarised in the lead. I disagree with you Jim about EMB. You seek to pick the lowest stds (anecdote/individual clinical experience) and I pick the highest in EMB (replicable proof). That's why the phrase scientific standards is there and the reference to proof - it modifies the EMB statement. So the statement "None of the claims for acupuncture have been proved to the scientific standards of evidence-based medicine (cf. Cochrane Collaboration)." is true. You seem to acknowledge that your strongest point (sorry for the pun)is P6 for nausea - but we both know that is hotly debated. Therefore it is not a settled question to the standard of scientific proof. Your wording in (c) also assumes, albiet only in the first phrase, that there is an effect beyond a placebo - yet there is no good, or strict or scientific evidence of this. The word "active" is also tautological in this context. If it is a matter of research then it is ongoing. I also reject the use of the word evidence applied to anecdote/an individual's clinical experience. Indeed "anecdotal evidence" is an oxymoron. Let me now turn to your other arguments. 1) the reader may not know what EMB is - that's why there is a hyperlink. 2) scientific stds here applies to the efficacy of acupuncture - not to safety. It's sophistic to try to argue otherwise. 3) I've addressed the EMB differences already. Disagree that a true statement that a reader MAY not understand becomes POV - sorry Jim, that's just illogical. If memory serves me correctly Jim is was you who put the cochrane stuff into the lead - if so, I'm surprised you've taken it out. Mccready 17:07, 5 May 2006 (UTC)

The issue seems simple enough. The lead section should adequately summarize the article. The article covers several POV's on scientific research and efficacy, and we've already agreed, it seems, that in the interest of NPOV most of it should stay. Is your version, which basically summarizing Bandolier's take on EBM, a fair and accurate summary of what the article says on these matters? Pretty clearly not. Your version appears to confuse scientific POV with NPOV again, and even then, it ignores the differences between Bandolier and Cochrane (on both P6 and headache), and the differences among NIH and the above-mentioned EBM groups in what to recommend clinically.

My version does not assume effects beyond placebo. It simply says that the nature of those effects is a matter of research. "A matter of active scientific research and debate" is meant, as I mentioned when I made the edit, to clarify that these questions are engaged by people in the mainstream, unlike e.g. flat-earthism. Your rejection of the idea of "clinical evidence" is one POV, but not the only one; even EBM factors in clinical experience, which some would call a kind of evidence. It's fine to mention EBM, but there should be some context, and safety should be mentioned as well. Please see my reply below to Piekarnia for suggestions on how to proceed. (BTW, it was you who placed Cochrane in the lead originally. It's better to just say EBM, with explanation.) thx, Jim Butler 07:11, 6 May 2006 (UTC)

We seem to be entering a edit war

Jim, Kevin and others. It's clear from the multiple reverts that are going on here with regard to the lead section that we are in the beginning stages of an edit war. Kevin, you have simply reverted the edits of 4 separate editors with regard to the same sentence, which clearly shows that you are the only contributer on this page who seems to think that the sentence belongs there with no modification. There are 4 who think it doesn't belong there. Wiki three revert rule guidelines strongly recommend reverting a change only once. Because Kevin, you obviously feel very strongly about this issue and are prepared to continually revert and make no changes to the sentence, there are several options available.

1. We can get some third party wikipedians to review our article and make suggestions about the lead section.

2. We can get dispute resolution

3. You can accept that the sentence you insist on inserting to the lead section is not appropriate and attempt to enter discussion about possible alternatives.

Continuing to revert changes made by multiple users does not constitute an option. It is obvious that your opinion with regard to this lead section does not represent the majority of editors on this page. Wiki three revert rule guidelines also state that as an alternative to reverting, a reword is often more appropriate. Obviously this is the easiest one to organise, and we hope that Kevin will be happy to discuss this before proceeding with further editing on this sentence.

Wiki guidelines state WP:LEAD that any specialist terminology that is ESSENTIAL to describing the topic needs to be defined in the lead section itself. A link is not sufficient. If it absolutely needs to be there, it needs to be defined in the lead section. The majority concensus is that reference to scientific debate is sufficient for the lead section. Making reference to cochrane collaboration and EBM brings into use non-essential specialist terminology in the lead section. Simply adding a link to the cochrane/ebm stuff is not enough, it either needs to be defined in the lead section or removed. My suggestion was to remove said sentence until it was rephrased to be more "layperson friendly". Kevin, you have not responded to my suggestions in this regard. Did you read my talk contribution before you reverted my changes the other day? Also, Kevin, if we're quoting EBM in general, we need to say that the findings are minimal and disputed (or similar). If we're quoting Cochrane as a standard for EBM, they have stated their P6 findings. You have not provided a reference to where the Cochrane collaboration dispute their own findings on P6. It is incorrect and inaccurate to quote the sentence as it stands regardless. Despite your anti-acupuncture sentiment on your personal home page, it is important to remember that you need to maintain NPOV at all times on this website. Piekarnia 02:38, 6 May 2006 (UTC)

Hi Piekarnia -- please see my remarks to Kevin just above as well. I think the best resolution is to proceed as you originally suggested, and expand the lead section. Rather than trying to simplify a bunch of POV's and stuff about research, efficacy and safety into a brief, general sentence, we can be NPOV by being inclusive. Kevin seems to have come around to this perspective with regard to leaving in NIH and WHO in the article alongside Cochrane and Bandolier, so it doesn't seem like a big stretch to work them all into a two- or three-paragraph lead. It's too late for me to wrap my mind around summing it up concisely right now; feel free, and I'll pitch in later as well. thx, Jim Butler 07:33, 6 May 2006 (UTC)

Hi,

My suggestion to an alternative in that lead sentence is simply to state both meanings on the matter. Like on the german wikipedia. I'm trying to accomplish this on the dutch version. We're having the same discussion there at this moment. The french version is also a little bit fuzzy about it.

johanna(excuses for bad english)

Thanks for your comments Piekarnia. I hope you would be the first to agree that this issue is about logical and rational editing, not numbers. Four editors don't disagree with me. In fact Jim prefers to say most of the claims don't meet EMB or science. Jim also prefered to have EMB and cochrane in the lead. If memory serves correctly, he put them there and his remark above says he prefers to expand the lead. If you object to the statement I propose you will need to provide evidence that any claim for acupuncture is agreed on by the scientific community. I'm happy to consider a mediator you propose, but I would prefer you to provide the evidence first, or consider a form of words we can all agree on. You haven't quite quoted WP:LEAD correctly. It says "Where uncommon terms are essential to describing the subject, they should be succintly defined within the introduction." The question is twofold; whether EMB is uncommon and whether it "describes" acupuncture. Describing and commenting on are two separate issues. I searched the talkpage for "layperson" friendly and only found one instance in your message above. What form of words would you proposed to describe EMB in such a manner? I'm not sure what you mean by "mininmal" findings. The ref to P6 is in the body of the article. Thanks for looking at my website. I hope it was informative. Mccready 07:59, 8 May 2006 (UTC)

Hi Kevin. Thanks for your response, it's nice to be able to discuss this issue with you. I feel that there is actually a lot of agreement with what needs to go in and what should be left out, but that it's just a matter finding the right phrasing. It was my suggestion to expand on the lead section and I think it is appropriate to have a representative paragraph on the scientific stuff. I also said that "none of the evidence" should be removed in the meantime because it is inaccurate and misleading. When I said that four editors disagree with you, I meant that four separate editors have reverted the same sentence that you kept adding back in. I stated my particular objection to the sentence as two-fold:

1. That one sentence on the topic is too little, and that it should be adequately explained in the lead section itself without the need for a link. Two or three sentences describing EBM in lay terms is better than a brief sentence that readers will only understand once following a link. One sentence describing what evidence based medicine is, one sentence outlining the key players, one sentence outlining the relevant opinions. The topic of EBM in the lead section will sound more relevant if it's in context. Previously it just sounded too weird and specific, because it was tacked on at the end of a bunch of unrelated stuff. Let's give it a few sentences to do it justice. It seems quite obvious to me that the concept of evidence-based medicine is not a common term that the average reader would be familiar with. There are some deductions that one could make from the terminology, but I think it is important to properly describe it in a few sentences, don't you?

2. My objection is to the word "none". The inference is that scientific evidence for acupuncture doesn't exist. That statement is incorrect, because there is a meta-analysis that supports the use of acupuncture for P6 (Cochrane) that is disputed by another group (Bandolier). It means that there is some evidence that has been reviewed and found effective by one group, but these findings are disputed by another group. It doesn't mean there is no evidence. Stating that there is no agreement is different to stating that there is no evidence. I'm not sure which part of my rationale you don't understand, I feel that I have adequately explained my perspective several times already. Are you questioning where the Cochrane collaboration sit on the hierarchy and proposing that Bandolier sits higher? Do you consider the Bandolier findings to negate and erase the Cochrane findings? I'm not sure why you want to put "none" in the introduction despite it not accurately representing the body of the article. That is why I object to "none" and changed it to "most". The relevant evidence is already in the article and you and I are both very familiar with it, I felt no need to site it again. Let me know if it's still not clear to you. Cheers, Piekarnia 01:51, 9 May 2006 (UTC)

I agree with your take, Piekarnia. In terms of EBM controversy, don't forget headache, besides P6. I moved the Cochrane commentary there and added some links.

Kevin, please stop putting words in my mouth. Of course I disagree with your original wording. What wasn't clear about what I said above? Please either read more carefully, or quit being disingenuous; either way, it's an insult to editors' intelligence and a waste of time. I don't agree with your spin on my views. (i.e., "In fact Jim prefers to say most of the claims don't meet EMB or science." -- I've explained already why the "is it scientific?" question isn't very meaningful.)

You avoid the central question I raised about your edit: "Is your version, which basically summarizing Bandolier's take on EBM, a fair and accurate summary of what the article says on these matters?" You want to place the burden on other editors to "provide evidence that any claim for acupuncture is agreed on by the scientific community," as if the issue were simply a test of your statement's truth value rather than its adequacy as a summary of the article. The lead must fairly summarize all the POV's covered and not only the view of a single group of EBM reviewers. If you disagree, explain why?

Piekarnia's longer version is an improvement, imo. thx, Jim Butler 07:50, 9 May 2006 (UTC)

Thanks P. Good comments again. Yes it's good to discuss (unlike my experience on some other pages). I'm happy to compromise with you and flesh out EBM in the lead, though as you will see from my earlier post, I don't think this is the place for a brief history of EBM. ie your points in 2 and 3 would seem better on EMB page. On "none", my wording was specific. It talked about "proof". There is no scientific proof for any of the claims of acupuncture. See Hafner and see Taub on this. It's also a question of the use of the word "evidence" - some see evidence in the entrails or clinical experience (ie the tautological anecodtal evidence) while others take it to mean something closer to proof. Supporting is also quite different to proof. Given all this I would be happy to compromise again if you prefer the wording "there is no scientific agreement about any of claims for the efficacy of acupuncture". I don't rank Cochrane versus Bandolier - I look at the evidence. I must say though that some of the Cochrane group are acupuncturists and this can be seen as a conflict of interest. As to Jim's edit above. Gee keep cool. Am I wrong that the statement beginning "most" was left there by you for ages? Jim, we are creating an encyclopedic article. Yes I know you disagree with my wording, I was referring to the wording about "most". Also the reader would like to know, I think, what science has to say about acupunture. Is the "single group of EBM reviewers" any scientist who says acupuncture is bunk such as Taub? Anyway, hopefully the two compromises I've suggested will meet with your approval. Please keep calm and assume good faith. Mccready 08:54, 9 May 2006 (UTC)

"What science has to say about acupuncture" -- no consensus on this in terms of efficacy, so can't refer to "science" as if it's a single voice. (Your desire to "look at the evidence" is one we certainly share, but your effort to extrapolate an undocumented majority view is contrary to all three pillars of Wikipedia -- you can't verify it, it's original research and it's POV.) Disagreement exists over what counts as evidence and how to interpret it (including the threshold for "proof") and how to apply it clinically. -Jim Butler 19:25, 9 May 2006 (UTC)

Merge with Acupuncturist

The page Acupuncturist has not been mentioned here, it makes sense to merge the two as with Osteopath redirecting to Osteopathic medicine to avoid duplication. apers0n 09:49, 6 May 2006 (UTC)

Good idea. Mccready 08:03, 8 May 2006 (UTC)

Agree. The only caveat is article length. There has been discussion of splitting the article, and one possibility for a daughter article is the section entitled "legal and political status", which covers issues including the training of L.Ac.'s. Even so, agree "acupuncturist" should be merged and that the term should redirect here for now. Jim Butler 01:16, 9 May 2006 (UTC)

Merger completed, added Acupuncture is practised by "Licensed Acupuncturists" and other healthcare professionals. All the rest is duplicated in the current article.

Interestingly there is also a proposal to split the Osteopathic medicine article to deal with legal and political status. apers0n 10:52, 9 May 2006 (UTC)

Pasted the following text from acupuncturist into 'legal and political status' pending splitting the article

An Acupuncturist is a healthcare professional who practices acupuncture. Acupuncture is a therapy in which thin needles are inserted into points on the body, and then gently manipulated. Acupuncturists may also practice other modalities such as herbal medicine or tui na, or may be medical acupuncturists, who are trained in allopathic medicine but also practice acupuncture in a simplified form. Acupuncturists who are not Western medical practitioners usually complete three years of acupuncture school, with a fourth year often required for those who wish to practice herbal medicine. License is regulated by the state or province in many countries, and often requires passage of a board exam.

In the United States, acupuncturists are generally referred to by the professional title "Licensed Acupuncturist", abbreviated "L.Ac.". The abbreviation "Dipl. Ac." stands for "Diplomate of Acupuncture" and signifies that the holder is board-certified by the National Certification Commission for Acupuncture and Oriental Medicine. Professional degrees are usually at the level of a Master's degree and include "M.Ac." (Master's in Acupuncture), "M.S.Ac." (Master's of Science in Acupuncture), "M.A.O.M." (Master's of Acupuncture and Oriental Medicine). "O.M.D." signifies Oriental Medical Doctor, and may be used by graduates of Chinese medical schools, or by American graduates of postgraduate programs. (However, the OMD degree is not currently recognized by the Accreditation Commission for Acupuncture and Oriental Medicine, which accredits American educational programs in acupuncture).

- needs looking at apers0n 11:22, 9 May 2006 (UTC)

Scientific Review of Alternative Medicine

This journal is cited as an example of debate over P6's efficacy for nausea and vomiting[19]. I think it's highly likely that this journal is biased against acupuncture. Its full title is: "The Scientific Review of Alternative Medicine And Aberrant Medical Practices". Its editor is Wallace Sampson, co-founder of Quackwatch and NCAHF, with Stephen Barrett. Here is what a court found in a lawsuit that the NCAHF brought and lost against a manufacturer of homeopathic remedies (emphasis added):

Furthermore, the Court finds that both Dr. Sampson and Dr. Barrett are biased heavily in favor of the Plaintiff and thus the weight to be accorded their testimony is slight in any event. Both are long-time board members of the Plaintiff; Dr. Barrett has served as its Chairman. Both participated in an application to the U.S. FDA during the early 1990s designed to restrict the sale of most homeopathic drugs. Dr. Sampson's university course presents what is effectively a one-sided, critical view of alternative medicine. Dr. Barrett's heavy activities in lecturing and writing about alternative medicine similarly are focused on the eradication of the practices about which he opines. Both witnesses' fees, as Dr. Barrett testified, are paid from a fund established by Plaintiff NCAHF from the proceeds of suits such as the case at bar. Based on this fact alone, the Court may infer that Dr. Barrett and Sampson are more likely to receive fees for testifying on behalf of NCAHF in future cases if the Plaintiff prevails in the instant action and thereby wins funds to enrich the litigation fund described by Dr. Barrett. It is apparent, therefore, that both men have a direct, personal financial interest in the outcome of this litigation. Based on all of these factors, Dr. Sampson and Dr. Barrett can be described as zealous advocates of the Plaintiff's position, and therefore not neutral or dispassionate witnesses or experts. In light of these affiliations and their orientation, it can fairly be said that Drs. Barrett and Sampson are themselves the client, and therefore their testimony should be accorded little, if any, credibility on that basis as well.[20]

The review in question uses dubious criteria to contest some of the RCT's, such as the fact that one was done in Taiwan, irrespective of its methodology. -Jim Butler 08:07, 9 May 2006 (UTC)

Further notes on AMA

Kevin, your latest addition to the AMA section was without reference, therefore I removed it. Until you can provide a source for your statement, and explain why you added that statement and not another statement of theirs in favour of acupuncture, then I see no reason to put it back in. There are plenty of examples of the AMA saying all kinds of stuff about acupuncture (some discussed in previous AMA section), but they have not issued a policy or report that is specific to acupuncture as far as my searches have concluded. Please enlighten the rest of us if you have found such a source before putting such derogatory statements on the page. Please remember NPOV. AMA have not ONLY published unsupportive material about acupuncture, so reporting only negative comments does not accurately represent their opinion, nor is it representative of NPOV to only publish one sided arguments. Thanks. Piekarnia 05:38, 10 May 2006 (UTC)

The reference was at the beginning of the section. The words are AMA's. I've restored and put the citation. If you wish to cite other AMA material please do so. Please assume good faith. Mccready 06:20, 10 May 2006 (UTC)

Hi Kevin, thanks for putting the reference. I didn't realise it was from the same article. The phrase you quote doesn't actually relate to acupuncture practice at all, but to the practice of injecting pharmaceuticals and/or anaesthetic into parts of the body surrounding autonomic nerves. This is Prolotherapy, not acupuncture, nor is it related to Traditional Chinese medicine. Perhaps such a link would be more relevant on that page instead. Cheers, Piekarnia 08:10, 10 May 2006 (UTC)

Thanks P, it be the case that some acupuncturists do it would it not? And the Prolotherapy doesn't mention acupuncture and does mention the notion of irritants, which is not the rationale apparent from the AMA quote. I have tried to craft words you may be in agreement with. Mccready 13:20, 10 May 2006 (UTC)

I do appreciate the reword, it's a good gesture on your behalf. Yes, some acupuncturists may also practice prolotherapy, but that does not make it acupuncture. Some acupuncturists also use crystal healing, that does not make crystal healing part of acupuncture. Some dentists may inject anaesthetic into an area of the body that just happens to be an acupuncture point, but that does not make what they practice acupuncture. Some gps also practice reiki, but that does not make reiki part of the standard practice of being a gp. I think you get what I mean here. Prolotherapy is not part of standard acupuncture practice, therefore has no place on this page - especially when it's described as acupuncture. With the hundreds of acupuncture points on the body, many of them near to nerve plexuses, a lot of injections are going to be into "acupuncture points". But I think you're missing the "point" by quoting this particular phrase, and as much as you would love to put the words "health fraud" and "acupuncture" in the same sentence and context, I'm afraid it's too much of a stretch for this article. Prolotherapy is not acupuncture. I would appreciate removing the references. The prolotherapy article doesn't mention acupuncture - because it's not acupuncture. Simple. They do mention the notion of irritants, and they list a few examples, one of which is lidocaine (a local anaesthetic) which is inferred from the AMA quote. You're already at your three-revert limit for this 24 hour period, why don't you sit on it and think about it before re-editing. Jim, your thoughts and contribution to this topic would be welcomed. Piekarnia 23:08, 10 May 2006 (UTC)

Agree, this is at best very peripheral to acu, deleted. Jim Butler 06:29, 11 May 2006 (UTC)

Happy to join consensus on this, enjoyed P's wry digs too. Mccready 18:30, 12 May 2006 (UTC)

Cool; thanks for fleshing out the Tonelli too. cheers,Jim Butler 20:39, 12 May 2006 (UTC)

Glad to provide some light entertainment for you, Kevin :) Piekarnia 06:51, 13 May 2006 (UTC)

Linkspam?

This user's only two contributions to wikipedia consist in placing this link California State Oriental Medical Association to a website in progress on the TCM page and acupuncture page. I'd rather see it removed at this stage, at least until their website is fixed.Mccready 06:23, 14 May 2006 (UTC)

There doesn't seem to be anything wrong with the webpage now, seemed fine when I visited it. Provides basic info on tcm plus a link to the Californian Journal of Oriental Medicine. Piekarnia 12:24, 14 May 2006 (UTC)

CSOMA is the practitioners' organization in California, where the profession is well-established. Actually one of the better sites of its kind (representing Western TCM practitioners), and the FAQ section works. I finally went ahead and reworked the External Links section; please let me know what you think. Haven't got the Spleen Qi to take on the bibliography just yet. ;-) thx, Jim Butler 04:29, 15 May 2006 (UTC)

Lead section, again

Kevin suggests:

Acupuncture (from Lat. acus, "needle" (noun), and pungere, "prick" (verb) or in Standard Mandarin, zhēn jiǔ (針灸) is a Traditional Chinese medicine whereby needles are inserted and manipulated into "acupuncture points" on the body in order to restore health and well-being.

That sentence is awkward and not technically correct, unlike the original:

Acupuncture (from Lat. acus, "needle" (noun), and pungere, "prick" (verb) or in Standard Mandarin, zhēn jiǔ (針灸) is a broad term covering techniques for inserting and manipulating thin needles into "acupuncture points" on the body in order to restore health and well-being.

Kevin suggests:

Acupuncture theory is not based on health knowledge accepted by the scientific community.

True for the most part, but not an adequate summary of what the article says about theory. If the lead section is going to discuss theory, it should say what it is (TCM, etc.) as well as what it isn't, and do so in proportional correspondence to what the article says about it. WP:LEAD is quite clear that the criteria for sentences in the lead section are not just that they be true, but that they adequately summarize the article. Given that, how is it justifiable to say about acu theory only that it's not scientific?

Kevin suggests:

Proponents of various acupuncture traditions throughout the world (Japanese, Korean, and classical Chinese) disagree on locations of acupuncture points for treating a given condition.

Source please? Extent of disagreement? Also see comments above re adequacy of summary -- those comments apply even more here. Currently there is no discussion of disagreement over point location in the article at all. So what's it suddenly doing in the lead?

Reverted/edited subsequent sentences in first paragroah to:

Acupuncture is practised by "Licensed Acupuncturists" and other healthcare professionals. In the West, it is sometimes considered a branch of Traditional Chinese medicine (TCM) along with herbal medicine and tui na. Other types of acupuncture, notably Japanese, Korean, and classical Chinese acupuncture, are practiced and taught throughout the world.

Jim Butler 06:37, 17 May 2006 (UTC)

Hi Jim, I took out the licensing stuff becuase it contains an inaccuate implication. In many parts of the world, for example in most of Australia, there are no licensing requirements. The tui na stuff may be relevant but not in the lead, likewise for herbal medicine. Of course the proponents of different schools disagree. How would you have product differentiation otherwise. But here are some links for you.

On Korean belief, a quick google finds 'Korean Hand Acupuncture is a popular subset of Korean Acupuncture where the hands are considered a microsystem of the entire body. Within this system you may diagnose and treat conditions anywhere in the body by treating just the hands.' Similarly on the Japanese belief To contrast with TCM, Japanese acupuncture typically uses thinner needles, less points and less stimulation by using more shallow needle insertions even to the point of just touching the needle to the skin. Additionally, while not entirely unique to Japanese acupuncture, practitioners tend to use the abdomen as a diagnostic tool more often than other styles of acupuncture. [21] Here's another link among hundreds [22]. And the Japanese style resembles next to nothing of TCM and on Korean The first school believes the middle (3rd) finger is the torso and head, with the arms being the 2nd and 4th fingers, and the legs being the 1st and 5th. The second school thought the thumb (1st) the head, the palm the torso, the 2nd and 5th fingers the arms, and the 3rd and 4th the legs.[23] Here's a nice piece of product differentiation Japanese acupuncture today is different from Chinese, though it originated in China and came to Japan about 14 centuries ago. Japanese acupuncture, generally speaking, involves thinner needles and a shallower needle insertion, making a treatment more relaxing and less uncomfortable. It relies on moxibustion (heat therapy) as much as it does on acupuncture needles in treating people. This combination is very effective at giving the patient a well-rounded gentle, yet, powerful treatment. and Traditional acupuncture associates each point with a list of symptoms that it treats, and then the practitioner chooses points accordingly. However, the Traditional style takes the individuality out of a treatment, treating each patient suffering from the same illness with the same points. The very important thing left out of the Traditional style is treating both the symptoms and the cause of your condition.

Classical style, on the other hand, targets both symptoms and cause. By doing so, your ailments will resolve and your constitutional health will be boosted. With this type of treatment your digestion, sleep, stress level, etc, will also change for the better and so your overall health will be greatly improved. That is why our clinic is called Classical Acupuncture clinic.[24] Do I need to provide further evidence? I don't need to provide links on Five Element Acu do I?

We don't need to say in the lead what TCM is. That's what the link is for.

Hope you can reconsider your revert in the light of this. Mccready 07:34, 17 May 2006 (UTC)

Added US qualifier for LAc.

Just providing a link to TCM doesn't address this central issue: "True for the most part, but not an adequate summary of what the article says about theory. If the lead section is going to discuss theory, it should say what it is (TCM, etc.) as well as what it isn't, and do so in proportional correspondence to what the article says about it. WP:LEAD is quite clear that the criteria for sentences in the lead section are not just that they be true, but that they adequately summarize the article."

Your references discuss different styles of acu, and the only mention of point location disagreements are in Korean Hand acu (which is in fact incorporated into O'Connor and Bensky's translation of Shanghia U of TCM's teaching text). There are also systems of ear, foot, face and nose acu. Except for ear acu, these systems aren't widely used in the West. They aren't the same as standard body acu. Your references on different styles would be good to put in the article, but there is in fact little disagreement over body acupuncture points (the main channel points and extra points, like Yintang). It's misleading to suggest that there is unless you have a good ref that says so. I'm fine with changing if you can show sources and congruence with policies on the lead. Haven't seen this demonstrated yet. thx,Jim Butler 08:56, 17 May 2006 (UTC)

The only other disagreements over the location of points that comes to mind is a collection of points called the "ghost points" that were initially described by sun-si miao in 1200AD (or whenever he was alive), but that has more to do with translation than anything else.

I agree with the removal of "Licensed acupuncturist" because not all acupuncture practitioners are "licensed" some are registered, some are qualified. The term acupuncturist is fine, and I think it is important to state that acupuncture is also practiced by people who aren't qualified as acupuncturists. We should keep that sentence and remove "Licensed".Piekarnia 09:16, 17 May 2006 (UTC)

Jim, Let's take this one step at a time. 1. The prominence now given to US licensing practices in the lead is misplaced. Why do you think the point belongs in the lead ahead of other issues? Or are you happy with P and I to join the consensus 2. The Korean hand school is definitely an example of different needling points believed to have differing effects. This needs to be in somewhere. And I hope you can concede this point. 3. On the issue of Japanese acu, I'm happy to concede you are correct and we are talking styles not acu points. In that case the article needs to make the point about differing styles. Mccready 11:39, 17 May 2006 (UTC)

Agree no reason to weight toward US terminology; removed sentence entirely for now. One accepted definition of "acupuncturist" is anyone who practices acupuncture (irrespective of their training), so it seems tautological and odd to say something like "acu is practiced by acu'ists and others". Not sure it's necessary for the lead to mention the issue of who practices and how they are licensed at all, since it varies so much by locality, so we'd just have a vague statement not conveying much useful info. Also removed mention of tuina and herbal medicine from lead.

Kevin wrote: "The Korean hand school is definitely an example of different needling points believed to have differing effects. This needs to be in somewhere. And I hope you can concede this point." Sure, please feel free to add a section to the article on Korean Hand Acu that mentions this and other salient points about that system. If that section grows into its own article, then your point could go in its lead section.

Kevin wrote: "On the issue of Japanese acu, I'm happy to concede you are correct and we are talking styles not acu points. In that case the article needs to make the point about differing styles." Yes, it would be good if the article also had good, NPOV coverage of Japanese, French, Five-Element, and other non-TCM acu's. thx, Jim Butler 21:06, 17 May 2006 (UTC)

Reversions May 26 2006

Recent edits to the "Safety and risks" section by Mccready are (as is often the case) misleading; these refer to malpractice by unregulated pracitioners and that needs to be clear. Article should accurately convey the degree of safety when regulated and risks of lack of regulation.

NIH cites surveys showing safety, which accord with restored sentence in first para. Need to cite reliable and unbiased source for assertion otherwise. thx, Jim Butler 21:45, 26 May 2006 (UTC)

You're way out of line here Jim. Whether an acupunturist is regulated or not is not the point. These people are practising acupuncture. In fact they are regulated by health and saftey provisions of local councils and by other ordinances, a fact you would have gathered if you had read the report properly. This is a government report about a serious health and safety issue. It contains concerns of "legitmate" practioners. It was povish of you to delete it, ESPECIALLY as we had already discussed it and you had already welcomed its inclusion. If you are reluctant to see your industry cleaned up, please don't bring that reluctance to your editorial attempts on this article. Mccready 01:52, 27 May 2006 (UTC)

Show me where I agreed on including those things out of context. What I did agree to is given above. This is an encyclopedia -- would an encyclopedic article on hand surgery include horror stories about hand surgeries gone wrong and omit the notable fact that the practitioners were unlicensed? Doubt it. And again you're engaging in careless editing: The second quote, from Li, is from Chapter 3, subsection entitled "The Case For Regulation", and is explicitly about unregistered practitioners. The first quote is from the same section, which outlines the harms of having inadequate regulation. Nowhere do you make this clear. If you want to include the issues raised in that article, do so less POVishly. I don't think other editors should have to keep cleaning up after your careless edits. I'm not the one whose user discussion page is covered with these complaints; you are. Fixing this is incumbent on you, not me. thx,Jim Butler 02:37, 27 May 2006 (UTC)

In the time you wrote this you could have made your little edits. It is against WP policy to delete material as you have done. There are NO LICENSED acupuncturists in NSW. They ARE regulated. I have edited again to try to meet YOUR needs. Please edit the material to suit yourself rather than deleting again. Your attitude is tiresome. Mccready 02:54, 27 May 2006 (UTC)

Come on, you should know better than to accuse me of violating WP policy for deleting POVish stuff. These issues are handled by consensus. Safety section needs some work and I'll do so soon. thx, Jim Butler 09:03, 30 May 2006 (UTC)

So I'm back after a short break (and dosed up with some Xiao Yao San). Kevin, I read the report that you linked to, and failed to see the relevance of the quotes you selected. The people referred to were in breach of the law and not representative of acupuncturists as a whole. I think it's important to state that single-use disposable needles should be used wherever available and disposed of properly. Just because a handful of practitioners - who probably aren't qualified - choose to break the law by not complying with the skin penetration act, doesn't mean it should find its way into an encyclopedia. It is an argument for more stringent regulation - which is happening. When acupuncture is practiced by competent and educated professionals in compliance with appropriate regulations it is quite safe. When the guidelines aren't followed, problems ensue - just like they would if a gp decided not to comply with such regulations. But it is not relevant on a general encyclopedic page about acupuncture. Cheers Piekarnia 09:38, 5 June 2006 (UTC)

Hi Piekarnia, good to see you back. I did think that those quotes were a bit undue-weight-ish as well, but since they are referring to things being done today by unlicensed/ill-regulated practitioners, they should go in -- same as if unlicensed midwives were failing to wash their hands, etc. As long as the section tells it like it is across the board, giving due weight to settings where acu'ists have to meet licensing standards and use standard precuations, I think it's fine. I've been meaning to get around to reorganizing that section. cheers, Jim Butler 22:08, 5 June 2006 (UTC)

References removed from main page until verified

The following were removed because they lacked crucial information required by Wikipedia Guidelines for Citing Sources.

• Zhen Jiu Xue/ Tai-zhong Association of Chinese Medical Doctors, the Publishing Committee on Acupuncture, 1976. (Chinese characters for all of this to follow)

Article is biased

Who wrote this, AMA shills? Acupuncture is highly efficacious. I am skeptical and not at all fond of New Age things, but acupuncture doesn't fall into that category at all. Nor am I a vegetarian or crank--I eat everything and I fully subscribe to Western medicine for everything. I would not go to an acupuncturist to cure a massive infection, for example. But acupuncture works beautifully for nervous conditions, stress, anxiety and a whole raft of non-specific complaints especially when the etiology can't be established. bamjd3d 03:10, 7 June 2006 (UTC)