Talk:Acupuncture

Origin

which part of the following text suggest/explains that "Acupuncture's origins in China are uncertain"? Shang Dynasty (1600–1100 BCE) is a dynasty in China. "Acupuncture's origins in China are uncertain" is ambiguous.

Acupuncture's origins in China are uncertain. One explanation is that some soldiers wounded in battle by arrows were believed to have been cured of chronic afflictions that were otherwise untreated,[37] and there are variations on this idea.[38] Sharpened stones known as Bian shi have been found in China, suggesting the practice may date to the Neolithic[39] or possibly even earlier in the Stone Age.[40] Hieroglyphs and pictographs have been found dating from the Shang Dynasty (1600–1100 BCE) which suggest that acupuncture was practiced along with moxibustion. — Preceding unsigned comment added by 69.159.47.75 (talk) 17:31, 14 January 2012 (UTC)

Lede: Existence of TCM concepts

In my understanding, this article is about the cultural phenomenon of acupuncture. Apart from informing the reader about A: "what this phenomenon actually is", a thorough encyclopedic article naturally should also inform about B: "what are the pros and cons about it?". But if we rush to B before properly laying down A, we get what we have here with the bracketed sentence in the lede: it sounds awkward and overzealous. Therefore, I recommend to delete it. The lede puts too much weight on the pros and cons of acupuncture already (but that's a problem we save up for later). --Mallexikon (talk) 04:44, 18 November 2011 (UTC)

No, the page is about acupuncture, period. Though a definition is important, so is the research. Also note that the sentence is now different, not bracketed and juxtaposed with the statement that many practitioners don't practice according to TCM. To have one page on "cultural phenomenon" and another on research, particularly when the research doesn't really support acupuncture, is to engage in content forking and that is not appropriate. Though the historical basis of acupuncture is important, the modern research is lively and ongoing, an increasingly large body of knowledge that is a hugely important part of acupuncture's use in modern society. The research can not be shunted or diverted to a separate page or ghettoized into a single "criticisms" section. Giving readers the impression that acupuncture is an old and sophisticated system without acknowledging that the system has failed to be validated by empirical testing is not appropriate. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:25, 18 November 2011 (UTC)

WLU your absolutism is discouraging improvement of the article. Please seek consensus rather than playing the role of a judge. Mallexicon is making some important points and we should discuss them further.Herbxue (talk) 19:10, 18 November 2011 (UTC)

The overwhelming, site-wide consensus is that WLU is correct. This consensus is laid out in guidelines such as WP:DUE, WP:FRINGE, and WP:CFORK. Local consensus cannot override that. WLU is working collaboratively and civilly within our existing content policies, and accusing him of combatively stunting the article is uncalled for. If you have a problem with another editor, please see WP:DR.   — Jess· Δ♥ 19:28, 18 November 2011 (UTC)

I'm not really buying into that "trust me, we know better, you have to do it this way" story. Consensus on this article's content needs to be hashed out here. WLU is not the arbiter of consensus, even though he is a really competent and collaborative editor. Even the best editors have been know to occasionally wikilawyer to advance a POV, no?

I do not see anyone trying to remove all criticism of acupuncture, and although I recommend a separate article on the contentious and messy topic of acupuncture research, I have never recommended removing all scientific research from this article completely. Please stop implying that that is what is being suggested. Still, the very fact that the issue of weight balance between description and criticism keeps coming up is a clear sign that consensus has NOT been reached.Herbxue (talk) 23:13, 18 November 2011 (UTC)

Obviously, the content of this article needs to be discussed on this page. I don't think anyone suggested otherwise. However, we absolutely cannot, even with local consensus to do so, violate a policy like WP:CFORK by separating the scientific view of acupuncture from the "cultural view", nor can we violate policies like WP:FRINGE and WP:DUE by pushing the criticisms out of the lead, and de-emphasizing their significance. Accusing WLU of being disruptive for pointing this out is unhelpful, and creating a "pro-acupuncture vs anti-acupuncture" mentality. You're welcome to see WP:DR if you have problems with that - an RfC could be helpful for instance - but a couple of editors here can't just decide to IAR away WP:NPOV.   — Jess· Δ♥ 01:38, 19 November 2011 (UTC)

Guys, please, come out of the trenches. My apologies if I didn't sound clear about this. I have not been suggesting to split this article when I talked about A and B. Of course and obviously the question (and research) about efficacy has to be a very important part of the acupuncture article. My concern right now is merely about the lede and the awkward impression it gives when it has to mention that "scientific research has failed to validate the existence of any of the TCM concepts" already in the very third sentence. Could me maybe at least move that sentence to the second half of the lede, where efficacy/criticism is discussed? --Mallexikon (talk) 06:31, 19 November 2011 (UTC)

Please note that I consistently cite policies, guidelines and sources to substantiate my points. Please do the same to substantiate yours. Claiming my suggestions and edits don't "improve the article" is invalid given my consistent integration of new sources and information in line with the P&G. I may not move it towards the version preferred by editors who believe acupuncture is a valuable and effective medical intervention, but your issue is with the sources, not with me.

The fact that the weight balance between description and criticism keeps growing is due to the fact that I keep discovering more and more criticism the more I dig. This suggests that "criticisms" (which is really scientific testing which fails to validate TCM concepts) are a large and vivid part of the research on acupuncture. The failure of science to validate TCM concepts should appear juxtaposed with the first discussion of those very concepts, and IMO should appear quite early. I believe this is a fairly routine editing decision and the only purpose to moving it to a later part of the lead would be to reduce criticisms of acupuncture - a violation of neutrality. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:58, 19 November 2011 (UTC)

Ok, I apologize for the attack on WLU, which I mistakenly thought was pretty mild. I have no time to learn how to paste fancy policy links in my posts, but I've read them, including fork, and I think they all basically back up common sense. For the last time - I never ever said take out all the criticism from the main article. In fact, I want the research given even more space in a separate article. Its not a violation of fork guidelines if the subject is large and complex enough to warrant a spin-off article - and acupuncture research is certainly a large enough issue. Skeptics like to think that the doubts and uncertainty in the literature can be summed up in a neat little box - that acupuncture is just placebo - but the reality is more complex. I think that complexity deserves to be represented properly.

Also, I support what Mallexikon is suggesting above. I understand what WLU is saying about NPOV, but disagree that every single sentence needs an awkward tit-for-tat negation.Herbxue (talk) 21:38, 19 November 2011 (UTC)

Having two articles on the topic is not a violation of WP:CFORK, but having one for criticism and another devoid of criticism is. Your proposal (however you decide to phrase it), fits into that problem area: one for science and another for "culture"; one history and another "modern practice"; one "practice" and another "pros and cons". These proposals all aim to discuss the claims of acupuncture in one place, and push the scientific criticism to another separate area. As WLU has pointed out, the scientific criticism of acupuncture is a rich part of this topic, and it deserves necessary weight alongside acupuncture's claims per WP:DUE. We could have two articles, but we'd need scientific reception of the topic in both.   — Jess· Δ♥ 22:05, 19 November 2011 (UTC)

Herbxue, I didn't read your post as an attack (or if it was one, I've seen far, far worse so no worries). Thanks for the apology, it wasn't necessary but I appreciate it anyway. I realize this is frustrating but the reason I keep pointing to policies, guidelines and sources is because they are what wikipedia is based on and without them we are anarchopedia (there's a reason they've only got 200 articles and we've got several million). If anyone can show that my actions are inappropriate per the policies and guidelines, or that I've mis-interpreted a source, I will do my best to correct it. But please realize my standard is always those three things.

As far as spin-off articles, the main page is a roll-up of daughter articles the way the lead is a roll-up of the body of an article. The significant points in parent articles are elaborated on in daughter articles, or the complexities of daughter articles are summarized (per WP:SS) in parent articles. It's not simply a matter of content forks and ghettoizing criticisms, it's also the fact that the articles themselves should show relationships in terms of what they cover. If a point is controversial in a daughter article, the parent article gives a brief overview of the controversy.

Mallexikon, why is the presentation of the lack of scientific validation of TCM "awkward"? Is it because of the wording? Because structurally, in my mind it makes a lot of sense to put the two together. Otherwise the reader will work through a paragraph of text, get the impression that acupuncture has some sort of theoretical basis, only to have to read in another paragraph that none of the theory can be substantiated. Most controversial or discredited topics note quite early that the topic is controversial or discredited. Written from a solely TCM-practitioner perspective the page may give too much credit to the scientific skepticism, but read from a scientific skepticism perspective it spends far too much time on prescientific magical concepts that there is no real reason to expect any sense from (much like the humoural theories of the Ancient Greeks, or the magical medicine of the Egyptians). WLU (t) (c) Wikipedia's rules:^simple/_complex 01:50, 20 November 2011 (UTC)

While it would not be right to pretend that many of TCM's theories, like "Qi" or "Essence" are unique, physically identifiable entities, I would recommend broadening your understanding of the phenomena they are an attempt to describe. For example, you might say that there is no such thing as "Yin" or "Yang", but these are relative concepts that describe things as they relate to other things. Qi is not as clean an example, but still to say that "Qi" does not exist because it is not a unique thing (like atoms) or energy (like heat) kinda misses the point of why people continue to consider it a useful concept. To the acupuncturist, heat is one manifestation of qi, nerve propagation is another; lack of of gastric secretion is a deficiency of qi in the digestive system, and so on. Its not a thing but a description of many phenomena. The reader would not have a chance to start to understand this thought process if every single term is immediately treated from a reductionist viewpoint. That viewpoint needs to be included, but describe the thing it refutes first.Herbxue (talk) 03:03, 20 November 2011 (UTC)

The thing is, I can't just read up on something and write it up. I would need to cite sources. If someone says that qi is not meant to represent an actual entity, then we need that person saying it in a source, and we need to cite that source. If you have these sources, I strongly urge you to integrate them! I have read comments like yours before, but I don't remember where, and I'm really not that interested in finding them again or reading an entire book on the subject. I have zero objections to this information being in the article (including the lead) but I have to insist it is attached to a source or I will remove it per WP:PROVEIT. I've said this before Herbxue, neither you, nor I, can use our own opinion as a source - we need a book, journal article, web page from a reliable publisher, etc. In order to integrate this information, someone needs to look on google books, google scholar, or just plain google. I would also suggest revisiting WP:RS for a common understanding of what "reliable" means. If you don't feel like integrating it, provide me with the publication and page number and I'd be happy to do it.

Also, just because there are those that use qi as a metaphor for actual metabolic processes doesn't mean we get to claim effectiveness; saying a deficiency of qi in the stomach is an analogy for low gastric secretions doesn't obviate the need to say testing has not supported acupuncture's ability to increase gastric secretions. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:15, 20 November 2011 (UTC)

I think Herbxue has a very good point, there, and just out of goodwill, you could take a look at our section dealing with qi, where it says: "...qi is something that is defined by five cardinal functions..." (it's sourced). Then again, WLU has a very good point here, too. If we want to state the point that most of these TCM entities like yin, yang, qi, the zang organs etc. are abstract entities only defined by their postulated functions, we need sources to verify that. So should I maybe transfer this:

"TCM's view of the human body is only marginally concerned with anatomical structures, but focuses primarily on the body's functions[40][41]... These functions are aggregated and then associated with a primary functional entity - for instance, nourishment of the tissues and maintenance of their moisture are seen as connected functions, and the entity postulated to be responsible for these functions is xuě (blood)[42] - but this is mainly a matter of stipulation, not anatomical insight.[43]"

from the TCM article? --Mallexikon (talk) 03:09, 21 November 2011 (UTC)

I'm willing to accept Herbxue's point, provided there are sources. My objections are continually based on the lack of adequate sourcing, not an abstract opposition to TCM (wikipedia is about verifiability, not truth). If there are sources, I want to be sure they are reliable, and I want them to be summarized accurately - that's as far as my concerns go.

Are we still talking about the lead? I don't think we should get into a lot of detail in the lead, I think the current version adequately summarizes the broad-strokes TCM concepts and the lack of scientific justification. If more detail is required in the body, I'm OK with that. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:42, 21 November 2011 (UTC)

That's all fine but my concern right now is with the lead. This sentence: "Scientific research has failed to validate the existence of any of the TCM concepts" has multiple issues which I hope we don't have to discuss here. Can we get a quick solution by consenting to changing it to "scientific research has failed to find physical equivalents for qi, meridians, and acupuncture points"? --Mallexikon (talk) 04:31, 22 November 2011 (UTC)

There has been no modern verification of any aspect of the concepts as far as I know. "Physical equivalents" implies that there are non-physical equivalents that justify TCM concepts. As far as I know there are none. I understand that people want to believe the Chinese discovered, despite lacking empirical testing, dissection, microscopes and chemistry, some sort of modern understanding of the body - but the evidence just isn't there. They invented an oriental version of Greek humourism that, like most pre-modern societies, is mystical rather than rational. Qi bears no resemblance to any actual modern understanding of anything I've seen - acupuncture at best reduces pain and nausea, though possibly only through placebo. It doesn't have any effect on disease that I'm aware of, only to symptoms highly amenable to placebo. Are there any "non-physical" equivalents that I've not seen yet? WLU (t) (c) Wikipedia's rules:^simple/_complex 11:23, 22 November 2011 (UTC)

One problem is the lumping of all TCM concepts together, and claiming that lack of science on one part = no evidence for any part. For example, a red sore throat would be labeled a "heat pattern" in TCM and treated with "cold herbs", in modern medicine it may be labeled and infection or inflammation and treated with antibiotics or NSAIDs. Both work very well. Some have tried to argue that "heat" = "inflammation" or "infection" but it is not really true and probably not even helpful. But many of the "cold" herbs also happen to have antibiotic or anti-inflammatory actions. So, is the TCM concept validated by the science? Or do you conclude that the "mystical" idea of treating hot with cold was a lucky guess? I know you hate to hear this, but the fact that TCM speaks a different language and is based on different assumptions poses a real problem for us and requires that we not make overly simplistic statements based solely on the modern medical model.Herbxue (talk) 21:19, 22 November 2011 (UTC)

What evidence is there for any concepts? Again, none of this debate really matters in the absence of sources. What specific sources support specific TCM concepts? What sources support "cold herbs" having antibiotic or anti-inflammatory properties? What sources support a "heat pattern" being inflammation (aside from the trivial observation that inflamed areas are warm)? Without sources, these abstract discussions are pretty pointless. If a reliable source echoes your assertion, for me the only real question becomes how to summarize it.

The assertion that TCM is speaking a different language rather than simply "right by accident" is also an assertion that requires a source. All prescientific medicine usually manages to be correct about certain herbs, be they emetics, analgesics, laxatives or soporifics, but that doesn't validate the medical system. And if we're debating the modern medical model, when modern medicine was introduced to China I believe that, like all nations, they experienced a considerable boom in longevity, a drop in infectious diseases and a much higher rate of survival out of childhood. Mao brought back TCM for political reasons, not because it was as effective as vaccinations, surgery and drugs.

But again - to be integrated into the page, sources are required. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:48, 22 November 2011 (UTC)

But now we're discussing efficacy again, which is a totally different topic. The sentence as it stands is semantically wrong as it states that the TCM concepts are not existing. But of course they are existing (we are dealing with them/discussing them right now) - a concept is something abstract after all. The question is whether these concept have an equivalent in the real/physical world. But instead of discussing philosophy here we should take a look at whether this semantically wrong sentence is really supported by its sources - and when I checked the sources that are accessible online, I couldn't find that they do. Could you point out the supporting quotes to me, please? --Mallexikon (talk) 03:21, 23 November 2011 (UTC)

“ Despite considerable efforts to understand the anatomy and physiology of the "acupuncture points," the definition and characterization of these points remain controversial. Even more elusive is the scientific basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and other related theories, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture. ”

“ Of course, the existence of qi has never been demonstrated in any sort of scientifically acceptable manner and perhaps never will. Without being able to scientifically validate the existence of qi, the traditional rational for acupuncture and Chinese medicine will never receive modern science’s seal of approval no matter how many clinical trails show effectiveness in treating disease. The combination of mounting evidence of acupuncture’s clinical effectiveness together with an inability to scientifically validate its traditional rational has lead to a new and rapidly growing class of acupuncture supporter; those who acknowledge acupuncture’s clinical value while disavowing its traditional rational. This new breed of supporter is beginning to do more to undermine long-held notions about Chinese medicine than all the sceptics who doubted its effectiveness combined! ”

“ Based on this review, the evidence does not conclusively support the claim that acupuncture points or meridians are electrically distinguishable ”

Mann also makes somewhat similar points, but obviously more complicated to summarize. Trick or Treatment does make this point I believe, but google books doesn't have a preview anymore. I'll request it from the library. Matuk wasn't a good choice as a reference, I've removed it. I've adjusted the wording to refer to a lack of link between any TCM concept and any biological structure or function. If anyone is going to claim that there is such a link or that TCM is a valid framework for diagnosis or treatment, I'd really, really like to see the source this is based on before discussing further. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:29, 23 November 2011 (UTC)

Fair. Regarding your wording, I think it's very good. I'll just change "TCM concepts" to "the concepts of qi, meridians, and acupuncture points" because that's what is supported by the sources, and it also goes smoother with the preceding text. The problem with "TCM concepts" as a whole is that this includes things like yin/yang and the Five Phases - to write that science couldn't come up with an anatomical/biological/functional equivalent to these philosophical/abstract concepts is probably true, but IMO smells of tautology. Altogether, I'd still have preferred to position the criticism a few lines further down, but that's a mere matter of style; and as it is now, it feels smooth. Cheers, --Mallexikon (talk) 10:14, 24 November 2011 (UTC)

@Famousdog: yes, that's even better wording. Thanks, --Mallexikon (talk) 02:57, 25 November 2011 (UTC)

I got Trick or Treatment out from the library and it does indeed verify this point. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:37, 3 January 2012 (UTC)

To claim that "Scientific research has not found any physical or biological correlate of qi, meridians and acupuncture points" is wrong. Am J Chin Med. 2005;33(5):723-8. finds 'Differences in electrical conduction properties between meridians and non-meridians.'

" The current conduction and potential profiles were compared after switching the current direction in the Hegu (LI-4) and Quchi (LI- 11) meridians and over a non-acupuncture point 1 cm from Quchi (LI-11) in 20 healthy subjects. Both meridians demonstrated significantly higher conductivity between Hegu (LI-4) and Quchi (LI-11) than between Hegu (LI-4) and the non-acupuncture point. The direction of current, peak frequency and absolute potential values in the direction Hegu (LI-4) to Quchi (LI-11) differed significantly from those in the direction Quchi (LI-11) to Hegu (LI-4). These results suggest that the conducting pathways are stronger in the meridians than in the non-meridians and that preferential conduction directions exist between two acupuncture points. These results are consistent with the theories of Qi-circulation and traditional Chinese medicine."Dickmojo (talk) 14:09, 30 January 2012 (UTC)

Indeed the source 5 listed to back this in the text after this quote itself says in relation to the electro-conductivity of meridians that "the findings are suggestive". Surely for balance this view ought to be alluded to.Dickmojo (talk) 00:03, 31 January 2012 (UTC)

Ok, so I just amended the text to include this part of source 5. Now to pre-empt any knee-jerk reaction by sceptics to automatically revert it out of hand, let me say that we are not here to *debunk* acupuncture. Well I mean, you guys are, but that is contrary to the spirit of WP. What we should actually be here to do is give a balanced and rounded summary of the various viewpoints out there, and it is a mainstream view amongst many acupuncturists that acupoints and meridians do have electro-conductivity properties. This is not a fringe view, and there is acceptable secondary evidence which is suggestive of such, so I don't think it should be reverted without due discussion.Dickmojo (talk) 13:27, 31 January 2012 (UTC)

I agree, and although there are questions about the research on conductivity, we should present sources that both confirm and fail to confirm any difference in conductivity on channels in order to present the current state of the research accurately.

One big difference for me, however, is that I think this issue is better discussed under the "Possible Mechanisms" section. I think the idea of debating the "existence" of TCM concepts is unfruitful. To argue whether Qi is a distinct force or material really misses the point of why it continues to be a useful concept.Herbxue (talk) 19:15, 31 January 2012 (UTC)

Wrong. See WP:MEDRS. PMID 16265984 is a primary source that should not be used on the page, particularly when a secondary source (PMID 18240287) that was published three years later concludes there is no good quality evidence to support the existence of meridians. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:58, 31 January 2012 (UTC)

Primary sources are not to be used to make medical claims (efficacy claims). This is not an efficacy claim. Thats why I think it should be discussed under possible mechanisms.

If the preponderance of evidence fails to show any anatomical, electrical, or other distinctiveness of meridians vs. non-meridians then the article should certainly say that, but that is not equivalent to saying they do not "exist" because they exist as a concept that is taught, studied, and tested on for entry to the profession, and as a tool used in practice.Herbxue (talk) 22:02, 31 January 2012 (UTC)

See WP:PSTS. Doesn't matter if it's a medical claim or not, the secondary source takes precedence in terms of age, reliability and policy. MEDRS is explicit about it, but the same statement applies - review articles take precedence over low-n studies and the latter can not be used to contradict the statements made in the former. Positive claims must rest on positive evidence, it's sufficient to note that traditionally acupuncture's mechanism is points, meridians and chi and that no good evidence has been found for any. We can note that people believe they exist, but must also mention that there's no actual evidence for it. In fact, per WP:STRUCTURE the current section discussing the lack of support for points, chi and meridians should be moved to the same section discussing their traditional alleged mechanism. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:43, 31 January 2012 (UTC)

If we are to mention in the lede that there is no scientific evidence for the existence of qi, acupuncture points and meridians, then we must ALSO mention that there is research which is suggestive of the electro-conductivity properties of acupuncture points and meridians, or else we are concealing parts of the broader picture and are in violation of NPOV. Either delete that sentence entirely or restore my qualifier. C'mon now! There's a link to the source, let people read it and make up their own minds! Don't try to hide parts of the body of knowledge that you personally find unpalatable WLU! Dickmojo (talk) 04:23, 1 February 2012 (UTC)

Pursuant to my point, the wording of that sentence ("there is no evidence blah blah blah") implies that research has been conducted and that the results of this research conclusively found that there was no evidence at all. Well, this is patently false, because the source itself says that 7 out of 9 studies reviewed found positive evidence to support the theory of enhanced electro-conductivity of meridians. Now it is a gross violation of NPOV to seek to cover that fact up, WLU, so I have restored it in the lede. If you want to delete it, then delete the whole sentence, and move it to the mechanism section.Dickmojo (talk) 06:37, 1 February 2012 (UTC)

7 out of 9 shoddy studies with poor methodologies. Would you accept a chemotherapy treatment, blood thinner or antibiotic with a similar evidence base? I wouldn't. Multiple reverts from multiple editors suggest nor would others. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:40, 1 February 2012 (UTC)

WLU, you are mistaken. This is NOT research into the efficacy or safety of acupuncture as a treatment. In fact, this research isn't even medical research, it is scientific research into the phenomena of Qi and Meridians themselves. Now, if we are going to infer that scientific research has been completely unable to find any evidence of Qi or Meridians AT ALL, then this is clearly biased POV, and does NOT correlate with the evidence, which is suggestive of the existence of electro-conductive properties of Acupoints and meridians.Dickmojo (talk) 22:16, 9 February 2012 (UTC)

Poor comparisons- acupuncture does not carry nearly the same risk, nor does it claim the same effects. But that's irrelevant to the question of whether or not we can include carefully qualified statements about research from primary sources in a field of research that is not well-covered. To give an accurate picture of the current scientific understanding of acupuncture, I think we should include primary sources as long as proper context is given. To only include the conclusion of the only systematic review of the very few studies of this kind gives the illusion of certainty of lack of "existence" due to the lack of context.Herbxue (talk) 16:20, 2 February 2012 (UTC)

You are right. Intervention-related risk is irrelevant, but your opinion as to what you "think we should include" is equally irrelevant. The Ahn et al (2008) review INCLUDES the Lee et al (2003) paper among its references. You know what that means? It means that they've already looked at it - and lots of other papers - and conclude: "The studies were generally poor in quality and limited by small sample size and multiple confounders. Based on this review, the evidence does not conclusively support the claim that acupuncture points or meridians are electrically distinguishable." If you include the Lee et al paper, then you should include ALL the primary sources from Ahn et al, and then what's the point of qualified researchers doing reviews AT ALL? Unfortunately, Ahn et al have thrown a spanner in the works by saying that "the preliminary findings are suggestive". Acupuncture adherents will of course jump on this as "evidence" that there's something in it. But Ahn et al don't say of what the preliminary findings are "suggestive." We cannot, and should not, interpret what Ahn et al may have meant by that statement. It could have meant that they thought the preliminary findings are suggestive of bullsh*t. We don't know. Debate over. Go home. Famousdog (talk) 16:49, 2 February 2012 (UTC)

Ok, don't get too bent out of shape, my point again is not to prove existence of Qi, but to allow some primary sources into the possible mechanisms section.Herbxue (talk) 17:52, 2 February 2012 (UTC)

NONSENSE famousdog! The findings are clearly suggestive of the enhanced electro-conductive properties of meridians and acupuncture points, because 7 out 9 studies and 5 out of 9 studies showed us as such. Now, this is important evidence. Yes, the methodology may not be perfect, it never is in this field. BUT if we are going to be balanced, then we can NOT infer that exhaustive research has been done and absolutely no evidence of the existence of Qi or Meridians has been found. This is patently false, and you are seeking to deceive our readers. Research has been conducted and evidence HAS been found which suggests the electro-conductive properties of acupoints and meridians, therefore you CANNOT state that "no evidence of qi or meridians has been found". If you want to keep this sentence here, then you MUST include a qualifier that refers to the fifth source. I will edit the lede again, your threats to ban me for edit-warring are preposterous. We need balance in this article, and you guys certainly aren't going to provide it, so I must.Dickmojo (talk) 22:16, 9 February 2012 (UTC)

@DM, this sort of comment, that you plan to edit war your preferred version into the article despite warnings, is unwise. You need to discuss your proposals and establish consensus before introducing them to the article. If you revert again, or insert content as ludicrous as your last edit, this will end up at a noticeboard. You can use that information as you see fit. To everyone else, I have to second WLU here, that primary sources are not ideal to establish the efficacy of medical claims, or the existence of supernatural entities for which we have secondary sources to the contrary.   — Jess· Δ♥ 23:04, 9 February 2012 (UTC)

What "supernatural claims"?!? You're the one being ludicrous! These are NOT medical claims, as I pointed out to WLU, this is scientific research in the fields of biology and physics into the electro-conductive properties of meridians, and the research suggests that in fact there ARE electro-conductive properties of meridians. This assumption that Chinese Medicine is all about "hocus pocus" and "woo woo" is not helpful. In fact its xenophobic. The scientific discoveries of TCM are far removed from us in modern day times in both time and space. Obviously the language they used was far, far different from the language we use today. But their scientific discoveries ARE valuable, and we have to approach them in the sense of open-minded earnestness and curiosity, not outright skepticism and dismissal like you Jess, and WLU, and famousdog et al are wont to do. My last edit was not ludicrous, it was pointing out the manifest truth that you people are fanatics. Skepticism is your religion and Edzard Ernst is your messiah and you are NOT helping to improve the richness and diversity of the fabric of life in modern society. In fact you are working sinisterly to accomplish the opposite.Dickmojo (talk) 00:24, 10 February 2012 (UTC)

Pursuant to this point, I'm not just saying it to take a gratuitous swipe at you, I mean, hey, everyone's entitled to their religious beliefs (even if you can't even admit that's what they are), but its important because if you're going to say "PROPONENTS of acupuncture claim blah blah blah", then your identification of one side of the debate needs to be balanced with recognition of who the other side of the debate making counter claims are (i.e. zealous rational-sceptic extremist fanatics). Otherwise, you are violating NPOV.Dickmojo (talk) 00:42, 10 February 2012 (UTC)

If there is actually something to meridians, then evidence will accumulate supporting this point. To date that hasn't happened despite several decades of research (meanwhile, the dividends paid by research in other areas of biology and medicine need no explanation or pointing out). The difference between science and religion is that science changes with evidence, while religion adheres to an orthodoxy - such as refusing to acknowledge, even in principle, that qi, meridians and acupuncture points might not exist. The research doesn't suggest meridians have electrical properties - the research suggests that shoddy experiments suggest they might - and the shoddier the experiment, the easier it is to fool yourself. High quality methodology and controls make it easier to determine the objective reality of things. If meridians actually exists, the best tests will demonstrate this. If only poorly-controlled studies done by the credulous can find any evidence, then that's strongly suggestive of pathological science. If ancient Chinese doctors really discovered something and just explained it badly, then science will confirm their discoveries. This hasn't happened, despite having microscopes that can visualize individual atoms. To assume that the ancient Chinese were onto something without proof a) ignores how every other culture in the past was wrong about nearly everything, b) is quite racist (both pro-Chinese and anti-everyone else) and c) is not xenophobic - it's simply asking that the same standard of proof is used universally. If an Indian, American, British, Nigerian or Brazilian scientist makes an empirical claim about the body, they're expected to prove it, and that proof must be replicable. Why should it be different for Chinese scientists? Do the Chinese have some sort of different way of knowing? Are they magical? Is there some reason that the concepts expressed by the language of the Yellow Emperor's Inner Cannon can not be translated clearly into modern English or confirmed by objective tests? All skeptics ask for is proof. Real proof, replicable proof, proof that doesn't depend on who is providing it. Instead of proof however, we get claims like "ancient wisdom", "you're racist", "the richness and diversity of life". Basically accusations that we're mean because we're not willing to accept a double-standard and drop the bar for evidence claims for the Chinese. Sorry, I believe racism is not an appropriate way to conduct science. WLU (t) (c) Wikipedia's rules:^simple/_complex 10:22, 11 February 2012 (UTC)

Ok WLU, that whole ranting diatribe you wrote is rock-solid bonafide proof of why you should NOT be an editor on this page. The closed-minded, arrogoant, hate-filled attitude which you displayed in that paragraph above is indicative of the way you treat this entire topic, and it affects the POV of your editing very badly. Please get a life and stop attacking things about which COMPLETELY IGNORANT. I mean, how can "qi, meridians and acupuncture points" not exist? What a ridiculous POV you have! Can the concept of 'force' in physics "not exist"? Of course not! Then how can the concept of 'qi' in TCM not exist?: there are the same thing! And your example of the electron microscope is just so indicative of the reductionist attitude which hinders you from seeing the truth here. Meridians are not defined by STRUCTURE but by FUNCTION. Honestly, this is an elementary principle, you are just SOOOOO blithely ignorant it hurts. The Ancient Chinese Taoist Masters did not explain their findings "badly", they used an entirely different conceptual framework (which was, and IS, valid), and which you stubbornly refuse to even begin to countenance understanding. So if you're not interesting in understanding the conceptual framework upon which all of acupuncture and TCM hinges, LEAVE! You have no business editing an article on a subject you have no inclination to understand. This article is not titled "Proof for Acupuncture", and although there is ample proof for acupuncture, it is incidental to the purpose of this article. Scientific knowledge is not the only kind of knowledge. Lore, history, tradition and experience are also valid forms of knowledge. Under your pernicious influence all these four types of knowledge have been effectively disregarded, imbalancing the weighting of this article. Now it IS racist of you a) treat this topic as if its solely a scientific matter (its not, its a cultural, historical, traditional and empirical matter mainly of great importance to Chinese culture) , and b) completely dismiss all of the rigorous scientific evidence which strongly supports acupuncture that emanates from China. It is quite acceptable for a WP article to outline an alternative mode of philosophical understanding the body WITHOUT framing it in the context of extreme criticism when compared to the currently accepted scientific paradigm of knowledge. Go and look at the God article. Tell me, where is the vehement criticism against that philosophical concept? No where, yet here you feel the need to protect your extremely biased criticism of philosophical concepts in this article. Tell me, why WLU, if not racist prejudice against another culture's belief system? Science has got nothing to do with it. Its philosophy and belief and your criticism of it smacks of racism here in this article.Dickmojo (talk) 14:22, 14 February 2012 (UTC)

WLU's comments (whether correct or not) were about the content of this article. Your comments, Dick ... must ... not ... make ... a joke ... mojo (phew!) were about WLU. Stop making outrageous personal attacks and act with civility or you will be blocked. Comment on content, not on other contributors. Famousdog (talk) 15:18, 14 February 2012 (UTC)

Until there is a general consensus that there is good evidence acupuncture points and meridians exist, there shouldn't be any suggestion on the page that they have a real existence and we shouldn't be debating their existence. We can discuss the cultural, historical and philisophical background regarding these concepts - but immediately afterwards we must note that there is no empirical reason to believe they exist. Don't like it, go elsewehere. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:59, 14 February 2012 (UTC)

Fine, but we don't need to say that there's evidence they exist. But we ALSO don't need to say that there's no evidence they exist. Such a statement is ludicrous. I had a look at the physics site and no where does it question the validity of the theoretical concept of "force". Therefore, we do not need to question the validity of the theoretical concept of "qi", (which is the same thing, just originating from a different culture and articulated in a different language), unless we intend to be racist. I certainly don't want to be racist, so why are you zealous skeptic extremists fanatics so intent on being racist?Dickmojo (talk) 23:43, 14 February 2012 (UTC)

"Force" can be empirically defined and demonstrated to work. Unlike qi. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:50, 14 February 2012 (UTC)

Rubbish. The two concepts are identical. You can demonstrate qi, just the same as demonstrating force. In fact, any experiment that demonstrates force, ALSO demonstrates qi, because they are the same thing, the only difference is a matter of nomenclature, and to imply that there is a difference just because qi is Chinese is racist.Dickmojo (talk) 23:55, 14 February 2012 (UTC)

Please provide a reliable source that verifies that qi is the same thing as force. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:03, 15 February 2012 (UTC)

What a ludicrous thing to say, WLU. You may as well ask for a reliable source that Odin and Zues are the same god. They are philosophical principles.Dickmojo (talk) 00:12, 15 February 2012 (UTC)

Wikipedia is based on what can be verified in reliable sources; lacking reliable sources to substantiate your points, since wikipedia is not a publisher of original research, you should not change the page based purely on your own opinion. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:08, 15 February 2012 (UTC)

Dickmojo, it's really very simple. PUT UP OR SHUT UP. That's how science and Wikipedia work. You say above that "the two concepts are identical" then when WLU asks for evidence you say that they are different. Stop squirming, playing semantics, moving the goalposts, calling other editors "racist" (as a lifelong member of the Anti Nazi League this particularly upsets me) and show us some EVIDENCE. Famousdog (talk) 10:29, 15 February 2012 (UTC)

No. you shut up, famousdog. You ARE a racist because you vehemently refuse to accept the validity of a philosophical paradigm which is alien to the Western Scientific paradigm you're attached to. You will never have an accurate understanding of acupuncture if you are too xenophobic to adopt the thought patterns of its endogenous native context, which is inherently Chinese, and seek to criticise and destroy it from a purely Western point of view.Dickmojo (talk) 05:33, 18 February 2012 (UTC)

ENOUGH! We're all volunteers here working on an encyclopaedic article. These ad hominem attacks are inexscusable, Dickmojo; they are also a very predictable way to have you topic banned from working on this article (and I don't want that). Famousdog, I respectfully ask you to not answer to this insult. --Mallexikon (talk) 05:41, 18 February 2012 (UTC)

Ok, I'm sorry for the ad hom. You're not racist famousdog, I retract that assertion. However, this topic is not purely a scientific matter, and should not be evaluated as such. This article should NOT read like its straight line for line copied from a "Quack-buster" website, and we need to show a LOT more cultural sensitivity and acceptance of foreign and historical culture's modes of thinking and intellectual paradigms.Dickmojo (talk) 05:56, 18 February 2012 (UTC)

Ok, thanks for retracting. Sorry that it didn't prevent the time-out. --Mallexikon (talk) 06:57, 18 February 2012 (UTC)

Source

[1]

Review article?

This was recently used as a source to support a direct quote from the article. I'm wondering if this counts as a MEDRS compliant article, however, as it simply reads like a summary of primary studies and doesn't seem to draw any conclusions regarding either acupuncture, nor does it contain analysis of the study. Thoughts? N^oformation ^Talk 06:39, 16 January 2012 (UTC)

It is certainly not a systematic review, but rather a convenient collection of individual studies. Depends on what it is being used to support - most likely it is better to reference the individual study mentioned in the article. Nonetheless I would say the article is a reliable source, just can't be used to establish general efficacy claims.Herbxue (talk) 17:32, 16 January 2012 (UTC)

I wouldn't include it - seven articles, all published in China, unreplicated, using vague secondary measures of "improved immune function" is a rather meaningless addition. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:45, 16 January 2012 (UTC)

I didn't think so. It was being directly quoted in this edit. Summarizing a list of primary sources seems equivalent to simply using primary sources as claims of efficacy. N^oformation ^Talk 20:19, 16 January 2012 (UTC)

"Vague secondary measure"?? leukocyte phagocytosis, interleukin-2 (IL-2) and natural killer (NK) cell activity, CD3+ and CD4+ T-lymphocyte subsets, white blood cell count etc are "vague"? "Secondary"? I'm afraid not WLU. And I'm sorry, but its racist to imply criticism of a study on the sole grounds that it originates from a certain country. I think this evidence ought to be included, its the latest research and readers have a right to know about it. NPOV would be seriously impaired if we omitted all mention of this evidence.Dickmojo (talk) 13:54, 1 February 2012 (UTC)

POV

The languaging of the intro has a clear bias against acupuncture. Whilst I'm no great fan of acupuncture, it should be judged in comparison to more conventional treatments for conditions it seeks to treat. The Cochrane Review alone is a stronger evidential basis than most conventional treatments have.

The POV languaging bias is of the form: 'Acupuncture doesn't work... except for maybe this'. Secondly, the intro is too long and too dense with scientific jargon. Most of this latter info is repeated later on in the Scientific Basis section and thus should be summarised in much simpler language. Mindjuicer (talk) 06:13, 3 February 2012 (UTC)

Whether it works, and on what, is probably the most important thing to know about a treatment. Explaining that in the lede seems appropriate to me. --Anthonyhcole (talk) 08:05, 3 February 2012 (UTC)

I agree. It is a bit more complicated than that though. Whether it will work for you depends on what your problem is and what your expectations are (both in encouraging placebo and what you measure 'works' by).

For most problems that I suspect acupunture patients are seeking help for, placebos work typically 50% of the time according to (ridiculous 6 week do-you-feel-any-better-at-all) standards of testing. Often the traditional treatment barely outperforms that eg 55%. For potential patients, that difference is practically insignificant.

So 'effective' and 'works' mean radically different things to different people and thus these terms should be avoided. Efficteveness of placebo is largely underestimated and so that's tricky too.

Two other segments of the audience I'd consider:

Medical professionals - these are the people who need to know how reliable the research is and what it says. But they should be looking in the Scientific Basis section.

Curious people - that Cochrane showed a particular acupuncture treatment worked as well as effective drugs for nausea is quite interesting.

You didn't say anything about the bias.

What proportion of editors for this article are anti-acupuncture zealots who are determined to keep the article negative? I don't want to waste my time here. Mindjuicer (talk) 10:01, 3 February 2012 (UTC)

Good point. And infact, I think we need to include this specification in the lede for balance. I.e, if we're going to say "proponents of acupuncture say blah blah blah", then we also need to specify that the people who disagree with this are in fact fanatic, zealous, Edzard-Ernst worshiping sceptic extremists. I shall amend the lede now, cheersDickmojo (talk) 22:00, 9 February 2012 (UTC)

"Anyone who doesn't agree with me is a zealot!" - "You're all in the pay of Big Pharma" - "You're all biased (but I'm a paragon of objectivity)!" - "Science isn't science it's scientism or pseudo-skepticism (or some other stupid neologism)!"

(ahem) Now that's out of my system, the placebo effect is effective. That is not an argument for acupuncure. It is an argument against acupuncure. Famousdog (talk) 10:18, 3 February 2012 (UTC)

Anti-acupuncture? There have been some in the past. I got blocked for abusing a couple once. But they don't last long; about as long as the pro-acupuncture editors. Of the two I'm referring to, one has been informally hounded off the project and the other has been officially permanently banned.

Bias? I don't see bias there. Acupuncture does work for some cases of pain and nausea, but there's no evidence for anything else.

Too long and dense? I agree. I think

"Systemic reviews have found conflicting results regarding the prevention of postoperative nausea and vomiting^{[14][15] though a 2009 Cochrane review concluded stimulation of the P6 acupuncture point was as effective as antiemetic medications.[15] Acupuncture also appears to have a small effect in the short-term management of some types of pain[10][16][17] though a 2011 review of review articles concluded that acupuncture was of doubtful efficacy in treating pain other than neck pain.[13]"}

is too much detail for the lede, and would be interested to hear whether you or others think it should be excised. --Anthonyhcole (talk) 10:43, 3 February 2012 (UTC)

I'm thinking rewriting that whole paragraph is in order. The NHS statement "'reasonably good evidence that acupuncture is an effective treatment" for nausea, vomiting, osteoarthritis of the knee and several types of pain' is clear, NPOV and concise. I'd definitely move the last sentence of the last paragraph of the intro to the Scientific Basis section. The remainder needs shortening.

But first I'd be looking for consensus on what _should_ be in the intro and what form of languaging is appropriate.

How do you cope with FamousDog? Mindjuicer (talk) 11:33, 3 February 2012 (UTC)

I feel the need to apologise to Famousdog. I actually mistook him for one of the much less polite zealots. Mindjuicer (talk) 16:58, 16 February 2012 (UTC)

Other editors don't "cope" with me. They attempt to argue their case and provide reliable sources for their edits rather than casting aspertions and trying to argue that perfectly good sources are somehow dubious. You say above that there is bias int he lead along the lines of: 'Acupuncture doesn't work... except for maybe this'. That's not bias. Considering the ridiculous claims that have been made for thousands of years regarding its efficacy for all sorts of maladies, that form of wording is a useful corrective of the acupuncture community's long-standing (and, it now turns out, empty) claims. You say that "the NHS statement ... is clear, NPOV and concise." It is certainly clear and concise, but that quote misrepresents the source and introduces a bias. Shortly after that statement in the NHS summary there is the following disclaimer: "... however, because of disagreements over the way acupuncture trials should be carried out and over what their results mean, this evidence does not allow us to draw definite conclusions." Who's introducing a POV now, then? Famousdog (talk) 12:16, 3 February 2012 (UTC)

I'm quite happy with that paragraph, apart from the excision I suggested. And I wouldn't support using that NHS statement. Your quote is followed by

However, because of disagreements over the way acupuncture trials should be carried out and over what their results mean, this evidence does not allow us to draw definite conclusions.

Some scientists believe that good evidence exists only for nausea and vomiting after an operation. Others think that there is currently not enough evidence to show that acupuncture works for any condition.

The existing wording and sourcing is fine by me. --Anthonyhcole (talk) 12:52, 3 February 2012 (UTC)

This is too wordy for an intro and probably no rewording would interest all readers.

POV is, of course, determined by the overall balance of the intro.

Even Famousdog seems to agree that the first part of the statement could be incorporated provided that there is some balance to it. My question is: what else needs to be in that paragraph? Mindjuicer (talk) 14:50, 3 February 2012 (UTC)

Personally, as I said, I'm happy with the lead, but I'd like to excise that text I mentioned earlier, unless someone has a problem with that. --Anthonyhcole (talk) 15:49, 3 February 2012 (UTC)

Famousdog, have you seen WP:PHARMANOIA? Might intrigue you.

Saying something "works" but only as well as placebo (and the placebo effect isn't unitary, surgery > needles > 2 pills > 1 pill) is a less honest way of saying that it can be explained by as a placebo - which the lead does. Normally I don't think we would compare one treatment to another in the treatment's page, though perhaps in the disease it is treating we might mention comparative effectiveness. The real issue isn't if it "works" or not, the real controversy is if it works beyond mere placebo. Right now it doesn't "work" for anything but pain and nausea, and they're having a hard time telling if this is due to placebo or something specific to the intervention.

Similarly, saying something has equivocal results for pain and nausea, then listing the types of pain and nausea it may work for, isn't good - for fairness we'd also have to list all types of pain and nausea for which it didn't work. Better to leave it as simply "results equivocal" which can incorporate those conditions it has evidence it does "work" for, and those it doesn't.

Nothing the NHS' endorsement of acupuncture doesn't seem right in the lead, particularly when it's accompanied by a "this endorsement has been criticized" citation and several other orgs that have had similar endorsements. Again, if we note what it's "effective" for, we should also be noting what it's not effective for, unless it's clearly and unambiguously a slam-dunk for a specific condition - which it's not.

I've shortened the lead, there were too many specifics and qualifications. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:17, 3 February 2012 (UTC)

The mistake you are making is thinking that "sham" acupuncture = placebo. It does not. "Sham" acupuncture is in reality precisely similar to certain techniques from Japanese schools of acupuncture hundreds of years old, that are still used to today by huge numbers of alternative acupuncture therapists, and which are noted for their subtle and powerful effects. "Sham" acupuncture is not an inert treatment, like a true placebo is supposed to be, and you look at the data: while the difference between "real" acupuncture and "sham" acupuncture is small, sometimes even clinically insignificant, the difference between "sham" acupuncture and no treatment is large. In fact, the data shows a significant difference between the effect of "sham" acupuncture and fake steroid injections, so we can see that so-called "sham" acupuncture is actually not analogous to placebo at all, therefore it is inappropriate to say that "acupuncture is a placebo" or "acupuncture only works through the placebo effect" like you are (shamefully persisting) in doing, WLU.Dickmojo (talk) 22:51, 9 February 2012 (UTC)

For example, look at this study of rats: it clearly shows a powerful effect from acupuncture above and beyond the placebo effect, objectively proven with chemical analysis: http://nccam.nih.gov/research/results/spotlight/010112.htm ACUPUNCTURE IS NOT PLACEBO Dickmojo (talk) 22:56, 9 February 2012 (UTC)

Feel free to start the page acupuncture in small groups of rats, but please restrict citations to secondary sources. "Sham" procedures incorporate a wide variety of techniques - altering the needling location, using nonpenetrating needles, most recently using toothpicks instead of needles [2], and in some studies, controlling for practitioner confidence and empathy. If "sham" and "real" acupuncture have identical results, doesn't that suggest to you that all the elaborate ceremony of interview, "diagnosis" and selection of points is worthless and education should instead be a brief study of how to maintain sterile procedures and avoid hitting nerves, blood vessels and organs? Of course, for a lot of practitioners that would be like a priest or someone with a PhD in theology becoming an atheist, it would be incredibly hard to admit they wasted so much of their lives on what is really the equivalent of memorizing the chants used by witchdoctors. It would take a lot of courage to abandon the pretense of "ancient Chinese wisdom" and stick with simple safety precautions instead. WLU (t) (c) Wikipedia's rules:^simple/_complex 09:59, 11 February 2012 (UTC)

In real life, you want to maximise the placebo effect as it is easily the main therapeutic mechanism for most ailments, even with traditional medicine. Only in trials do you want to minimise it.

I'm glad you shortened the intro but it's still about twice as long as it should be. I note that you removed mention of the Cochrane review and effectively stated that the successful treatment of nausea it concludes is equivocal??? Mindjuicer (talk) 13:57, 13 February 2012 (UTC)

Doctors quite conciously use the placebo effect + real effective medicine to treat patients. Suggesting that the placebo effect + any old nonsense is "good enough" and we should make use of it, would constitute a disturbing breach of patient-practitioner trust. The same applies to any treatment that relies solely on the placebo effect, such as homeopathy and the vast majority of alternative medicine. Why not give up acupuncture completely an concentrate on teaching doctors how to maximise the placebo effect in their daily practice? That would be a much better use of time and resources. Famousdog (talk) 15:56, 13 February 2012 (UTC)

Unfortunately for you, Cochrane says acupuncture is effective for nausea. Mindjuicer (talk) 16:30, 13 February 2012 (UTC)

Unfortunately for me? You imply by that statement that I have a problem with listing things on this page for which there is good evidence that acupuncture can help. I most certainly do not. I, like other editors you would smear as "skeptics", just want to see the evidence behind acupuncture's claims. It seems to me that for everything except nausea, that evidence base is weak to non-existent. This is not unfortunate for me in the slightest - it is, however, unfortunate for acupuncture practitioners and the people that trust them. Famousdog (talk) 11:57, 14 February 2012 (UTC)

Sorry but it's strongly implied in your previous comment. We seem to agree on everything else that you said, with the slight difference that traditional medicine often falls short when properly tested too. Mindjuicer (talk) 16:30, 16 February 2012 (UTC)

WLU says "If "sham" and "real" acupuncture have identical results, doesn't that suggest to you that all the elaborate ceremony of interview, "diagnosis" and selection of points is worthless and education should instead be a brief study of how to maintain sterile procedures and avoid hitting nerves, blood vessels and organs?". No, WLU, in fact not. You are engaging in pure speculation here, pure undiluted speculation. And while you're entitled to your speculations, you cannot pretend even for one instance that they are anything BUT pure, fanciful, undiluted speculations. The truth is that most "sham" acupuncture controls that are used in testing are actually valid and effective forms of treatment. But of course there are different standards used, which actually makes most of the research on acupuncture that's been done practically useless and unreliable, especially so since the critical aspect in the efficacy of acupuncture is the skill of the practitioner. This is noted in the classic texts, going all the way back to the Huang di nei jing. The skill of the practitioner's manipulations and needle techniques are critical, yet none of the studies take this variable into account, therefore they are essentially worthless. Indeed, the only really valuable research out there are the Chinese studies (because of the expert skill of Chinese practitioners in general in this regard vis-a-vie Western practitioners), and you'll note that they are all universally positive on the efficacy of acupuncture. But for a zealous rational-skeptic extremist fanatic like you to accept that WLU would be like a Spanish Inquistor suddenly deciding to stop persecuting witches for their "heresy".Dickmojo (talk) 14:35, 14 February 2012 (UTC)

Firstly, WLU's comments ("for a lot of practitioners that would be like a priest or someone with a PhD in theology becoming an atheist") were about acupuncture practitioners generally (and he has a point, namely: undisprovable = pseudoscience). What you just said ("zealous rational-skeptic extremist fanatic like you...") was a personal attack. Do not cross this line again please. Famousdog (talk) 15:18, 14 February 2012 (UTC)

There, fixed. Now can we please get back to my points about the article?Dickmojo (talk) 23:51, 14 February 2012 (UTC)

What specific changes do you want to make? WLU (t) (c) Wikipedia's rules:^simple/_complex 23:54, 14 February 2012 (UTC)

The same thought crossed my mind as well. DM is either engaging in special pleading or is putting acupuncture into the realm of pseudoscience; I believe the former is correct. N^oformation ^Talk 23:56, 14 February 2012 (UTC)

I am not engaging in special pleading, and pseudoscience is a term that's loaded with negative connotations. But the idea is vaguely similar, in that we are dealing with a science that was developed before the conventions and terminology of modern science were constructed, so we must approach the topic broad-mindedly, in a spirit of reconciliation and earnestness. We need to change the POV of this article, otherwise, it is xenophobia.Dickmojo (talk) 00:06, 15 February 2012 (UTC)

Acupuncture would be a protoscience with a strong evidential basis that traditional medical science is somewhat lacking. Mindjuicer (talk) 23:22, 15 February 2012 (UTC)

No sources, no suggestions, not a forum, no point continuing. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:11, 15 February 2012 (UTC)

We have plenty of sources here, WLU. More than most articles. We do not need more sources, we need to interpret the ones we have with a more neutral POV.Dickmojo (talk) 00:26, 15 February 2012 (UTC)

For example, Mindjuicer is 100% right, unfortunately for you guys, Cochrane finds acupuncture and acupressure at PC6 effective for nausea. Now, the point is no where near the stomach, nothing in western medicine predicts this response, but there it is, the response is provably real. The only hypothesis which predicts such a response is TCM meridian theory. Therefore, TCM meridian theory is proved valid. Now, the studies of acupuncture that have returned negative results are not reliable, since they use an effective and valid form of treatment itself as a placebo control, and do not account for a key variable, namely practitioner skill. Therefore we cannot rely on such research as a basis for treating acupuncture with as much disdain as we do in this article. Rather, we need treat it open-mindedly, especially since acupuncture theory is provably correct in the case of nausea, when no other comparable western scientific theory exists that predicts this response.Dickmojo (talk) 00:32, 15 February 2012 (UTC)

Actually, you are demonstrating the flaw of jumping direct to clinical research - you have no idea what may be responsible for reducing nausea (including placebo effect, pain and nausea are both symptoms that are extremely susceptible to psychogenic factors). All you know is that stimulating this point appears to reduce nausea. Does stimulating other points also reduce nausea? Does it attract the attention of nausea-reducing fairies? Is it a simple distraction from nausea? Is there a genuine link between the nerves in the wrist and the nausea centres in the brain (which has nothing to do with TCM's explanation for things)? You need a lot of research to truly tease out what's actually causing the response, that is establishing causation rather than mere correlation.

Also, this does nothing to validate TCM and acupuncture as a whole, and certainly not any of it's claims that it can treat disease or manipulate qi (or that qi exists). Jumping from "a single intervention on a single point does X" to "a prescientific medical system completely works" is not how science is done.

For a final point, nausea is a neurological symptom - it occurs in the brain. It doesn't occur in the stomach. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:20, 15 February 2012 (UTC)

This an unfounded assertion. Mindjuicer (talk) 23:22, 15 February 2012 (UTC)

TCM meridian theory is not proven valid. All you can say is that medical theory is incomplete and that meridian theory would be the prevailing albeit untested explanation. Mindjuicer (talk) 16:30, 16 February 2012 (UTC)

May I suggest to my fellow editors that we end this futile discussion and concentrate on improving the article. Dickmojo and Mindjuicer will clearly not be swayed by any argument and I, personally, am done here. Famousdog (talk) 10:33, 15 February 2012 (UTC)

Indeed WLU, your points are all valid, and actually, TCM theory predicts this phenomenon in stating "The mind leads the qi, the qi leads the blood", which is taken to mean that the mind is the primary inducer of the healing effects of acupuncture. Now, when TCM theory itself predicts this mechanism of action, you can't come along and denigrate it with loaded terms like "placebo", even if the meaning is roughly similar. We could all get along much more civilly around here if you guys agreed to abandon the terminology and paradigm of pharmaceutical drug testing (i.e. "placebo"), and began to adopt the more holistic approach of TCM, which doesn't even really include the notion of "causation", everything is interconnected in webs of correlation. It is a completely different mindset, and I for one want us to appreciate it and explore it and enjoy it. Sure, the scientific pharmaceutical drug trial paradigm has validity, in its own native context, but in this different context, I implore us to use more of the TCM theory paradigm, which is the native context of acupuncture.Dickmojo (talk) 15:35, 15 February 2012 (UTC)

WP:FAITH much? Mindjuicer (talk) 23:22, 15 February 2012 (UTC)

(not taking the bait) Famousdog (talk) 15:49, 15 February 2012 (UTC)

Per WP:SILENCE, this is me saying I see no reason to change the page based on anything in this discussion. Per WP:FORUM, I suggest this source-free discussion be taken elsewhere than wikipedia. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:40, 15 February 2012 (UTC)

The question is whether or not the article has a neutrality problem and the answer is yes. WLU it is true that the individual edits you have made are valid and source based, but the weight of various sources and the overall tone of the article are not decided by secondary sources, they are decided by editors. The fact that this keeps coming up over and over again is due to people not finding the article to be neutral. The debate is not going to go away until the structure and tone of the article achieve neutrality, and that must come about by consensus.Herbxue (talk) 21:21, 15 February 2012 (UTC)

Weight is not arbitrarily determined by editors. Read WP:Weight. Weight is determined by sources, just like everything else on WP.   — Jess· Δ♥ 21:25, 15 February 2012 (UTC)

Thanks Jess, it says weight should be "based on reliable sources" - but here's where we will all disagree: From the perspective of those informed about the subject, "reliable sources" for info on acupuncture include many books and articles written in Asia over a 2000 year span of time. From the perspective of those who only want to view the subject as a form of science-based medicine, there are very few sources that qualify because they would only accept systematic reviews. We as editors need to decide: Should the WP article titled "Acupuncture" cover the subject in all its breadth and depth, or should it mainly answer the question "How does it do in RCT's"? — Preceding unsigned comment added by Herbxue (talk • contribs) 21:37, 15 February 2012 (UTC)

Correct. And according to secondary sources, acupuncture works for one thing, nausea. There are conflicting results for pain and secondary sources show no difference from placebo for some other conditions.

So if we clumsily split into two sides: acupuncture works vs acupuncture doesn't work, both have some validity. A 50/50 split seems NPOV to me, so equal weight for what acupuncture seems to work for vs what it doesn't seem to work for. Mindjuicer (talk) 23:22, 15 February 2012 (UTC)

As much as I enjoy these recurrent skeptics-vs.-proponents skirmishes: wouldn't it be more fruitful if we discussed a specific text passage instead of general world views? --Mallexikon (talk) 07:29, 16 February 2012 (UTC)

Well yes indeed, Mallexikon. Yet everytime I merely suggest an alteration I get accused of edit warring, receive threats and am subjected to bullying. Now they've even gone and complained about me on the Dispute resolution board. But nevertheless, I don't care about my own personal wellbeing, I am just trying to bring truth and balance to this article, thus I will persist.

The two suggestions I have already proposed, but got shouted down and abused for even raising them, are:

1) In the lede, it is obscuring the full story to infer that exhaustive research on meridians and acupoints and qi have been conducted with absolutely no evidence found, (like we are currently implying). In fact, the source 5 says that, actually, the substantial majority of the studies conducted into these phenomenon in fact show positive correlation between acupoints and meridians and their electro-conductivity properties vis-a-vie adjacent areas of tissue. If we are going to say that there has been research conducted in this area, we can't just imply that it was universally fruitless as this is simply untrue, we must either delete the sentence or include an acknowledgement of the fifth source which suggests there is scientific substance to the meridian theories of TCM.

2) In the next paragraph, if we are going to identify "PROPONENTS of acupuncture blah blah blah", then we must also identify who the OPPONENTS are! We can't just imply that "science" opposes acupuncture, because in fact science is open minded about it. Indeed, To quote one of my heroes - Jacob Bronowski:

“One aim of the physical sciences has been to give an exact picture of the material world. One achievement of physics in the twentieth century has been to prove that that aim is unattainable. The world is not a fixed, solid array of objects, out there, for it cannot be fully separated from out perception of it. There is no absolute knowledge. And those who claim it, whether they are scientists or dogmatists open the door to tragedy. All information is imperfect. We have to treat it with humility. That is the human condition.” J Bronowski – The Ascent of ManDickmojo (talk) 12:42, 16 February 2012 (UTC)

Dickmojo, the only one making accusations, threats and bullying is you. Famousdog (talk) 13:17, 16 February 2012 (UTC)

Specific discussion

@Famousdog: c'mon, let's not go down to that ad hominem level. @Dickmojo: Ok, let's talk about this fifth source, the review dealing with electro-conductivity. Its conclusion says "Based on our review of the English literature, the evidence does not conclusively support the claim that acupuncture points or meridians are electrically distinguishable. In general, the studies were of poor quality, involved small sample sizes, and limited their evaluation to the upper extremity and to healthy individuals" Why do you think this should not be used to support the sentence in the lede? --Mallexikon (talk) 14:24, 16 February 2012 (UTC)

Selective quoting will not help you. The key word here is "conclusively". Were there conclusive evidence, that claim would have to be removed entirely.

The very next sentence which you failed to quote is "However, the preliminary findings are suggestive". As this is a Pubmed secondary source, the claim has to be moderated. I concur completely with Dickmojo's point 1.

Re point 2, I'd remove the proponents sentence entirely and have that section NPOVly and accurately represent what the science currently says.

I'd add a point 3

3) The current weight of pro vs anti in the lede is about 30-70. As I suggested, 50/50 would be much more NPOV. Mindjuicer (talk) 16:55, 16 February 2012 (UTC)

The two perspectives are not equal - those arguing for the existence of meridians are making quite startling claims. That there exists anatomical structures, with real biological effects, that were discovered by a prescientific community, with no known method to identify them, despite a century of microscopic (and electron microscopic), pathological and imaging investigations of the body. In my opinion, it is simply not worth including in the lead that a single article has reviewed a body of evidence supporting a single proposed criteria for possibly distinguishing these pathways and found it to be so flawed it can not make even a tentative conclusion on their existence. Even in the body, this would merit a single sentence. We don't split the weight in half because there are two sides - we allocate according to weight in reliable sources. The actual, conclusively proven existence of acupuncture points or meridians would be a major new addition to our understanding of gross anatomy, probably the first one in several decades. That hasn't happened. All we have is a single review article from four years ago summarizing a small number of poor-quality primary studies. That's not worth editing the lead as far as I'm concerned. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:53, 16 February 2012 (UTC)

The lead does not make those claims and so most of your point is moot.

It makes the analytic claim Scientific research has not found any physical or biological correlate of qi, meridians and acupuncture points, and some contemporary practitioners needle the body without using a theoretical framework.

This is a perjorative statement implying that science isn't even close to finding them. But a secondary source contradicts this implication. The statement needs to be rewritten to remove its perjorative nature. Mindjuicer (talk) 20:32, 16 February 2012 (UTC)

Saying scientists haven't found any doesn't imply that they never will find any. Indeed, what you've written is the only text making implications, namely that scientists will find them, which is yet unsupportable. I can't draw up any alternative wording which more directly states that a previous failure to find a biological correlate does not necessarily imply future attempts will also fail, without also implying they're likely to succeed. What wording are you proposing?   — Jess· Δ♥ 20:47, 16 February 2012 (UTC)

In line with my previous comments on reducing the length, I'd rewrite the whole of the intro something like:

Acupuncture aims to treat problems through insertion and manipulation of thin needles in a patient's skin. According to traditional Chinese medicine, this corrects imbalances in the flow of Qi along meridians.

Following growing Western interest for alternative medicine, acupuncture has been subjected to a significant amount of scientific research. It shows a beneficial effect for treating nausea but fails to outperform placebo for other conditions tested. It also shows little evidence for Qi and meridians.

You could go on and talk about the debate over national health supply but frankly the longer the intro, the more POV tends to sneak in. Mindjuicer (talk) 00:04, 17 February 2012 (UTC)

Comparing with the current lead: you've dropped alternative medicine, which is important; you've dropped description of the needles, and alternative forms of acupuncture; you've dropped the link to TCM history, now only implying it; you've placed significant weight on the idea that interest in Acupuncture is growing in the West and is being subject to increased, partially positive, testing; you've made definitive statements about its effects on nausea, removing any controversy surrounding its comparison with placebo; you've entirely purged every single negative review of acupuncture. Absolutely unacceptable. The lead reflects the body; we can't simply excise that amount of content just to make the lead more sympathetic to the subject.   — Jess· Δ♥ 00:40, 17 February 2012 (UTC)

Oh I thought you were serious about considering changes. Seems like you only wanted to shoot me down. Not one single positive bit of feedback. And you wonder why NPOV editors complain?

So what if I've dropped description of the needles? Like that needs to be in the intro...

I did not say anything about links so why accuse me of dropping them? There's no such thing as Traditional Chinese Medicine (capitalised) but clearly it can still be linked..

I've not said that interest in acupuncture is growing!?

It is being subject to increased, partially positive testing.

Cochrane is pretty definitive - what exactly is your problem with that source?

I haven't purged any negative review of acupuncture - I've merely restated everything bar the ridiculous statement about some practitioners not using 'theoretical frameworks'.

"we can't simply excise that amount of content just to make the lead more sympathetic to the subject" -- why not if it makes it NPOV with less badly-written verbiage?? The content should be in the body of the article, not the lead. Mindjuicer (talk) 02:08, 17 February 2012 (UTC)

It appears that you don't know the rules for creating a WP:LEAD. Read it. -- Brangifer (talk) 02:13, 17 February 2012 (UTC)

Thanks for this. Seems more guidelines than rules but am happy to go with consensus on length and content. At risk of repeating myself, I point out that the current lead is neither clear nor accessible nor NPOV. Mindjuicer (talk) 05:38, 17 February 2012 (UTC)

Imagine I went to Evolution and said "this introduction is really long. I'm going to reduce it down to five short sentences". Editors would very rightly object that I'd removed a great amount of necessary detail. It would be ridiculous for me to respond to their objections by saying "you obviously aren't serious about this article... you have not one good thing to say about my proposal." I'm sorry Mindjuicer, but your proposal is not an improvement. It is not an accurate representation of the body. It is not an accurate representation of the sources. It excludes major details, like safety, conditions it's used to treat, its origins and claimed mechanisms. It includes improper weight, like "growing western interest in alternative medicine" (source?), "beneficial effect for nausea" (what about the negative systematic reviews?). I don't know what else to tell you. If you disagree with my assessment, and you're serious about this proposal, then hold an RfC.   — Jess· Δ♥ 02:36, 17 February 2012 (UTC)

You and I obviously disagree on what constitutes necessary detail. I note your ongoing purely critical manner and find it very unproductive.

Where are the negative systematic reviews re nausea? Mindjuicer (talk) 05:45, 17 February 2012 (UTC)

I'm sorry Mindjuicer, I don't know what to tell you. I can't be overtly positive about changes with which I disagree. I'm not calling you names, or telling you to leave the page; I'm giving you an honest, reasoned and professional assessment of your proposal, as far as I can manage. Collaboration doesn't mean agreeing on everything, or anything for that matter. Collaboration means providing feedback during disagreements, which is what I've done to the best of my ability. I'm sorry you feel slighted that I disagree with you, but I've provided you a means for seeking broader community input if you find my position short sighted. You can still take that route. All the best,   — Jess· Δ♥ 06:11, 17 February 2012 (UTC)

This is my third time asking you for negative systematic reviews re nausea. If you don't answer this time, I guess we assume that the Cochrane review stands uncontested. Mindjuicer (talk) 06:18, 17 February 2012 (UTC)

They're in the article. See the discussion below about that sentence. I didn't write it; you simply excluded it in your proposal. With that, I think it's time for me to duck out of this discussion. I just don't see us getting anywhere. If you have another proposal, feel free to make it in a new section, or hold an RfC for broader community input. Thanks.   — Jess· Δ♥ 18:19, 17 February 2012 (UTC)

@Bullrangifer&Jess: I think we would have a much better discussion if we all could soften our tone a little here. @Mindjuicer: Thanks for your proposal concerning the lede. I'd like to focus on the part of "... acupuncture has been subjected to a significant amount of scientific research. It shows a beneficial effect for treating nausea but fails to outperform placebo for other conditions tested. It also shows little evidence for Qi and meridians." I can live with the first two sentences, however, I disagree with the last one. So far, no evidence has been found for finding a physical correlate of qi or meridians. And "preliminary findings are suggestive" doesn't count as evidence, I'm afraid. --Mallexikon (talk) 02:47, 17 February 2012 (UTC)

What does "preliminary findings are suggestive" count as then? Is there any more reliable source on this matter? Or a more recent paper that throws light on the subject? Mindjuicer (talk) 06:04, 17 February 2012 (UTC)

1) It only counts as being a suggestion, I'm afraid. That's why the authors' general conclusion reads: "the evidence does not conclusively support the claim that acupuncture points or meridians are electrically distinguishable." 2.) This is a reliable source. I don't know if there are any else. 3.) Not to my knowledge. Cheers, --Mallexikon (talk) 07:18, 17 February 2012 (UTC)

As I have said before, it would be WP:OR or WP:SYN for us to mind-read what Ahn et al meant by "suggestive" in their 2008 review. They conclude: "The studies were generally poor in quality and limited by small sample size and multiple confounders... the evidence does not conclusively support the claim that acupuncture points or meridians are electrically distinguishable." Ahn et al don't say of what the preliminary findings are "suggestive" and we cannot, and should not, interpret what Ahn et al may have meant by this. It is poor writing on their part to refer to as "suggestive" research that they clearly think is comprimised and of poor quality. Famousdog (talk) 13:52, 17 February 2012 (UTC)

Sorry but they are a secondary source and you are not. I think their wording was carefully chosen, presumably through consultation with the third party journal and was subject to peer-review.

It is not a suggestion. It is "suggestive" and the only rational interpretation is that it is suggestive of an electical basis for acupuncture points and meridians. Secondly, I have to argue that it is scientific evidence from any definition I'm aware of. It may be weak scientific evidence but it still is evidence. Mindjuicer (talk) 17:29, 17 February 2012 (UTC)

The split of the article to argue that there is "Western" and "non-Western" (presumably Eastern, or Chinese) medicine is completely untenable. We are serious about discussing changes - based on wikipedia's policies and guidelines, not based on the beliefs of editors already convinced of acupuncture's effectiveness. The definition of "badly written" here is an inaccurate summary. It's not whether the statement places appropriate accolades on acupuncture.

On a hopefully final point - the lead isn't "negative" for nausea - it actually says it is effective for certain types. And that's true - there is evidence that stimulating the P6 point is helpful for post-operating nausea. I don't believe there is a review article saying it is effective for all types of nausea, but perhaps I'm wrong. Could you provide a link please? WLU (t) (c) Wikipedia's rules:^simple/_complex 14:26, 17 February 2012 (UTC)

Mindjuicer is clearly correct. Someone decided to delete this source all together, they'd rather hide the truth from our readers than let them see it and make their minds up for themselves. But I'm sorry, I don't care how much of a sceptic extremist fanatic you are, if the study states that "Five out of 9 point studies showed positive association between acupuncture points and lower electrical resistance and impedance, while 7 out of 9 meridian studies showed positive association between acupuncture meridians and lower electrical impedance and higher capacitance", then this is REAL scientific evidence, and can we please have it back. http://onlinelibrary.wiley.com/doi/10.1002/bem.20403/abstract;jsessionid=58BB2FDAA1322DB50ADB06D305F41969.d03t04 Dickmojo (talk) 05:28, 18 February 2012 (UTC)

I'm tired of the IDHT behavior rampant on this talk page, and I'm about ready to stop responding to certain editors unless they demonstrate they're actually participating in the discussion and furnishing sources. @DM, this was discussed repeatedly. Quoting directly from the source: "The studies were generally poor in quality and limited by small sample size and multiple confounders. Based on this review, the evidence does not conclusively support the claim that acupuncture points or meridians are electrically distinguishable." We cannot, under any circumstances, use this source to state that there is positive evidence for these claims, as the study itself says that it is not. Without further sources, that is IMO the end of the discussion.   — Jess· Δ♥ 05:40, 18 February 2012 (UTC)

@Mindjuicer: The full text of the abstract of that study is: "Five out of 9 point studies showed positive association between acupuncture points and lower electrical resistance and impedance, while 7 out of 9 meridian studies showed positive association between acupuncture meridians and lower electrical impedance and higher capacitance. The studies were generally poor in quality and limited by small sample size and multiple confounders. Based on this review, the evidence does not conclusively support the claim that acupuncture points or meridians are electrically distinguishable. However, the preliminary findings are suggestive and offer future directions for research based on in-depth interpretation of the data" We have to stay true to the source here, and their finding is that, yes, there are studies which found positive associations, but these studies can't count as evidence since their quality was poor. If you want to cite this source to include the fact that preliminary findings are suggestive of an association - please go ahead (just not in the lede, please). But evidence it is not. BTW you used an ad hominem attack in your above comment again. Please stop that. No need to. --Mallexikon (talk) 05:55, 18 February 2012 (UTC)

Jess and Mallexkion, yes I understand its not conclusive evidence, but you must understand its suggestive evidence, and our readers have a right to know about it and make up their own minds!Dickmojo (talk) 06:05, 18 February 2012 (UTC)

Lede change?

To incorporate some of Mindjuicer's suggestions, I propose we change

• "... However, current scientific research only supports its efficacy in the relief of certain types of pain and nausea[8][9][10][11][12] and systematic reviews have found these results to be conflicting and equivocal.[13][14][9][15][16] It has been suggested that the positive results reported for acupuncture can be explained by placebo effects and publication bias[11][15][17][18][19] and researchers have pointed out the difficulty in designing an adequate scientific control for any placebo effect acupuncture might have due to its invasiveness.[2][8][20][21][22]"

to

• "... Acupuncture has been subjected to a significant amount of scientific research. It shows a beneficial effect for treating nausea but fails to outperform placebo for other conditions tested. It has been suggested that the positive results reported for acupuncture can be explained by placebo effects and publication bias[11][15][17][18][19] and researchers have pointed out the difficulty in designing an adequate scientific control for any placebo effect acupuncture might have due to its invasiveness.[2][8][20][21][22]"

Comments? --Mallexikon (talk) 07:51, 17 February 2012 (UTC)

I'm fine with the wording change, except for the exclusion of "systematic reviews have found these results to be conflicting and equivocal.[13][14][9][15][16]". On what grounds are we excluding those sources?   — Jess· Δ♥ 07:58, 17 February 2012 (UTC)

Also, why is "Acupuncture has been subjected to...research" necessary? I've seen sources claiming we need more research, and when viewed next to Evolution, antibiotics, etc, it comparatively has very little.   — Jess· Δ♥ 08:01, 17 February 2012 (UTC)

Well, I guess compared to other alternative therapies, there really has a significant amount of research been done here. Regarding the "systematic reviews have found these results to be conflicting.." sentence: I don't like it. Out of the 5 (!) sources cited, I only find one (i.e., source no. 13) to support its message, and that uses pretty inexact wording ("Overall the article suggests that acupuncture and acupressure are ineffective in preventing and managing PONV in adult patients."). Sources no. 14,15 and 16 actually tentatively support acupuncture, and 9 is broken. I suggest we leave this sentence out. --Mallexikon (talk) 08:43, 17 February 2012 (UTC)

Actually, I just read source no. 12, and the author (Ernst) says that "unanimously positive conclusions" exist for acupuncture treatment of neck pain. So I think the lede sentence should be "... shows a beneficial effect for treating nausea and neck pain but fails to outperform placebo for other conditions tested." Cheers, --Mallexikon (talk) 09:16, 17 February 2012 (UTC)

But as I've said elsewhere recently, "acupuncture" does not "show() a beneficial effect for treating nausea". That is a very general statement backed up by an extremely specific source. Acupuncture or acupressure of one point on the wrist "shows a beneficial effect for treating postoperative nausea". This is not evidence that "acupuncture" in general is beneficial for "nausea" in general. I'm sorry, but I think the current wording ("current scientific research only supports its efficacy in the relief of certain types of pain and nausea and systematic reviews have found these results to be conflicting and equivocal") is fine. The key words here are "...certain types...". I agree that ref 15 (Furlan et al) is not "equivocal" it is quite specific. See my recent edit to the article. Famousdog (talk) 10:40, 17 February 2012 (UTC)

Yes, sorry, you're right and I didn't pay enough attention here. The sentence would have to be "... shows a beneficial effect for treating postoperative nausea and neck pain but fails to outperform placebo for other conditions tested", then. I still can't find support for the "...found these results to be conflicting..." sentence in the given sources, though. Could you point out the relevant text passages in those sources for me? --Mallexikon (talk) 11:01, 17 February 2012 (UTC)

The Lee et al review is pretty unequivocal, so I've moved it. Abraham found that only three studies out of ten showed P6 stim to be effective and says: "population samples were small and the research designs had numerous anomalies." So I think that is pretty equivocal (to negative), but it is older than the Lee review (which should be given precedence as a result). Ernst 2006 says: "Some findings are encouraging but others suggest that its clinical effects mainly depend on a placebo response." That's pretty equivocal. The Madsen paper says: "A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias." That's a pretty negative conclusion, so I'm moving it. Famousdog (talk) 11:18, 17 February 2012 (UTC)

The evidence for pain and nausea are both equivocal - there is evidence that very specific types of pain and nausea can be treated with acupuncture. Not all pain and nausea. We're better off being conservative in the lead and making a broad blanket statement than we are placing undue weight on the tiny number of conditions for which there is evidence of efficacy. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:23, 17 February 2012 (UTC)

Yes, the evidence collectively for pain and nausea is equivocal. But saying "the results are equivocal" then citing all the studies together en masse would not seem to be very helpful. What do you think of my recent edits? Famousdog (talk) 11:38, 17 February 2012 (UTC)

I dislike the use of italics, WP:ITALICS suggests their use only when the meaning of the sentence might otherwise be misunderstood - I don't think this is likely.

I agree with MJ's point that "significant research" is unnecessary. I am actually OK with removing the "conflicting and equivocal" point, particularly if the sources don't explicitly support it). With some embarassement, I think it may have been me that added it, with the rationale of "studies 1, 2 and 3 are positive, studies 4, 5 and 6 are negative, therefore overall they are equivocal". If that's the case, that's a clear WP:SYNTH that I should never have made. Now, if I'm just misremembering and the sources do verify these points, I've no issue. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:11, 17 February 2012 (UTC)

Lee et al 2009 is both more recent and much more reliable than the other sources FamousDog mentioned. It makes a claim specific to post-operative nausea whereas the others seem to concern vomiting as well.

Accurately and succintly describing the conclusion of a Cochrane review is not giving it undue weight. Mindjuicer (talk) 16:10, 17 February 2012 (UTC)

Agreed, which is why it is included as a citation for the sentence "However, current scientific research only supports its efficacy in the relief of certain types of pain and nausea and some systematic reviews have found these results to be equivocal." Lee would fall into the category of the "certain types of nausea". It's already there, it's already given appropriate weight, so I don't see your issue. Given the vast number of claims for acupuncture's efficacy, noting the two symptoms for which it may be useful in alleviating is perfectly appropriate. I don't think anybody here is arguing it's not effective for postoperative nausea, I think we just don't believe it's worth the volume of text it would take to adequately describe this single result in the lead. We could change it to "Research indicates acupuncture is completely useless for everything except nausea after surgery and neck pain and there is no reason to believe it is useful for any other illness, symptom or indication" if you'd like. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:08, 17 February 2012 (UTC)

Again your bias is showing.

The lead makes none of the "vast number of claims for acupuncture's efficacy". You do not get to use WP to balance your own discomfort with what you think the world is claiming. WP is not your propaganda tool.

Likewise, you haven't addressed why older and less reliable studies are given equal weight to Cochrane.

The lead weighting remains about 30-70. I understand this is what you want it to be. However, this contradict's WP's primary policy, that of NPOV. Mindjuicer (talk) 18:12, 17 February 2012 (UTC)

You're right, the lead doesn't discuss any claims of efficacy beyond equivocal ones for pain and nausea because there are no reliable sources that it's actually effective for any of those vast claims. The most recent Cochrane reviews and review articles, as far as I know, state that acupuncture is not useful for anything but postoperative nausea and neck pain. They're the "certain types of pain and nausea" found in the current lead. I'm not sure what "30-70" you're talking about. The lead talks about what acupuncture is, where it comes from, how it's traditionally explained as working, that this explanation has no scientific support, that proponents claim it treats diseases, that there's no evidence for this (bar "certain types of pain and nausea"), that the apparently positive results can be explained through placebo and publication bias, difficulties in conducting research, that it's safe with small risks, that some organizations have endorsed it but these endorsements have been criticized. Acupuncture is a controversial area of active research where no definite conclusions exist - would you prefer we pretend it's a settled science with conclusive answers? How can you justify this with the policies and guidelines? WLU (t) (c) Wikipedia's rules:^simple/_complex 18:32, 17 February 2012 (UTC)

You take a lot of space and barely comprehensible language to state pretty much nothing. Oh and a strawman at the end.

The lead remains highly POV with 30% favourable and 70% unfavourable -- please follow the talk next time. It's very unhelpful to demand explanation of everything that's already been discussed. Mindjuicer (talk) 20:42, 17 February 2012 (UTC)

MJ, I'm pretty sure that I have explained to you on the EFT talk page that NPOV does not mean giving a 50-50 equal treatment to any particular set of ideas. NPOV means that we represent the sources in proportion to their prominence, so your 70-30 argument is a non starter. Consider our article on evolution for instance, it is 100-0 in support of evolution and against intelligent design. As you can see the weight is the same in the ID article even though the article is about ID because all the reliable sources support evolution. Since the majority of acupuncture studies have found no effect or marginal effects, that is what our article will represent. I don't agree with your 70-30 assessment, but whether it's 70-30, 80-20, etc, is not really relevant. As WLU explained before, we have studies that show some positive effect on pain and nausea and that is the only positive thing we can say because that is the only positive result from the sources. There is no room for special pleading. N^oformation ^Talk 21:02, 17 February 2012 (UTC)

Sorry, it was asked earlier what the weight should be and no-one contested 50/50. Mindjuicer (talk) 21:44, 17 February 2012 (UTC)

Sorry but that's not what the sources indicate the weight should be. There are far more publications that are either critical of acupuncture or that find no effect than there are positive effects and that's how the weight has to be represented. N^oformation ^Talk 21:48, 17 February 2012 (UTC)

OK, what have you got that's comparable in reliability to Lee et al 2009?

Also why are you accusing me of special pleading? Mindjuicer (talk) 00:09, 18 February 2012 (UTC)

How is that comment regarding Lee relevant? That's the one source that supports it being useful for post-operative nausea; this is reflected in the lead.

The weight is dictated by sources, per WP:NPOV and WP:UNDUE. Specifically, "Neutrality requires that each article or other page in the mainspace fairly represents all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint." There is no arbitrary percentage that we need to use to give false balance - it's dictated by the number, type and quality of the sources. As I've asked in the section below - what sources are missing? If you can't find any, then there's not really much to discuss. You keep saying "there's too much emphasis on criticism". Well, find some reliable sources that indicate the criticism is unwarranted, unreasonable, or simply false because there is good quality evidence acupuncture has efficacy against some symptom or disease. Otherwise, we're all kinda wasting our time. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:11, 18 February 2012 (UTC)

Because Lee et al 2009 seems to be the most reliable source. Please keep up.

And your new section is about as relevant as your last 3 comments. I'm beginning to think you're purposefully trying to derail the debate. Mindjuicer (talk) 01:41, 18 February 2012 (UTC)

Yes, Lee is unarguably reliable. But it only substantiates one point - that the P6 point (that is, a single point) is considered effective for treating postoperative nausea (that is, a single symptom). This statement is already reflected in the current lead. I see no reason to rewrite the lead based on a single citation that is already used appropriately, particularly in the face of multiple citations that verify acupuncture being controversial and having only one other indication - neck pain. You can assert all you want that acupuncture is useful in treating a myriad conditions, but only sources are sufficient to actually change the article. Keep asserting in the absence of evidence and you'll eventually get blocked or banned for tendentious editing. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:50, 18 February 2012 (UTC)

Easy, easy, nobody will be blocked here. Please guys, you're all doing a very good job here. We all know this is a very challenging topic. Just don't take it so personal, okay? --Mallexikon (talk) 02:33, 18 February 2012 (UTC)

Mallexikon, editors can be blocked for POV-pushing. Dickmojo and Mindjuicer, by completely failing to adhere to the relevant policies, are certainly edging towards that particular cliff (though they're more likely to be banned from this page). WLU (t) (c) Wikipedia's rules:^simple/_complex 11:58, 18 February 2012 (UTC)

I note your misrepresentation of my position and your completely unwarranted threats against me. I have adhered to WP policies, do not assert that "acupuncture is useful in treating a myriad conditions" except as placebo and am probably only one of 2 editors here not POV-pushing. --Mindjuicer (talk) 18:17, 18 February 2012 (UTC)

What threat? I can't block you, I'm not an admin. Your own behaviour puts you at risk of being blocked.

As for the "myriad conditions", you keep complaining the lead does not fairly represent efficacy. Well, there are only two conditions for which it has any efficacy (neck pain and postoperative nausea). Since these conditions are noted in the lead, I can only assume you mean some other conditions are missing. However, since you never make a solid claim what they are, or present any references to substantiate them, I'm left to guess. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:21, 18 February 2012 (UTC)

DRN

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The following discussion has been closed. Please do not modify it.
In the face of near-total intransigence on the part of Dickmojo, I have begun dispute resolution procedures. Famousdog (talk) 12:27, 16 February 2012 (UTC) "near-total" (?) Dickmojo (talk) 12:43, 16 February 2012 (UTC) Apologies, that clearly should have read "total." Famousdog (talk) 13:15, 16 February 2012 (UTC) I'd say "total" as well. Reading this talk page gives me a headache. For one thing the near twin status of Mindjuicer and Dickmojo is astounding, and makes me wonder if we're encountering one or more socks and/or meatpuppets related to a previous SPI at Wikipedia:Sockpuppet investigations/Brendan.mattson/Archive. The identical arguments and language, the continual repetition of the same debunked points, and the failure to understand the same key policies is very troubling. -- Brangifer (talk) 01:56, 17 February 2012 (UTC) Their arguments are nothing like each other and dickmojo's tone has been bombastic for a long time. Mindjuicer has made some really positive suggestions and you douches keep shutting him down because you are tired of dickmojo. As far as I can see, WLU, Mallexicon, and Mindjuicer are making the most sincere effort on this page, even though I disagree with Mallexicon and WLU's overly strict thinking that this is a biomedical article and only can be viewed as such. Bullrangifer, you're swinging wildly and not helping. Herbxue (talk) 03:23, 17 February 2012 (UTC) @Bullrangifer: I agree with Herbxue. If you're seriously suspecting a meatpuppet, maybe it would be better to investigate it than to talk about it here. BTW, are you referring to the Brendan.Mattson incidence where everybody not sharing PPdd's point of view suddenly was a meatpuppet suspect, including Herbxue and me? --Mallexikon (talk) 03:42, 17 February 2012 (UTC) Yes, it's that SPI. I agree that PPdd did indeed list too many people, but it revealed a massive COI situation, several socks were discovered, and lots of newbies got acquainted with our rules. If you read my comment there, you'll see that I was rather lenient. There was also some legitimate suspicion created by the confusion about Herbxue's previous username, etc.. That kind of thing happens, and his explanations seemed to satisfy most people, including myself. I haven't been participating here much lately, but when I read this page I was appalled that this was still continuing and that the two editors hadn't been blocked or banned yet. Very surprising, because they're really pushing the envelope. My concern here is that, at least lately, the two editors named above have become more similar in their vitriol and personal attacks, and it really looks bad. If everyone would tone it down it would help a lot. I'm also concerned about Herbxue's involvement here as a professional acupuncturist with a huge COI. Isn't he still topic banned, or has that run out? Even if it has, the COI still exists, so he should be cautious. That applies to all professionals here. Being a professional doesn't give any special privileges (on the contrary!), and it's considered a liability because of the COI situation. Also the blatant advocacy here is appalling. That's very strictly forbidden. Discuss specific edits, and not the subject in general (see the top of the page). Just sayin'... As long as everyone keeps these things in mind, I have no intention of starting an SPI or anything. -- Brangifer (talk) 04:27, 17 February 2012 (UTC) BTW, my inclusion of Mindjuicer in my comments isn't just because of this page, but because of his comments at Wikipedia:Dispute_resolution_noticeboard#Acupuncture, where he chooses to side with Dickmojo. He should let Dickmojo fight his own battle, rather than joining him in his arguments and rhetoric. If he really wants to help Dickmojo, he should advise him to tone it down a whole lot and not side with him. Right now Mindjuicer is (unintentionally) acting as an enabler and encourager of Dickmojo's bad conduct and thus seems to be adding fuel to the fire around Dickmojo. That makes an explosive combination that might end up burning both of them. That would be unfortunate. -- Brangifer (talk) 04:45, 17 February 2012 (UTC) I still don't find your comments or tone very helpful here. No need to issue veiled threats against Herbxue and Mindjuicer. Are you actually aware that the bigger part of your latest comments are all ad hominems? --Mallexikon (talk) 05:07, 17 February 2012 (UTC) I have to agree. This isn't the place to discuss sockpuppetry, and accusations of that sort without hard evidence typically makes things worse. I'm hatting the discussion, as there's no need to hash out this discussion further. Thanks.   — Jess· Δ♥ 05:11, 17 February 2012 (UTC)

Missing sources

I, along with others, have been accused of not acknowledging that acupuncture is effective for a variety of conditions. If this is true, it needs to be addressed. Accordingly, I assume there are reliable, secondary sources that exist that establish the effectiveness of acupuncture that are not currently used. Please list them below and we can discuss how to best use them in the page. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:17, 17 February 2012 (UTC)

Citation overkill

Please read WP:Citation overkill once more (quote: "A good rule of thumb is that one footnote after a sentence is almost always sufficient, two or three may be a good way of preventing linkrot for online sources or providing a range of sources that support the fact, and more than three should be avoided as clutter"). I understand why we have a few sentences with 4, 5, and even 6 citations in the lede (quote again: "One cause of "citation overkill" is edit warring...") - we all know we're working on a very controversial, embattled article here. But for the sake of readability, and to make editing/verifiability more transparent (yesterday was kind of an eye opener for me), I'm going to trim some of these citation rows down to three (as a rule of thumb). Objections? --Mallexikon (talk) 01:22, 18 February 2012 (UTC)

Technically the lede doesn't even need citations so no objections here. N^oformation ^Talk 01:31, 18 February 2012 (UTC)

Ya, see WP:LEAD. Lead only needs citations if it's for controversial points. Since most of the points are controversial...

Citations should only be removed once the lead is stable. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:48, 18 February 2012 (UTC)

Alright, I'm not going to delete all citations in the lede. Just ease the overkill a little. --Mallexikon (talk) 02:36, 18 February 2012 (UTC)

I think removing any references is a bad idea. There is a way to deal with the clutter of lots of refs without removing them. They can be grouped together. Look at references 76-81 in the Quackwatch article to see how I fixed that mess. It was necessary to keep all the references, and that fix has worked just fine. -- Brangifer (talk) 08:23, 18 February 2012 (UTC)

Sorry. Too late. --Mallexikon (talk) 08:59, 18 February 2012 (UTC)

Why did you delete the one source that we've been talking the most about? Why do you want to hide the truth from readers? The concepts of qi and meridians are very contentious, because they don't exist from a reductionist, disectionist, Western medical science point of view.

Do you want to know what meridians are? Every type of tissue, muscle fiber, etc, is wrapped up and enclosed in fascia. Meridians are the spaces in between these fascia, you are never going to "find" them by cutting bodies apart and looking at them in a microscope. They are the nothingness that provides function, as in verse 11 of the Tao Te Ching:

"Thirty spokes converge

In the hub of a wheel;

But the use of the cart

Will depend on the part

Of the hub that is void.

With a wall all around

A clay bowl is molded;

But the use of the bowl

Will depend on the part

Of the bowl that is void.

Cut out windows and doors

In the house as you build;

But the use of the house

Will depend on the space

In the walls that is void

So advantage is had

From whatever is there;

But usefulness arises

From what is not."

These interfascial spaces have increased salt concentrations and thus increased electro-conductivity properties, and it is the manipulation of the bioelectrochemical energy (i.e. "qi") in these spaces which acupuncture seeks to accomplish.

Now yes, this is original research on my behalf, and cannot be included in the text. But the SOURCE which is suggestive of such MUST be included in the text: http://onlinelibrary.wiley.com/doi/10.1002/bem.20403/abstract;jsessionid=58BB2FDAA1322DB50ADB06D305F41969.d03t04 Dickmojo (talk) 05:51, 18 February 2012 (UTC)

Ok, why don't you think of a sentence this source could support and we'll see how it can be worked into the text. Just keep in mind, please, that evidence is not the same as suggestions. There also is no such thing as suggestive evidence as far as I know. --Mallexikon (talk) 07:10, 18 February 2012 (UTC)

I'm so sick of hearing accusations that requiring proof is somehow "Western". It's not. More appropriate to this page - requiring proof is a policy requirement. Quoting the Tao Te Ching does absolutely nothing but waste server resources, there is no specific information there that could be used on this page, and even if it did explicitly say "Oh, and by the way, meridians and acupuncture points exist as real phenomena in the physical body" it's still nowhere near reliable enough to override the myriad modern sources that have found no evidence. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:02, 18 February 2012 (UTC)

WLU, don't you realise that racism is only racism when we're doing it? ;-) Famousdog (talk) 23:09, 18 February 2012 (UTC)

You simply contradict yourself. First you try to argue that "reductionist" science cannot see the great mystical truth that "Meridians are the spaces in between these fascia...They are the nothingness that provides function". Then you say that "these interfascial spaces have increased salt concentrations...". Oh so, "reductionist" science can identify real subtances with alleged real and measurable effects then? There aint no 'nothingness' after all. Please make up your mind. If you can source the claim that meridians are interfascial space and that electricty is conducted through them, you won't need to quote the Tao Te Ching because you will be making one of those evil materialistic "Western" evidence-based claims. Paul B (talk) 16:22, 18 February 2012 (UTC)

That's an important point, Paul. DM, while I share your enthusiasm for those wonderful intersections between modern science and traditional theory, I prefer to argue for more weight given to traditional theory on its own terms, as it developed in isolation from reductionist science. My point is that it is not helpful or necessary to prove the existence of qi as a distinct type of energy - Most docs in China nowadays see Qi as a conceptual tool that allows us to appreciate and understand the interconnection of physiological (and psychological) processes that do not always have a clear mechanistic interconnection. The Han dynasty ideas about Qi are different from Song dynasty ideas about Qi, and neither are exclusively talking about electrical, thermal, chemical or any other distinct form of energy from the western perspective. We are better off not engaging in the unfruitful attempts to explain meridians or Qi in a scientific context. They are clinically valuable concepts (to those that understand pattern discrimination), even if they are not quantifiable.Herbxue (talk) 07:50, 19 February 2012 (UTC)

Traditional theory is history. If validated by empirical tests, it becomes science. I've still yet to see any sources that qi is a concept rather than actual energy, despite many editors claiming it is. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:18, 21 February 2012 (UTC)

Comment on Ernst 2006

"The development and inclusion of retracting needles as a form of placebo control has resulted in a much larger number of studies concluding acupuncture's effects are due to placebo.[12]" was recently removed from the lede and later reinstated. Perhaps I am wrong, but as far as I can see Ernst makes no comparison between the outcomes of trials with non-penetrating sham devices and trials without. Nor do I see how this statement can be otherwise derived from the presented tables. All that can be said using Ernst 2006 as a source is something along the lines of Ernst's own conclusion about trials using non-penetrating sham devices, "the majority of these trials suggests that the effects of acupuncture could after all be mostly due to a placebo response", rather than saying that a much larger number of studies conclude acupuncture's effects are due to placebo. Randomnonsense (talk) 22:34, 18 February 2012 (UTC)

Correct, Ernst isn't clear about this at all.

Anyone opposed to removing such claims?

Ernst also says Some clinicians argue that the main point about any medical intervention is that it alleviates the suffering of patients regardless of mechanism and that ‘it is not meaningful to split complex interventions into characteristic and incidental elements’. If acupuncture alleviates suffering through a powerful placebo effect which theoretically could exceed the total therapeutic effect of conventional therapeutic options, it should be accepted as a useful treatment. Some scientists, however, might find this notion difficult to accept which is an important viewpoint supported by a strong secondary source -- unlike other things in the lead --Mindjuicer (talk) 17:48, 19 February 2012 (UTC)

That's all fine, except that in the last 6 years of doing acupuncture trials and reviews, Ernst's opinion has got increasingly negative. His more recent reviews don't say anything quite so positive about acupuncture. However, by all means use that quote. Famousdog (talk) 20:24, 19 February 2012 (UTC)

It is not entirely clear to me whether the sentence beginning "If... " is meant to represent the views of Ernst or if he is continuing to report the views of the "some clinicians" in the previous sentence. Particularly given the following text where he emphasizes that clinically relevant non-specific factors should be investigated in general rather than focusing on acupuncture. Randomnonsense (talk) 21:18, 19 February 2012 (UTC)

That might actually be sourced to Trick or Treatment as well, I'd thought it a point made there. Anyone have a copy? Otherwise I can request it from the library again. WLU (t) (c) Wikipedia's rules:^simple/_complex 10:59, 20 February 2012 (UTC)

ToT and the 2006 paper discuss the development of telescopic needles (ToT p 103 onwards, UK ed) and ToT says: "...the first results have begun to emerge..." which woudl seem to contradict the statement "...has resulted in a much larger number of studies..." so that should go. However, in discussing these studies, he says in ToT: "These initial conclusions have generally been disappointing for acupuncturists..." and in the 2006 paper he concludes that the weight of evidence from sham trials suggests a placebo response, so the rest of the sentence shoudl perhaps say "...a new wave of studies, from which the weight of evidence suggests acupuncture's effects are due to placebo." This could also be sourced to ToT in addition to Ernst's 2006 paper. With regards the suggestion that the placebo response is often sufficient and placebos (like acupuncture and homeopathy) should be used for that simple reason, in ToT Ernst and Singh state categorically (p 296): "... we strongly believe that it would be wrong ..." and go on to state that the breach of trust between doctor and patient is unacceptable. This leads me to believe that in the 2006 paper, he is simply stating the argument made by acupuncturists, not his own opinion. Famousdog (talk) 11:34, 20 February 2012 (UTC)

His own opinion would be primary, not secondary, and of little interest to this article.

ToT isn't a particularly reliable source and is somewhat out of date - especially when making a claim contradicted by a later Cochrane review (Lee et al 2009). --Mindjuicer (talk) 18:29, 20 February 2012 (UTC)

This RSN posting started by you seemed to conclude pretty plainly that Trick or Treatment is an adequately reliable source.

Lee et al. 2009 merely says that one particular acupuncture point works to prevent one particular type of nausea. It certainly doesn't validate the entirety of acupuncture's TCM roots and theory. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:32, 20 February 2012 (UTC)

Is that a strawman I see? The RSN is far from conclusive.

The claim is basically made twice. I removed it. Feel free to add the extra detail to the first instance of the claim. --Mindjuicer (talk) 02:38, 21 February 2012 (UTC)

Please look at the article straw man and while you're at it, read about ad hominem also, have a read of primary source and secondary source since it appears that you don't understand ANY of these concepts or are just being deliberately bloody-minded. That RSN looks very conclusive to me. We have had this argument over and over and over and over again with you. I for one am not repeating myself. ToT is a perfectly respectable source, acceptable to almost all WP editors except those pushing POV. Move on, please. Famousdog (talk) 10:12, 21 February 2012 (UTC)

Paterson and Dieppe 2005

Characteristic and incidental (placebo) effects in complex interventions such as acupuncture [3]

I created a new section as this secondary source summarises the significant view that trying to force something like acupuncture into a standard Randomised Control Trial (RCT) doesn't adequately test it.

It is the source of "it is not meaningful to split complex interventions into characteristic and incidental elements" quote from Ernst 2006 above. It doesn't seem to be currently listed as a source.

Here is another quote that summarises their simplest point in layman's language: "A sham controlled trial is only appropriate for comparing two acupuncture interventions —- for example, to compare the effects of different needling techniques."

In other words, sham needles, toothpicks etc may a significant active therapeutic benefit.

Another point they make is that RCTs may not allow the normal ongoing diagnostic process of an acupuncturist over several sessions.

Are there any meta-analysis that investigate comparative trials eg acupuncture vs standard traditional treatment?

For what it's worth, most of 'medical science' hasn't been subjected to the double-blind gold standard either. Fisher and Greenbury 1993 [4] stated that over 80% of 'double blind' drug trials had been compromised. They imply that a lot of the problem is down to the clinicians themselves. — Preceding unsigned comment added by Mindjuicer (talk • contribs) 00:06, 20 February 2012 (UTC)

I will read that with interest, Mindjuicer, but as with my comments above on the Ahn et al study, the fact that it has already been included in other, later reviews will possibly count against it. If it presents a genuinely unique argument and presents evidence supporting that viewpoint (at first glance it seems to be a theoretical paper) it should of course be included. I will have a look. Famousdog (talk) 09:42, 20 February 2012 (UTC)

Hmm. They present an interesting argument, but I would say that this paper simply amounts to special pleading for certain types of intervention. Their thesis is based on interview data with acupuncurists and their clients (not the most objective of datasets at the best of times) and were we to accept their thesis, isn't this an argument for practicing conventional medicine in such a way as to maximise the incidental/placebo effects of medications that can be shown by other means to "work" rather than pursuing (with public money) treatments, the effective component of which (if it exists) cannot be accurately disentangled from the 'incidentals' of a consultation? Secondly, if the RCT is not an "appropriate" context in which to judge acupuncture, should we throw out any RCT studies that show a positive effect of acupuncture (such as those summarised in the 2009 Cochrane review on postoperative nausea?). I find it unlikely that you would accept that course of action. Famousdog (talk) 10:33, 20 February 2012 (UTC)

Ugh, great, an official source for "you can't test my woo". They're actually arguing for the interview being considered part of acupuncture? They've actually tested needling-vs-interaction. High-enthusiasm interaction is more effective than any type of needling. Agree with Famousdog, this is little more than special pleading. If integrated, it should be brief and attributed. It could never be used to support efficacy claims. It should not be in the lead. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:09, 20 February 2012 (UTC)

Sorry, this is a secondary source supporting a mainstream scientific viewpoint outlined by your hero Ernst amd seemingly supported by the WHO, the NHS etc. There is nothing you can do to suppress it. Your own POV is irrelevant as far as WP policy is concerned.

However, if you can show on this talk page that any of the claims are factually incorrect (as I did with your ToT claim), I personally will not try to include them, because I do not POV push. --Mindjuicer (talk) 18:24, 20 February 2012 (UTC)

Looks like a pretty important paper for contextualizing the whole debate. Kaptchuk's work is also valuable in this regard (http://tedkaptchuk.com/selected-publications). Don't worry, this isn't a blank check to fund all woo claims, it just gives an honest look at the complexities involved. — Preceding unsigned comment added by Herbxue (talk • contribs) 18:36, 20 February 2012 (UTC)

Note that I didn't say "the source should not be used". I simply stated it should be attributed and not used in the lead. I would use it in the body to verify that people have claimed the acupuncture interview is more important than the interview used for regular medical assessment. Very amusingly, the "short abstract" states that "The specific effects of non-pharmaceutical treatments are not always divisible from placebo effects and may be missed in randomised trials". Which seems to be saying that the specific effects of nonpharmaceutical treatments are the same thing as placebo effects. To turn it around - if a drug were given as part of an extensive, empathetic consultation and found to be no better than placebo, under this rationale it could still be prescribed.

I'd be interested to see any responses to this paper. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:28, 20 February 2012 (UTC)

If there is no alternative and a drug has no side effects & actively invokes the placebo response, why not prescribe it? This is commonly done where there are better alternatives eg antibiotics prescribed for viral infections, prozac prescribed for mild depression.

The former is a rational basis for prescription... unlike the pseudoscientific claim to have proven efficacy in a double blind trial.

Your argument to exclude it from the lead remains based on factually incorrect OR. My challenge to you and others remains open. --Mindjuicer (talk) 19:43, 20 February 2012 (UTC)

It's a step backwards into the paternalistic era of medicine, a waste of resources and a form of lying to patients. But acupuncture can't be compared since it does have side effects and claims to be an effective treatment for symptoms and conditions (which it's not bar one type of nausea and one location of pain).

My argument to exclude it form the lead is that it's an old publication based on interviews which would require pretty extensive explanation to even make it sensible. There's no indication the assertions in the paper are actually correct, that the consultation for acupuncture is somehow different from a consultation for the diagnosis of a medical condition. It's essentially "in the opinion of Paterson & Dieppe, the interaction between the acupuncturist and the patient may have implications for testing acupuncture that may not be present in clinical trials for drugs". It's two people's opinions, and they're not actually sure about it. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:54, 20 February 2012 (UTC)

Please consider putting a statement in the lead that summarizes the general opinion that typical placebo control research raises questions about the best way to study acupuncture, as it is a notable opinion as evidenced by this paper and the work of Kaptchuk. No need to make a medical claim here, just present the controversy and cite sources. And WLU, you keep saying "acupuncture is not effective" and that is not the statement made in any secondary sources. Reviews of studies have found that the studies were of poor quality and thus no firm conclusions could be made. Those are not equivalent statements. Lack of evidence does not prove lack of effectiveness. Lets not over-simplify the message in our sources (per Original Research), it may not always be accurate.63.139.146.30 (talk) 15:35, 21 February 2012 (UTC)

There are many, many researchers who do research on acupuncture. How many consider Paterson & Dieppe's objections to be reasonable, and thus to control for? What evidence is there that P&D's article is a general opinion?

Without evidence of effectiveness, there's no reason to portray (or even assume) that any intervention is effective. Again, consider if a drug manufacturer were to say this - "our drug is effective, trust us; you don't need to test it with a placebo, just give it to people and see if it gets better". Does it make sense? Acupuncture has been tested extensively, and there are two conditions for which it has been found effective - postoperative nausea and neck pain. That's it. No need to include the assumption that there are lots of other conditions it's expected to be effective for at some point in the future. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:31, 21 February 2012 (UTC)

Not appropriate use of the talk page. Discussion of editors, not the article.
The following discussion has been closed. Please do not modify it.
It's not been contradicted by later reliable sources unlike certain claims in the lead. And there are older and much less reliable sources in the lead. Your first and last paragraphs are OR. I'll give you another 12 hours to come up with something actually relevant else I'll start a discussion on how to incorporate it. --Mindjuicer (talk) 21:24, 20 February 2012 (UTC) What are we doing now? I've already said I can see including it, but not in the lead and firmly expressed as Paterson & Dieppe's opinion. WLU (t) (c) Wikipedia's rules:simple/complex 23:45, 20 February 2012 (UTC) It seems you're stalling... --Mindjuicer (talk) 01:16, 21 February 2012 (UTC) You're still treating this like a battleground, MJ. If you think something should be included, you need to make a solid proposal on what and where. Giving other editors deadlines and ultimatums is almost never appropriate.   — Jess· Δ♥ 02:18, 21 February 2012 (UTC) I disagree with your first point and I'm going for the "almost" XD Feel free to discuss it on my talk page, where it won't detract from actual progress we're making. --Mindjuicer (talk) 02:54, 21 February 2012 (UTC) I did not mean 'almost' the way you took it. I've seen users topic banned for this sort of behavior. You're obviously free to take my advice as you see fit, but being hostile to collaborative users is not going to result in the article being changed. Make a proposal to discuss, or drop it, please.   — Jess· Δ♥ 03:09, 21 February 2012 (UTC) Yup. I totally agree with Jess. --Mallexikon (talk) 03:54, 21 February 2012 (UTC) Acupuncture HAS been proven effective in every single study ever conducted. The criticism that fanatic skeptics extremists have of it is that, while the difference between acupuncture and no treatment is very very large in every case, the difference between acupuncture and so-called "sham" acupuncture is small, sometimes even clinically insignificant. But this phenomenon makes total sense when we take into account the fact that this "sham" acupuncture is not analogous to placebo at all, but in fact is strikingly similar to a very authentic traditional style of Japanese acupuncture (shallow needle insertion/non-penetration, alternate acupoint and meridian location, etc) that has been in common use for centuries are is still widely practiced to this very day. The fact is, acupuncture is effective, and its silly to even try to test it against a placebo in the first place, because its not a pill or a drug or a substance that lends itself to such methodology. So what if some of acupuncture's effects originate in the mind? TCM theory itself states that, in therapy "the mind leads the qi, the qi leads the blood", indeed predicting itself the main criticism that fanatic skeptic extremists have against it. Its time to realise that Chinese Medicine is a valuable body of knowledge and lore, and to end the racism and xenophobia that insists that only Western culture is capable of developing an effective system of medicine. Afterall, if Chinese Medicine in so ineffective, how come the population of China is so much bigger than in Europe, where Western Medicine developed?Dickmojo (talk) 10:13, 21 February 2012 (UTC) NOT a personal attack, NOT special pleading, but an accurate summation of the situation. I did not attack any person, and I am not pleading for anything accept tolerance of different POV's Dickmojo (talk) 10:41, 21 February 2012 (UTC) Roll on Dickmojo's permanent ban... Famousdog (talk) 10:20, 21 February 2012 (UTC) Possible personal attacks: "The criticism that fanatic skeptics extremists have of it...", "...end the racism and xenophobia..." Whether these are personal attacks against other editors, or references to skeptics generally, this sort of language is unhelpful and expresses a WP:BATTLEGROUND mentality. I would have thought you'd have toned down the use of derogatory terms that you have previously applied to other editors. But, it seems you are determined to smear everybody who disagrees with you as a racist or fanatic. Special pleading: "...its silly to even try to test it against a placebo in the first place, because its not a pill or a drug or a substance that lends itself to such methodology..." And let's not forget that you are still using Talk:Acupuncture like a forum. You haven't suggested any changes or improvements to the article, just ranted about your opinion. Famousdog (talk) 10:46, 21 February 2012 (UTC)

Lede: Placebocontrols

I don't feel comfortable adding the Ernst 2006 material about retractable needles to the lede while banning the Paterson and Dieppe 2005 material to the body. Placebocontrol in acupuncture is a tricky and complex subject - I think too complex to go into details about it in the lede. If we want to include it there, though, Paterson & Dieppe probably should be included, too. Comments? --Mallexikon (talk) 03:46, 21 February 2012 (UTC)

For sure. Whilst much is necessary for NPOV, I believe the criticism of acupuncture claims is both inaccessible and has excessive weight. I'd rather see that trimmed than introducing new complexity. On the other hand, it's an important and very educational issue that affects a huge number of treatments. There is also an existing statement "Other researchers have pointed out the difficulty in designing an adequate scientific control for any placebo effect acupuncture might have due to its invasiveness" which could be incorporated. --Mindjuicer (talk) 04:12, 21 February 2012 (UTC)

Paterson & Dieppe's opinion is bad science and incredibly unnoteworthy - certainly not comparable to Edzard Ernst's opinion. While Ernst's opinion is based on hundreds of studies aggregated in systematic reviews, Paterson & Dieppe's is based on interviews. It's barely a secondary source, and it's nothing but opinion (not to mention special pleading - find me a drug trial where the doctor doesn't ask the patient about side effects during the trial, that's how drugs get adverse effect lists; really want to compare the two? Turn it into a full interview and physical). By putting P&D in the lead, you're comparing meta-analyses to...interviews summarized in a two page paper. That doesn't strike me as neutral per NPOV, that strikes me as false balance. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:16, 21 February 2012 (UTC)

Well, technically Ernst and P&D are both secondary sources. And the argument is that all these meta-analyses of Ernst are based on a wrong assumption in the first place. --Mallexikon (talk) 17:07, 21 February 2012 (UTC)#

Yes. WLU's first sentence is OR, which he's completely failed to justify despite many requests. Ernst 2006 and ToT are both excluding Lee et al 2009. There's an a priori case for excluding any older claims contradicted by Lee, unless Ernst or anyone has made subsequent criticisms of Lee.

Ernst 2006 mentions another viewpoint to P&D and as such, that can be included. Frankly, P&D is highly relevant to any part of the article concerning research design and scientific validation. --Mindjuicer (talk) 21:46, 21 February 2012 (UTC)

As I have explained, patiently and with civility before, P&D's theoretical paper has been included in subsequent secondary sources (such as this review not by Ernst's group) and primary sources (such as this experiment also not by Ernst's group) which, it would appear, didn't assign it much weight and did not agree with it's conclusions. If you want to add this, but aren't willing to add every single other cited reference from these two papers, you are doing so because it agrees with your POV, not because you care about WP:WEIGHT. Famousdog (talk) 10:14, 22 February 2012 (UTC)

Patience and civility would seem to be mandatory and yet you're trying to big yourself up over it whilst accusing me of POV pushing. This is an ad hominem attack.

Both the articles you cite are behind paywalls and so I don't know whether you refer to claims therein or the discredit claim still in the lead that "the weight of evidence ... suggests acupuncture's effects are due to placebo" which has been contradicted by a later Cochrane review. --Mindjuicer (talk) 19:58, 22 February 2012 (UTC)

Criticism / Qi, acupuncture points and meridians section too long

I notice this section is just getting longer and longer - and it's important by all means -, however, I don't quite see the need to incorporate two quotations of Mann and I don't see the significance of the Matuk article here at all. Can someone point it out to me? Otherwise I'd delete some of that. --Mallexikon (talk) 06:36, 21 February 2012 (UTC)

New source

Wow, there are a lot of new (2011) sources on pubmed, including a lot of new Cochrane reviews. However, there is also this source, which is pretty interesting:

• [5]

The results: "The treatment effect was not found to be associated with any factors in both the strict and less strict trials. However, the placebo effect was found to be associated with the publication year in both the strict and less strict trials (P=0.009 and 0.005, respectively). The placebo effect increased by 0.05 in effect size per year in trials that were published more recently." So this appears to be pretty explicit evidence that Ernst's statement is true - the evidence base for acupuncture appears to be eroding. Where should we put this? WLU (t) (c) Wikipedia's rules:^simple/_complex 19:45, 21 February 2012 (UTC)

Here's another interesting one, [6]:

"The quality of the current TCM RCTs as judged by their publications is generally poor, especially those published in Chinese journals. In future, researchers of TCM RCTs should attach more importance to experimental design and methodological quality, receive relevant training, and improve reporting quality using the Consolidated Standards of Reporting Trials (CONSORT) statement, so as to improve the quality of TCM clinical research and ensure truth and reliability of conclusions."

Again supporting Ernst's statement that Chinese trials tend to be of poor quality - and this one coming from China so accusations of racism and results being due to Western bias are not really applicable. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:02, 21 February 2012 (UTC)

Another one, this time discussing the need for protocols to determine safe needling depth [7]. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:06, 21 February 2012 (UTC)

The first abstract doesn't really indicate anything, except maybe people's expectations of acupuncture treatment are increasing. Herbxue (talk) 20:51, 21 February 2012 (UTC)

It would be a bit OR-y to draw such a conclusion without evidence of an increase in clients expectation, Herbxue. But maybe such a study exists... In the meantime, we should merely report what the study says, namely that over recent years an increasingly large portion of the "improvement" from baseline in acupuncture trials can be explained by placebo.

"...accusations of racism and results being due to Western bias are not really applicable..." Yes. Let's see Dickmojo contort his way out of that one, shall we? Famousdog (talk) 21:31, 21 February 2012 (UTC)

As P&D said, sham needles may have an active effect. This would explain improving response to placebo. As would increasing expectations due to WHO, NHS acceptance (it is notable that placebo response to SSRIs shot up at the their peak of popularity).

Famousdog's proposed claim is perhaps inadvertently weasily. A fairer claim would be that "We et al 2012 casts further doubt on efficacy of acupuncture for conditions other than nausea. However, it's also consistent with P&D's claim that acupunture may never have been tested versus placebo."

Or we could just agree that all these claims are OR and simply summarise the original conclusion in the experiment design section. --Mindjuicer (talk) 22:12, 21 February 2012 (UTC)

The claim that there is no spot that won't be an acupuncture point renders the theory untestable, and thus pseudoscientific. Though we can acknowledge this quite common claim, it doesn't excuse away criticisms of acupuncture. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:17, 22 February 2012 (UTC)

Whilst I'm interested in whether there are non acupuncture areas of the body, your pseudoscience rationale simply isn't true. Placebo based validation isn't the be all and end all of medical science and almost no medical science has been proven with a verified blind.

If several independent sources show that eg acupuncture is more effective than the standard treatment for some condition, that's more reliable than almost everything else in medical science.

You can also test different sets of points - according to acupuncture theory, kidney points do something different from stomach points. --Mindjuicer (talk) 01:16, 22 February 2012 (UTC)

Which acupuncture theory, Chinese, Korean, Tibetan, Japanese?

Before the development of needles with retractable heads, the primary form of placebo control was changing the point needled, and I believe the results were negative there as well. Each aspect of acupuncture can be tested - practitioner interaction (enthusiasm matters more than needle location), acupunture point (point needled doesn't matter), needle penetration (penetration doesn't matter, or even the use of needles, as toothipicks can also be used). WLU (t) (c) Wikipedia's rules:^simple/_complex 14:38, 22 February 2012 (UTC)

I'd be surprised if any variation of basic acupuncture theory stated that kidney points do exactly the same thing as stomach points.

Since in most cases we're talking about minor improvement over 'placebo' at best, I'd expect enthusiastic practitioners to get better results and this would also be true for most psychiatric medicine.

I'll be interested if you can offer any sources for "point doesn't matter". Since we've only really shown a positive effect for nausea, you'd have to show other points than P6 causing the same effect.

"Penetration doesn't matter" wouldn't surprise me given acupressure, reflexology, EFT etc. On the other hand, more grandiose placebos work better, placebos with stronger side effects (eg pain) work better, magnetised needles may work better (though I doubt it given perpendicular orientation to meridians).

Let's try and keep away from WP:FORUM and work towards a consensus on how to deal with the placebo problem. --Mindjuicer (talk) 19:31, 22 February 2012 (UTC)