Talk:Acupuncture

"Its effects are due to placebo"

I have removed this statement from the effectiveness section because it is a definitive statement that is unproven, and only one of the 3 cited sources even suggests that its effects are due to placebo (the Ernst paper). None, even the Ernst, suggests that placebo is the only mechanism by which it works, therefore the statement is unsupported by the sources. Herbxue (talk) 19:42, 5 August 2013 (UTC)

Dominus keeps reverting the edit, so I proposed a compromise to the inaccurate blanket statement that is not supported by the sources cited. Herbxue (talk) 20:09, 5 August 2013 (UTC)

All three citations support the statement. Furthermore, it's the default position. Do you have more recent systemic reviews which demonstrate otherwise? TippyGoomba (talk) 05:28, 6 August 2013 (UTC)

Only one even comes close, and its the Ernst, which more than one other editor has expressed concerns about undue weight. Even his paper does not make the blanket statement "acupuncture's effects are do to placebo" - it is careful to say there is the evidence suggests acupuncture may be nothing more than placebo, which is an admitted speculation. Show me a quote in multiple reviews that support a sweeping generalization like that. Herbxue (talk) 06:17, 6 August 2013 (UTC)

You guys are still reverting me, returning to a version that is not supported by the sources. Its not even supported by Ernst, the man on a mission to discredit acupuncture does not even go so far as to say "it's effects are due to placebo" - if you ever intend to say "we follow the sources" with a straight face again, I suggest you read the fucking sources before reverting me, or propose and edit, supported by the sources. A1candidate made that edit erroneously and I have corrected it numerous times. Dominus and Tippy keep supporting the erroneous edit without actually reading the source that supposedly supports it, or intentionally misrepresenting what the source actually says. That basically means you are liars. Herbxue (talk) 03:15, 12 August 2013 (UTC)

no, u TippyGoomba (talk) 04:36, 12 August 2013 (UTC)

Looking at the sources again, I wonder if it is overstating their case to say the effects are due. Ernst's blog on the topic from earlier this year contains the wording: "the evidence from the most rigorous clinical trials seems to suggest that much, if not all of the effects of acupuncture might be due to placebo". Alexbrn ^{talk|contribs|COI} 07:31, 14 August 2013 (UTC)

Since things have escalated, I've taken Herbxue to ANI, see WP:ANI#Herbxue. Please correct me there if I've missed something. TippyGoomba (talk) 03:20, 15 August 2013 (UTC)

IMO, Dominus Vobisdu and TippyGoomba have not AGF at all and have continuously focused on the editor here instead of the edits. Interesting that neither Tippy or Dominus has felt it necessary to comment on the sources that Herbexue is referring to, they just keep drive-by reverting to a version that is not supported by those sources. TippyGoomba and Dominus Vobisdu have repeatedly restored the text in the lead that says "the effects of acupuncture are due to placebo", yet the sources do not support this text. The body of our article also does not support this text in the lead; our article says:

"A 2012 meta-analysis found significant differences between true and sham acupuncture, which indicates that acupuncture is more than a placebo when treating chronic pain (even though the differences were modest).[104] A 2010 systematic review also suggested that acupuncture is more than a placebo for commonly occurring chronic pain conditions, but the authors acknowledged that it is still unknown if the overall benefit is clinically meaningful or cost-effective.[105]"

As Alexbrn points out, even the well-known critic Ernst can only say that it "might be due to placebo". I would love to hear how Dominus or Tippy justify continuously restoring the text when it is not supported by the sources and refusing to engage in discussion here? and then have the nerve to report Herbexue to ANI? Puhlaa (talk) 04:47, 15 August 2013 (UTC)

Alt-med proponents love to take advantage of the public's lack of knowledge about what "placebo" is. Placebo is not something that has to be proved. It is the default conclusion of any medical trial, and remains true until it is disproved. The burden rests solely on alt med proponents to do so. They always try to shift the burden on scientists to prove that their method doesn't work, instead of providing credible evidence that it does work. So far, no convincing evidence has been produced. All of the studies to date have either been fundamently flawed because of faulty methodolgy or bias, or have produced weak, contradictory and non-reproducible evidence.

They also prey on the public's lack of knowledge about what "effectiveness" is. If the effectiveness of a method is no better than placebo, that means it is not more effective than holy water or beads and rattles.

None of the reliable studies performed to date have indicated that there is more at play than simple placebo efect, a fact that Ernst makes clear in his "review of reviews" www.dcscience.net/Ernst-2011-AcupunctAlleviatePainRiskReview.pdf‎, which has been removed from the article. The review of reviews states that recent high-quality studies indicate that the effects of accupuncure are due to "non-specific effects such as therapist conviction, patient enthusism, or receiving a treatment believed to be helpful", in other words, placebo. Or that "real" acupuncture works no better than sham (placebo) acupuncture. It goes on to state that if

The Madsen metastudy says very clearly that sham accupuncture (placebo} worked better than no treatment, and that the difference between "real" and sham accupucture (placebo) was not clinically relevant and could not be distinguished from bias [[1]].

There is a quibble also on "may be due to placebo", another common ploy used by alt med proponents. In normal English, this means "may be due to causes other than placebo". It's a banal statement that is true in all medical trials, as it can never be disproved (it's unfalsifiable), only proved. This does not imply that it is caused by other causes, nor does it lend any credence to such conclusions. It's mere speculation that is inherent in the scienific method. Until credible evidence is produced that identifies other causes, it is basically a meaningless statement, and the conclusion that any effects are due to placebo remains the only valid conclusion. Dominus Vobisdu (talk) 02:41, 16 August 2013 (UTC)

"Default position" of who? Can you show that conventional medicine holds drugs and surgical procedures to such a standard? You have a tendency to invent criteria for inclusion or exclusion of information based on your POV, yet you still have not acknowledged that the cited sources do not support your reversions of my edits. Ernst himself, a controversial figure, is far more careful to qualify and nuance his statements than you, and he is clearly on a mission. Have you read any of Kapchuck's work? You are trying to prevent the reader from coming to their own conclusions about issues that clearly do not have a definitive answer. I am amenable to the possibility that the general reader may have a bias towards "believing" in unproven things, but that does not justify falsifying the facts to prevent them from believing something that hasn't been proven to be false. The edit you defend does just that. Herbxue (talk) 05:03, 16 August 2013 (UTC)

Lesen Null hypothesis. Placebo is the null hypothesis of any medical trial, no exceptions. See Clinical trial. Bottom line, the effects of any treatment are by definition placebo effects until proven otherwise. Dominus Vobisdu (talk) 05:19, 16 August 2013 (UTC)

The NCAHF put is this way: "There is no physiologic rationale for why acupuncture should work other than for its placebo or counter-irritant and distracting effects." Alexbrn ^{talk|contribs|COI} 05:42, 16 August 2013 (UTC)

Alexbrn that statement is from an era where the Internet had not even existed yet. I prefer the MEDLINE database's consensus of scientific evidence, not because I support pseudoscience based on quackery, but because its updated frequently: Researchers don't fully understand how acupuncture works. -A1candidate (talk) 08:22, 16 August 2013 (UTC)

The statements are not incompatible. It seems many explanations are floating around, even regression to the mean. There is however, no accepted "physiologic rationale". Alexbrn ^{talk|contribs|COI} 08:41, 16 August 2013 (UTC)

"Mights" are dime a dozen in the world of science, the stuff pizza boxes and cocktail napkins are made for, and don't mean anything without evidence to back them up. Results talk, and bullshit walks. All we have here is a pathetic attempt to spin bullshit into results. Dominus Vobisdu (talk) 09:34, 16 August 2013 (UTC)

Your opinion is shared by many, but the writers of the systematic reviews are simply not willing to conclude that placebo is the only explanation for the positive effects of acupuncture. The edit you keep supporting is not supported by the sources (which is the topic of this thread). Herbxue (talk) 05:04, 17 August 2013 (UTC)

I think that concluding the sweeping statement that "General scientific consensus maintains that the effects of acupuncture has not been shown to be due to anything more than placebo, and is therefore dependent on a patient's expectation of treatment outcomes" from the sources Ernst 2006, Madsen et al. 2009 and Furlan et al. 2008 as stated in the article is a synthesis. Besides this, several studies that find statisticaly significant advantages of acupuncture over placebo seem to make this sweeping statement too generalized (such as Albrecht, Vickers, Crew, Manheimer) Ochiwar (talk) 19:47, 19 August 2013 (UTC)

A review by Hopton actually states " The accumulating evidence from recent reviews suggests that acupuncture is more than a placebo for commonly occurring chronic pain conditions" Ochiwar (talk) 20:15, 19 August 2013 (UTC) And Kong states "We believe our study provides brain imaging evidence for the existence of different mechanisms underlying acupuncture analgesia and expectancy evoked placebo analgesia" Ochiwar (talk) 20:29, 19 August 2013 (UTC)

• Note that this article and this particular statement is the subject of a discussion over at Wikipedia:ANI#Herbxue (permalink). To me this looks like a relatively extreme misrepresentation of sources and my hope is that out of the discussion over there, some action will take place to put pressure on the editors responsible to stick to sources in the future. I've already pinged the editors responsible (User:Dominus Vobisdu, TippyGoomba, and User:A1candidate) but so far none has really made a response. II | (t - c) 23:45, 19 August 2013 (UTC)

A few of the sources provided state that the effect may be nothing more than placebo. I have toned the wording down to reflect this possibility. Agree that the bit on "scientific consensus" is over stating things a bit but am happy to AGF. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:39, 20 August 2013 (UTC)

If there are still issues I would strongly suggest that those involved start a RfC rather than continue to revert. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:47, 20 August 2013 (UTC)

• Why can't we just be honest and admit that Researchers don't fully understand how acupuncture works? Because not doing so allows us to completely ignore a plethora of reliable sources and disregard numerous peer reviewed studies showing that acupuncture is more than placebo. -A1candidate (talk) 08:42, 20 August 2013 (UTC)

Stating that it is not clear how something works is different than stating that it is not known if it works or not. We should discuss both these aspects I agree. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:07, 21 August 2013 (UTC)

In that case, I hope other editors would also agree with us that if we include the placebo effect as a possible mechanism for accupuncture, then in order to be fair, we should ideally include other mechanism as well as long as the source is reliable. In other words, should this removal be restored? I dont see the point of only including the placebo effect as a possible mechanism while ignoring the others. If there are concerns about the reliablity of some specific sources, then those should be replaced with better sources, which isn't that difficult at all. -A1candidate (talk) 16:00, 22 August 2013 (UTC)

I'll just comment on the reversion back to include the list of potential mechanisms for the "efficacy of acupuncture". First, the items in that list are not "theories", but more similar to conjecture or ideas or proposals. Second, by and large, they are represented by one or two papers each from many years ago; we need to include current ideas that are based on significant replication and newer studies. In other words, how are these ideas accepted today? Third, a list of proposals for "how acupuncture works" presupposes that it does work. If we embrace the rather weak consensus that acupuncture has some efficacy for some indications, for example, some pain and some nausea, then the proposals can only relate to these indications. Another issue is the combining of studies where different forms of acupuncture are used, for example, electro-acupuncture. There is no reason to expect that simple needling and needling combined with electrical stimulation would have the same underlying mechanism. Until these points are addressed, it is not clear that including a list of "potential mechanisms" is going to be useful. Desoto10 (talk) 23:30, 1 September 2013 (UTC)

It does work, the question we are asking is whether it works by placebo or otherwise? Like I said, its not that difficult finding newer, reliable sources for that. And lastly, they do relate to pain and nausea (among others), and from what I know have nothing whatsoever to do with electroacupuncture -A1candidate (talk) 19:17, 8 September 2013 (UTC)

The Lancet paper referenced above is about electroacupuncture. The purine hypothesis (from the article that A1 refers to) does not explain "how acupuncture works" unless we are talking about just sticking needles into the skin anywhere. Note that the figures in that paper just have a needle poking the skin causing ATP release; there is no mention about special locations. I think we need to restrict the article to actual acupuncture explanations which require needling in specific locations and why those specific locations are important. The gate model of pain reduction by acupuncture, also referenced above, also does not directly relate to acupuncture as the effect can be elicited by stimulation anywhere. Desoto10 (talk) 03:42, 9 September 2013 (UTC)

Rant

Pain science - those who spend their lives studying the biology, psychology and sociology of pain - is open to the probability that needling will have some, probably minor, probably temporary, effect on pain. This is because of the well-attested phenomenon, diffuse noxious inhibitory control (pain, in some circumstances, raises the global pain threshold). If needling elicits pain, it may have a just-measurable above-placebo effect on the perceived intensity of pain resulting from another stimulus.

The pain of needling may also, plausibly, minimally affect the perceived "unpleasantness" (a different subjective phenomenon and neural network from "sensation intensity") of other negative homeostatic emotions such as nausea and itch too, because the "unpleasantness" of all homeostatic emotions is embodied in one common neural network and if pain diminishes global perceived "unpleasantness", which is uncertain, then it will affect the perceived unpleasantness of nausea, etc. too.

I realise this unsourced rant is probably outside Wikipedia:Talk page guidelines, but I'm hoping to pour a little oil on these troubled waters. I agree it is implausible that acupuncture may have an impact on bubonic plague or Down syndrome, but would appreciate it if the skeptics here could step back a little and exercise genuine objectivity when it comes to (a) the plausibility that the minimal pain of acupuncture may minimally affect the perceived intensity or unpleasantness of other pains or other homeostatic emotions, and (b) the scientific evidence (or lack of it) regarding this purported psychophysical effect. --Anthonyhcole (talk · contribs · email) 08:31, 20 August 2013 (UTC)

Thank you for this, Anthony. I have followed your posts about pain for a couple years now (you weighed in during PPdd's reign of terror, in a way that I perceived was not helpful to TCM), and although you have generally not expressed approval of acupuncture, I greatly appreciate your call for "genuine objectivity". Obviously I am a proponent of acupuncture, but I think this is an issue worth insisting on an honest appraisal of the sources, rather than a political "science vs. woo" battle. Herbxue (talk) 04:01, 21 August 2013 (UTC)

Sham Studies

There is considerable controversy about the validity of the methods used to study acupuncture. For instance, sham controls are highly controversial and while many outsiders view these as reasonable controls which equate with biomedical placebos, those in the industry seem to have a completely different opinion. STRICTA standards are a good example of this. There is a system of acupuncture, Master Tung-style, which needles acupoints in many different places: between traditional points, between meridians, etc. Every portion of the body, according to the system, is a potential acupoint. Several other styles, such as Kiiko-style Japanese acupuncture may also utilize any point on the skin. Therefore, studies which utilize sham-controls, could actually be seen as studying traditional TCM points versus random Tung-style points or Kiiko-style points, not "placebos". Given this fact, it seems a decision should be made. Since there is no "consensus" within the field, do we remove all talk about sham studies and acupuncture not being more than placebo, or do we instead confine all this interesting debate to another section or article titled "acupuncture studies" or the like? Egamirorrimeht (talk) 23:11, 11 September 2013 (UTC)

No, I don't see that a decision has to be made... we already have a section about the sham-acupuncture-problem. If you have (reliably sourced) material you'd like to add to it, please feel free to do so. Cheers, --Mallexikon (talk) 03:25, 12 September 2013 (UTC)

I suppose that's a valid point. My concern, really, is the page appears very low quality and obviously amateurish. Modern scientific research on acupuncture is a subject with which I am very up to date with, and as the page reads it is embarrassing to anyone familiar to evidence based medicine in general. In many instances, there are statements that read as though "the science is settled and acupuncture is no more than a placebo" yet most of these statements find their basis in very controversial sham controls. Further, many of the cited studies do not pass STRICTA checklist standards on multiple counts. Seeing that STRICTA is the gold standard for acupuncture research, purporting consensus with flawed research causes this article to reek of dilettantism. Further, the studies used as source material to purport consensus are isolated studies and not meta-analyses. Again, low quality. I can certainly add much reliably sourced material to the page, but what it first needs is to have all the unreliably sourced material removed. I just think its prudent to air these concerns on the talk page first before pruning the article with a chainsaw. Egamirorrimeht (talk) 05:07, 12 September 2013 (UTC)

As for adding material, perhaps you could add more about STRICTA standards?Herbxue (talk) 03:06, 13 September 2013 (UTC)

Absolutely, I believe it will help this page considerably. Egamirorrimeht (talk) 17:58, 13 September 2013 (UTC)

Yes, please provide the extent that STRICTA is embraced by the scientific community. Have major international scientific societies supported it? Is following these guidelines required for publication? Who has claimed that STRICTA is the "gold standard"? Thanks. Desoto10 (talk) 03:40, 13 September 2013 (UTC)

Hello! STRICTA uses reporting guidelines, not strict requirements per se that a researcher or group must adhere to. This allows full transparency in research. For instance, in many studies where acupuncture is performed, a nurse, medical doctor or even a research scientist is the person performing acupuncture and not a trained acupuncturist. In this example, publications which use STRICTA reporting standards report not only report the profession but also the number of years one has in practice. Another example would be the description of needling involved. Oftentimes, studies only outline the points used. Under STRICTA reporting standards, the type of needle--length, gauge, serration, etc. are reported, as well as depth of insertion, type of needle manipulation used, whether sensations of "de qi" (also known as the arrival of qi) are experienced by the patient or not, needle retention time, etc, etc. As for journals that support STRICTA standards, you can find the list here. Not all acupuncture research is equal, or even credible. On the Wikipedia page, I would suggest that all research should be up to this standard. That is not to say that the publishing journal must be on STRICTA's participating list--that would be too exclusive--but that the cited research ought to be transparent. In other words, if a study does not specify who performed acupuncture on subjects, or does not specify how long needles are retained, then it should not be cited. Instead, a citation of transparent research should be used in its place in support of the claim. Egamirorrimeht (talk) 16:42, 13 September 2013 (UTC)

Hi Egamirorrimeht, I think you're likely to find pruning the article with a chainsaw will be met with resistance unless you can give a better argument that the sources are indeed unreliable. Can you point to published reliable sourcing that questions the validity of the sham studies? That'd be a good start. Zad68 03:44, 13 September 2013 (UTC)

Hi Zad! Here is an article regarding research conducted by the Osher Institute at Harvard Medical School showing that Sham acupuncture is not equal to placebo pills Egamirorrimeht (talk) 16:09, 13 September 2013 (UTC)

That's an interesting result but it's an individual primary study. Can you point to a textbook or a review article or other such secondary source? Zad68 16:24, 13 September 2013 (UTC)

Absolutely.. A textbook that talks about this phenomenon in detail is Acupuncture Research: Strategies for Establishing an Evidence Base by Hugh Macpherson. Egamirorrimeht (talk) 17:25, 13 September 2013 (UTC)

This is all very interesting and relevant. Do you have specific changes for the article? I suspect that the best thing for you to do would be to make a change and see how it flies. I would advise against wholesale changes all at one time. Desoto10 (talk) 03:27, 14 September 2013 (UTC)

What is this even saying

I'm sorry, but I don't understand this sentence. Maybe it's the semicolon throwing me off? A semicolon works more or less like a period--whatever follows it should be a complete thought. But even when the semicolon is removed, the sentence doesn't make sense.

"A number of studies comparing traditional acupuncture to sham procedures found that both sham and traditional acupuncture were superior to usual care but were themselves equivalent; findings apparently at odds with traditional Chinese theories regarding acupuncture point specificity." — Preceding unsigned comment added by 2602:30B:8266:2759:C9A6:A59B:2619:204 (talk) 22:42, 12 September 2013 (UTC)

correct. TippyGoomba (talk) 04:14, 14 September 2013 (UTC)

Wording of lede needs to stick close to sources

The most recent revision to the lede is a substantial change to what had been stable wording consistent with sources. Now it says that the evidence says acupuncture is no more effective than placebo, and this statement is not sourced to the best quality MEDRS's, which also happen to be old ('05, '05, '08). The new wording uses these sources to rebut several sources saying acu is effective, but none mention the UK NHS source, a superior MEDRS that postdates them all; this is a bad change that introduces OR and strays from sources. Additionally, the article body cites better MEDRS's that says it is effective, e.g several at Acupuncture#Pain. Reverting to this revision from Oct. 27. Please get consensus here before making substantial changes. --Middle 8 (talk) 11:19, 30 October 2013 (UTC)

"Some scientists" is OR. So you are not sticking close to the source. Do all or any of the sources say "Some scientists". QuackGuru (talk) 17:37, 30 October 2013 (UTC)

I agree with QG. The previous version was alt med POV-pushing, and so I reverted back to the more neutral version to avoid the acupuncturist slant. jps (talk) 19:21, 30 October 2013 (UTC)

The blatant OR I tagged has been removed. QuackGuru (talk) 19:30, 30 October 2013 (UTC)

I'll take the blame for that one. ;) jps (talk) 19:47, 30 October 2013 (UTC)

"Independent researchers have criticized these "endorsements"...

Is there a better way to describe it than using the word "endorsements"? Maybe recommendations oder reports will work. QuackGuru (talk) 20:01, 30 October 2013 (UTC)

"Recommendations" or "reports" is good. "Independent scientists" is fine. One-liner "rv alt-med POV pushing" ES's don't address the concerns I raised above, viz.: The new wording uses these sources to rebut several sources saying acu is effective, but none mention the UK NHS source, a superior MEDRS that postdates them all; this is a bad change that introduces OR and strays from sources. Additionally, the article body cites better MEDRS's that says it is effective, e.g several at Acupuncture#Pain. Let's not fall into WP:IDHT again. Comments? --Middle 8 (talk) 22:04, 30 October 2013 (UTC)

Actually, I think the discussion did deal well with your concerns, though you seem to not understand the problem with using poor sources as these. jps (talk) 00:33, 31 October 2013 (UTC)

Your IDHT is showing... NHS vs. other sources? Bueller? Bueller? --Middle 8 (talk) 05:52, 31 October 2013 (UTC)

Endorsements is descriptive. Why the change? IRWolfie- (talk) 23:59, 30 October 2013 (UTC)

But it's misleading. These groups didn't *endorse* acupuncture. They described standard practices for its use. The statements are quite broad. jps (talk) 00:33, 31 October 2013 (UTC)

I removed the OR. Don't know why it was restored. QuackGuru (talk) 02:49, 31 October 2013 (UTC)

There was no endorsement. Why is this continuing. QuackGuru (talk) 03:46, 31 October 2013 (UTC)

Hmmm. The problem is that some of them did actually endorse it, however, the NHS didn't... Alright, let's stick with "recognized". Cheers, --Mallexikon (talk) 03:55, 31 October 2013 (UTC)

NHS should be separate from that sentence; it's not what "some independent scientists" (or whomever we're calling them) are talking about. Heck, it postdates them, IIRC. --Middle 8 (talk) 05:52, 31 October 2013 (UTC)

Poor sourcing on the Pain section

Thanks to User:Middle 8 for pointing out that the Acupuncture#Pain section has been using cherry-picked and poorly-vetted sources to try to claim that there is something more to acupuncture than the placebo effect. I notice that the gold-standard study by Ernst is being marginalized. And the Journal of Saudi Medicine? Tsk, tsk. The lack of mechanistic basis is enough to preference a null hypothesis in a Bayesian sense, so Ernst's review remains the best. Sorry. I've POV-section tagged the thing until it can be cleaned up. There is no evidence for acupuncture being effective for anything but people who are wide-eyed and credulous believers in the subject. jps (talk) 02:06, 31 October 2013 (UTC)

I'll always cheer a skeptic stance. But if you try to ignore newer review results (like the one listed in the efficiency section) in order to deny "that there is something more to acupuncture than the placebo effect" that's not skeptic - that's just plain POV. --Mallexikon (talk) 02:24, 31 October 2013 (UTC)

The null result is the preference and there are no good studies (the newer ones are compromised and in shitty third-rate journals -- this isn't "JAMA", this is just an internal medicine journal under the umbrella of JAMA, but sorta a JAMA-in-name-only thing) that pass the WP:REDFLAG test. Wikipedia is not supposed to be innovative. There is no evidence that acupuncture is better than a placebo. Studies attempting to say as much have been roundly criticized by independent analysts. No omnibus review has gone past Ernst's conclusion that I stated in the first sentence. That's where this article will be fixed to say with the appropriate work. jps (talk) 02:27, 31 October 2013 (UTC)

FYI, JAMA Internal Medicine (formerly Arch. Int. Med). If it sucks as bad as you say, RS's will have said so. If you can meet the WP:BURDEN to make your Ernst quote the default position, great. Show (rather than assert the existence of an abundance of) the (non-blog) sources that outweigh the others. Try and do this civilly, without drama and edit-warring. --Middle 8 (talk) 05:52, 31 October 2013 (UTC)

I already showed it. And you accuse me of WP:IDHT? This is ridiculous. Ernst is the gold standard and he has pointed out that the Vickers source does not even contradict him, so by doing a this-and-that or this-or-that treatment, this article is extremely biased. jps (talk) 11:44, 31 October 2013 (UTC)

Removing Vickers

On the basis of this:

Edzard Ernst, emeritus professor of complementary medicine at the University of Exeter, said the study “impressively and clearly” showed that the effects of acupuncture were mostly due to placebo. “The differences between the results obtained with real and sham acupuncture are small and not clinically relevant. Crucially, they are probably due to residual bias in these studies. Several investigations have shown that the verbal or non-verbal communication between the patient and the therapist is more important than the actual needling. If such factors would be accounted for, the effect of acupuncture on chronic pain might disappear completely.”

jps (talk) 02:24, 31 October 2013 (UTC)

Source of quote? And is Ernst talking about the source you removed? Per NPOV we need to depict disputes fairly, not delete one or the other side. --Middle 8 (talk) 03:00, 31 October 2013 (UTC)

The claim that NPOV demands "two sides" is spurious because here one side is conflicted and the other side is independent. In this case we can say that acupuncturists and their supporters claim efficacy uncontroversially, but Vickers is not a MEDRS-quality source. Ernst is.

I should point out that MEDRS policy demands that we do this as well: Wikipedia:Identifying_reliable_sources_(medicine)#Use_independent_sources. The fact is that this source is promulgated by acupuncture supporters in a way that is highly problematic and very gaming-the-system. Ernst said this here: [2]. The source has been roundly impeached. It should be removed. jps (talk) 02:41, 31 October 2013 (UTC)

Hmmm, assuming stuff about editorial motivation is kinda NPA-ish. What is, and how does one idenfify, an "acupuncture supporter"? Good editors find good sources, and weight and stick close to them. And it would be better if you would propose changes at talk and seek consensus here rather than your current approach. --Middle 8 (talk) 03:00, 31 October 2013 (UTC)

Okay, let's leave it more simply: anyone here supporting the inclusion of Vickers is in violation of WP:MEDRS since the source is clearly not independent enough. I think it will be clear to outsiders that the current crop of editors here has created a page that is far too biased towards claiming efficacy of acupuncture. And I still think you need to tread more lightly in articlespace since you have a professional stake in making sure the subject is advertised well. jps (talk) 03:07, 31 October 2013 (UTC)

"... anyone here supporting the inclusion of Vickers is in violation of WP:MEDRS"? And trying to silence Herbxue? Interesting... --Mallexikon (talk) 04:38, 31 October 2013 (UTC)

No, we don't remove one source because another disagrees (where have I read that before...?). --Middle 8 (talk) 05:27, 31 October 2013 (UTC)

The source has been criticized. QuackGuru (talk) 06:04, 31 October 2013 (UTC)

This source you present is a mere letter to the editors... And it criticizes Vickers in such a general way that I have troubles even formulating its rationale... I'm afraid you'll have to come up with something a little more substantial in order to throw out a MEDRS that you don't like. --Mallexikon (talk) 06:17, 31 October 2013 (UTC)

There is a lot more criticism of the article. See Placing Acupuncture in Perspective. QuackGuru (talk) 06:23, 31 October 2013 (UTC)

This is another letter to the editors... It's not even criticizing Vickers et al. (on the contrary, it calls it a "well-conducted analysis"); it just says "that 2 important issues are not considered in their article or in the Invited Commentary that would help place acupuncture in better perspective for clinicians who wish to consider this modality as a possible treatment for chronic pain..." Your grasping at straws here. --Mallexikon (talk) 08:00, 31 October 2013 (UTC)

But the issue with the Vickers source is one of interpretation. These are straws, these are very real rejoinders which Vickers tried to address in the journal later on in the way fringe proponents often do, attacking the messengers as "skeptics" (as if such was a bad thing). Anyway, the source is duly impeached. We will be removing it or at least contextualizing it, it's clear to me. The question is now just how we will go about doing that. jps (talk) 11:48, 31 October 2013 (UTC)

Right now we have one RS (Ernst's quote -- from wherever it came originally) disagreeing with Vickers. In both EBM and MEDRS, expert opinion is at the lower end of the tier of evidence, while meta-analyses of RCT's are at the high end, so we'd weight accordingly. If the other sources (non-RS blogs) are making really good points, someone will publish them in an RS eventually. --Middle 8 (talk) 15:59, 31 October 2013 (UTC)

Shoddily done meta-analyses, I would hope, we would tend to avoid. As it is, Vickers has been roundly criticized by medical doctors and professors of complementary and alternative medicine for problems with interpretation. So, I'm unclear as to how you are declaring Vickers et al. to be reliable as anything other than an opinion of a credulous acupuncturist. Where is the evidence that this study is considered a good study? Where are the citations to it in the literature by independent sources? Because I see absolutely none. This is in contrast to Ernst's excellent track record and huge number of citations to his work from both believers and independent analysts alike. So I say it's pretty clear that Vickers et al. is impeached, and should only be used in context, not as some sort of declaratory work that acupuncture is effective, as the text currently reads. jps (talk) 18:22, 31 October 2013 (UTC)

Neither criticism, Barrett or the latter, truly refutes Vickers' conclusions. To say that NSAID's do better against pill placebos than acupuncture does against sham acupuncture is apples and oranges. Additionally, the GERAC study and others conclude that acupuncture beats standard of care (including NSAIDS) for knee and back pain. I still see nothing that convincingly discredits Vickers.Herbxue (talk) 06:33, 31 October 2013 (UTC)

The refutation is on the interpretation that Vickers irresponsibly provides. Much of their reporting of other work is true in the sense that the other work they report on exists. They simply aren't very good at meta-analysis, is all. That's Ernst and all the others' points. jps (talk) 11:46, 31 October 2013 (UTC)

"Funding/Support:The Acupuncture Trialists' Collaboration is funded by an R21 (AT004189I from the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) to Dr Vickers) and by a grant from the Samueli Institute. Dr MacPherson's work has been supported in part by the UK National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0707-10186). The views expressed in this publication are those of the author(s) and not necessarily those of the NCCAM NHS, the NIHR, or the Department of Health in England."[3]

It looks like the study was funded or ran by alternative medicine promoters. I am not sure. QuackGuru (talk) 18:05, 31 October 2013 (UTC)

Well, NCCAM funding is notoriously indicative of very shoddy research. There was an expose of this in the Skeptical Inquirer. [4]. jps (talk) 18:25, 31 October 2013 (UTC)

Safety

The entire article is littered with old references. There are newer sources on safety, for example. QuackGuru (talk) 03:01, 31 October 2013 (UTC)

This probably should be incorporated somehow. jps (talk) 03:09, 31 October 2013 (UTC)

The RAE is on the order of 5 in a million, which is why basically everyone agrees that it's safe. --Middle 8 (talk) 05:35, 31 October 2013 (UTC)

There are many people who have been injured. The rate is not well-calibrated and Ernst has pointed out that there are some very bad actors. The problem is that because acupuncture is not able to be regulated like normal medical practice, there are some opportunities for bad actors. Given the normal "minimal invasiveness" of typical acupuncture proceedures, the number of safety issues is alarmingly high. jps (talk) 11:42, 31 October 2013 (UTC)

Sounds like an assumption. You're basing this on....?Herbxue (talk) 15:43, 31 October 2013 (UTC)

@JPS -- who says the "rate is not well-calibrated"? According to whom is acu "not able to be regulated like normal medical practice"? In practice it may not be well-regulated, and IIRC most adverse events are in Asia, with poorly-trained practitioners -- bad actors, as you say. Most of the AE's are preventable. "Alarmingly high"? Are you sure? That's like the 10th thing you've said is alarming today. --Middle 8 (talk) 15:50, 31 October 2013 (UTC)

Hmm, did you read QG's citation? jps (talk) 17:26, 31 October 2013 (UTC)

There is no specific argument against including this source. So I am going to add the source to the article. QuackGuru (talk) 17:37, 31 October 2013 (UTC)

Recommend reverting

This edit summary seems to be referencing Vickers which is a source that does not trump Ernst in the least. I recommend reverting the revert. This is terrible POV-pushing. Really disgraceful. jps (talk) 03:25, 31 October 2013 (UTC)

Well, I recommend you tone your language down a little, or we'll be having an argument about incivility at the appropriate place. Nobody's pushing a POV here. Your claim that Vickers' meta-analysis should be an unreliable source is just not well supported. If you think differently, take it to the Reliable sources noticeboard. --Mallexikon (talk) 04:20, 31 October 2013 (UTC)

I removed the OR in the sentence. QuackGuru (talk) 04:09, 31 October 2013 (UTC)

Ernst says the following: "Some findings are encouraging but others suggest that its clinical effects mainly depend on a placebo response." [5]. You just tried to distort a source here in order to push a certain POV. Now I'll assume Good Faith here - maybe you didn't do this on purpose, but just didn't read his article careful enough before stating that he can be used as a source for "Its effects are mainly due to placebo." Because, if you would have done this on purpose, this would certainly be a case for the noticeboard. --Mallexikon (talk) 04:31, 31 October 2013 (UTC)

Using Vickers without qualification is essentially POV-pushing because the source is SO bad. jps (talk) 11:40, 31 October 2013 (UTC)

The source does not say anything about "may be". QuackGuru (talk) 04:39, 31 October 2013 (UTC)

Then what would your close paraphrasing of Ernst's original sentence look like? --Mallexikon (talk) 04:49, 31 October 2013 (UTC)

"Most studies show its effects have not been reliably distinguished from that of a placebo."

Well, no. Ernst doesn't say most studies. --Mallexikon (talk) 05:24, 31 October 2013 (UTC)

"Its effects are suggested to be mainly due to placebo."

Well, only by some. Ernst himself writes that "some findings are encouraging".

There are different ways to write the text. QuackGuru (talk) 05:14, 31 October 2013 (UTC)

Yes, sure. But if you find that "may be" is not true to the source, you'd have to come up with something that is. Your above suggestions clearly are not. --Mallexikon (talk) 05:24, 31 October 2013 (UTC)

Source: "The majority of studies using such devices fails to show effects beyond a placebo response."[6]

Proposal: "Most studies show its effects have not been reliably distinguished from that of a placebo."

"Most" and "majority" mean the same thing. QuackGuru (talk) 05:30, 31 October 2013 (UTC)

Not enough context, and not close enough to the source. Source: "Some findings are encouraging but others suggest that its clinical effects mainly depend on a placebo response." - that statement is in line with a previous line in the abstract that there is "heterogeneity" in the research. The statement about a majority failing to show significant difference between sham and verum specifically refers to a specific subset of studies. Therefore, using Ernst to state that the "majority of studies suggest it is no more than placebo" is an example of original research and not true to the source. Herbxue (talk) 05:46, 31 October 2013 (UTC)

Yes. To complicate matters, this source of Ernst we talk about is from 2006... The high-quality reviews we have that show efficiency of acupuncture are much younger than, so he hasn't even taken them into account. --Mallexikon (talk) 05:57, 31 October 2013 (UTC)

I removed OR from two sentences. QuackGuru (talk) 06:02, 31 October 2013 (UTC)

"Research appears to imply ..." is weaselly. --Middle 8 (talk) 15:46, 31 October 2013 (UTC)

Source: The emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions. The close paraphrasing is supported by the source. The previous version without the context was OR. QuackGuru (talk) 17:17, 31 October 2013 (UTC)

The current text: Emerging research appears to imply acupuncture is effective for some but not all conditions.[8] Some research is encouraging but others suggest its effects are mainly due to placebo.[12]

Middle 8, do you still think the text is still weaselly or I was only being faithful to the sources? QuackGuru (talk) 17:08, 2 November 2013 (UTC)

I meant that the "seems to imply" part could just be pared down to "implies", but let me think about the broader context a little.... Thanks Middle 8 (talk) 02:31, 3 November 2013 (UTC)

Mass MEDRS violations

The dated references must go. QuackGuru (talk) 17:51, 31 October 2013 (UTC)

I agree. This is not good practice. We have some excellent meta-reviews by Ernst which should be explained clearly as the only basis for evidence (or, really, lack of evidence) and some controversies over whether governments should pay for acupuncture. That's about it, I'd say. jps (talk) 18:23, 31 October 2013 (UTC)

But you want to keep Ernst from 2006? What is your criteria? There is no justification for this edit. This is clearly cherry picking.Herbxue (talk) 22:50, 31 October 2013 (UTC)

Recent is almost always better, but some things don't change, and the inherent safety of needling (with proper training and precautions) seems like one of those things. Maybe there are better newer studies, but really good older ones ought to do, IMO. Anyway, a more recent source: "Acupuncture can be considered inherently safe in the hands of well trained practitioners." (WHO Bulletin, 2010, incl. everyone's favorite alt-med EBM guy as coauthor). --Middle 8 (talk) 01:42, 3 November 2013 (UTC)

Ah, QG added this already! Sorry, I missed that. --Middle 8 (talk) 10:14, 3 November 2013 (UTC)

Proposal

Instead of reducing this article into a Vickers vs. Ernst quarrel, why dont we summarize the scientific consensus from reputable institutions instead? If we can't agree on using the World Health Organization's statement about acupuncture, than we should try citing from a similarly neutral institution like this one. I don't understand why Vickers or Ernst should be considered more trustworthy than a national health organization. -A1candidate (talk) 18:29, 31 October 2013 (UTC)

There isn't much that can be said about evidence for the efficacy of acupuncture in terms of institutions. Most institutions don't speak to the profound lack of evidence for its efficacy except to make unsupported nods in the direction that "we think it might work".... but invariably they cite poorly considered or even withdrawn studies. While I agree that institutional support for acupuncture is relevant to this page, the fact that institutions support acupuncture says nothing about the evidence for acupuncture's efficacy. jps (talk) 18:51, 31 October 2013 (UTC)

These groups have their own experts who are better qualified than self-selected groups of WP editors, which is why they are top-tier MEDRS's and WP isn't even an RS. --Middle 8 (talk) 00:20, 2 November 2013 (UTC)

@A1Candidate, yes, the larger bodies carry more weight, although we should still use other MEDRS's too, from meta-analyses to expert opinion. Another good independent, institutional source -- as big as they get, probably -- is the National Health Service, currently mentioned in the lede but incorrectly noted as being disparaged by some sources who criticized the older WHO source. --Middle 8 (talk) 00:20, 2 November 2013 (UTC)

Dr. Nancy Snyderman information repeatedly removed

The following information has been repeatedly removed:

Nancy Snyderman, chief medical editor for the Today Show, finds acupuncture to be safe and effective. She states that doctors have found it to be effective for treating chronic pain, nausea, and migraines; she also uses it in the treatment of many of her cancer patients.[7] Snyderman states, "We know that acupuncture, when the needles are placed correctly, can affect the nervous system of the body. Though the reason that acupuncture helps may be somewhat of a mystery, it is a serious study that deserves attention."[8]

The summary notes given were "Using anecdotes as evidence?" and the other called the information "nonsense". While a couple of Wikipedia editors may not agree with Snyderman, apparently the Today Show finds her opinions credible or they wouldn't employ her as the spokesperson for their medical information. It is not Wikipedia's place to censor the veiws of very well-known medical experts. Gandydancer (talk) 18:34, 31 October 2013 (UTC)

Why should Snyderman's opinions about a procedure she has neither researched nor actually done be relevant on this page? I think they make more sense to include on the Nancy Snyderman page. Please explain. jps (talk) 18:48, 31 October 2013 (UTC)

No, it would be WP:UNDUE to include this mention of this one individual's view. An independent secondary source demonstrating that Snyderman's view on this topic is particularly well-recognized, influential and notable would be required. Otherwise we run the risk of the article filling up with a huge list of hand-picked quotes. There are surely holders of named chair positions at top-tier universities who we should be citing for their opinions before we're looking for that of a TV personality. This kind of thing should fail WP:MEDRS under the "popular press" clause. Zad68 18:53, 31 October 2013 (UTC)

There is simply no justification for treating a spot on Good Morning America as a serious reference. Even if the individual speaking were (hypothetically) the foremost expert in the world, we have no reason to consider that the show's editing and fact-checking processes are reliable, or that the statements went to air fully intact. Then there's the minor point that Snyderman's expertise lies elsewhere. LeadSongDog come howl! 21:01, 31 October 2013 (UTC)

We can't delete this and then keep the other nonsense in the article. QuackGuru (talk) 03:19, 1 November 2013 (UTC)

QG, of course you're right those aren't MEDRS's. And I think I see what you're getting at. They may be OK as RS's, but we don't need RS's to criticize acu, because we already have MEDRS's that do. We only use RS's to clobber fringe topics that are so fringe they're not even in the sci literature.... that's the import of WP:FRINGE. Now, if we're gonna quote RS opinion to depict how acu is received culturally (which could be a small part of the article), then we should quote both proponents and critics, per usual WP:WEIGHT standards. regards, Middle 8 (talk) 00:31, 2 November 2013 (UTC)

Disagreement with Vickers

Just in case you missed it, I added the disagreement with Vickers. QuackGuru (talk) 19:05, 31 October 2013 (UTC)

A good start. Thanks, QG. jps (talk) 19:13, 31 October 2013 (UTC)

And a good end. QuackGuru (talk) 19:13, 1 November 2013 (UTC)

I have no problem "balancing" Vickers with Ernst as long as we don't do it this way: "A peer-reviewed meta-analysis concluded so-and-so, BUT Distinguished Professor X said he disagrees, and here is his exact quote ...(....)." --Middle 8 (talk) 02:00, 3 November 2013 (UTC)

Note

https://www.ncbi.nlm.nih.gov/pubmed/23573135

If this source is not already in the article then we could it. QuackGuru (talk) 03:46, 1 November 2013 (UTC)

Sure, even if 294 adverse events had occurred in 1 year in the U.S. it would still show acupuncture is incredibly safe, BUT, the article actually shows 294 adverse events in 12 YEARS in 25 COUNTRIES! Acupuncture is obviously one of the safest interventions available to the public.Herbxue (talk) 03:53, 1 November 2013 (UTC)

Unless you are ill, and need something to fix it !! --Roxy the dog (resonate) 04:18, 1 November 2013 (UTC)

Don't conflate issues. Safety data is crystal clear - acupuncture adverse events are exceedingly rare, especially relative to conventional medical interventions. When it comes to efficacy, the most recent reviews are increasingly positive. No one is suggesting acupuncture for fractures or sepsis, so unless you have a sense of context and scale you will sound foolish making sweeping generalizations.Herbxue (talk) 04:39, 1 November 2013 (UTC)

Adverse events needs updating

Serious adverse events are exceedingly rare—on the order of five in one million—[27][unreliable medical source?][9][10]

I added two newer sources to the article but I did not rewrite text or deleted the older sources. The text needs to updated and the sources need to be formatted. See Acupuncture#Adverse events. QuackGuru (talk) 16:59, 2 November 2013 (UTC)

Not sure

"Proponents believe acupuncture can assist with fertility, pregnancy and childbirth, attributing various conditions of health and difficulty with the flow of qi through various meridians.[132]"

Not sure why this is in the article. QuackGuru (talk) 04:43, 1 November 2013 (UTC)

I think it is important and encyclopedic to cover what the proponents say it is useful for, however I am not sure this particular source covers that. At the very least the statement should be ascribed to Zita West, the author of the book cited, and not "proponents" (unless Zita West is making that general statement in her book, and the book is a reliable source for such a statement... the ref just cites the whole book and at 100+ pages that's not helpful). Zad68 14:26, 1 November 2013 (UTC)

Notable critics

I tried a compromise. QuackGuru (talk) 19:26, 1 November 2013 (UTC)

As I mentioned above, I agree with QG that per WP:FRINGE, we don't need RS's to speak to acu's efficacy or lack thereof when we already have MEDRS's that do that. --Middle 8 (talk) 00:34, 2 November 2013 (UTC)

News article about modern study on acupuncture

• Acupuncture Meets West: Harvard Med School Teams up with Korea for Research - It shows brain scan differences between acupuncture patients and control patients. It's a good source, but I don't know how people would choose to use it here. - Sidelight12 ^Talk 02:21, 2 November 2013 (UTC)

Could not verify the text

"A 2007 review article noted that superficial needling, the primary form of traditional acupuncture in Japan, can stimulate endogenous production of opioids which could result in non-specific analgesia.[119]"[11]

Not sure about the text. QuackGuru (talk) 16:49, 2 November 2013 (UTC)

Low level details

Low level details are not encyclopedic. We are not going to add an author's name to every source. QuackGuru (talk) 06:06, 3 November 2013 (UTC)

Of course not. But since Ernst is now mentioned twice (each time at length, and with wikilinks) as an important critic of acupuncture, him co-authoring an overview that finds evidence that "acupuncture is effective for some but not all kinds of pain" is of interest to the reader. --Mallexikon (talk) 06:24, 3 November 2013 (UTC)

I think it would be better to avoid the unencyclopedic quotes and low level pointy details. Because Ernst is now mentioned twice is not a reason to add low level details. QuackGuru (talk) 06:44, 3 November 2013 (UTC)

The nonsense continues. QuackGuru (talk) 06:12, 3 November 2013 (UTC)

Don't be uncivil, please. It's not nonsense. I agree with Mallexicon. Ernst has written a variety of things and if we're only going to use his name with "acu is placebp" type statements, that's a WP:WEIGHT vio plain and simple. I'm reverting, but I'd rather we get consensus rather than edit-war, and it's obvious enough from the edit history who's edit-warring the most. --Middle 8 (talk) 10:30, 3 November 2013 (UTC)

Quotes

If possible editors should try not to add quotes. I rewrote the text without the low level details about Ernst. QuackGuru (talk) 06:44, 3 November 2013 (UTC)

Notes

German Acupuncture Trials seems to be non-notable. What is it doing in articlespace? QuackGuru (talk) 06:10, 3 November 2013 (UTC)

In the lede of Traditional Chinese medicine there are seven references to verify the text.[1][2][3][4][5][6][7][unreliable medical source?]

This seems pointy. QuackGuru (talk) 06:56, 3 November 2013 (UTC)

"Significant", "effective", "improvement", "benefit"

I'm a bit concerned by the lack of clarity around the use of the above terms in the pain section of this article. For instance, in their review, Vickers et al. make it clear the significance they discern in the effect of acupuncture is statistical significance, and their comments about the modesty of the effect, while not saying anything explicit about clinical significance certainly allows that the effect is clinically insignificant. Laymen will read "effective" differently than researchers. A researcher will describe an intervention as effective if only a miniscule, clinically irrelevant, statistically-reliable improvement can be demonstrated. A layman is likely to read "effective" as meaning at least of some practical use. Similarly "improvement" and "benefit".

Saying blankly, "effective for some but not all conditions", "effective for the treatment of chronic pain", "effective for some but not all kinds of pain", "more effective than routine care in the treatment of migraines," "benefit for acupuncture combined with exercise in treating shoulder pain after stroke", "pain relief and improvement compared to no treatment or sham therapy", and "effective for chronic low back pain" without an indication of the clinical relevance of the effect, improvement or benefit is at best remiss, and almost certainly misleading most of our readers.

I really can't be bothered reading the above discussion, so if this has been touched on already, I apologise, but my superficial reading of the sources in the pain section tells me that they are surprisingly consistent, when you clarify what each author says or implies about effect significance. --Anthonyhcole (talk · contribs · email) 09:57, 3 November 2013 (UTC)