Talk:Acupuncture

Semi-protected edit request on 29 May 2024

I would like to see some updated and specific data related to recent research and coverage for acupuncture in the United States Sam Collins 33 (talk) 19:05, 29 May 2024 (UTC)

Sam Collins 33 please don't dump massive walls of text that are copied directly from websites or published articles here - WP:COPYVIO covers this. Now, if you are going to make an edit request, you need to be specific - 'change X to Y', supported by a particular source. You don't need to copy the contents of the source here, you can just link to it. However, it looks like you are asking for sweeping changes to be made to the article, and an edit request isn't really suitable for that. You're going to need to discuss the changes you want to see made here, and the sourcing, and gain consensus for the change. Girth Summit _(blether) 19:13, 29 May 2024 (UTC)

Pseudoscience?

Hi, I personally don't know much about this topic, but I recently read an article by the NIH (https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know#:~:text=Acupuncture%20is%20a%20technique%20in,for%20at%20least%202%2C500%20years.) which states that acupuncture is to some degree supported by scientific research, so it surprises me that this Wikipedia article starts off saying that "acupuncture is a pseudoscience" when (apparently) it does have some support from a reputable health agency. Shaked13 (talk) 16:22, 2 June 2024 (UTC)

The article describes it as pseudoscience because appropriate reliable sources describe it as pseudoscience. And that's by the NCCIH, by the way, which is not quite the same as the NIH. Brunton (talk) 16:40, 2 June 2024 (UTC)

The NCCIH is part of the NIH.

I don't doubt that appropriate reliable sources describe it as a pseudoscience, it just seems that (at least one) (seemingly) appropriate reliable source describes it as not a pseudoscience.

Now I see that you and a few other editors seem to think that this is not a reliable source. What is the basis for that. I understand that being a government agency doesn't automatically make a source reliable but I was under the impression that the NIH is considered to be a reliable source. Shaked13 (talk) 17:45, 3 June 2024 (UTC)

Nope, NCCIH is a pro-quackery wing of the US government, and it is technically independent from being controlled by NIH. tgeorgescu (talk) 18:21, 3 June 2024 (UTC)

DEscribing the NCCIH as a reputable health agency is something of a stretch. I mean, it has a reputation, but it isn't a good one... Girth Summit _(blether) 17:11, 2 June 2024 (UTC)

It's from NCCIH, so no fuzz about it, sole mumbo jumbo. --Julius Senegal (talk) 18:06, 2 June 2024 (UTC)

The categorization of acupuncture as pseudoscience and the fact that it has been studied scientifically can both be true. The ancient theory of why acupuncture works is certainly pseudoscience; there is plenty of evidence that there is no qi flowing through the human body, and that it is not necessary to poke needles into specific body points to access qi. The fact that acupuncture does reduce pain perception for some people has been shown scientifically, and as the NCCIH and Wikipedia articles explain, that's a placebo effect. Especially for people with incurable chronic pain, understanding placebo effects can help design useful placebo-based treatments. (NCCIH also mentions there "may" be direct effects on connective tissue; I'm not familiar with the evidence for or against that, but it's physically plausible that disturbing tissue stimulates it in some way, and unrelated to the qi theory.) -- Beland (talk) 17:52, 11 June 2024 (UTC)

Yes, I agree. I think a fair statement would be: Traditional acupuncture theories are prescienctific [ref] pseudoscience. The theories and practices of TCM are based on naturalist theories [ref] rather than on scientific knowledge.

[ref] = Kaptchuk, T. J. (2002). Acupuncture: theory, efficacy, and practice. Annals of internal medicine, 136(5), 374-383 Youhanna1111 (talk) 22:33, 7 July 2024 (UTC)

Correctly said, "Traditional acupuncture theories were prescientific until roughly 100 years ago. Now they are pseudoscience. The theories and practices of TCM are based on ideas which pass nowadays for Ancient superstitions. TCM is a hoax produced by Chairman Mao so that he didn't have to buy expensive medicines from foreign countries, and trick his totalitarian subjects into a false sense of getting medically treated. And he sent to the labor camp anyone who declared that anesthesia by acupuncture does not work." tgeorgescu (talk) 03:45, 8 July 2024 (UTC)

The article currently says Mao claimed the practice was based on scientific principles. It does not mention anything about motivation or labor camps. Can you point us to reliable sources that support those claims? I'm not sure acupuncture meets the definition given in superstition, and that term sounds pejorative. -- Beland (talk) 18:46, 8 July 2024 (UTC)

@Beland: See e.g. Unschuld, Paul U. (2010). Medicine in China: A History of Ideas. Comparative Studies of Health Systems and Medical Care. University of California Press. p. 364. ISBN 978-0-520-26613-1. Retrieved 8 July 2024. tgeorgescu (talk) 20:14, 8 July 2024 (UTC)

Ah, great. I'm afraid I'm not getting access to page 364; could you give a quote that supports the above claims? -- Beland (talk) 20:35, 8 July 2024 (UTC)

Okay: an eye surgeon was so foolish as to report to his superiors that anesthesia through acupuncture does not work; his report got labeled with "three hats" and he was subjected to "criticism of the masses". People, due to pain, were shouting political slogans during surgery. Because they were not allowed to say they feel pain.

And it is largely copy/pasted here. It says if one did not accept that anesthesia through acupuncture works, they were deemed counterrevolutionaries.

So, the Chinese medical consensus wasn't based upon empirical evidence, but upon argumentum ad baculum. CCP ideologues decided how the scientific consensus should be, real scientists had no say in this matter. Empirically investigating the effectiveness of acupuncture was a crime against the state (if the scientists dared to express politically taboo conclusions).

So, yes, "acupuncture does not work" was a taboo enforced through political policing and reeducation camp sentences. tgeorgescu (talk) 21:55, 8 July 2024 (UTC)

That wasn't a direct quote, but I managed to get a copy of the page upon reloading. It doesn't say anything about Mao himself or labor camps or a law making empirical investigation a crime, but what it does say is interesting enough to add to the article. Any idea what "criticism of the masses" is supposed to mean? -- Beland (talk) 22:01, 8 July 2024 (UTC)

At the second RS mentioned by me: acceptance of anesthesia through acupuncture was one of the standards used to judge if someone was for Mao's revolution or against it. Of course, it does not say they were sentenced to labor camps, but you just have to know what happened to people deemed to be against Mao's revolution.

"Criticism of the masses" meant public humiliation (show trial), possibly accompanied by some torture, and losing one's job. tgeorgescu (talk) 22:08, 8 July 2024 (UTC)

If you want to mention labor camps in the article, then we need a reliable source that makes that connection with acupuncture specifically, to avoid original synthesis. Is there a realiable source which defines "criticism of the masses"? Presumably there is an underlying Chinese phrase which is being translated. -- Beland (talk) 00:10, 9 July 2024 (UTC)

We'll just say they were labeled counterrevolutionaries, which is WP:V, and people will have to look up for themselves what that entailed.

This source describes that "criticism by the masses" entailed violence, sometimes lethal: Paquet, Philippe; Rose, Julie; Barnes, Julian (2017). Simon Leys: Navigator between Worlds. Schwartz Books Pty. Limited. p. fn. 51. ISBN 978-1-925435-56-6. Retrieved 9 July 2024. tgeorgescu (talk) 00:24, 9 July 2024 (UTC)

I don't see the word "counterrevolutionary" in Unschuld. -- Beland (talk) 00:55, 9 July 2024 (UTC)

Prioreschi, Plinio (1996). A History of Medicine: Primitive and ancient medicine. A History of Medicine. Horatius Press. p. 178. ISBN 978-1-888456-01-1. Retrieved 9 July 2024. During the period of "Cultural Revolution," acupuncture anesthesia served politically as a standard to judge progress or backwardness, revolution or non-revolution. Physicians and patients were under the pressure of the political requirements of that time. They had no choice but to have exceptional courage in order to carry out or undergo surgery, especially as the patients who felt pain could not cry out. Also in Unschuld 2010, p. 364

Morals: acupuncture anesthesia simply means that Mao was a sadistic tyrant. tgeorgescu (talk) 01:20, 9 July 2024 (UTC)

Are you interpreting reference to "non-revolution" to imply the labelling of people as "counter-revolutionary"? -- Beland (talk) 01:23, 9 July 2024 (UTC)

From the context is quite clear that any dissent from acupuncture anesthesia was politically repressed.

To put it otherwise, backwardness and non-revolution were grave political felonies. They didn't think that backwardness means being a bit dumb, so one needs more help from functionaries. It was a brutal police state, and acupuncture anesthesia was its sacrosanct dogma. Compulsory state ideology led to mass madness, especially in the hands of such a tyrant. It was like the Inquisition, with Maoism instead of Christianity.

The Chinese consensus about acupuncture anesthesia was championed by yesmen and sycophants. tgeorgescu (talk) 05:01, 9 July 2024 (UTC)

I know, but the question is not how you or I would describe the situation, but precisely how it should be described in a neutral article based on reliable sources. You keep introducing new words into the conversation which are great for expressing an opinion in a colorful way, but don't follow the identified sources, and can't be used in the article. -- Beland (talk) 06:55, 9 July 2024 (UTC)

Political repression of disbelievers in acupuncture anesthesia is clearly WP:V in the WP:RS mentioned above. Who was targeted by it? Scientists, MDs, and even patients. Practically anyone who disbelieved it was a target for being repressed. Mao was in some respects outstandingly stupid, sadistic, or delusional. tgeorgescu (talk) 11:10, 9 July 2024 (UTC)

• To bring this back on point, the premise of the question (that if something is subject to the scientific method, it is not pseudoscience) is fallacious. Many/most pseudosciences are subject to scientific research - there has been an an entire journal dedicated to homeopathy for example. More simply, for Wikipedia, it's required to follow the sources which consider the question of whether acupuncture is a pseudoscience or not. By them, it is; and we are required by policy to reflect that. Bon courage (talk) 07:01, 9 July 2024 (UTC)

Reverse

Can you please tell us one by one what was wrong with the references provided supporting the text you removed?

I am an expert in meta analysis so I am happy to provide clarification and guidance on the parts you remove. Happy to provide more details on the scientific findings reported in the papers you removed and the effect sizes provided in them.

Many thanks Safetystuff (talk) 16:42, 30 June 2024 (UTC)

I'll leave it to the folks (Valjean, McSly, and Tryptofish) who reverted to explain their objections to the added material. I would suggest that instead of using studies showing effectiveness on specific conditions to claim that the technique is effective in generally, citations to such studies should only be used to support claims for the specific conditions under study. Many drugs and treatments are effective for a narrow set of diseases despite being studied in a wide range. It also helps the article be more neutral if instead of arguing over whether acupuncture is good or bad overall, it simply gives specific facts and lets readers draw their own conclusions.

Trying to put details into the intro about insurance coverage that are not mentioned in the body of the article is also a problem. This information would be better added to the Adoption section if it's added anywhere, though the phrasing made it sound like the author was trying to promote acupuncture on the grounds that it must be good if it's covered by insurance. Wording should be more neutral and also rules for English spelling and punctuation, and MOS:USA should be followed. I do think it's actually interesting to know where it's covered and most importantly on what grounds. Whether the grounds are "studies found effectiveness for certain conditions" or "people pay for the service even where it's not effective, and so insurance companies sell expensive insurance that includes the service" that is interesting and important to know.

Outside of the recent additions, I'd like to note for interested editors that the phrase in the intro "generally provide no good evidence of benefit" seems to contradict the Efficacy section, where two indications are given as an exception. It seems the intro should be re-worded to note the exceptions or the body should be re-worded to bring the statements into alignment (e.g. these were not meta-studies, they were poor quality, or whatever the case may be).

I also see that the Adoption section says German studies showed efficacy for certain uses. It seems like these should be mentioned in the Efficacy section, and also taken into account in the intro in the same way. -- Beland (talk) 18:14, 30 June 2024 (UTC)

I've added a summary of German acupuncture trials to the Efficacy section, and tagged the contradiction with the intro. -- Beland (talk) 19:04, 8 July 2024 (UTC)

@Valjean: Regarding this revert, the above comments are why I tagged the intro as having a contradiction; the Efficacy section seems to say there has been benefit shown for some conditions, though presumably for reasons other than manipulating qi. It could be clarified if this is simply a strong placebo effect, if there may be some physical effects, or if this is unknown or disputed. But if there's an no-efficacy exception, it should be noted in the intro. -- Beland (talk) 20:33, 8 July 2024 (UTC)

My reading of the current version of the Efficacy section is that it says that everything can be accounted for by the placebo effect. In that case, I'm not seeing a contradiction. --Tryptofish (talk) 21:08, 8 July 2024 (UTC)

@Beland: I may be wrong, but if, as Tryptofish says, we're talking about a placebo effect, then it's better not to note what may seem like a contradiction. It would be better to reword the "troublesome" content in the Efficacy section to make that plain. Does that make sense to you? As I said, I may be wrong, and won't object if my edit is reversed. I just want to draw attention to possible issues with that content. I believe it can be improved. -- Valjean (talk) (PING me) 21:17, 8 July 2024 (UTC)

Sure, then it would make sense to reword the intro so it says there's no benefit compared to placebo. That's different than no benefit, which in this case matters. Not sure the phrase "not an effective method of healthcare" would be needed, and might be problematic given it's a topic of current controversy whether or not strong placebos are a useful and effective technique in medicine, especially for pain. -- Beland (talk) 21:48, 8 July 2024 (UTC)

As I write this, I have a vague feeling that this exact language has been discussed on this talk page in the past. At any rate, it's worth looking at the two sources that are cited at the end of the sentence in the lead section. They really do say things that are accurately summarized by what the sentence says. It's awfully tricky to say, in Wikipedia's voice, that a placebo effect is "an effective method of healthcare". Perhaps there could be a better word than "effective". But I think that just saying that it's effective in the way that placebos are effective, without qualifying such a statement further, is an inaccurate presentation of the source material, and there's a limit to how much nuance can fit into the lead. --Tryptofish (talk) 22:32, 8 July 2024 (UTC)

We could just say "is a method of health care no more effective than placebo", if that was supported by sources. I checked the first RS listed as a citation for that claim, which seems to partially contradict that summary. It includes studies rated as high certainty that show:

• “Verum acupuncture is more effective than sham acupuncture for pain relief, improving sleep quality, and improving general status in fibromyalgia syndrome posttreatment.”
• “Acupuncture was superior to sham acupuncture in terms of pain relief.” for shoulder pain
• “[There were] better effects of electroacupuncture plus western conventional treatments for improving National Institutes of Health Stroke Scale.” though I'm not sure what the comparitor was there.

The second source is not peer-reviewed, and is mostly just commentary on the first source.

While it seems clear the traditional qi theory has been disproven and there is no benefit over placebo for the vast majority of claimed conditions, it's unclear to me which of these is happening:

• There are some studies picking up real benefits over placebo on a small number of conditions caused by other physical mechanisms related to jamming needles into tissue, and people rightly skeptical of acupuncture's traditional claims are tossing out that evidence as bunk in an overly hasty manner.
• The reported benefits over placebo for a small number of conditions are artifacts of the research methods, despite some of the studies being rated as high-quality evidence. -- Beland (talk) 00:53, 9 July 2024 (UTC)

As for efficacy. The revert is absolutely justified.

We should stick to the best, newest metareviews. Although Ernst is reliable, one meta-review was published 2005. Too old. Just as example for cherry-picking in that case. PMID 36416820 shows the way.

Also, please keep in mind that metareviews from China are not trustworthy (see this or that).

Also, there is no "conflicting evidence", there is just no proof that acupuncture is better than placebo. Despite tons of studies. --Julius Senegal (talk) 19:32, 30 June 2024 (UTC)

There's a lot to respond to here. First, as already noted, it wasn't Beland who did the revert, but I appreciate what Beland has said (as well as what Julius S. said).

I fully agree with the revert that McSly made. It was reverting blatant POV-pushing.

I'm OK with the more sweeping revert that Valjean made, although I would also have been OK with leaving the version reverted to by McSly, which had the corrections I tried to make.

Here's a combined diff of the edits I made: [1]. Some of what I changed was simply a matter of good writing (fixing "subsidized subsidized", as an obvious example). That's also what I did in my subsequent edit, whose edit summary should be self-explanatory: [2]. But there were also much more substantive things that I needed to fix, where the content added completely misrepresented what the sources said:

1. I removed the claim that Brazil subsidizes the costs of acupuncture, cited to this source: [3]. The source doesn't say that at all (as a self-described "expert" should have been able to readily see). It's a summary of primary research (not WP:MEDRS-compliant), that isn't about how costs are paid for. That should never have been put on the page.
2. I moved a statement about Australia, sourced to this: [4]. The text that I had to correct said that the Australian government subsidizes acupuncture costs. But the source actually says coverage is mainly provided by some private insurance policies (or if the acupuncturist "is also a general practitioner").
3. I changed the wording about New Zealand. The text that I had to correct said simply that NZ subsidizes acupuncture. And yet one of the cited sources, [5], actually says: "Traditional Chinese acupuncture is not regulated in New Zealand. Be careful when reading acupuncture websites and advertising... It's not recommended that you have acupuncture as a sole treatment for your health problem." Taking a source that prominently says that, and using it to say simply that NZ pays for acupuncture, is WP:Cherrypicking, and serious misrepresentation of the source material.
4. And, perhaps most importantly, I changed the wording about the studies that had been presented as supporting the claim that acupuncture "has significant impact on pain relief and treating other disorders", and were used to justify saying that the evidence in favor of acupuncture was "not unanimous". Not unanimous makes it sound like there is just a little bit of evidence against acupuncture; the source material says the opposite. The first cited source, [6], actually says: "For patients with acute low back pain, data are sparse and inconclusive. Data are also insufficient for drawing conclusions about acupuncture's short-term effectiveness compared with most other therapies... No evidence suggests that acupuncture is more effective than other active therapies." The second, [7], says: "Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture." The third, [8], says: "the evidence level was moderate or low." And the fourth, [9], in a relatively minor journal, says: "More studies with rigorous designs and larger sample size are warranted to verify the efficacy and safety of acupuncture for insomnia...". When I changed the wording on the page from "acupuncture has a significant impact" to "acupuncture has a measurable but modest impact... , albeit not superior to other methods of treatment", I was following the sources, and I think it was actually a rather gentle change.
5. Also, when Safetystuff partially reverted where I said "and often negative", [10], I let that stand.

In context, I think the edits I made were indeed rather gentle, and I was motivated by an intention to try and preserve what I could from what Safetystuff had done. Valjean subsequently reverted all of it – and, as I said, that's OK with me. Looking at the edit summary, [11], I agree that the material about the Medicare (United States) subsidy was better sourced and more relevant than the rest. I could certainly make the case for only including that, although probably not in the lead section. (Some of the sources for other countries, I wasn't sure if they were government sites, or sites from individual practitioners.) As for the material on the meta-analyses showing some partially positive effects, my reasoning was that I would preserve a "both sides of the issue" version of the page, and see what other editors thought. But Valjean makes a point I can agree with: some of those analyses were from a pretty long time ago, so the sources already on the page (concluding that acupuncture "is not an effective method of healthcare") are more current, and therefore should be given greater weight. For the more recent ones, I also have reservations about giving them much weight, because they appear to be outliers relative to the meta-analyses that were already cited. Another point that supports the revert is that the lead section is supposed to summarize what is in the rest of the page. It shouldn't contain material just put there to argue a POV. --Tryptofish (talk) 21:02, 30 June 2024 (UTC)

• Note: A subsequent edit changed the header for this talk section from "Beland reverse" to "Reverse". --Tryptofish (talk) 21:35, 1 July 2024 (UTC)